Why some people with ADHD self-medicate — including me
There was one class in college that I just could not seem to get through without falling asleep. It was a 3 p.m. class, and the subject matter was super interesting. But something about that time of day always came with a crash.
I wasn’t sleeping well (I also had an 8 a.m. class) and I’d always been prone to what’s called “intrusive sleep,” which is a documented symptom of ADHD. Except at that point, I hadn’t yet been diagnosed with ADHD.
So, I loaded up on anything I could to help me stay awake, alert, and tuned in to class. First it was garden-variety energy drinks. Then it was caffeine and diet pills. Then, when I found a reputable connection, it was teeny-tiny bumps of cocaine, which did the trick — but was expensive, inconvenient, and risky.
I would continue to get ambushed by inconvenient naps for years to come. In anticipation of a crash, I’d load up on whatever uppers I could get (and stomach). This put a huge amount of pressure on my body, further wrecked my sleep, and only helped a little.
My ADHD medication, though? It helps a lot. In fact, getting medicated for ADHD helped me stop using illegal substances, cut my drinking significantly, and generally helped me stop self-medicating.
Not everyone is so lucky.
For years, we’ve known that people with undiagnosed or untreated ADHD have higher rates of substance use and abuse. It’s been proven both socially and in clinical settings. These findings have been confirmed as recently as this year; a report published in the May edition of the journal Alcohol and Alcoholism stated the following:
“One in three young adults with ADHD had a lifetime alcohol use disorder (36%) compared to 19% of those without ADHD. After adjusting for all control variables, those with ADHD had higher odds of developing alcohol use disorders, cannabis use disorders, and other drug use disorders.”
I had no idea that was me back in college. But once I was out of school, I had health insurance for the first time. And after one too many “bad patches” from my previously diagnosed and, at the time, unmedicated bipolar disorder, I knew it was time to talk to someone.
I didn’t expect to discuss anything other than bipolar disorder. But the doctor started throwing some ADHD-like questions at me — including the ones about how I slept and what substances I used recreationally.
I’d started using cocaine recreationally when I worked in the restaurant industry and often worked late nights or very early mornings. Whereas my co-workers would use it to get amped for the morning, I used it to clear my head of an almost permanent state of mental exhaustion.
In the same way I’d used caffeine in college, cocaine (and, let’s be honest, also a lot of caffeine and diet pills and anything else that was marketed as an upper) became the thing I used to help counteract my perpetual sleepiness.
I’ve known other people with ADHD — the more hyperactive flavor — who have used alcohol to achieve an opposite effect. I have friends who find that a drink or two can help them sit still, listen, and focus in on what people are saying. But this kind of self-medication, like mine, is always dangerous. It’s much too easy to think that a little bit of a substance helps some, so a lot of a substance must help a lot. That’s how people get into trouble.
Drugs and alcohol aren’t the only places folks with undiagnosed ADHD look for relief. They may also find themselves self-medicating with substances that aren’t illicit or especially dangerous, but that may lead to other health complications.
High consumption of sugar and simple carbohydrates, which can provide a dopamine hit, is commonly reported. So are eating disorders, which may be the result of self-medication through food, which then becomes an unhealthy relationship with it. (That’s me, too.)
Why do so many of us have these issues? Are our ADHD brains just more impulsive and less capable of regulating their substance use? Or are we seeking relief from our own rapid thoughts, our twitchy hands, or our near-debilitating perfectionism?
Drugs from a dealer or drugs from a doctor?
The deeper “why” behind substance use has been hotly debated. But asking users why they use can be illuminating. One recent survey found that a quarter of users with ADHD say they were pursuing substances in order to get high. Meanwhile, 36% stated that they were turning to substances as a way to medicate their ADHD symptoms. That seems significant, because it creates a clear motive: To get relief.
This is a problem when the medication — the real medication — is not available for a variety of reasons. Often, this forces people to look for options that are illegal, dangerous, and unreliable.
Using street drugs comes with ample risk. At a time when adulterated cocaine can kill a person with just one line, making actual medical interventions accessible and affordable should be a top priority for public health officials. Instead, ADHD medications are still controlled substances, making them challenging to get reliably, even with a prescription.
There has long been data that self-medication among people with ADHD is common , dangerous, and potentially preventable. Instead of waiting until people with ADHD find themselves in rehab for substance use, what if we were screening earlier and helping create healthy coping mechanisms? What if we stopped demonizing medications that prevent disordered behavior?
What if we treated people with ADHD as people with a disorder that actually needs to be addressed, rather than a moral failing? The research is there. Now we just need to put it to use.