Self-Reported ADHD Diagnosis and Illicit Drug Use and Prescription Medication Misuse Among U.S. Working-Age Adults.

Objective: To estimate differences by self-reported lifetime ADHD diagnosis status in the percentage of U.S. working-age (18- to 64-year-old) adults in 2023 who report lifetime and past-year use or misuse of 11 different categories of illicit drugs and prescription medications, overall and among those without a self-reported drug use disorder (DUD).

Method: We analyze data from the 2023 National Wellbeing Survey (total sample unweighted N = 7,044; no DUD sample unweighted N = 6,484) to estimate lifetime and past-year use of seven illicit drugs (marijuana, powder cocaine, crack cocaine, methamphetamine, heroin, fentanyl, and hallucinogens) and misuse of four prescription medications (opioids, tranquilizers, sedatives, and stimulants) among working-age adults, by self-reported lifetime ADHD diagnosis status, sex, age, race/ethnicity, nativity, education, and rural-urban residence. Weighted descriptive and multivariable logistic regression model estimates are obtained for the total population and for the subpopulation without a self-reported DUD.

Results: In 2023, lifetime and past-year use or misuse of all 11 categories of drugs and medications was significantly higher among working-age adults with ADHD than among those without ADHD. Statistically significant differences by self-reported ADHD status persisted in multivariable models that controlled for demographic characteristics, with adjusted odds ratios (AORs) ranging from 1.77 for lifetime misuse of prescription sedatives to 3.08 for lifetime misuse of prescription stimulants, and from 1.63 for past-year use of crack cocaine to 3.33 for past-year misuse of prescription stimulants. Among those with no DUD, results indicated significantly higher lifetime use or misuse among persons with ADHD than among persons without ADHD for all 11 categories of drugs and mediations, with AORs ranging from 1.69 for misuse of prescription opioids to 2.87 for prescription stimulants. Past-year use or misuse among working-age adults never diagnosed with a DUD was significantly higher for 7 of 11 categories of drugs and medications among persons with ADHD relative to persons without ADHD, with statistically significant AORs ranging from 1.54 for use of heroin to 3.48 for misuse of prescription stimulants.

Conclusion: Results suggest that ADHD is a risk factor for higher illicit drug use and prescription medication misuse among U.S. working-age adults, even in the absence of a DUD. Clinicians working with adults with ADHD should assess use and misuse of a broad range of drugs and medications regardless of whether the person with ADHD has a co-occurring DUD diagnosis, and engage in therapeutic interventions when appropriate. Future national data collection efforts that include measures of drug use and medication misuse (e.g., NSDUH, NHIS, and BRFSS) should include measures of lifetime and current ADHD diagnosis, symptoms, and treatment history.