There is a common misconception that attention-deficit/hyperactivity disorder (ADHD) is a childhood condition. However, modern psychiatry has come to understand that it can continue into adulthood. Today, many people who went undiagnosed in childhood are receiving diagnoses in their twenties, thirties, and beyond.
With a clearer understanding of the statistics regarding how many people struggle with ADHD, we have gotten further clarity on another issue: its connection with addiction.
Studies have indicated that 25% of adults treated for substance use have ADHD. This is around 5 times the prevalence of ADHD in the general population. This is strong evidence that people with ADHD are much more likely to become addicted to substances.
What is the reason for this connection? And what does it mean for adults who struggle with both ADHD and substance use disorders.
This article will delve into the link between ADHD and addiction to find the answers.
What is ADHD?
Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by persistent patterns of inattention, hyperactivity, and impulsivity that interfere with daily functioning. ADHD has traditionally been diagnosed in childhood, often soon after a child starts school. Today we understand that, in between a third and a half of children with ADHD, the disorder persists into adulthood.
Symptoms of ADHD
ADHD symptoms are categorized into two main types: inattention and hyperactivity-impulsivity. Some individuals may predominantly exhibit symptoms from one category, while others may have a combination of both.
Inattention: Difficulty sustaining attention, frequent careless mistakes, trouble organizing tasks, forgetfulness in daily activities, and being easily distracted. This was traditionally called attention-deficit disorder (ADD) but is now categorized as a subtype of ADHD.
Hyperactivity-Impulsivity: Fidgeting, inability to stay seated, running or climbing in inappropriate situations, excessive talking, interrupting others, and difficulty waiting for one’s turn.
Prevalence and Diagnosis
ADHD affects about 5-10% of children worldwide, with a significant number of cases continuing into adulthood. The prevalence among adults is estimated to be around 5%. Diagnosis involves a comprehensive evaluation that includes clinical interviews, behavioral assessments, and standardized rating scales. It is crucial to rule out other conditions that might mimic ADHD symptoms, such as anxiety, depression, or learning disabilities.
Impact on Daily Life
People with ADHD often struggle with executive functioning, which includes the mental skills needed to plan, focus attention, remember instructions, and juggle multiple tasks successfully. This can lead to difficulties in academic, occupational, and social settings. Children with ADHD may experience academic underachievement and social challenges, while adults may face issues with employment, relationships, and self-esteem.
Why is ADHD Connected to Addiction?
If the prevalence of ADHD is five times larger in addiction recovery centers than in the general population, what accounts for the difference? There are a number of reasons given for the higher risk of addiction in people with ADHD.
Self-Medication
People with ADHD often turn to substances as a form of self-medication. Stimulants like cocaine and methamphetamine might temporarily alleviate ADHD symptoms, while alcohol and marijuana can reduce hyperactivity. This self-medication can lead to dependency and addiction.
This is not unique to people with ADHD. Addiction occurs at higher rates in people suffering with mental illnesses such as depression, bipolar disorder, anxiety, and others, as they turn to substances to deal with symptoms.
People with ADHD often struggle with depression and anxiety as well. The day-to-day impact of ADHD can lead to low self-esteem and the perception of a lack of control, which can make life feel overwhelming. As such, this too leads to self-medication using drugs and alcohol.
Research also suggests that people with ADHD have a strong craving for dopamine as their brains don’t produce or release enough on their own. This leads to the use of substances that temporarily boost dopamine levels as a kind of self-medication.
Increased Impulsivity
Another reason for the prevalence of substance use issues for people with ADHD is the symptom of impulsivity. This is especially common in the hyperactivity/impulsivity subtype of ADHD. The associated struggle with impulse control leads to risk taking and bad decisions.
A person with ADHD may therefore use substances even when they know logically that it is highly dangerous. They may also put themselves in situations where substance use is common – including bars and clubs – more often than others. People without ADHD are likely to stay in when they have important work the next day, but heightened impulsivity makes that decision more difficult.
What Challenges are There in Treating Addiction and ADHD?
There are specific challenges in treating addiction and ADHD. Recovery centers need to focus on addressing both issues, as treating addiction alone is unlikely to lead to a sustained recovery.
Diagnosis Issues
The symptoms of ADHD can often be mistaken for or masked by the effects of substance abuse, leading to misdiagnosis or underdiagnoses. For example, the hyperactivity and impulsivity associated with ADHD might be attributed to the effects of drug use, while the inattention could be seen as a consequence of addiction-related cognitive impairment.
To get an accurate diagnosis, healthcare professionals experienced in recognizing the overlapping symptoms need to administer comprehensive assessments. They use a range of diagnostic tools, including clinical interviews, behavioral assessments, and standardized rating scales specifically designed to identify ADHD in the context of substance use disorders.
Treatment Resistance
Impulsivity and a difficulty with sustained attention can lead to a lack of engagement in therapy sessions or adherence to treatment plans. This can result in higher dropout rates and lower success rates in standard addiction treatment programs.
Moreover, the chronic nature of ADHD symptoms means that even if an individual manages to achieve sobriety, the underlying ADHD symptoms can persist, potentially triggering a relapse. Therefore, addressing ADHD symptoms through appropriate medical and behavioral interventions is crucial to support long-term recovery.
Medication Management
Medication can play a significant role in managing ADHD symptoms. However, this poses a unique challenge in individuals with a history of substance abuse. Stimulant medications, which are commonly prescribed for ADHD, have a potential for abuse and might be contraindicated for individuals with addiction issues.
Non-stimulant medications, such as atomoxetine and certain antidepressants, may be used as alternatives. However, finding the right medication and dosage requires careful monitoring and collaboration between addiction specialists and mental health professionals to minimize the risk of abuse and ensure effective symptom management.
A further issue for healthcare providers to consider is the difficulty people with ADHD may face in taking chronic medication. Since forgetfulness is a symptom of ADHD, the individual needs to have measures in place to ensure consistency. The therapist or psychiatrist should help with this, as implementing these structures is a skill that is underdeveloped in people with ADHD.
What Role Should Addiction Recovery Centers Play?
The top addiction recovery centers recognize the importance of integrated treatment approaches to manage both conditions simultaneously, ensuring a more comprehensive and effective recovery process. They offer the following:
Specialized Programs
These programs are tailored to address the unique challenges posed by the intersection of addiction and ADHD. They provide a structured environment where individuals can receive targeted therapies that cater to both conditions.
A specialized program may include a combination of medication management, behavioral therapies, and supportive services.
Multidisciplinary Teams
Multidisciplinary teams at recovery centers typically consist of psychiatrists, psychologists, addiction specialists, and other healthcare professionals who work collaboratively to provide comprehensive care.
- Psychiatrists and Psychologists: play a crucial role in diagnosing and managing ADHD symptoms, prescribing appropriate medications, and offering psychotherapy to address underlying psychological issues.
- Addiction Specialists: focus on the substance use disorder aspect, providing addiction counseling, developing relapse prevention strategies, and facilitating support groups.
- Therapists and Counselors: offer behavioral therapies such as Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) to help individuals develop coping mechanisms and emotional regulation skills.
- Case Managers: ensure continuity of care by coordinating between different specialists, monitoring progress, and adjusting treatment plans as needed.
This team-based approach allows for a more holistic treatment plan that considers all aspects of an individual’s health and well-being. It also ensures that any potential interactions between treatments for ADHD and addiction are carefully managed.
Types of Therapies
One type of treatment provided by these experts is cognitive-behavioral therapy (CBT) which is used to help individuals recognize and change negative thought patterns and behaviors associated with both conditions. CBT can be particularly effective in teaching individuals how to manage ADHD symptoms without resorting to substance use.
Another effective treatment used by recovery centers today is dialectical behavior therapy (DBT), which uses mindfulness principles as a foundation. Mindfulness-Based Stress Reduction (MBSR) has also shown effectiveness in improving emotional regulation, reducing impulsivity, and increasing focus and attention.
Aftercare
Aftercare should be provided for every person who attends a recovery center, but is especially important with ADHD. Aftercare programs help individuals navigate the challenges of everyday life while maintaining their sobriety and managing their ADHD symptoms. They include therapy sessions, coaching, support groups, family therapy, and more.
Conclusion
There is now ample research showing the link between ADHD and addiction. This is a consequence of both the impulsivity of ADHD and the risk of self-medication. The best addiction recovery centers treat ADHD and addiction in a comprehensive program, ensuring that recovery is sustainable long after the inpatient program ends.
Sources
- Psychiatry Research: Prevalence of attention deficit hyperactivity disorder in adults: Umbrella review of evidence generated across the globe. Accessed 27 June 2024.
- NIH: Attention-Deficit/Hyperactivity Disorder (ADHD). Accessed 27 June 2024.
- Molecular Neurobiology: Role of Dopamine Receptors in ADHD: A Systematic Meta-analysis. Accessed 27 June 2024.
- Frontiers in Psychiatry: Attention-Deficit/Hyperactivity Disorder in Relation to Addictive Behaviors. Accessed 27 June 2024.
