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Le TDAH et les substances partagent un câblage : la course au plus. Cette étagère rassemble la recherche derrière cette phrase, lue par la Maison et mise en mots simples. Un livre ou un article à la fois.

LivreAnna Lembke, 2021

Dopamine Nation

Finding balance in the age of indulgence

Pleasure and pain run on one balance. Press one side and the brain presses back on the other. Lembke’s book says why the chase for more ends in less, and why four weeks is the number.

Lu par la Maison · 14 octobre 2026 · environ 5 minutes

Lisez-le

DiegoMercredi, 8 h 40

Lisez une chose à la fois, puis écrivez trois lignes : ce qu’elle dit, ce qu’elle change, ce que vous ferez avant jeudi. Ne lisez pas toute l’étagère en une nuit. C’est encore la course. — Diego

Recherche sélectionnée

Des articles évalués par les pairs que la Maison a lus en entier. Chaque ligne donne le chiffre à retenir et ce qu’il change. Dites-nous s’il en manque un.

Pourquoi le TDAH et les substances vont ensemble

Prospective association of childhood attention-deficit/hyperactivity disorder (ADHD) and substance use and abuse/dependence: a meta-analytic review (s’ouvre dans un nouvel onglet)
Lee SS, Humphreys KL, et al. · Clinical Psychology Review · 2011
Across 27 studies that followed children with and without ADHD into adolescence and adulthood, the children with ADHD were more likely to go on to use nicotine and other drugs and to develop alcohol, nicotine, cannabis and cocaine use disorders.
about 3×the odds of nicotine dependence later in life, across 27 studies
Childhood attention-deficit/hyperactivity disorder and future substance use disorders: comparative meta-analyses (s’ouvre dans un nouvel onglet)
Charach A, Yeung E, et al. · Journal of the American Academy of Child and Adolescent Psychiatry · 2011
Children with ADHD who were followed prospectively were more than twice as likely to be using nicotine by mid-adolescence and about a third more likely to have an alcohol use disorder by young adulthood.
OR 2.36the odds of nicotine use by mid-adolescence (95% CI 1.71 to 3.27)
Childhood psychiatric disorders as risk factor for subsequent substance abuse: a meta-analysis (s’ouvre dans un nouvel onglet)
Groenman AP, Janssen TWP, et al. · Journal of the American Academy of Child and Adolescent Psychiatry · 2017
Pooling 37 longitudinal studies, childhood ADHD roughly doubled the odds of a later substance problem, and the risk did not disappear when conduct problems were taken into account.
762,000people across 37 studies; childhood ADHD about doubled the odds of later addiction

À quel point c’est fréquent en traitement

Prevalence of attention-deficit hyperactivity disorder in substance use disorder patients: a meta-analysis and meta-regression analysis (s’ouvre dans un nouvel onglet)
van Emmerik-van Oortmerssen K, van de Glind G, et al. · Drug and Alcohol Dependence · 2012
Pooling 29 studies of people in treatment for a substance use disorder, almost one in four met the criteria for ADHD, with lower rates among people dependent on cocaine than on alcohol or opioids.
23.1%of 6,689 people in treatment met the criteria for ADHD (95% CI 19.4 to 27.2)
Variability in the prevalence of adult ADHD in treatment seeking substance use disorder patients: results from an international multi-center study exploring DSM-IV and DSM-5 criteria (s’ouvre dans un nouvel onglet)
van de Glind G, Konstenius M, et al. · Drug and Alcohol Dependence · 2014
When the IASP study assessed 3,558 people entering addiction treatment in 10 countries with the same procedure, the share with adult ADHD ran from 5.4% in Hungary to 31.3% in Norway, far narrower than the 2% to 83% spread of earlier studies.
5.4% to 31.3%adult ADHD among people entering treatment, by country (DSM-IV)
Psychiatric comorbidity in treatment-seeking substance use disorder patients with and without attention deficit hyperactivity disorder: results of the IASP study (s’ouvre dans un nouvel onglet)
van Emmerik-van Oortmerssen K, van de Glind G, et al. · Addiction · 2014
Among 1,205 people in addiction treatment at 47 centres, those who also had ADHD were twice as likely to carry a further diagnosis, with antisocial and borderline personality disorder and hypomanic episodes all more common, and depression more common where alcohol was the main substance.
75% vs 37%had at least one more disorder, with and without ADHD
Prevalence of attention deficit hyperactivity disorder (ADHD) among substance use disorder (SUD) populations: meta-analysis (s’ouvre dans un nouvel onglet)
Rohner H, Gaspar N, et al. · International Journal of Environmental Research and Public Health · 2023
A decade on, an updated meta-analysis of 31 studies again found that about one in five people with a substance use disorder has ADHD.
21%pooled prevalence of ADHD across 31 studies
Systematic review and meta-analysis of attention deficit hyperactivity disorder: first estimates of the prevalence by sex amongst people who use psychoactive substances and alcohol (s’ouvre dans un nouvel onglet)
Comiskey C, McDonagh D, et al. · Journal of Dual Diagnosis · 2026
Pooling 84 studies and 34,036 adults using drug and alcohol services, about one in five had ADHD, and among men the rate was highest where the main substance was a benzodiazepine or an opioid.
22%of 34,036 adults in substance services had ADHD (95% CI 19 to 25)

À quoi ressemble le câblage

Depressed dopamine activity in caudate and preliminary evidence of limbic involvement in adults with attention-deficit/hyperactivity disorder (s’ouvre dans un nouvel onglet)
Volkow ND, Wang GJ, et al. · Archives of General Psychiatry · 2007
Never-medicated adults with ADHD had fewer available dopamine receptors in the caudate and a smaller dopamine rise after intravenous methylphenidate, yet liked the drug more than controls did.
19 vs 24never-medicated adults with ADHD and healthy controls, scanned with PET
Evaluating dopamine reward pathway in ADHD: clinical implications (s’ouvre dans un nouvel onglet)
Volkow ND, Wang GJ, et al. · JAMA · 2009
Unmedicated adults with ADHD had lower dopamine receptor and transporter availability than controls in the reward pathway, and the lower the receptor availability, the worse the inattention.
53 vs 44adults with ADHD and controls; attention tracked receptor availability (r = 0.35)
Motivation deficit in ADHD is associated with dysfunction of the dopamine reward pathway (s’ouvre dans un nouvel onglet)
Volkow ND, Wang GJ, et al. · Molecular Psychiatry · 2011
Adults with ADHD scored lower on a trait-motivation scale, and within the group lower motivation went with lower dopamine receptor availability in the accumbens and midbrain.
r = 0.41motivation against midbrain dopamine receptor availability in 45 adults with ADHD
Ventral-striatal responsiveness during reward anticipation in ADHD and its relation to trait impulsivity in the healthy population: a meta-analytic review of the fMRI literature (s’ouvre dans un nouvel onglet)
Plichta MM, Scheres A · Neuroscience & Biobehavioral Reviews · 2014
Pooling brain-imaging studies, people with ADHD showed a reliably weaker ventral striatum response while anticipating a reward.
d = 0.48weaker reward anticipation in ADHD, pooled across fMRI studies
Attention-deficit/hyperactivity disorder and monetary delay discounting: a meta-analysis of case-control studies (s’ouvre dans un nouvel onglet)
Jackson JNS, MacKillop J · Biological Psychiatry: Cognitive Neuroscience and Neuroimaging · 2016
Across 25 comparisons, people with ADHD discounted delayed money more steeply than controls, preferring the smaller reward now to the larger one later.
d = 0.43steeper delay discounting in ADHD across 3,913 people

Traiter le TDAH aide-t-il ou nuit-il

Does stimulant therapy of attention-deficit/hyperactivity disorder beget later substance abuse? A meta-analytic review of the literature (s’ouvre dans un nouvel onglet)
Wilens TE, Faraone SV, et al. · Pediatrics · 2003
Pooling six long-term studies, young people with ADHD who had been treated with stimulants were less likely, not more, to develop a substance use disorder later.
674 vs 360treated and untreated young people across 6 studies; treatment lowered the later risk
Stimulant medication and substance use outcomes: a meta-analysis (s’ouvre dans un nouvel onglet)
Humphreys KL, Eng T, et al. · JAMA Psychiatry · 2013
Across 15 longitudinal studies, children with ADHD treated with stimulants ended up with the same rates of later alcohol, nicotine, cannabis and cocaine use and dependence as children who were not treated.
2,565people across 15 studies; no difference either way
Adolescent substance use in the multimodal treatment study of attention-deficit/hyperactivity disorder (ADHD) (MTA) as a function of childhood ADHD, random assignment to childhood treatments, and subsequent medication (s’ouvre dans un nouvel onglet)
Molina BSG, Hinshaw SP, et al. · Journal of the American Academy of Child and Adolescent Psychiatry · 2013
Eight years after children with ADHD were randomly assigned to medication, behavioural treatment, both or community care, the four groups did not differ on teenage substance use, and all used more than classmates without ADHD.
436children with ADHD followed for 8 years against 261 classmates
Stimulant ADHD medication and risk for substance abuse (s’ouvre dans un nouvel onglet)
Chang Z, Lichtenstein P, et al. · Journal of Child Psychology and Psychiatry · 2014
In Swedish national registers, people with ADHD on stimulant medication had about a third fewer substance-abuse events three years later, and the longer the treatment, the lower the rate.
HR 0.6931% lower rate of substance abuse among 38,753 people with ADHD (95% CI 0.57 to 0.84)
ADHD medication and substance-related problems (s’ouvre dans un nouvel onglet)
Quinn PD, Chang Z, et al. · American Journal of Psychiatry · 2017
In almost three million insured people with ADHD, the same man had fewer emergency visits for substance problems in the months he took ADHD medication than in the months he did not, and the lower risk was still visible two years later.
OR 0.6535% lower odds of a substance-related emergency for men while on medication (95% CI 0.64 to 0.67)
ADHD drug treatment and risk of suicidal behaviours, substance misuse, accidental injuries, transport accidents, and criminality: emulation of target trials (s’ouvre dans un nouvel onglet)
Zhang L, Zhu N, et al. · BMJ · 2025
Among 148,581 people in Sweden newly diagnosed with ADHD, those who started medication within three months had fewer first substance misuse events over the next two years than those who did not.
IRR 0.85first substance misuse events, medication starters against non-starters (95% CI 0.83 to 0.87)
Methylphenidate for attention deficit hyperactivity disorder and drug relapse in criminal offenders with substance dependence: a 24-week randomized placebo-controlled trial (s’ouvre dans un nouvel onglet)
Konstenius M, Jayaram-Lindström N, et al. · Addiction · 2014
In 54 men with ADHD and amphetamine dependence leaving Swedish prisons, 24 weeks of methylphenidate alongside weekly therapy cut ADHD symptoms and produced more drug-free urine samples and better retention than placebo.
54 menmean age 42; more drug-negative samples on methylphenidate (p = 0.047)

L’équilibre lui-même

Drug addiction, dysregulation of reward, and allostasis (s’ouvre dans un nouvel onglet)
Koob GF, Le Moal M · Neuropsychopharmacology · 2001
Addiction is described as a spiral in which the brain’s counter-reaction to reward fails to bring it back to level, leaving the reward set point chronically lowered; this is the model behind Lembke’s balance.
2 processesthe high and the press-back against it; with repetition the press-back grows and outlasts the high, so the set point stays moved
Neurobiology of addiction: a neurocircuitry analysis (s’ouvre dans un nouvel onglet)
Koob GF, Volkow ND · The Lancet Psychiatry · 2016
Addiction runs as a three-stage cycle of binge, withdrawal and preoccupation, each anchored in a different brain system, with reduced dopamine reward and raised stress signalling in the withdrawal stage.
3 stagesbinge, withdrawal, preoccupation, each with its own circuit

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