The Library
ADHD and substances share a wiring: the chase for more. This shelf holds the research behind that line, read by the House and put in plain words. One book or paper at a time.
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.
Read by the House · October 14, 2026 · about 5 minutes
Read itRead one thing at a time, then write three lines: what it says, what it changes, what you’ll do before Thursday. Don’t read the whole shelf in one night. That’s the chase again. — Diego
Peer-reviewed papers the House has read in full. Each row gives the one number worth keeping and what it changes. Say if one is missing.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
The Library · ScienceHouse Guatemala