Skip to main navigation menu Skip to main content Skip to site footer
FrancoAngeli Journals

Saggi, Studi e Ricerche

No. 75 (2026)

ADHD and the risk of benzodiazepine misuse: A systematic review and meta-analysis

DOI
https://doi.org/10.3280/mis75-2026oa21951
Submitted
gennaio 28, 2026
Published
2026-10-08

Abstract

Background. Attention-Deficit/Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disorder that often persists into adulthood and is associated with an elevated risk of substance use disorders. Benzodiazepines (BDZs), frequently prescribed for anxiety and sleep-related symptoms, carry a high potential for misuse and dependence. Preliminary evidence suggests that individuals with ADHD may be particularly vulnerable to problematic BDZ use, yet this association has not been systematically reviewed or quantitatively assessed.

Objectives. This review aimed to systematically examine the association between ADHD and BDZ misuse or dependence in adult populations, and to quantify this relationship through meta-analytic synthesis of observational data.

Methods. A systematic literature search was conducted in PubMed, Scopus, and ScienceDirect for relevant observational studies published up to April 30, 2025. Inclusion criteria focused on original research reporting BDZ misuse or dependence in adults with a clinical diagnosis of ADHD. A random-effects meta-analysis was performed to calculate pooled odds ratios (ORs) and 95% confidence intervals (CIs). Risk of bias was assessed using the Joanna Briggs Institute checklist for analytical cross-sectional and cohort studies.

Results. Four studies met the inclusion criteria, each contributing one independent effect estimate. The pooled OR indicated a significant association between ADHD and BDZ misuse or dependence (OR = 1.94; 95% CI: 1.31–2.89), with moderate heterogeneity observed (I² ≈ 42%). Patterns of misuse included high-dose intake, intravenous/intranasal administration, and prolonged BDZ use.

Conclusions. Adults with ADHD demonstrate a significantly increased risk for BDZ misuse and dependence. These findings emphasize the need for targeted screening and cautious prescribing practices in this population.

References

  1. Faraone S.V., Biederman J., & Mick E. (2006). The age-dependent decline of attention defi cit hyperactivity disorder: a meta-analysis of follow-up studies. Psychol Med., 36(2): 159-65. Doi: 10.1017/S003329170500471X.
  2. Fayyad J., Sampson N.A., Hwang I., Adamowski T., Aguilar-Gaxiola S., Al-Hamzawi A., Andrade L.H., Borges G., de Girolamo G., Florescu S, Gureje O., Haro J.M., Hu C., Karam E.G., Lee S., Navarro-Mateu F., O’Neill S., Pennell B.E., Piazza M., Posada-Villa J., Ten Have M., Torres Y., Xavier M., Zaslavsky A.M.,& Kessler R.C. (2017). WHO World Mental Health Survey Collaborators. The descriptive epidemiology of DSM-IV Adult ADHD in the World Health Organization World Mental Health Surveys. Atten Defic Hyperact Disord., 9(1): 47-65. Doi: 10.1007/s12402-016-0208-3.
  3. Song P., Zha M., Yang Q., Zhang Y., Li X.,& Rudan I. (2021). The prevalence of adult attention-deficit hyperactivity disorder: A global systematic review and meta-analysis. J Glob Health., 11, 04009. Doi: 10.7189/jogh.11.04009.
  4. Wilens T.E., Faraone S.V., Biederman J.,& Gunawardene S. (2003). Does stimulant therapy of attention-defi cit/hyperactivity disorder beget later substance abuse? A meta-analytic review of the literature. Pediatrics, 111(1): 179-85. Doi: 10.1542/peds.111.1.179.
  5. Olfson M., King M., & Schoenbaum M. (2015). Benzodiazepine use in the United States. JAMA Psychiatry, 72(2): 136-42. Doi: 10.1001/jamapsychiatry.2014.1763.
  6. Maust D.T., Lin L.A., & Blow F.C. (2019). Benzodiazepine Use and Misuse Among Adults in the United States. Psychiatr Serv., 70(2): 97-106. Doi: 10.1176/appi.ps.201800321.
  7. Lugoboni F., Zamboni L., Mantovani E., Cibin M., Tamburin S., & Gruppo InterSERT di Collaborazione Scientifica (2020). Association between Adult Attention Deficit/Hyperactivity Disorder and Intravenous Misuse of Opioid and Benzodiazepine in Patients under Opioid Maintenance Treatment: A Cross-Sectional Multicentre Study. Eur Addict Res., 26(4-5): 263-273.
  8. Moore E., Sunjic S., Kaye S., Archer V., & Indig D. (2016). Adult ADHD Among NSW Prisoners: Prevalence and Psychiatric Comorbidity. J Atten Disord., 20(11): 958-967. Doi: 10.1177/1087054713506263.
  9. Page M.J., McKenzie J.E., Bossuyt P.M., Boutron I., Hoffmann T.C., Mulrow C.D., Shamseer L., Tetzlaff J.M., Akl E.A., Brennan S.E., Chou R., Glanville J., Grimshaw J.M., Hróbjartsson A., Lalu M.M., Li T., Loder E.W., Mayo-Wilson E., McDonald S., McGuinness L.A., Stewart L.A., Thomas J., Tricco A.C., Welch V.A., Whiting P., & Moher D. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ., 372, n71. Doi: 10.1136/bmj.n71.
  10. Moola S., Munn Z., Tufanaru C., Aromataris E., Sears K., Sfetcu R., Currie M., Qureshi R., Mattis P., & Lisy K. (2020). Chapter 7: Systematic reviews of etiology and risk. In: Aromataris E., & Munn Z. (Eds.). JBI Manual for Evidence Synthesis. Joanna Briggs Institute.
  11. Seabold S., & Perktold J. (2010). Statsmodels: Econometric and statistical modeling with Python. In: Proceedings of the 9th Python in Science Conference (Vol. 57, pp. 61-66).
  12. Lugoboni F., Bertoldi A., Casari R., Mantovani E., Morbioli L., & Tamburin S. (2020b). Adult Attention-Deficit/Hyperactivity Disorder and Quality of Life in High-Dose Benzodiazepine and Related Z-Drug Users. Eur Addict Res., 26(4-5): 274-282. Doi: 10.1159/000507852.
  13. Young J.T., Carruthers S., Kaye S., Allsop S., Gilsenan J., Degenhardt L., van de Glind G., van den Brink W., & Preen D. (2015). Comorbid attention deficit hyperactivity disorder and substance use disorder complexity and chronicity in treatment-seeking adults. Drug Alcohol Rev., 34(6): 683-93. Doi: 10.1111/dar.12249.
  14. Volkow N.D., Wang G.J., Kollins S.H., Wigal T.L., Newcorn J.H., Telang F., Fowler J.S., Zhu W., Logan J., Ma Y., Pradhan K., Wong C., & Swanson J.M. (2009). Evaluating dopamine reward pathway in ADHD: clinical implications. JAMA., 302(10): 1084-91. Doi: 10.1001/jama.2009.1308. Erratum in: JAMA (2009), 302(13): 1420.
  15. Faraone S.V., & Biederman J. (2005). What is the prevalence of adult ADHD? Results of a population screen of 966 adults. J Atten Disord., Nov, 9(2): 384-91. Doi: 10.1177/1087054705281478.
  16. Wilens T.E., & Morrison N.R. (2011). The intersection of attention-deficit/hyperactivity disorder and substance abuse. Curr Opin Psychiatry, 24(4): 280-5. Doi: 10.1097/YCO.0b013e328345c956.
  17. Arnsten A.F. (2009). The Emerging Neurobiology of Attention Deficit Hyperactivity Disorder: The Key Role of the Prefrontal Association Cortex. J Pediatr., May 1, 154(5): I-S43. Doi: 10.1016/j.jpeds.2009.01.018.
  18. Koob G.F., & Volkow N.D. (2010). Neurocircuitry of addiction. Neuropsychopharmacology, Jan, 35(1): 217-38. Doi: 10.1038/npp.2009.110. Erratum in: Neuropsychopharmacology, Mar, 35(4): 1051.
  19. Sohal V.S., & Rubenstein J.L.R. (2019). Excitation-inhibition balance as a framework for investigating mechanisms in neuropsychiatric disorders. Mol Psychiatry, Sep, 24(9): 1248-1257. Doi: 10.1038/s41380-019-0426-0. Epub 2019 May 14.
  20. https://nida.nih.gov/publications/research-reports/misuse-prescription-drugs/overview (September 16th, 2025).
  21. Naguy A., Pridmore S.,& Alamiri B. (2022). Benzodiazepines in autism spectrum disorder-wise or otherwise?. CNS Spectr., Oct, 27(5): 552. Doi: 10.1017/S1092852921000481.
  22. McHugh R.K., Geyer R.B., Chase A.R., Griffi n M.L., Bogunovic O.,& Weiss R.D. (2021). Sex differences in benzodiazepine misuse among adults with substance use disorders. Addictive Behaviors, 112, 106608.
  23. Castellano-García F., Benito A., Jovani A., Fuertes-Sáiz A., Marí-Sanmillán M.I.,& Haro G. (2022). Sex Differences in Substance Use, Prevalence, Pharmacological Therapy, and Mental Health in Adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD). Brain Sci., May 2, 12(5), 590. Doi: 10.3390/brainsci12050590.

Metrics

Metrics Loading ...