Cannabis use prevalence was 14.3% in adults with ADHD versus 4.3% in those without, with the hyperactive subtype initiating use at age 13.8 compared to 16.3 for the inattentive subtype.
Read this if you have ADHD and use or are considering cannabis, and want to understand the patterns and risks.
Cannabis use 3x more common in ADHD; hyperactive type started 2.5 years earlier
What the researchers found
Using data from the National Epidemiologic Survey on Alcohol and Related Conditions, researchers examined cannabis use patterns among adults with and without ADHD. The prevalence of cannabis use was more than three times higher in people with ADHD (14.3%) compared to those without (4.3%).
Among ADHD patients who used cannabis, those with the hyperactive subtype initiated use significantly earlier, at an average age of 13.8 years, compared to 16.3 years for the inattentive subtype. This 2.5-year gap in initiation age is clinically meaningful given the vulnerability of the developing brain during early adolescence.
Cannabis-using ADHD patients also had notably higher rates of psychiatric comorbidity. Having any psychiatric disorder was 2.8 times more likely, and lifetime personality disorders were 4 times more likely in ADHD patients who used cannabis compared to those who did not.
Why it matters
ADHD is one of the most common neurodevelopmental disorders, and understanding its relationship with cannabis use has practical implications. The finding that hyperactive individuals start using cannabis nearly 2.5 years earlier than inattentive types suggests that impulsivity and hyperactivity drive earlier substance use initiation, creating a larger window of developmental vulnerability.
The numbers in context
Cannabis use prevalence: 14.3% with ADHD vs 4.3% without. Hyperactive subtype initiation age: 13.8 years. Inattentive subtype initiation age: 16.3 years (p = 0.0017). Any psychiatric disorder: AOR = 2.8 (95% CI 1.08-6.41). Lifetime personality disorder: AOR = 4.04 (95% CI 1.84-8.84).
How the study worked
Data were from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (2004-2005). Psychiatric disorders were assessed using the AUDADIS structured interview. Multivariate logistic regression models adjusted for sociodemographics, psychiatric disorders, and substance use disorders.
What this study cannot tell us
The cross-sectional design cannot determine whether ADHD drives cannabis use or whether both share common risk factors. The data are from 2004-2005 and may not reflect current patterns. Self-reported ADHD diagnosis and cannabis use may be subject to recall bias. The study cannot assess whether cannabis use represented self-medication for ADHD symptoms.
How to read the evidence
This is a large national survey with appropriate statistical controls, providing moderate evidence of associations between ADHD and cannabis use patterns.
When this study was published
Published in 2018 with data from 2004-2005. Cannabis accessibility has changed significantly since.
The bigger picture
This study sits at the intersection of two major public health topics: ADHD management and cannabis use. As some people with ADHD turn to cannabis for self-medication (particularly for restlessness and sleep), understanding the risks and patterns of this co-occurrence becomes increasingly important, especially given the high rates of psychiatric comorbidity observed.
Questions still open
- Does treating ADHD effectively reduce the risk of cannabis use initiation? Are people with ADHD self-medicating with cannabis, and if so, does it help or harm their symptoms? Should ADHD treatment guidelines specifically address cannabis use prevention?
Common questions
Is cannabis more common in people with ADHD?
Does the type of ADHD matter?
Read the original research
Clinical Correlates of Cannabis Use Among Individuals With Attention Deficit Hyperactivity Disorder.
The Journal of nervous and mental disease, 206(9), 726-732
Citation
Brandt, Ariel; Rehm, Jürgen; Lev-Ran, Shaul. (2018). Clinical Correlates of Cannabis Use Among Individuals With Attention Deficit Hyperactivity Disorder.. The Journal of nervous and mental disease, 206(9), 726-732. https://doi.org/10.1097/NMD.0000000000000877
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