Treating ADHD in Patients With Bipolar Disorder and Substance Use

Lenard Adler, MD, explains how clinicians can safely and effectively treat ADHD when bipolar disorder and addiction are also in the picture. He addresses how to distinguish chronic ADHD symptoms from episodic mood disorders, why bipolar disorder is often missed in adults referred for depression or attention problems, and how substance use complicates both diagnosis and medication selection.

Dr. Adler also shares guidance on identifying red flags for diversion or misuse, setting appropriate expectations for medication trials, and navigating the limits of current treatment guidelines. The episode closes with a look toward emerging directions in ADHD treatment, including research on emotional dysregulation, executive function deficits, and next-generation neurofeedback approaches.

Lenard Adler, MD, is Pottash Professor of Psychiatry and Director of the Adult ADHD Program at NYU Langone Health

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00:00 Why ADHD, Bipolar Disorder, and Addiction Must Be Treated Together
01:02 What Makes These ADHD Cases So Difficult
02:05 ADHD vs. Bipolar Disorder: Key Diagnostic Distinctions
04:43 The Link Between ADHD and Addiction
05:53 Using Stimulants Safely When Substance Use Is a Concern
07:57 Choosing Stimulants vs. Non-Stimulants
10:07 How Severity and Comorbidity Shape Treatment Decisions
12:06 The Limits of Guidelines and Biomarkers in ADHD Care
15:34 Executive Function and Emotional Dysregulation
16:13 Where ADHD Treatment Is Headed Next

This episode is intended for psychiatrists, mental health clinicians, and others interested in complex adult ADHD presentations.

This discussion is for educational purposes and does not substitute for individual clinical judgment or patient care.

Senior Producer: Jon Earle