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Cocaine and ADHD Relationship

13 Minutes

Edited & medically reviewed by THE BALANCE Team
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Have you ever wondered why it is so common for someone with ADHD to get tangled with cocaine? What may seem like a coincidence to you has multiple theories backing up the strong relationship between the two.

With a mixture of impulsivity, hyperactivity, and inattention, ADHD can easily lead you down a tricky path, often involving drugs like cocaine. Known for its highly euphoric and intensely addictive nature, cocaine can become a quick fix for anyone with ADHD. But many don’t realise this combination often makes them pay a hefty price.

Let’s discuss more about the complex relationship between the use of cocaine and ADHD, exploring how they overlap, the associated risks, and how to co-manage both issues.

Attention deficit hyperactivity disorder or ADHD is a psychiatric disorder with overlapping patterns of hyperactivity-impulsivity and inattention. This frequent overlap significantly interferes with daily functioning and development. [1]

ADHD can be categorised into the following three primary presentations:

  • Predominantly hyperactive-impulsive presentation: This subtype may cause you to talk excessively, fidget frequently, and act impulsively. You may also need help to remain seated.
  • Predominantly inattentive presentation: This subtype may cause you to struggle with poor attention and organisational activities. It may also become difficult for you to follow through on any task.
  • Mixed presentation: This subtype includes a mixture of symptoms mentioned above.

ADHD often begins in childhood and easily persists into adulthood, negatively affecting social, occupational, and academic functioning. The primary cause involves a complex blend of neurobiological, environmental, and genetic factors that mess with the brain’s dopaminergic transmission to alter the levels of dopamine hormone.

Derived from the coca plant, cocaine is a stimulant drug, famous for its immediate euphoric effects and high risk of addiction. It stops serotonin, norepinephrine, and dopamine from rebabsorping into the system, increasing their blood concentration. With a high concentration of these neurotransmitters in the brain, your brain activates the reward pathway and produces intense feelings of pleasure, heightens your alertness levels, and boosts energy. [2]

Most effects of cocaine described above are short-lived. Yet, its continued use can lead to significant health risks, such as neurological damage, cardiovascular issues, and psychological problems like addiction, paranoia, and anxiety. The short-lived effects also leave you craving for more, and repeated use quickly leads to addiction.

Approximately 8.7 per cent of adolescents and 4.4 per cent of adults currently live with attention deficit hyperactivity disorder. Research closely monitoring this population has so far revealed that they are at a higher risk of acquiring a substance use disorder than the rest of the population.

A research study performed in 2017 found that 23.1 per cent of people with an underlying substance use disorder also had ADHD. While the choice of substance for the participants was highly variable, many were reportedly misusing cocaine, too. [3] More recent investigations focusing on ADHD and its relationship with substance use disorder support the findings. Another trial performed in 2023 aiming to calculate the estimated prevalence of ADHD in adults with substance use disorder found it to be 19% for people actively misusing cocaine. [4]

Another study exploring the relationship between ADHD treatment and stimulant misuse has also offered some interesting insights. It revealed that adolescents are much more likely to misuse stimulants and cocaine than the rest of the population. This prevalence of stimulant and cocaine misuse was more prevalent in adolescents who had received treatment for ADHD in the past. [5]

Research indicates that people with underlying ADHD are more likely to acquire substance use disorders, such as cocaine addiction than those without this psychiatric illness. Several factors can add to this risk, such as the following:

  • Risk-Taking and Impulsivity: The impulsive behaviours related to ADHD are typically the reason why you may find yourself using drugs like cocaine. These substances can also make you less restless or bored, convincing you to take them repeatedly.
  • Self-Medication Hypothesis: Experts believe that individuals with ADHD frequently use substances like cocaine as self-medication. The aim is to alleviate the underlying symptoms and improve focus and performance. [6]
  • Environmental Influences: Factors like a lack of support or traumatic childhood experiences can make anyone vulnerable to using substances, especially in people with ADHD.
  • Neurobiological and Genetic Overlap: substance use disorder and ADHD share many neurobiological and genetic factors, especially when it comes to the dopaminergic system. This overlap may explain why the two problems often co-exist.

Let’s look at these factors in more detail in the following sections.

Neurobiologists have been working for years to unravel the relationship between cocaine use and ADHD in terms of how the brain works. So far, many vital mechanisms have been proposed that supposedly facilitate this connection. [7]

  • Dopaminergic Dysfunction: Both cocaine addiction and ADHD are characterised by a dysregulated dopaminergic system. ADHD blocks dopamine transmission and causes its deficiency, making you impulsive and inattentive, whereas cocaine blocks dopamine reuptake to make up for this deficiency. However, in the long run, it only exacerbates the underlying dysregulation.
  • Impairment of Prefrontal Cortex: Responsible for executive functions, like attention, impulse control, and decision making, the prefrontal cortex remains underactive in many people with ADHD. Using cocaine adds to this impairment, pushing you into a vicious cycle of worsening symptoms and consequent increased use of cocaine to tackle it.
  • Neuroplastic Adaptation: long-term use of cocaine can induce several neuroadaptive changes in your brain, such as changes how dopamine receptors function. These changes worsen the ADHD symptoms, making you use more cocaine.
  • Alterations in Reward Pathways: The reward pathway in the brain involves the dopamine system, and if pathway altes, it plays a crucial role in fueling cocaine use and ADHD.

Continued research on the relationship between ADHD and cocaine use has revealed multiple social and psychological factors contributing to this connection. Some of these factors include the following:

  • Co-occurring psychiatric issues: It is common for ADHD to coexist with many other psychiatric illnesses, such as anxiety, conduct disorder, and depression. These comorbidities can add to the complexity of the clinical picture, making you more likely to use cocaine for self-medication.
  • Sensation-seeking & impulsive behaviour: ADHD can cause you to exhibit highly sensation-seeking impulsive behaviours. Under this impulsivity, you may find yourself engaging in risky behaviours and experimenting with drugs.
  • Academic & occupational stress: Facing difficulties in professional or educational settings is common for people with ADHD. These difficulties can easily frustrate you and add to stress, making you vulnerable to using cocaine to enhance your performance or escape the negativity.
  • Social environment & peer pressure: Young adults with ADHD are likely to start using cocaine under peer pressure or general social influence. This is especially evident in people who lack a robust support system or social network.

Since cocaine has stimulating properties, it can cause euphoria and increased energy in people without diagnosed ADHD. However, in people labelled with this psychiatric disorder, it has a paradoxical calming effect. The drug acts on their dysfunctional dopaminergic transmission and boosts dopamine levels. With these effects, you may feel an improvement in your ADHD symptoms, such as restlessness, inattentiveness, and impulsivity.

Inside your body, cocaine can directly affect multiple brain structures, including the following:

  • The hippocampus and amygdala, which control your working memory
  • Ventral pallidum and accumbens, that form your brain’s reward system
  • Subcallosal and orbitofrontal cortices, which are responsible for volition
  • Cingulate gyrus and prefrontal cortex, which help with executive controls

Cocaine use also reduces the reuptake of serotonin, norepinephrine, and dopamine. What this means is it ensures that these happy hormones remain in the blood. In people with ADHD, this causes hyperarousal, hyperalertness, increased vigilance, and euphoria. However, if you have been diagnosed with ADHD, it can calm the behavioural and executive dysfunctions that you commonly experience.

In short, you may:

  • Notice your racing thoughts slowing down
  • Feel less overwhelmed
  • Get more in control of your thoughts
  • Feel your concentration levels improving
  • Become less hyperactive and impulsive
  • Notice a sense of calm prevailing in your mind

While these effects may seem desirable, they are short-lived and can make you crave more cocaine just to keep experiencing them. This dangerous cycle can propel you down the road of cocaine addiction, which comes with hazardous risks.

The misuse of cocaine in individuals with ADHD can lead to severe risks and potentially damaging consequences. Adopting a comprehensive, multidisciplinary approach is critical to avoiding these negativities.

Because ADHD and cocaine abuse are two distinct issues, addressing their co-occurrence requires a comprehensive treatment plan that manages them both together. Such plans are known as integrated plans and can be more effective than treating both issues separately.

Following are some fundamental approaches that an integrated plan can include:

Early Identification and Acknowledgment

Getting a diagnosis of ADHD early on and pinpointing your growing cocaine use can be highly beneficial in managing both issues. This early awareness allows you to start planning on treatment with a greater compliance rate.

Medical Treatment

Attention Deficit Hyperactivity Disorder treatment typically involves the use of stimulant medicine, such as amphetamines and methylphenidates. These first-line drugs work by boosting the levels of norepinephrine and dopamine, which, in turn, keep impulsivity and inattention under control. In some cases, particularly when you have a previous history of substance abuse, experts often resort to non-stimulant drugs, like guanfacine and atomoxetine. Ensuring that you get these medications prescribed and take them regularly is imperative, as doing so will keep your symptoms well-managed, reducing the need to self-medicate with cocaine.

Behavioural Therapies

Cognitive behavioural therapy and other similar interventions are a primary component of treatment for ADHD and cocaine abuse. These therapies can help you acquire healthy coping strategies, reduce impulsivity, and improve executive functioning.

Education & Psychoeducation

Seeking awareness and education regarding a problem you are actively facing is crucial before you can start treating it. This awareness also helps you adhere to your ongoing treatment plan and empowers you to make good decisions while saving yourself from pitfalls.

Continuous Monitoring & Support

Following initial treatment, you must ensure continuous monitoring and support to keep up adherence while addressing any issues that emerge with time. For this purpose, you must regularly attend follow-up appointments and actively participate in support groups.

ADHD and cocaine are two different realms with a high tendency to intertwine. Understanding their association is similar to untangling a badly knotted ball of yarn. The process can be messy and highly complex, leaving people scratching their heads. But with the right level of awareness and support in the community, getting on top of this mess is definitely possible.

From impulsive tendencies to self-medication, many factors can lead you down risky paths, creating vulnerabilities that ultimately lead to cocaine use and addiction. However, this blame game cannot help you or anyone else treat the underlying issue.  The actual management involves identifying your challenges, developing an understanding, and seeking support.

With an intricate web of psychology, neurobiology, and social dynamics pushing a person with ADHD toward cocaine use, it becomes clear that the solution to this issue should be multifaceted. Ultimately, combining medical interventions with behavioural therapy and support from the community is the key to success.

[1] Wilens TE, Spencer TJ. Understanding attention-deficit/hyperactivity disorder from childhood to adulthood. Postgraduate medicine. 2010 Sep 1;122(5):97-109.

[2] Nestler EJ. The neurobiology of cocaine addiction. Science & practice perspectives. 2005 Dec;3(1):4.

[3] Luo SX, Levin FR. Towards precision addiction treatment: new findings in co-morbid substance use and attention-deficit hyperactivity disorders. Current psychiatry reports. 2017 Mar;19:1-6.

[4] Rohner H, Gaspar N, Philipsen A, Schulze M. Prevalence of attention deficit hyperactivity disorder (ADHD) among substance use disorder (SUD) populations: Meta-analysis. International Journal of Environmental Research and Public Health. 2023 Jan 10;20(2):1

[5] Schepis TS, Werner KS, Figueroa O, McCabe VV, Schulenberg JE, Veliz PT, Wilens TE, McCabe SE. Type of medication therapy for ADHD and stimulant misuse during adolescence: a cross-sectional multi-cohort national study. EClinicalMedicine. 2023 Apr 1;58.

[6] Mariani JJ, Khantzian EJ, Levin FR. The self‐medication hypothesis and psychostimulant treatment of cocaine dependence: an update. The American journal on addictions. 2014 Mar;23(2):189-93.

[7] Cunha PJ, Gonçalves PD, Ometto M, Dos Santos B, Nicastri S, Busatto GF, de Andrade AG. Executive cognitive dysfunction and ADHD in cocaine dependence: searching for a common cognitive endophenotype for addictive disorders. Frontiers in psychiatry. 2013 Oc

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