Executive functioning difficulties are common in people seeking help for substance use, compulsive behaviors, mood instability, and chronic problems with follow-through. These challenges affect planning, time management, sustained attention, impulse control, and emotional regulation - the everyday skills required to carry out what someone intends to do.
When executive functioning systems are inconsistent, people can look ambivalent or resistant. The underlying issue is often difficulty implementing plans under stress.
How Common Is the Overlap?
There is strong evidence linking ADHD and substance use disorders. Meta-analytic work suggests that roughly one in five people with substance use disorders also meet criteria for ADHD, with rates varying by substance type and treatment setting (van Emmerik-van Oortmerssen and subsequent reviews, 2023).
ADHD is also associated with earlier onset of substance use and increased risk for certain substance problems across multiple longitudinal studies.
The relationship between autism and substance use is more variable. Some studies show lower overall rates of use, while others find higher rates of substance-related problems in specific subgroups, particularly when ADHD is also present. Large registry studies report substantially higher substance use disorder rates in autistic adults who also have ADHD compared with those without it.
Across both groups, anxiety, depression, and chronic stress are common and can increase reliance on fast-acting coping strategies like substance use.
Executive Functioning and Behavioral Addictions
Differences in delay tolerance, reward processing, and impulse control are also linked to behaviors such as gambling, gaming, compulsive internet use, and binge patterns. Fast, high-reward activities are simply easier for these nervous systems to engage with than slower, delayed-reward tasks. It’s predictable, not irrational.
Real-World Impact
Executive functioning problems often show up as repeated difficulty following through on plans, missed appointments or inconsistent engagement, strong intentions that collapse under stress, trouble using prior learning in the moment, and greater vulnerability to impulsive decisions. Without recognizing this layer, treatment systems frequently label people “noncompliant,” “not ready,” or “self-sabotaging.
Why It Matters
Executive dysfunction is associated with poorer retention in traditional treatment, greater relapse risk during high-stress periods, and difficulty implementing coping strategies outside sessions.
Addressing these skills directly increases the likelihood that psychotherapy, medication, and recovery supports translate into daily behavior.
How We Address Executive Functioning
Because these difficulties are common in the populations we serve, executive functioning support is integrated into both outpatient and residential care. We identify where follow-through breaks down, build practical planning and implementation systems, integrate regulation skills into real situations, and coordinate with psychiatric care when ADHD is present. A formal ADHD diagnosis isn’t required for this work to be useful. The focus is functional: what helps you reliably do what matters.