By Beau Black
Attention deficit hyperactivity disorder (ADHD) is a condition that can alter how we think or behave. Specific symptoms include chronic difficulty focusing, hyperactivity, and problems with impulse control. There’s a strong connection between ADHD and substance abuse, which can make treating the co-occurring conditions challenging.
Many adults who grew up with undiagnosed or untreated ADHD now live with the consequences of that delayed diagnosis or treatment, including increased risk for struggles with addiction. However, understanding how they work together can lead to successful treatment.
LIVING WITH ADULT ADHD
In as many as 75% of cases, studies indicate that symptoms of ADHD from childhood linger into adulthood. According to ADDitude, an online resource for those affected by ADD/ADHD, the symptoms of adult ADHD include:
Inattention
- Poor attention to detail
- Difficulty getting started and completing tasks
- Difficulty focusing and regulating attention
- Forgetfulness
- Poor time management, organizational skills
Inpulsivity
- Fidgeting
- Restlessness
- Interrupting frequently
- Talking excessively
Emotional dysregulation
Low frustration tolerance
These symptoms often lead people with the condition to self-medicate through substance abuse, a process that can begin early on and lead to addiction.
NEUROBIOLOGY OF ADHD AND ADDICTIVE BEHAVIORS
ADHD and addictive behaviors share a link beyond that of self-medication — neurobiology. ADHD and substance abuse affect, and are affected by, how the brain produces and processes dopamine and how the mesolimbic pathway functions. This mesolimbic pathway is related to motivation, incentivization, and impulsivity, factors relevant to both ADHD and substance use disorders.
ADHD and substance abuse affect, and are affected by, how the brain produces and processes dopamine and how the mesolimbic pathway functions.
Mental Health and Addiction Research shares that both ADHD and addiction involve neurobiology related to poor response to mental rewards. They involve “a blunted response to typical rewards” like life’s big and small pleasures. To experience the effects of dopamine, you may feel you “need” a more extreme source of neuron activation (i.e., drugs or alcohol).
And because of neurobiology, ADHD and addiction are also both related to troubles with executive function, the “cognitive processes that are required for top-down control of behavior, emotions and thoughts, involving the ability to organize thoughts and activities, prioritize tasks, manage time, make decisions.“ Executive function impacts our ability to make good choices about using or not using drugs and our ability to resist urges to use again. And executive function is in turn controlled by the prefrontal cortex and the neurobiology of the mesolimbic and mesocortical systems, neurobiology that may be imbalanced to begin with by ADHD or may become imbalanced through drug use.
THE CONNECTION BETWEEN ADHD AND ADDICTION
People with ADHD are significantly more likely to struggle with substance abuse, multiple studies show. One cited by ADDitude observed that 15% of ADHD sufferers had abused or were dependent on alcohol or drugs during the previous year. That statistic is three times higher than the rest of the population.
According to Frontiers in Psychiatry research, those with ADHD have an increased risk for addiction disorders like alcoholism and substance abuse: “Both ADHD and addictions have also been associated with personality traits such as impulsivity, reward-seeking, anxiousness, and negative affect.”
The Frontiers study also observed that substance and alcohol abuse were about six times more likely in patients with ADHD, and that females were at significantly higher risk than males. Additionally, those with ADHD tend to progress from use to abuse in higher numbers and exhibit greater social and psychiatric impairment.
The report showed the ADHD-drug use/abuse link works both ways: “It has been estimated that up to 50% of adolescents and adults with substance abuse disorders have a lifetime diagnosis of ADHD.”
Why do those with ADHD struggle more with substance abuse? Aside from the common traits listed above, they tend to try to self-medicate their symptoms. Among young adults with ADHD, “Only 30% said they used substances to get high; 70% are doing it to improve their mood, to sleep better, or for other reasons,” says ADDitude’s Timothy Wilens, MD, an associate professor of psychiatry at Boston’s Harvard Medical School.
One patient, who was also a student, said, “I didn’t drink to get smashed, but to concentrate and get my homework done. The boredom was impossible. I could be sitting in an interesting lecture and be totally bored. When I drank, I didn’t care that I was bored.”
In children, it’s important to diagnose and treat the condition early, as there is a connection between appropriate treatment, ADHD medication, and addiction risk. Those with ADHD who were appropriately treated with medication in childhood were 50% less likely than their peers to struggle with substance abuse in young adulthood. But what about adults today who are living with a previously untreated condition? A combination of the right medication, Cognitive Behavioral Therapy, and 12-Step treatment may work best.
Dual Diagnosis, ADHD, Addiction, and You
A dual diagnosis, also referred to as co-occurring disorders, is when you face a mental health issue like ADHD at the same time as a substance use disorder. As mentioned, substance abuse in ADHD individuals is common. But ADHD may not be the only mental health concern on your plate. The Centers for Disease Control and Prevention lists the following as possible components of your ADHD and substance use diagnosis:
- Depression
- Anxiety
- Learning disorders
- Oppositional defiant disorder (ODD)
- Conduct disorder (CD)
As with ADHD and addiction, getting a proper diagnosis is essential for then receiving the right ADHD treatment and addiction treatment, such as appropriate behavioral interventions.
Behavioral Interventions for ADHD and Addiction
Behavioral interventions for ADHD and addiction are designed to encourage positive behaviors and steps towards long-term health. They can prevent or treat mental and physical health issues such as ADHD and addiction and support an overall healthy lifestyle and mindset. So what is a behavioral intervention?
A behavioral intervention is a highly personalized plan, so it starts with a professional assessment. These interventions are based on the assumption that behaviors are learned, and that we all have unique learning processes and life experiences that have taught us. You can’t develop the tools and strategies that will work best for you without first knowing your own particular recovery needs. An assessment helps you determine what behaviors need to change, why they’re occurring in the first place, and how best to change them. This may involve positive reinforcement through rewards and strategies for developing healthy habits while breaking unhelpful old ones.
You can’t develop the tools and strategies that will work best for you without first knowing your own particular recovery needs.
Behavioral interventions can help you stay on track with taking ADHD or any needed medications safely and routinely. They will help you make the most of treatment and then continue to participate in regularly scheduled therapy for any co-occurring issues. And behavioral interventions support strategies for overall wellness including eating right, staying active, and planning ahead.
PLANNING AHEAD
One of the best ways ADHD patients can guard against substance problems is to treat the condition, reports ADDitude — even if that means using medication.
Exercise, keeping mentally stimulated and active, and having ongoing challenges to work toward can help. Having a support system is also important.
One of the helpful coping mechanisms for ADHD and addiction is HALT, which stands for:
- Avoiding hunger
- Avoiding anger
- Avoiding loneliness and
- Not letting yourself get too tired
All of these can be triggers for a substance use relapse in ADHD patients, so planning ahead to mitigate them can be key.
Seeking treatment early and sticking with it, staying appropriately occupied, and having a safety net of people (including a doctor) who will keep tabs on you and know the warning signs of an impending relapse — will all help you to stay on track.
Though complex, these often-entwined conditions can be brought under control with thoughtfully planned treatment and a willing patient. If you or someone you know is struggling with ADHD, addiction, or any number of other behavioral health issues, we are here for you. Reach out today to learn more and take that vital first step toward wellness.