ADHD and Cannabis Use

Writer: Rafael Chetata

Editors: Ariana Brown and Nayla Taniajura

Attention-Deficit/Hyperactivity Disorder (ADHD) is a diagnosis that has received more attention in recent years. ADHD is a neurological disorder that begins in childhood, and describes an inability to regulate focus and other key executive functions (Brown 2014). In recent years, there has been recognition of different presentations of the disorder and, therefore, an increase in diagnoses, especially for adults. More recognition doesn’t always translate to adequate management of this condition, which is harder if maladaptive behaviors are present. In the United States, cannabis has been legalized in 39 states, with 24 states allowing recreational use. During legalization, cannabis use has increased (Kerr 2019). This could be because marijuana is less stigmatized as its legal status has offered it legitimacy. There has also been a growing support for theorized medical properties. However, regular use of cannabis has been shown to have a negative effect on anxiety, motivation and several executive functions, like working memory and attention. In extreme cases, it can induce psychotic disorders, chronic bronchitis and Cannabis Hyperemesis Syndrome, a condition that is characterized by severe gastrointestinal upset in response to cannabis (Petker et al., 2020). While it is not physically addictive, many develop a dependance. Despite these risks, individuals with ADHD are likely to endorse the  “effectiveness of cannabis…in improving negative mood and irritability” (Stevens et al., 2020). Since addictions are a risk for people with ADHD, they should be aware when a substance is being consumed regularly.  This is especially worrying during college, where executive functions (skills like memory, flexible thinking, and self-control) are required and hindered by regular cannabis use (Petker et al., 2020). In summary, individuals with ADHD are more likely to start smoking, become  dependent on weed, and struggle to quit.

In his book Smart but Stuck : Emotions in Teens and Adults with ADHD (2014), Dr. Thomas E. Brown, details his treatment of several patients struggling with unmanaged ADHD, two of those having issues with marijuana abuse. Dr. Brown is a clinical psychologist who has published many articles and books on ADHD. He served on the Yale medical board for years, furthered the concept of executive functions, and has run a successful private practice for over 30 years. Through examining the examples of these patients and others, they reveal some examples of the complex relationship between ADHD and cannabis. 

One of his patients is Eric, a college student who took medical withdrawal to avoid being dismissed from his university. He attributes his poor performance to be a result of overconsumption of weed, lack of previous support,, and depression. After starting treatment, he was willing to cease his cannabis use, and had little issue stopping. However, Eric was often unable to go to sleep before 4 or 5 in the morning. Dr. Brown notes that this is common for ADHD due to rumination or a delayed sleep cycle. His insomnia wasn’t resolved by exercise, better sleep hygiene, and common sleep medications. Eric’s insomnia leading to marijuana use is not uncommon. Sleep is a large motivator for continuing or re-starting cannabis use, and over 70% of those with ADHD report sleep issues (Stevens et al., 2020). It has been suggested that treatment for sleep disturbance could be useful for cession of cannabis, but removing the need for it. Due to the severity of Eric’s sleep issues, Dr. Brown approved a small amount for nights where Eric’s insomnia was worse. His ADHD was managed by the creation of new goal/reward systems, low dose medication, and therapy for his anxiety. He transformed his problematic relationship with cannabis into a beneficial one. Therefore, the study’s theory has been shown to be correct for the case of Eric.

The other patient is Martin, a college student who was both failing classes and socially isolated. On his first visit with Dr. Brown, he was advised to cease using cannabis, so he could start a low dose of stimulant medication. Brown explained that ADHD medication “would not be effective for someone heavily using marijuana.” While this could be true, it can be suggested that medication can be a useful tool in reducing marijuana use. A double blind study has shown that extended release mixed amphetamine salts reduced cannabis use and promoted  abstinence more than placebo (Levin et al., 2024). There is divided opinion on the inclusion of ADHD medication during cannabis dependance. 

After failing to stop his use once, Martin then moved back home for summer class, saw Dr. Brown regularly, and actually ceased his marijuana use to start medication. Through his treatment with Dr. Brown, Martin had repeated episodes of excessive cannabis use despite quitting several times for his own betterment. Martin was extremely shy, causing him a lot of anxiety when around his peers, so he used marijuana to relax in groups and not overthink the experience after. He also faced extreme stress before exams, and often smoked as self-sabotage to “protect his self-esteem” from possibly doing poorly academically after earnest effort. For Martin, cannabis caused “amotivational syndrome,” causing a reduction in motivation of heavy users every time his use resumed. Dr. Brown plainly showed him the negative effects, like pointing out his growing disengagement and slipping grades. In a 12-month study on veterans with ADHD, there was a link between those with ADHD motivated to use cannabis for emotional regulation reported a larger quantity used than others. This is because using it to cope “perpetuate the cycle of emotion dysregulation, maladaptive coping, and subsequent cannabis problems” (Stevens et al., 2020). This larger trend has explained Martin's frequent relapses as he is unable to cope with those intense negative emotions, and those emotions “tigger[ed] a feeling of increased urgency to smoke again.” It is emotionally easier to self-sabotage than to actually try. Those with ADHD can struggle with distress tolerance, and relapsing can reinforce the belief that the chosen substance is the only solution for this feeling. Since Martin’s cannabis use was a maladaptive behavior, it could be resolved by learning to tolerate those uncomfortable emotions and correcting the underlying thoughts that cause them. After five years of treatment, Martin had been able to complete his bachelor’s and maintain satisfying personal relationships.

While these two men have worked to reduce or eliminate their cannabis use, there are those who have the opposite goal. A case study of three early-20s men who include it as a part of their treatment describes their medication, motives, and the effect of their current cannabis use. Although co-morbidities and methods of consumptions differ, they cite that cannabis improves focus, mood, and racing thoughts. Two continued their use of stimulant medication, while the other has forgo it completely for marijuana. All attest that there have been significant positive changes in their life. These aren’t the only individuals that have this thought process. There has been a growing sentiment of cannabis as treatment for mental disorders. The report theorizes that the benefit could be due to “induction of dopamine release,” which makes sense due to other ADHD medications aiming to increase dopamine productions (Mansell et al., 2022). While it may be possible that there exists a treatment plan for individual self-medicating with marijuana that would be more effective, that could be said for a majority of treatment plans with any level of effectiveness. 

In conclusion, cannabis can be a risk factor for those with ADHD. The short and long-term impairments from cannabis are often weak points for people with ADHD, so they will be worse off than their neurotypical peers. However, there is a growing acceptance for it as a recreational drug, and even treatment. Despite the growing anecdotal evidence for cannabis’s benefits for those with ADHD, ADHD increases risk of dependency and abuse. This should be further studies on their relationship, while acknowledging the risks, which are higher for those with ADHD.