Addiction and neurodivergence

CLA Evidence Note 001
Last reviewed: October 2026

Evidence status: Strong evidence of association for ADHD; developing and mixed evidence for autism; limited evidence for some other forms of neurodivergence.

Addiction is often discussed as though it can be separated neatly from the rest of a person's health and circumstances. Increasingly, the evidence suggests that this is a mistake.

There is a significant overlap between substance use disorders and some forms of neurodivergence, particularly ADHD. The relationship with autism is less straightforward, but there is enough evidence to raise important questions about the way addiction is understood, treated and, in some cases, judged.

This does not mean that neurodivergence causes addiction. Nor does it mean that neurodivergent people are inherently more likely to use drugs or alcohol. What it does suggest is that, for a substantial number of people, addiction may sit alongside underlying neurological differences which affect impulse control, emotional regulation, reward, concentration and the way distress is managed.

That matters both for treatment and for public policy.

ADHD and substance use

The connection between ADHD and addiction is now difficult to ignore.

A 2023 meta-analysis drawing together 31 studies estimated that around 21% of people with substance use disorders also had ADHD.1 Estimates for persistent ADHD in the general adult population are closer to 2.5–3%.2

The difference is striking.

More recent research has found similar patterns when individual substances are examined. A 2024 meta-analysis found that people with ADHD were around three times as likely to have cannabis use disorder as comparison groups.3

NICE already recognises the relationship. Its guidance on ADHD recommends discussing the increased risk of substance misuse and self-medication with people following diagnosis.4

There are several possible explanations. ADHD can involve impulsivity, difficulties regulating emotion, altered responses to reward and problems with sleep or concentration. Other mental-health conditions also commonly occur alongside it.

For some people, alcohol or drugs may initially appear to solve a problem. A substance might make it easier to slow down, sleep, concentrate, socialise or escape an uncomfortable emotional state. What begins as a way of coping can become harmful in its own right.

This idea is sometimes described rather loosely as “self-medication”. The term should be used carefully: it does not explain every case and it should not be used to romanticise harmful substance use. But the underlying point is important. Behaviour which looks from the outside like simple recklessness may, in some cases, have developed in response to symptoms or distress that had never been recognised.

That is one reason international clinical guidance has argued for ADHD to be actively considered in people receiving treatment for substance use disorders, and for both conditions to be addressed together where they coexist.5

Autism presents a more complicated picture

The evidence on autism is less uniform.

Some research suggests autistic people are less likely than the general population to drink heavily or use recreational drugs. Other studies have found substantially higher risks of substance-related problems within particular groups of autistic people.

A large Swedish population study involving nearly 27,000 autistic people found an increased risk of substance-use problems even among autistic people without intellectual disability or ADHD. The risk was higher again where autism and ADHD occurred together.6

Research from Cambridge has added another dimension. Autistic participants were less likely overall to report regular drinking or binge drinking, but autistic people who did use recreational drugs were more likely to say they did so to manage behaviour or mental-health symptoms.7

Taken together, this suggests that there is probably no useful single answer to the question, “Are autistic people more vulnerable to addiction?”

Autistic people are not a homogeneous group. Some may be less exposed to alcohol and drugs. Others may be particularly vulnerable because of anxiety, trauma, social isolation, sensory difficulties, ADHD or other co-occurring conditions.

The important point is that autism can be relevant to both why someone uses a substance and how they respond to treatment.

There is also evidence that mainstream addiction services are not always well designed for autistic people. Research with drug and alcohol practitioners has identified the need for more autism-specific knowledge and for adjustments to conventional approaches, including communication, session structure and therapeutic expectations.8

The same basic problem can arise with unidentified ADHD. If a person is repeatedly treated for the consequences of addiction while an underlying neurodevelopmental condition remains unnoticed, part of the problem may simply never be addressed.

Why this matters beyond healthcare

There is a wider issue here.

Under the Equality Act 2010 (Disability) Regulations 2010, addiction to alcohol, nicotine or another substance is expressly excluded from being treated as an impairment for the purposes of the Act, except where the addiction originally resulted from medically prescribed drugs or treatment.9

That does not mean that a person experiencing addiction can never be protected by the Equality Act. Someone may qualify because of another physical or mental impairment, including a neurodevelopmental condition, provided the legal test for disability is met.

But addiction itself is treated differently.

The developing evidence around neurodivergence makes that distinction harder to regard as uncomplicated.

If, for some people, addiction is closely entangled with an underlying neurological condition; if those conditions are themselves capable of amounting to disabilities in law; and if addiction services are increasingly expected to recognise and accommodate those conditions, there is a legitimate question about whether the law's categorical treatment of addiction remains justified.

That is not the same as saying that every addiction should automatically amount to a disability.

It is a question about whether excluding an entire class of people in advance reflects what we now know about addiction.

A more evidence-led approach

There is still a great deal we do not know.

The evidence is considerably stronger for ADHD than it is for many other forms of neurodivergence. Research involving autism points in several directions and needs to be interpreted with care. For dyslexia, dyspraxia, Tourette syndrome and other conditions, the evidence base is much thinner.

We should resist filling those gaps with assumptions.

At the same time, uncertainty should not become an excuse for continuing to treat addiction principally as a matter of character, irresponsibility or choice.

For CLA, the important principle is straightforward: people should be judged according to the reality of their condition and circumstances, not according to an old distinction between conditions thought to be deserving and those thought to be self-inflicted.

Where addiction and neurodivergence overlap, treatment should recognise that overlap. Services should be capable of making appropriate adjustments. And where the law deliberately withholds protection from people experiencing addiction, that decision should be capable of standing up to modern evidence.

The evidence increasingly suggests that addiction is more complicated than the law sometimes allows.

References

  1. 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;20(2):1275. PubMed.
  2. Song P et al. The prevalence of adult attention-deficit hyperactivity disorder: A global systematic review and meta-analysis. Journal of Global Health. 2021;11:04009. DOI.
  3. Froude AM et al. The prevalence of cannabis use disorder in attention-deficit hyperactivity disorder: A clinical epidemiological meta-analysis. Journal of Psychiatric Research. 2024;172:391–401. DOI.
  4. National Institute for Health and Care Excellence. Attention deficit hyperactivity disorder: diagnosis and management (NG87). NICE recommendations.
  5. Crunelle CL et al. International Consensus Statement on Screening, Diagnosis and Treatment of Substance Use Disorder Patients with Comorbid Attention Deficit/Hyperactivity Disorder. European Addiction Research. 2018;24(1):43–51. DOI.
  6. Butwicka A et al. Increased Risk for Substance Use-Related Problems in Autism Spectrum Disorders: A Population-Based Cohort Study. Journal of Autism and Developmental Disorders. 2017;47:80–89. PubMed.
  7. Weir E, Allison C, Baron-Cohen S. Understanding the substance use of autistic adolescents and adults: a mixed-methods approach. The Lancet Psychiatry. 2021;8(8):673–685. DOI.
  8. Brosnan M, Adams S. Adapting Drug and Alcohol Therapies for Autistic Adults. Autism in Adulthood. 2022;4(3):214–223. PubMed.
  9. Equality Act 2010 (Disability) Regulations 2010, regulation 3; UK Government guidance on the definition of disability under the Equality Act 2010. GOV.UK guidance.

This is a living evidence note. CLA intends to review and expand it as relevant research develops.