ADHD and the Risk of Benzodiazepine Misuse: A Systematic Review and Meta-Analysis
Lorenzo Zamboni1, Angela Federico1, Rebecca Casari1
1Unit of Addiction Medicine, Department of Internal Medicine, Integrated University Hospital of Verona, Policlinico "G.B. Rossi", Verona, Italy.
Substance Use & Misuse
|December 6, 2025
Summary
Adults with Attention-Deficit/Hyperactivity Disorder (ADHD) have nearly double the risk of benzodiazepine (BDZ) misuse or dependence. This highlights the need for careful prescribing and screening for BDZ misuse in ADHD patients.
Area of Science:
- Neuroscience
- Psychiatry
- Pharmacology
Background:
- Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder with adult persistence.
- ADHD is linked to a higher risk of substance use disorders.
- Benzodiazepines (BDZs) are frequently prescribed but have high misuse potential, with individuals with ADHD potentially being more vulnerable.
Purpose of the Study:
- To systematically review and quantitatively assess the association between ADHD and benzodiazepine misuse or dependence in adults.
- To synthesize observational data using meta-analysis to determine the magnitude of this association.
Main Methods:
- A systematic literature search was conducted across PubMed, Scopus, and ScienceDirect for observational studies up to April 2025.
- Inclusion criteria focused on adults with ADHD and reported BDZ misuse or dependence.
- A random-effects meta-analysis was performed to calculate pooled odds ratios (ORs) and 95% confidence intervals (CIs).
Main Results:
- Four studies were included, contributing one effect estimate each.
- A significant association was found between ADHD and BDZ misuse or dependence (OR = 1.94; 95% CI: 1.31-2.89).
- Moderate heterogeneity (I² ≈ 42%) was observed, with misuse patterns including high-dose, altered administration routes, and prolonged use.
Conclusions:
- Adults with ADHD exhibit a substantially increased risk of benzodiazepine misuse and dependence.
- These findings underscore the importance of targeted screening for BDZ misuse in individuals with ADHD.
- Cautious prescribing practices for benzodiazepines are recommended for this population.
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