ADHD and Addiction

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What is ADHD?

Attention Deficit Hyperactivity Disorder, or ADHD, is a mental disorder characterized by irregularities in concentration, excessive activity, and difficulty controlling and regulating behavior.

Although difficulty concentrating or sustaining focus is a common problem with ADHD, hyper-focus is also a characteristic of the disorder. When a person with ADHD finds a topic or task especially interesting, they may concentrate so intensely that they work for hours, uninterrupted, with no idea of how much time is passing. Nevertheless, most tasks that require sustained attention are challenging for someone with ADHD, even when the task is essential, and they very much want to accomplish it.

When it comes to mental health and addiction, co-occurring disorders are common, and it’s no different with attention deficit hyperactivity disorder. Individuals with ADHD often struggle with impulsivity, which can compound the urge to self-medicate the emotional difficulties created by the disruptive effect of ADHD symptoms.

What are the Signs and Symptoms of ADHD?

ADHD symptoms appear before age 12, but the diagnosis is often not made until years later, especially for girls, who may not experience hyperactive symptoms, or whose hyperactivity may only manifest as racing thoughts or talkativeness. To be diagnosed with ADHD, the symptoms of the disorder must have caused problems in at least two areas of the individual’s life (such as school or home).

  • Difficulty regulating attention and concentration
  • Excessive activity or restlessness (this can be mental as well as behavioral)
  • Difficulty controlling behavior
  • Disruptive thoughts and actions (anxiety, obsessiveness, inappropriate speech or behavior)
  • Impulsivity (difficulty delaying gratification, frequent interrupting, acting without thinking)
  • Problems with organization (both externally and internally)
  • Often forgetful, loses things
  • Easily distracted
  • Struggles with details
  • Difficulties with stimulation (can either crave stimulation or become easily overwhelmed and exhausted by too much)
  • Difficulty translating a decision or desire into action
  • Sleep problems

How Does ADHD Interact with Addiction?

It’s estimated that nearly 25 percent of adults who seek drug and alcohol addiction treatment also have ADHD, which complicates treatment for both disorders.

One of the things that make the correlation between ADHD and addiction so strong is that they share similar symptoms. Furthermore, the common symptoms of ADHD are often those that develop once addiction becomes present.

These include the following:

  • Distraction
  • Impulsivity
  • Difficulty handling stress
  • Difficulty staying on task
  • Dramatic swings in mood and energy

While many people with addiction have ADHD, those with an attention deficit disorder are also more at risk of becoming addicted. Even without a history of drug or alcohol abuse, adults diagnosed with ADHD are two to three times more at risk of becoming addicted than those of the general population.

Stimulants are particularly appealing to individuals with ADHD, as they do, in fact, control ADHD symptoms. Undiagnosed adults with ADHD may discover that rather than feeling sped up by stimulants, they feel calm and focused, and better able to gather their thoughts and act on their decisions. As there is no absolute cure for ADHD, even individuals who have been diagnosed and prescribed an appropriate stimulant medication may misuse their prescription or supplement it with illegal substances, in a desire for a stronger effect or a complete relief of symptoms.

Alcohol and marijuana addiction are also common among people who have ADHD. These substances can temporarily relieve the intense anxiety that individuals with ADHD often experience, both directly from their hyperactive minds, and indirectly because the disorder often makes them feel as if they are not in control of themselves or their lives.

Individuals with undiagnosed ADHD are at very high risk of developing a substance use disorder. Having ADHD feels like being out of step with everyone else, and discovering a substance that suddenly allows them to work, study, or socialize in a way that comes naturally to other people is immensely appealing. Self-medicating the anxiety and depression that often co-occurs with ADHD due to the challenges of living with the disorder is also very tempting. Any use of substances that aren’t regulated by a doctor can quickly become abuse, and then addiction, especially when the impulsivity aspect of the disorder is factored into behavior.

Dopamine’s Role

While the mental health and addiction connection is often seen as a chicken versus egg conundrum, many people believe that both ADHD and addiction are connected to the brain’s dopamine levels. For individuals with ADHD, the natural levels of dopamine present in the brain are lower than average, and most addictive substances increase dopamine levels and keep more dopamine present in the brain for a longer time. However, while drug or alcohol abuse may help depress the symptoms of ADHD initially, they will eventually complicate the disease, making symptoms more intense and debilitating.

How are ADHD and Addiction Treated?

The appropriate treatment approach for a dual diagnosis of ADHD and addiction will depend a great deal on the substance being abused and the severity of the addiction. As ADHD and substance abuse have many overlapping symptoms, and because substance abuse can both relieve and intensify the symptoms of ADHD, a medically-supervised detox should ideally take place before any medications can be prescribed. This can mean having the patient go for up to six weeks without using addictive substances or taking prescription medication for ADHD so that doctors can make an accurate assessment of symptoms.

Psychotherapy and cognitive behavioral therapy can begin immediately, however, and these treatments will benefit both the substance use disorder and ADHD. Both addiction and ADHD can produce intense feelings of guilt, blame, shame, and frustration that need to be dealt with for recovery, and the patient’s best chance of a successful recovery will come from inpatient treatment. The irregularities of attention, impulsive behavior, and difficulty governing actions experienced with ADHD will present unique challenges in treatment that will be better served by around the clock support from a professional team.

Seek Dual Treatment

Considering the overlapping effects of ADHD and addiction, it can be difficult to treat one disorder without the other. When a dual diagnosis does occur, the side effects of one disorder may get worse as the other gets better. For this reason,  the needs of patients with co-occurring ADHD and addiction cannot be met by a standard treatment center that only employs staff with expertise in addiction. A facility that specializes in dual diagnosis or co-occurring disorders will allow the patient to simultaneously receive both ADHD and addiction treatment so that the diseases are better managed, and the individual has an improved focus on the steps they must take for recovery.

Non-Stimulant Medication

One of the issues with treating both addiction and ADHD is that the most common medications prescribed for ADHD are stimulants that become highly addictive when they are taken more often or in larger doses than prescribed. Medications such as Ritalin and Adderall are natural to abuse and therefore not recommended as a useful treatment option for anyone with a history of addiction or drug abuse. There are extended release stimulant medications that are not easily abused; however, that can be effective for individuals with a dual diagnosis.

There are also non-stimulant medications available for those with ADHD. Bupropion (brand name Wellbutrin) for example, is an antidepressant that inhibits the reuptake of dopamine and norepinephrine, leading to consistently higher levels of these neurotransmitters in the brain. This not only relieves depression, but it also allows the brain to transmit signals more effectively, thereby making it easier for individuals with ADHD to translate thought and will into targeted action.