ADHD and the Risk of Benzodiazepine Misuse: A Systematic Review and Meta-Analysis

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.