What is ADHD?
ADHD, or attention-deficit/hyperactivity disorder, is one of childhood’s most common neurodevelopmental disorders. However, approximately 5% of adults suffer from ADHD as well (though some data reveals much higher numbers). The symptoms often present as trouble paying attention, controlling impulsive behaviors, and being overly active. While research has not revealed all the causes of this neurodevelopmental disorder, there is agreement that it is partly genetic.
Other causes and risk factors include:
- Brain injury
- Exposure to environmental risks (e.g., lead) during pregnancy or at a young age
- Alcohol and tobacco use during pregnancy
- Premature delivery
- Low birth weight
However, the focus of this blog is on adults and addiction. Symptoms of ADHD in adults look a bit different than in children. Hyperactivity, for example, may be seen as extreme restlessness. In any case, many children begin to self-medicate in their teens to manage their symptoms. Misuse of drugs and alcohol, including marijuana (which exacerbates issues like focus, memory, and impulse control), is the most common usage among teens suffering from ADHD. In a study of Substance Use Disorder (SUD) patients seeking treatment, “of 3558 subjects from ten countries, [researchers] found that 40% of subjects screened positive for ADHD…”
Adults and ADHD
Adults with untreated ADHD suffer from inattention, disorganization, forgetfulness, unreliability, difficulties completing tasks, and time management. “In middle-aged and older adults, the occurrence of depression and anxiety increases the number of ADHD symptoms…Adult ADHD is associated with problems in many spheres of life, including work (unemployment), education (low attainment), and interpersonal relationships.”
Like teens who self-medicate, many undiagnosed adults self-medicate as well. Indeed, if adults have been undiagnosed since childhood, the likelihood of addiction increases into adulthood; that is not to say that all adults with ADHD will develop a SUD. However, “studies have found that adults with ADHD are more likely than their peers without ADHD to develop a SUD sometime during their lives.”
Most college students who have reported using “diverted” prescription medication for ADHD do so to “improve school performance” and not to get high.
SUD and Adults with ADHD
According to an article in Psychiatric Times, alcohol, cannabis, cocaine, and nicotine are the more commonly abused drugs among people with ADHD. Sadly, studies demonstrate that SUD complicates the symptoms of an ADHD adult.
Some adults crush and snort stimulant drugs, such as Ritalin, which increases the speed at which the user feels the drugs. Additionally, cocaine and other stimulants will be used to mitigate the effects of ADHD on behavior. These drugs are known to increase the dopamine levels in the brain, which are responsible for pleasurable feelings, focus and attention, and increased energy, among other things. Unfortunately, some drugs can mimic other mental health disorders complicating diagnosis.
“Studies in both adults and adolescents have found ADHD to be associated with earlier initiation and higher rates of lifetime substance use (nicotine 41–42%, alcohol 33–44%, cocaine 10–35%, cannabis 51%, opiates 16–19%)….”
According to this same article from Cambridge University Press:
- Patients presenting with substance use disorder should be screened for the presence of ADHD
- Screening instruments for adult ADHD can be invaluable tools in the assessment of this group
- Assessment of these individuals should include current and childhood history of ADHD symptoms, detailed history of current and past substance use, previous treatments, and psychiatric, family, and forensic history
- At least one month of abstinence is helpful for accurate and reliable assessment of ADHD symptoms
- It is imperative to watch for signs of possible misuses, such as missed appointments, and signs of possible diversions, such as repeated requests for higher doses and a pattern of ‘lost’ prescriptions
- It is essential to exclude high-risk situations (e.g., comorbid antisocial personality disorder, strong forensic history, and family member or peers with substance use disorder)
Whether SUDs cause ADHD or ADHD leads to SUD is not the issue of concern here. In the majority of cases now found among those choosing to enter SUD (alcohol and/or drug) treatment, clients suffer from co-occurring disorders. In many cases, a mental health disorder existed before drug or alcohol use, but the use of drugs exacerbates many mental health conditions. Additional mental health disorders can develop the longer a person suffers from active addiction, these conditions are impacted by the types of drugs ingested regularly.
Regardless of which comes first, the reality of dealing with a mental health disorder successfully without addressing the SUD means an unsuccessful result in the long run. Furthermore, drugs and alcohol consumption over time changes brain function. That reality will need to be addressed during treatment as well. Additionally, mental health disorders and SUDs can run in families. “Environmental factors, such as stress or trauma, can cause genetic changes that are passed down through generations…”
Treating ADHD and SUD
Treating ADHD and SUDs can be tricky. Some drugs will mimic ADHD symptoms. The goal for successful treatment protocols is to understand the client’s complete history, family history, as well as the variety of drugs/alcohol taken on a regular basis. The treatment team must make continuous comprehensive assessments in detox (the step before treatment can begin) and during treatment. People with ADHD and SUD must receive care targeted at the ADHD as well as the drug/alcohol addiction. There are a both stimulants and non-stimulants that are currently used in clinicians’ psychopharmaceutical choices. The team approach in all circumstances is considered the best approach. Multiple drug and addiction clinicians, doctors, and nurses are required to handle ADHD and SUD clients successfully.
If you believe you are suffering from ADHD (perhaps combined with anxiety, depression, and other disorders) and have a substance use disorder call our trained staff to speak with someone about treatment. Your questions are treated with the utmost confidentiality and empathy. You can get help and end the cycle of addiction and mental health decline now.