ADHD and problems with alcohol or drugs often go together. NICE lists people with a history of substance misuse among the groups with higher rates of ADHD. The HSE says drug and alcohol misuse are more common in adults with ADHD.
Having both does not rule you out of ADHD assessment or treatment. Large studies have not found that prescribed ADHD medication raises the risk of later substance problems. But treatment needs extra care, and the alcohol or drug problem usually needs its own help too.
Safety first: do not stop drinking suddenly if you may be dependent
The NHS says that if you are physically dependent on alcohol, stopping overnight could be harmful. Get advice first. The HSE says severe withdrawal can cause seizures, confusion and hallucinations, and that delirium tremens (DTs) is life-threatening.
Two details matter. In the 2012 review, ADHD was less common among people dependent on cocaine than among those dependent on alcohol or opioids. In the 2011 review, children with ADHD were not more likely to have ever tried alcohol. They were more likely to develop alcohol problems.
The causes are not fully understood, and this page does not claim one. A few things are clear from guidance.
Alcohol and drugs affect attention, sleep and mood. The HSE lists anxiety, irritability, low mood and difficulty sleeping among alcohol withdrawal symptoms. The HSE model of care lists substance misuse among the main conditions to tell apart from ADHD in adults.
So a clinician will want to know whether your difficulties were there before you started drinking or using. NICE says ADHD symptoms should have begun in childhood and persisted throughout life. School reports, or a parent's memory of you as a child, can help.
The 2018 consensus statement recommends routine ADHD screening for people with substance use disorders. It says a diagnostic process should follow "as soon as possible" when screening is positive.
NICE says that before starting ADHD medication, the assessment should include a "risk assessment for substance misuse and drug diversion". This is standard for everyone, not a judgement on you. Being honest helps the clinician choose safer options. Our guide to what happens at an adult ADHD assessment covers the rest of the process.
Many people worry about this. The largest studies point the other way, though they are observational.
Both studies compared people with themselves at different times, or adjusted for other factors. They still cannot prove the medication caused the lower risk. The Swedish authors said clinicians "should remain alert" to stimulant misuse and diversion. Our article on what ADHD stimulants actually do covers how addictive they are in more detail.
UK product information for both methylphenidate (Concerta XL) and lisdexamfetamine (Elvanse Adult) warns about potential for abuse, misuse and diversion. Both advise caution in people with a history of drug or alcohol dependence. The Elvanse Adult information adds that the risk of misuse may be greater in adults, especially young adults.
NICE says:
The Concerta XL information says that for some people at high risk, stimulants may not be suitable and a non-stimulant should be considered. The HSE model of care says a clinician may choose not to prescribe a stimulant because of concerns about misuse or diversion. See our guide to non-stimulant ADHD medication.
The evidence is mixed and limited.
The 2026 review said the limited evidence did not support fears that stimulants trigger substance problems in this group. It also said firm conclusions were not possible.
The 2018 consensus statement recommends treating both conditions at the same time, in an integrated way, using medication and psychological therapy together.
UK product information for Concerta XL says alcohol may worsen the side effects of methylphenidate on the brain and nervous system. Lab tests found strong alcohol can speed up release of the medicine from the tablet; the effect in people is not known. It advises not drinking alcohol during treatment. The Elvanse Adult information says data on alcohol interactions are limited. Ask your prescriber what applies to you.
Effective treatments exist, including medication for alcohol and opioid use disorders. See addiction treatments that work. If drinking is also affecting your sleep, our article on alcohol and sleep explains why.
If you are thinking about suicide or harming yourself, get help now.
Yes. Guidance expects clinicians to assess ADHD alongside other conditions, including substance misuse. The clinician will look closely at whether your difficulties started before your substance use. Be honest about what you use.
Not necessarily. NICE and UK product information advise caution and closer monitoring, not an automatic ban. A clinician may choose a long-acting stimulant or a non-stimulant instead, depending on your situation.
UK product information for methylphenidate (Concerta XL) advises avoiding alcohol during treatment. Data for lisdexamfetamine are limited. Ask your prescriber, and never stop drinking suddenly if you might be dependent.
Prescribed, monitored ADHD medication has not been linked to higher rates of later substance problems in large studies. Some studies found lower rates during treatment. Stimulants can still be misused, which is why prescribers monitor for it.
You can read about Proco's planned assessment service on our assessments page.
This article is general information, not medical advice. It cannot diagnose ADHD or a substance use disorder. Talk to your GP or prescriber about your own situation. Do not stop drinking suddenly if you may be dependent, and never stop or change a medicine without advice.
Reviewed by: Proco Team
Last updated: November 2026