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ADHD: The chicken or the egg?

Reading time: 6 minutes

Although medical authorities have focused on the potential deadliness of recreational drugs, combination drugs regularly prescribed for ADHD hold the same risks. Nicola Lund reports

Peter Hitchens, a renowned British author, broadcaster and Daily Mail columnist, recently wrote an article questioning the existence of a disorder that has been increasing at a curious rate in adults—ADHD (attention deficit hyperactivity disorder). This drew my attention following a recent personal experience of querying the diagnosis of a family member.

In June 2022, my young cousin was found dead in his flat in South Wales with his throat cut, one week before his 30th birthday. Tom was an only child—a tall, handsome, gentle soul adored by an army of friends and family. He was an avid festivalgoer with music in his blood and adventure in his soul, but for over 10 years he had sadly allowed recreational drugs to take over his psyche.

He wasn’t an addict; he held down a number of jobs over the years and enjoyed running half-marathons and generally living life to the full. But he had become reliant on the next “high” on nights out, and at music festivals in particular.

Public Health Wales has acknowledged an alarming rise in the numbers of drug-related deaths in recent years, although its report focuses on recreational drugs and prescription drugs accessed illegally through non-medical routes.1 Oddly—and predictably—it does not pay heed to drugs accessed through legal medical routes or even acknowledge that some deaths could be down to a combination of the two.

Several years before his death, after moving away from his hometown, Tom was diagnosed with ADHD. I hadn’t had a great deal of contact with him since this time, but as a former teacher and having been extremely close to him throughout his childhood, I found this shocking. He had shown no behavioral or attention issues whatsoever at school or at home.

The ADHD–drug use link

Now that I’ve started to research this, I realize a number of scientific papers have linked ADHD and other psychiatric symptoms to ongoing recreational poly-drug use,2 which we now know Tom was engaged in. The NHS website states that ADHD is a developmental disorder believed unable to develop in adults without first appearing during childhood. It also explains that symptoms are well defined and usually appear before age six.3

The problem is that a cursory internet search of “ADHD and poly-drug use” returns pages of links between the two, promoting the school of thought that ADHD is associated with a higher risk of substance abuse and dependence. Could this not be the chicken-and-egg conundrum? Could symptoms of drug addiction be presenting as ADHD, which might explain the rising diagnosis numbers in recent years?

One study mentions over 25 percent of adolescents with substance use problems fit the diagnostic criteria for ADHD.4 A similar paper (which looked at the psychiatric status of ecstasy/MDMA users in particular) concluded that use of these drugs is associated with a “range of psychiatric symptoms and psychobiological problems.”5

A spokesperson for the Royal College of Psychiatrists told me, “Every ADHD assessment should include a review of substance use. It’s important that the clinician has the patient’s full and accurate history of substance use in order to complete an accurate diagnosis.

“We are not aware of an established evidence base that suggests that people are regularly being misdiagnosed with ADHD; however, the effects of recreational substances can mimic the symptoms of ADHD, as can the withdrawal symptoms experienced by people who are dependent on such substances.”

It doesn’t add up

In the period leading up to his death, Tom was prescribed numerous medications concomitantly, including gabapentin for nerve pain,6 the antidepressant mirtazapine7 and lisdexamfetamine for ADHD.8 These three drugs in particular all list suicidal thoughts as possible side effects.

I was tasked with communicating with the coroner’s office, and Tom’s parents, several close friends and I agreed that we would question the ADHD diagnosis and the alarming array of potentially harmful medications. I even contacted the Medications and Healthcare Products Regulatory Agency (MHRA) to see if they might point me toward help with this task, but they failed to reply.

Our inquest was adjourned for a Serious Incident Clinical Desktop Review with Swansea Bay Health Board. Having obtained medical records and read a psychiatrist’s 2022 report (based on a telephone assessment due to Covid), we found several statements by Tom within the report that we categorically knew to be untrue. We wondered whether this might be a case of false memory syndrome, which can occur in those with a history of depression.9

We also queried the diagnosis in light of a study by Dr Jonathan Haverkampf that discusses how ADHD can be misdiagnosed in adulthood10 and the existence of several other disorders that can be misdiagnosed as ADHD.11

The initial diagnosis had been made by a consultant psychiatrist in North Wales under the troubled Betsi Cadwaladr Health Board.12 The same psychiatrist was reported to have given evidence at an inquest of another young man who had slit his throat in 2020.13

Following the review, the last psychiatrist to have seen my cousin claims the diagnosis was upheld after his own (telephone) assessment due to the following symptoms:

  • Mood instability
  • Trouble falling asleep
  • Trouble getting up in the morning
  • Disruptiveness in primary school
  • Cleverness
  • Playing video games for hours
  • Truancy in secondary school
  • Never doing homework—easily distracted

Several of these points, particularly those relating to school and homework, were simply not true and can be verified with school reports. Clearly the doctor had taken Tom at his own word. He had even stated, “I can confirm that Thomas had ADHD which started in childhood” despite there being absolutely no evidence for this.

The remaining “symptoms” listed are arguably experienced by vast swathes of the population. Mood instability in particular is known to be caused by recreational drugs and also by depression. Our concerns regarding the side effects of prescribed medications were simply met with a statement from the health board that these are “more likely in adolescence.”

It appears that the doctor who had assessed Tom over the phone presumed himself to be a more capable judge of Tom’s character and mental capacity than his family, who had known him for almost three decades. He did not acknowledge the possibility that he had made an error in judgment, to add insult to the family’s suffering. The outcome of the “investigation” was merely lip service to a number of very minor “lessons learned” with no recommendations noted.

Side effects of ADHD drugs

Internet searches give the impression that ADHD diagnosis is strongly associated with suicide and attempted suicide. Some headlines even give the impression that suicide has occurred due to patients not being given medication.14 But could the medications themselves be causing suicidal ideation, especially in conjunction with other substances, such as recreational drugs and alcohol?

Five drugs are licensed in the UK for treating ADHD:

  • methylphenidate (Ritalin)
  • dexamphetamine
  • lisdexamfetamine
  • atomoxetine
  • guanfacine

All of these, apart from guanfacine, list suicidal thoughts as a possible side effect, though it’s cited as “rare.”

Repeatedly taking ADHD medications, most of which are stimulants, can even lead to psychosis, anger and paranoia if the user does not have the condition, according to the US National Institutes of Health.15 In 2011 in the US, a young man named Richard Fee hanged himself after becoming addicted to prescription medication for ADHD, which he never had, according to his parents.16

An ongoing problem

I contacted Peter Hitchens to thank him for questioning the alarming rate of new ADHD diagnoses. He has written critically about this for many years and said, “It is very rare for anyone to take on my arguments. Generally, the reaction is abuse, mixed with (incorrect) claims that I have done no research, or that the writer’s subjective experience decides the issue. I have concluded that the diagnosis of ADHD quite suits a lot of those who receive it, and in some cases their parents and their teachers—who are relieved of responsibility for the person’s behaviour.”

One parent whom I spoke with recently about her 19-year-old daughter’s diagnosis expressed concern that her daughter had gone along with a college tutor’s suggestion to get assessed for ADHD because she is now entitled to financial assistance. Thankfully she has chosen not to take medication. The organisation ADHD Embrace lists funding and discounts available to ADHD children and young people and to their carers.17

The fact remains that there must surely be many other tragic cases like Tom’s in which medication was needlessly prescribed without enough lifestyle questions asked. Tom had both short- and long-term plans, and to this day we wonder whether drug-induced psychosis18 could have led him to fatally wound himself.

Mental health professionals must be aware of the similarity between poly-drug use or withdrawal symptoms and those defined as ADHD. While the government refuses to tackle drug use, the normalisation and acceptance of such diagnoses will likely result in an upward trajectory of “ADHD” suicides.



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  1. Public Health Wales, Harm Reduction Database Wales: Drug Related Mortality, 2022,
  2. Hum Psychopharmacol, 2012; 27(2): 209–16
  3. NHS, “Symptoms: Attention Deficit Hyperactivity Disorder (ADHD),” Dec 24, 2021,
  4. NHS, “ADHD, Autism and Epilepsy,” in Health and Care of People with Learning Disabilities Experimental Statistics 2019 to 2020, March 6, 2023,
  5. Am J Addict, 2007; 16(supp 1): 45–56
  6. Psychopharmacology (Berl), 2001; 159(1): 77–82
  7. DailyMed, “Label: Mirtazapine Tablet,” Nov 30, 2021,
  8. University of Illinois-Chicago, “Lisdexamfetamine, Oral Capsule,” June 6, 2018,
  9. Kimberly Holland, “False Memory: What You Need to Know,” April 23, 2019,
  10. Christian Jonathan Haverkampf, “The Misdiagnosis of ADHD in Adults,” 2020,
  11. Keath Low, “Conditions That Can Produce ADHD-Like Symptoms,” Dec 18, 2022,
  12. Paul Worthington, “Betsi Cadwaladr University Health Board: A Timeline of Events,” May 17, 2023,
  13. The Leader, “Psychiatrist Gives Evidence at Inquest of Wrexham Man Who Slit His Own Throat,” Jan 9, 2020,
  14. Robert Dalling, “'Our Son Died Three Days before Receiving the Medication That Might Have Saved His Life, after an Admin Error,” May 28, 2022,
  15. National Institute on Drug Abuse, “Prescription Stimulants DrugFacts,” June 2018,
  16. Lisa Flam, “Dad's Word of Warning: Adderall 'Changed' My Son,” Feb 7, 2013,
  17. ADHD Embrace, “Funding and Discounts for ADHD Children, Young People and Their Carers,” n.d.,
  18. William Shanahan, “What Is Drug Induced Psychosis?,” October 2022,
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