Behavioral Health Is Essential To Health • Prevention Works • Treatment Is Effective • People Recover

ADVISORY

Fall 2015 • Volume 14 • Issue 3

Adults With Attention Deficit 

Hyperactivity Disorder and 

Substance Use Disorders

Attention deficit hyperactivity disorder (ADHD) 

is one of the most common childhood mental 

disorders, and it can persist through adolescence 

and adulthood. The medications most commonly 

used to treat ADHD are stimulants, and survey 

data show that abuse of prescription stimulants 

is on the rise. This Advisory discusses the cooccurrence of ADHD and substance use disorders 

(SUDs), the misuse of prescription stimulants, 

and treatment and prevention approaches to 

these problems.

The Definition of ADHD

According to the Diagnostic and Statistical 

Manual of Mental Disorders (5th ed.; DSM-5),1

the essential feature of ADHD is a persistent 

pattern of inattention, hyperactivity-impulsivity 

(they are grouped together), or both that interferes 

with normal functioning and development.1

The manifestations of inattention include 

wandering off task, lacking persistence, and 

being disorganized.1

 Hyperactivity includes 

fidgeting, tapping, and talkativeness. Impulsivity 

is a tendency toward heedless, hasty action. (See 

Exhibit 1 for DSM-5 ADHD diagnostic criteria.)

Which ADHD symptoms are most prominent 

varies with age and circumstance. The hyperactivity symptoms are usually the most noticeable 

during the preschool and elementary school 

years. Late in elementary and middle school, 

the inattention symptoms come to the fore.2

Among adolescents, hyperactivity may be limited 

to fidgeting and be experienced as feelings of 

jitteriness and impatience. DSM-5 notes that 

ADHD symptoms wax and wane depending 

on the circumstance. Close supervision, a new 

setting, an engrossing activity, or frequent rewards 

for appropriate behavior may make symptoms go 

away temporarily.1

Adult ADHD

For many years, experts believed that children 

and adolescents outgrew ADHD.3

 However, 

research that followed children with ADHD into 

adulthood showed that the condition can persist 

into adulthood. Depending on the criteria used 

to define ADHD, anywhere from 15 percent 

(if the full criteria are used) to 65 percent (if 

cases classified as being in partial remission are 

included) of children and adolescents with ADHD 

continue to have the disorder when they are young 

adults, according to one meta-analysis.4

How Common Is ADHD?

International studies have shown that about 5 percent of children and adolescents have 

ADHD.5 The prevalence among adults is about half that, or between 2 percent and 

3.5 percent.1,6 In the United States, the number of children and adolescents diagnosed 

with ADHD has been climbing fast. In 2011, 11 percent of children and adolescents had 

been diagnosed with ADHD at some time in their lives, a 42-percent increase from 2003.7
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Behavioral Health Is Essential To Health • Prevention Works • Treatment Is Effective • People Recover 

Exhibit 1. DSM-5 Diagnostic Criteria for ADHD

A. A persistent pattern of inattention and/or hyperactivityimpulsivity that interferes with functioning or development, 

as characterized by (1) and/or (2):

1. Inattention: Six (or more) of the following symptoms 

have persisted for at least 6 months to a degree that 

is inconsistent with developmental level and that 

negatively impacts directly on social and academic/

occupational activities:

Note: The symptoms are not solely a manifestation 

of oppositional behavior, defiance, hostility, or failure 

to understand tasks or instructions. For older 

adolescents and adults (age 17 and older), at least 

five symptoms are required.

a. Often fails to give close attention to details or makes 

careless mistakes in schoolwork, at work, or during 

other activities (e.g., overlooks or misses details, work 

is inaccurate).

b. Often has difficulty sustaining attention in tasks or 

play activities (e.g., has difficulty remaining focused 

during lectures, conversations, or lengthy reading).

c. Often does not seem to listen when spoken to directly 

(e.g., mind seems elsewhere, even in the absence 

of any obvious distraction).

d. Often does not follow through on instructions and 

fails to finish schoolwork, chores, or duties in the 

workplace (e.g., starts tasks but quickly loses focus 

and is easily sidetracked).

e. Often has difficulty organizing tasks and activities 

(e.g., difficulty managing sequential tasks; difficulty 

keeping materials and belongings in order; messy, 

disorganized work; has poor time management; 

fails to meet deadlines).

f. Often avoids, dislikes, or is reluctant to engage 

in tasks that require sustained mental effort (e.g., 

schoolwork or homework; for older adolescents 

and adults, preparing reports, completing forms, 

reviewing lengthy papers).

g. Often loses things necessary for tasks or activities 

(e.g., school materials, pencils, books, tools, wallets, 

keys, paperwork, eyeglasses, mobile telephones).

h. Is often easily distracted by extraneous stimuli (for 

older adolescents and adults, may include unrelated 

thoughts).

i. Is often forgetful in daily activities (e.g., doing chores, 

running errands; for older adolescents and adults, 

returning calls, paying bills, keeping appointments).

2. Hyperactivity and impulsivity: Six (or more) of the 

following symptoms have persisted for at least 6 months 

to a degree that is inconsistent with developmental 

level and that negatively impacts directly on social and 

academic/occupational activities:

Note: The symptoms are not solely a manifestation 

of oppositional behavior, defiance, hostility, or a failure 

to understand tasks or instructions. For older 

adolescents and adults (age 17 and older), at least 

five symptoms are required.

a. Often fidgets with or taps hands or feet or 

squirms in seat.

b. Often leaves seat in situations when remaining 

seated is expected (e.g., leaves his or her place in 

the classroom, in the office or other workplace, or in 

other situations that require remaining in place).

c. Often runs about or climbs in situations where it is 

inappropriate. (Note: In adolescents or adults, may 

be limited to feeling restless.)

d. Often unable to play or engage in leisure activities 

quietly.

e. Is often “on the go,” acting as if “driven by a motor” 

(e.g., is unable to be or uncomfortable being still for 

extended time, as in restaurants, meetings; may be 

experienced by others as being restless or difficult 

to keep up with).

f. Often talks excessively.

g. Often blurts out an answer before a question has 

been completed (e.g., completes people’s sentences; 

cannot wait for turn in conversation).

h. Often has difficulty waiting his or her turn (e.g., while 

waiting in line).

i. Often interrupts or intrudes on others (e.g., butts into 

conversations, games, or activities; may start using 

other people’s things without asking or receiving 

permission; for adolescents and adults, may intrude 

into or take over what others are doing).

B. Several inattentive or hyperactive-impulsive symptoms 

were present prior to age 12 years.

C. Several inattentive or hyperactive-impulsive symptoms 

are present in two or more settings (e.g., at home, school, 

or work; with friends or relatives; in other activities).

D. There is clear evidence that the symptoms interfere with, 

or reduce the quality of, social, academic, or occupational 

functioning.

E. The symptoms do not occur exclusively during the course 

of schizophrenia or another psychotic disorder and are not 

better explained by another mental disorder (e.g., mood 

disorder, anxiety disorder, dissociative disorder, personality 

disorder, substance intoxication or withdrawal).

Reprinted with permission from the Diagnostic and Statistical Manual 

of Mental Disorders, Fifth Edition (Copyright 2013). American 

Psychiatric Association.
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In most instances, the hyperactivity and impulsivity 

symptoms taper off with age.8

 Most adults with ADHD 

struggle mainly with the manifestations of inattention, 

including disorganization, forgetfulness, unreliability, 

and difficulties with planning, task completion, and 

time management.9

 In middle-aged9 and older adults,10

the occurrence of depression and anxiety symptoms 

increases as the number of ADHD symptoms increases. 

Studies have found that adolescents and adults with

ADHD have higher rates of driving-related problems 

(e.g., tickets, accidents) than their peers without 

ADHD.11,12 Other studies have found an association 

between ADHD and some psychopathic traits (e.g., 

blame externalization, rebellious nonconformity,13

antisocial behavior14,15,16). In fact, adult ADHD is 

associated with problems in many spheres of life, 

including work (unemployment), education (low 

attainment), and interpersonal relationships.14

Treatment of ADHD

ADHD is treated with several different kinds 

of stimulant medications, including:

● Methylphenidate (Concerta, Daytrana, Metadate, 

Methylin, Quillivant XR, Ritalin).

● Dexmethylphenidate (Focalin).

● Dextroamphetamine (Dexedrine, ProCentra).

● Dextroamphetamine-amphetamine (Adderall).

● Lisdexamfetamine dimesylate (Vyvanse).

Stimulant medications are available in immediaterelease and sustained-release formulations. The 

immediate-release formulations control ADHD 

symptoms for 3 to 4 hours before wearing off.17 The 

sustained-release pills—also known as controlledand extended-release—control symptoms for 6 to 

10 hours.17 Controlled studies have found that from 

65 percent to 75 percent of children and adolescents 

respond to a single stimulant medication,18 and as 

many as 85 percent may respond when more than one 

stimulant is used.19 Studies have shown variability in 

the adult response rate to stimulant medications,20 but, 

on average, it is about the same as the response rate 

of children and adolescents.17

ADHD is also treated with nonstimulant medications. 

The nonstimulant medications approved by the Food 

and Drug Administration (FDA) include atomoxetine 

(Strattera) and extended-release forms of guanfacine 

(Intuniv) and clonidine (Kapvay). Atomoxetine is 

approved as a treatment for ADHD for people of all 

age groups; extended-release guanfacine and clonidine 

are approved for use by children and adolescents.

Nonstimulant medications may be an alternative for 

people with ADHD for whom prescription stimulants 

are ineffective, cause intolerable side effects, or 

are contraindicated because of another medical 

condition.21,22 Whether nonstimulants are as effective 

as stimulants at controlling ADHD symptoms is an 

open question. Research involving direct comparisons 

of stimulant and nonstimulant medication is lacking. 

Evidence from existing studies and meta-analyses 

suggests that nonstimulants may not be as effective, 

but some experts say longer studies might show 

otherwise, because nonstimulants take several weeks 

to become fully effective.22

Behavioral therapy is also a recognized part of 

ADHD treatment. Adding cognitive–behavioral 

therapy (CBT) to medication can be an effective 

treatment strategy for adults with ADHD.23 CBT 

helps people with ADHD by making them more 

aware of the symptoms and providing some 

coping techniques.23

Substance Use Disorders Among 

Adults With ADHD

Studies have found that adults with ADHD are 

more likely than their peers without ADHD to 

develop an SUD sometime during their lives.24,25,26,27

For example, one large epidemiological study 

(the National Comorbidity Survey Replication 

[NCS-R])28 found that 15.2 percent of adults with 
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ADHD also met criteria for an SUD, compared with 

5.6 percent of adults without ADHD. Substance use 

typically begins earlier,25,27 SUD remission rates 

are slower,29 and the risks of attempted suicide are 

greater in those with co-occurring SUDs and ADHD 

compared with those without ADHD.30 In addition, 

the transition to more severe substance use is more 

likely to occur if someone with an SUD also has 

ADHD.25 Research has also suggested that as the 

severity of ADHD increases, so might the SUD 

risk. In a recent analysis of data from the National 

Epidemiologic Survey on Alcohol and Related 

Conditions, each additional ADHD symptom before 

age 18 was associated with a greater lifetime chance 

of developing substance dependence.31

Although there is no definitive evidence that explains 

the relationship between ADHD and susceptibility 

to developing SUDs, several hypotheses have been 

proposed, including the following:

● Poor executive functioning is intrinsic to ADHD, 

so when adolescents and young adults with ADHD

are exposed to alcohol, tobacco, and illicit drugs,

they lack self-restraint and are more likely to use 

substances heavily.32

● ADHD often leads to demoralization and failure, 

factors commonly associated with SUDs in 

adolescents.33

● Studies have shown that the reward system in 

the brain may be impaired in people with ADHD. 

Nicotine and cocaine may activate that system 

in ways that produce effects similar to those 

of stimulant medications used to treat ADHD.34

● Misuse of alcohol and marijuana by people with 

ADHD may be an attempt to alleviate the tense 

feelings that can accompany the disorder.35

● Disorders involving externalizing pathology, such 

as ADHD, antisocial behavior, and SUDs may be 

related to shared genetic risk factors.36

Some research suggests that ADHD increases the 

risk of substance use especially when it co-occurs 

with conduct disorder,34,37 a mental disorder of 

children and adolescents characterized by behavior 

that violates social norms (e.g., bullying, stealing, 

destruction of property).1

College Students, ADHD, and SUDs

Studies have shown that between 2 percent and 

8 percent of college students have ADHD.32

College students with the disorder tend to 

struggle academically and also have difficulty 

making use of study aids, test strategies, and time

management techniques that might help them 

do better.38

Studies of college students with ADHD have 

found associations between the condition and 

increased tobacco and marijuana use.39,40

Research findings on whether ADHD is related 

to alcohol abuse among college students have 

been inconsistent.32

One of the major concerns about prescribing 

stimulant medications for children with ADHD 

is that the stimulants may lead to an increased risk 

of developing an SUD later on. Some research has 

shown just the opposite: that starting stimulant 

therapy earlier lowers this risk, perhaps because 

early stimulant therapy alters brain development.41

However, a meta-analysis published in 2013 that 

included 15 studies found that use of stimulant 

medication by children and adolescents neither 

protected against nor increased risk for SUDs 

later in life.42

ADHD Among Adults With 

Substance Use Disorders

Research on ADHD prevalence among those with 

SUDs has produced widely varying results. The 
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NCS-R28 found that among adults with an SUD, 

10.8 percent met criteria for ADHD, compared 

with an ADHD prevalence of 3.8 percent in adults 

without an SUD. When Australian researchers 

screened people who use cocaine and methamphetamine, they found that 45 percent of them had 

ADHD symptoms.43 A study conducted in Spain 

found that about 20 percent of treatment-seeking 

cocaine users had “probable ADHD” based on a 

screening test,44 and a study of patients at alcohol 

and drug detoxification facilities in London found that 

12 percent had undiagnosed ADHD.45 A meta-analysis 

published in 2012 that included 29 studies found that 

23 percent of all SUD subjects had ADHD.35

Misuse of Prescription Stimulant 

Medications

Prescription stimulants can give people a euphoric 

high and are often misused to improve concentration 

and alertness. Large doses can be dangerous, resulting 

in psychosis, seizures, heart attacks, and strokes.46

On college campuses, prescription stimulants 

are sometimes called “smart pills.” Social media 

researchers looking at Twitter messages originating 

from areas where colleges are located have found 

that the number of messages mentioning “Adderall” 

peaks during exam periods.47

Studies have found that college students misuse 

dextroamphetamine-amphetamine more than 

other prescription stimulants.48,49 According to the 

2012 National Survey on Drug Use and Health, 

during the past several years the nonmedical use 

of dextroamphetamine-amphetamine has risen 

sharply among both college-aged adults and adults 

ages 26 and older (see Exhibit 2).

Exhibit 2. Nonmedical Use of Adderall

in the Past Year, by Age Group50

Misuse of prescribed stimulants by 

people with a prescription

Studies of people with ADHD have found that a 

sizable minority (up to about a quarter) misuse 

their medications, usually by taking more than 

the prescribed dose.51,52 A small study of college 

students found that those who reported misusing 

their stimulant medication were more likely to score 

higher on sensation-seeking measures and to report 

recreational use of nicotine, marijuana, hallucinogens, 

opioids, and cocaine than those who reported that 

they had not misused their medication.53 Misuse 

has also been associated with greater hyperactivity 

and impulsivity.54
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Misuse of prescribed stimulants by 

people without a prescription

Much of the research into misuse of prescribed 

stimulants by people without a prescription has 

focused on college students. Studies have found 

that between 4 percent and 20 percent of college 

students have used a prescription stimulant without 

having a legitimate prescription in the past year.55

Many students obtain prescription stimulants from 

friends, who either sell their medications or give 

them away. Roughly a third of college students with 

ADHD report that they have sold or given away their 

medication at least once.56 Research has suggested 

that fraternity and sorority members are at greater risk 

than other students of using prescription stimulants 

without a prescription;57 one study conducted at a 

large public university in the Southeast found that 

55 percent of fraternity members had used 

prescription stimulants without a prescription.58

The main motivation students give for using 

diverted prescription stimulants is to improve school 

performance, with recreational use a distant second. 

In a survey of 4,580 college students, improving 

concentration (65 percent) and help with studying 

(60 percent) were the two most common reasons 

given for misusing prescription stimulants. About half 

as many (31 percent) listed getting high as a reason.49

However, there is currently no evidence that the use 

of prescription stimulants among students without 

ADHD improves their academic performance.59

Research has shown that people who habitually use 

diverted stimulant medication are more likely to 

have ADHD symptoms, so some students misusing 

prescribed stimulants may be self-medicating 

undiagnosed ADHD.60 Researchers have also found 

an association between use of diverted prescription 

stimulants and depression among adolescents and 

young adults.61

The different stimulant medications vary in how 

much they are misused. Surveys have indicated 

that dextroamphetamine-amphetamine is misused 

more often than the methylphenidate medications.49,60

Dextroamphetamine-amphetamine is more 

stimulating62 and stays in the body longer17

than methylphenidate.

People who want a euphoric high from prescription 

stimulants may seek out the immediate-release 

formulations because they can be crushed and 

administered intranasally. The extended-release 

formulations of the stimulant medications are less 

likely than the immediate-release versions to be 

misused because the former are difficult to administer 

intranasally or via injection.33,34

Screening for ADHD in Adults

ADHD can be difficult to distinguish from SUDs 

because some of the presenting symptoms—

restlessness, emotional dysregulation, impulsivity—

are the same.63 It can also be difficult to distinguish 

between ADHD and bipolar disorder.64 When 

ADHD co-occurs with SUDs or mental disorders, 

the complexities only increase. These complexities 

reinforce the importance of collaboration between the 

medical and behavioral health services professionals 

who provide treatment to individuals with these cooccurring disorders. For example, clients may see 

behavioral health professionals more frequently than 

they see medical providers; consequently, behavioral 

health professionals may become aware first of new 

symptoms, medication side effects, or other problems 

requiring medical attention.

Screening for ADHD in people seeking treatment for 

an SUD can help clinicians make appropriate referrals 

for professional assessment, diagnosis, and evidencebased ADHD treatments. Below are two examples 

of screening tools.
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Adult ADHD Self-Report Scale-V1.1 (ASRS-V1.1) 

Screener. This six-question screening test65 has been 

endorsed by the World Health Organization and is 

used in epidemiological research. One of the major 

advantages of this screening test is brevity; it takes 

only about a minute, on average, to complete.66

However, the test asks only about the presence

of symptoms; it does not determine whether 

they began in childhood, which is an essential 

component of the official ADHD diagnosis. In a 

large international study of adults seeking treatment 

for SUDs, the test was better at ruling out ADHD 

than reliably identifying the disorder.67

Wender Utah Rating Scale. This 25-question 

screening test68 focuses on recollection of childhood 

symptoms of ADHD. In a study of people seeking 

outpatient treatment for cocaine dependence, it 

was more sensitive (missed fewer cases) than the

ASRS-V1.1 Screener.

Treatment of Co-Occurring ADHD 

and SUDs

Whether stimulant medications should be first-line 

therapy for people with co-occurring ADHD and 

SUDs is an active area of research. Many of the 

studies have focused on people who use cocaine; 

less is known about people with ADHD who use 

other substances.34 Researchers have found that 

methylphenidate is effective at reducing ADHD 

symptoms in people with co-occurring ADHD and 

SUDs.34 However, many studies in this area have 

been small and brief, and the findings have not 

been consistent. For example, in a randomized trial 

of sustained-release methylphenidate in people 

with co-occurring ADHD and cocaine dependence, 

participants who took the medication did not show a 

significantly greater reduction in ADHD symptoms 

than did participants who took a placebo.69

Another question is whether stimulant medications 

might have a positive effect on the SUDs of people 

with co-occurring ADHD and SUDs, particularly 

if some substance use stems from self-medication. 

The evidence from several studies is promising but 

inconclusive.34

The risk of stimulant medication abuse does not seem 

to be appreciably higher in people with co-occurring 

ADHD and SUDs than in those with ADHD alone, 

although the close monitoring and regular visits that 

are part of many studies may make their findings less 

applicable to people receiving care in the community.70

In a study of adults with alcohol use disorder who 

recently stopped drinking, the nonstimulant medication 

atomoxetine was shown to help with ADHD; the 

effects on drinking behavior were inconclusive.71

However, in a study of 70 adolescents with ADHD 

and at least one non-nicotine SUD, the medication

had no effect on ADHD symptoms or substance use.72

Currently, there are no guidelines for treating people 

with co-occurring ADHD and SUDs, partly because the 

research is limited and findings have been inconsistent.34

Nor are there FDA-approved medications for addictions 

to stimulants. Therefore, treatment of addiction to 

prescription stimulant medication is based on behavioral

therapy for treating cocaine and methamphetamine 

addictions.73 Depending on the circumstance, the first 

step may be to taper the amount of the drug being used, 

and, after that, cognitive–behavioral or contingency 

management therapy might be effective.73

Prevention of Prescription 

Stimulant Abuse

Prescribing extended-release formulations may 

prevent some stimulant medication abuse. They 

are believed to have less abuse potential than 

the immediate-release formulations because the 
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medication enters the bloodstream more slowly, 

so the stimulating effects also occur more slowly.34

In addition, it is difficult to extract the stimulant 

medication from the extended-release formulations 

for injection or intranasal administration.34 Another 

approach is to avoid the stimulant medications 

altogether and prescribe a nonstimulant such as 

atomoxetine if appropriate.

Strategies proposed for reducing stimulant abuse 

on college campuses include programs to educate 

students about the possible harms of stimulant 

use.58 Researchers have found that students who use 

diverted stimulant medication to cram for tests and 

write papers know little about the medications and 

believe they are harmless. Providing more academic 

support to students so they are less likely to resort to 

taking stimulants has been proposed, as has tighter 

control of prescription stimulants so people with 

ADHD do not have surplus pills to sell or give away.58

Resources

Adult ADHD Self-Report Scale-V1.1 (ASRS-V1.1) 

Screener

www.hcp.med.harvard.edu/ncs/ftpdir/adhd/6Q

_ASRS_English.pdf

Centers for Disease Control and Prevention

www.cdc.gov/ncbddd/adhd

National Institute of Mental Health

www.nimh.nih.gov/health/publications/attention

-deficit-hyperactivity-disorder/index.shtml

National Resource Center on ADHD

www.help4adhd.org

Wender Utah Rating Scale

www.uvm.edu/medicine/ahec/documents/Wender

_Utah_Rating_Scale.pdf

Notes

1 American Psychiatric Association. (2013). Diagnostic and 

statistical manual of mental disorders (5th ed.). Arlington, 

VA: American Psychiatric Publishing.

2 Barkley, R. A. (2006). Primary symptoms, diagnostic 

criteria, prevalence, and gender differences. In R. A. 

Barkley (Ed.), Attention-deficit/hyperactivity disorder: 

A handbook for diagnosis and treatment (3rd ed., 

pp. 76–121). New York: Guilford Press.

3 Laufer, M. W., Denhoff, E., & Solomons, G. (2011). 

Hyperkinetic impulse disorder in children’s behavior 

problems. Journal of Attention Disorders, 15(8), 620–625. 

(Excerpted from original work published 1957, Journal 

of Pediatrics, 50, 463–474)

4 Faraone, S. V., Biederman, J., & Mick, E. (2006). The 

age-dependent decline of attention deficit hyperactivity 

disorder: A meta-analysis of follow-up studies. 

Psychological Medicine, 36, 159–165.

5 Polanczyk, G., Silva de Lima, M., Horta, B. L., 

Biederman, J., & Rohde, L. A. (2007). The worldwide 

prevalence of ADHD: A systematic review and 

metaregression analysis. American Journal of Psychiatry, 

164(6), 942–948.

6 Rösler, M., Casas, M., Konofal, E., & Buitelaar, J. (2010). 

Attention deficit hyperactivity disorder in adults. World 

Journal of Biological Psychiatry, 11, 684–698.

7 Visser, S. N., Danielson, M. L., Bitsko, R. H., Holbrook, 

J. R., Kogan, M. D., Ghandour, R. M., et al. (2014). 

Trends in the parent-report of health care providerdiagnosed and medicated attention-deficit/hyperactivity 

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American Academy of Child and Adolescent Psychiatry, 

53(1), 34–46.

8 Biederman, J., Mick, E., & Faraone, S. V. (2000). Agedependent decline of symptoms of attention deficit 

hyperactivity disorder: Impact of remission definition and 

symptom type. American Journal of Psychiatry, 157(5), 

816–818.

9 Das, D., Cherbuin, N., Butterworth, P., Anstey, K. J., & 

Easteal, S. (2012). A population-based study of attention 

deficit/hyperactivity disorder symptoms and associated 

impairment in middle-aged adults. PLoS ONE, 7(2), 

e31500.
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10 Michielsen, M., Comijs, H. C., Semeijn, E. J., Beekman, 

A. T. F., Deeg, D. J. H., & Kooij, J. J. S. (2013). The 

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220–227.

11 Barkley, R. A., & Cox, D. (2007). A review of driving 

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12 Fischer, M., Barkley, R. A., Smallish, L., & Fletcher, K. 

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13 Eisenbarth, H., Alpers, G. W., Conzelmann, A., Jacob, 

C. P., Weyers, P., & Pauli, P. (2008). Psychopathic traits 

in adult ADHD patients. Personality and Individual 

Differences, 45, 468–472.

14 Brassett-Grundy, A., & Butler, N. (2004). Prevalence and 

adult outcomes of attention-deficit/hyperactivity disorder: 

Evidence from a 30-year prospective longitudinal 

study. Bedford Group for Lifecourse and Statistical 

Studies Occasional Paper: No. 2. Institute of Education, 

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15 Gudjonsson, G. H., Sigurdsson, J. F., Young, S., 

Newton, A. K., & Peersen, M. (2009). Attention deficit 

hyperactivity disorder (ADHD). How do ADHD 

symptoms relate to personality among prisoners? 

Personality and Individual Differences, 47, 64–68.

16 Young, S., Gudjonsson, G. H., Wells, J., Asherson, P., 

Theobald, D., Oliver, B., Scott, C., & Mooney, A. (2009). 

Attention deficit hyperactivity disorder and critical 

incidents in a Scottish prison population. Personality and 

Individual Differences, 46, 265–269.

17 Volkow, N. D., & Swanson, J. M. (2013). Adult attention 

deficit–hyperactivity disorder. New England Journal of 

Medicine, 369(20), 1935–1944.

18 Greenhill, L. L., Pliszka, S., Dulcan, M. K., & American 

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Group on Quality Issues. (2002). Practice parameter 

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children, adolescents, and adults. Journal of the American 

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41(Suppl. 2), 26S–49S.

19 Pliszka, S., & American Academy of Child and 

Adolescent Psychiatry Work Group on Quality Issues. 

(2007). Practice parameter for the assessment and 

treatment of children and adolescents with attentiondeficit/hyperactivity disorder. Journal of the American 

Academy of Child and Adolescent Psychiatry, 46(7), 

894–921.

20 Wilens, T. E., Morrison, N. R., & Prince, J. (2011). An 

update on the pharmacotherapy of attention-deficit/

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SAMHSA Advisory

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Recommended Citation: Substance Abuse and Mental Health Services Administration. (2015). Adults With Attention Deficit 

Hyperactivity Disorder and Substance Use Disorders. Advisory, Volume 14, Issue 3.

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