The Connection Between ADHD and Addiction
What is ADHD?
Attention-deficit/hyperactivity disorder (ADHD) is characterized by hyperactivity, impulsivity, and inattention that directly affect social and academic or occupational activities.1 Symptoms must be present before 12 years of age, occur in 2 or more settings (home, school, or work), and interfere with or reduce the quality of social, academic, or occupational functioning. According to the National Survey of Children’s Health (NSCH), 11% of children, 8.7% of adolescents, and 4.4% of adults in the United States have been diagnosed with ADHD.2 According to the Centers for Disease Control and Prevention (CDC), as of 2016 there are roughly 14 million doctor’s office visits for ADHD per year.3 In the state of Nevada, 3.8% of children ages 2–17 have been diagnosed ADHD.4
ADHD has a typical onset in childhood with symptoms continuing into adulthood. Given the psychosocial and behavioral impairments seen with ADHD, studies have shown that people with ADHD also have an increased risk of substance abuse and alcohol dependence .5. Additionally, estimates show that 50% of adolescents and adults with substance abuse disorders have a lifetime diagnosis of ADHD.5 This article will look at the link between ADHD and substance abuse and provide resources for how to get help.
Common Symptoms of ADHD
ADHD symptoms interfere with attaining some of the expected developmental milestones of childhood and adolescence, including academic, motor skills, social and adaptive skills. According to the DSM-5, ADHD diagnosis is based on the presence of at least 6 of the following signs or symptoms:1
- Not paying close attention to tasks
- Missing small details
- Rushing through tasks
- Not seeming to listen when spoken to
- Difficulty organizing things
- Not finishing work.
- Disliking or avoiding tasks that take sustained mental effort
- Losing things
- Feeling like an internal motor is always running
- Leaving their seat
- Climbing on things
- Being loud
- Blurting out answers
- Talking excessively or out of turn
- Having trouble waiting their turn
- Interrupting or intruding on others.
Although all children may exhibit some of these symptoms occasionally, the diagnostic signs or symptoms must be present in multiple settings and impact attaining developmental milestones or academic success and social relationships to receive a diagnosis.
How Are Substance Abuse and ADHD Related?
Children diagnosed with ADHD have a greater susceptibility to developing a substance use disorder than those without the diagnosis of ADHD.8 Some of the factors associated with higher rates of drug use in people with ADHD may be the poor impulsivity and poor decision-making that are commonly seen.6 Although the exact mechanisms of how ADHD affects the brain are not yet fully understood, it is believed that it involves the brain’s prefrontal cortex, the part of the brain involved in executive function and decisions.8
Research has suggested that adults with a history of ADHD may be more likely to develop substance use disorder, which has been associated with poor executive function.8 People with ADHD often internalize problems resulting from peer rejection, especially as a teen, causing depression and anxiety, which are contributing factors for the development of a substance use disorder. 5 Without adequate social support, people with ADHD may turn to self-medicating to cope with stress and lack of friendships.5 The American Academy of Pediatrics has also advised appropriate medical management of ADHD to help teens and adults avoid self-medicating instead to get a sense of normality in their lives.7
Finally, children with ADHD and adolescents with a substance use disorder are more likely to also develop alcohol dependence as adults. However, children with ADHD who did not have a substance use disorder as a teen are less likely to develop new-onset alcohol abuse as adults.8
Some physiological models have shown that people with ADHD may have a greater number of receptors that respond to the reward molecule in the brain, called dopamine.7 Drugs like cocaine, amphetamine, ecstasy, nicotine, alcohol, opiates, and marijuana can all temporarily increase dopamine levels, leading to misuse of these substances if the signs and symptoms of ADHD go unnoticed and they are not evaluated and treated by a medical provider.
Stimulants like amphetamine and methylphenidate are effective in reducing the symptoms of ADHD in children, adolescents, and adults.6 However, these medications are commonly misused. Signs that the medications are being misused or abused include: 7
- Taking larger doses or taking doses more frequently than prescribed.
- Using another person’s prescription.
- Developing symptoms of withdrawal after missing a dose.
Some of the common reasons that these medications will be abused include: 8
- Trying to perform better on exams, improve grades, or concentrate better.
- Improve athletic performance.
- To “party” or get “high”.
Stimulants can be misused in a variety of ways, such as crushing and snorting tablets or injecting into a vein.9 It is believed that, in people with ADHD, the brain’s reward pathway has a higher number of receptors that respond to dopamine, thus the reward feelings tend to not last as long.7 Since stimulants affect the reward pathway in the brain, people with ADHD may begin to look forward to the feeling of reward that is achieved with the use of stimulants.9 Additionally, long-term misuse of prescription stimulants can lead to tolerance, meaning that the person needs higher or more frequent doses of the drug to get the desired effect. With continued use, the person may develop substance abuse. When trying to stop, you might experience withdrawal symptoms, which include:9
Commonly Prescribed Drugs for ADHD
There are 2 main pharmacological therapies in the treatment of ADHD—stimulants and non-stimulants. Stimulants, such as amphetamines and methylphenidates, are the mainstay medication. Stimulants have been shown to be effective in about 70% of people with ADHD in reducing the symptoms.6 The side effects of stimulant treatment include:6
- Decreased appetite.
- Increased blood pressure.
- Increase in frequency of tics.
- Risk of dependency.
Some of the brand names of stimulants used in the treatment of ADHD include:6
Stimulants are formulated to be immediate/short-acting release or extended-release. Stimulants have a high risk for abuse, with short-acting forms being the highest risk for abuse.7 Stimulants are considered Class II medications, which indicates that they are known to have a high potential for abuse and are addictive.
Some of the non-stimulant medications used in the treatment of ADHD include antidepressants like Strattera; however, this form of treatment may not be as effective.6 This medication is often used in children who cannot tolerate the effects of stimulants or have comorbid conditions such as ADHD and anxiety.6 Other antidepressants used in the treatment of ADHD include bupropion and tricyclic antidepressants due to their broad side-effect profile. 6 Finally, alpha agonists such as clonidine and guanfacine can be used in the treatment of ADHD. These have side effects of low blood pressure, sedation, weight gain, and lightheadedness. Your child may feel tired while on these medications, but they are less addictive than stimulant medication.6
Integrated Treatment for ADHD and Addiction
Co-occurring disorders or dual disorders refers to people who suffer from a substance abuse disorder and a psychiatric disorder, like ADHD. These conditions have a high comorbidity, with roughly 36% to 40% of young adults with a serious mental health disorder also meeting the criteria for a substance use disorder.10 Approximately 15% of adolescents diagnosed with ADHD are also diagnosed with a substance use disorder.10. This is when integrated treatment of dual disorders is extremely helpful, as it normally involves an interdisciplinary team of social workers, psychotherapists, student counselors, and case managers to help the patient through their treatment.10
When starting treatment for substance use disorder and ADHD, it’s important to first start with substance use treatment and then follow with ADHD treatment.11 This is because the symptoms of ADHD—mainly those of impulsivity, poor organizational skills, and difficulty in following instructions, can cause a higher risk for possible relapse in those with diagnoses of ADHD and a substance abuse disorder. One of the ways to help with the treatment of substance use disorder and ADHD is to start with brief residential treatment, then focus on adequate management of ADHD.10
Finally, it’s important to remember that medication treatment is not the only way to manage ADHD. Behavioral therapy and alternate interventions have shown to have protective effects on the development of substance use disorders, particularly at 2 years post internvention.5 It is never too late to get treatment for ADHD. The American Academy of Pediatrics recommends beginning treatment, both pharmaceutical and behavioral, when the diagnosis of ADHD is made.5 Since ADHD can go undiagnosed for years, treatment can start at any age, even in adulthood.
Is Integrated Treatment Right for Me?
Mental health, substance abuse, and co-occurring disorders are major public health concerns in the United States and in Nevada. According to a needs assessment conducted by Nevada Public Health, approximately 1 in 5 adults age 18 or older have experienced some form of mental disorder, and about 1 in 4 adults diagnosed with a mental health disorder will also have a substance use disorder.12 in co-occurring disorders. If you have been diagnosed with a mental disorder, and are battling substance use, then integrated treatment may be right for you.
If left untreated, co-occurring disorders can be life-threatening. Therefore, it is important to speak with your medical provider. Remember that drug addiction is a chronic brain disease with long-lasting effects. Drug addiction is also a relapsing disease, with relapse being the return to drug use after an attempt to stop. The treatment of co-occurring diseases usually requires long-term care to address the high risk for relapse.
Integrated treatment for co-occurring conditions is multimodal. When considering treatment, look for a treatment program that will not only help you stop using drugs, but help you to stay drug-free, be productive in your family, work, or in society, and live sober.14 Many successful treatments have several steps, which include:14 Treatment
- Behavioral counseling.
- Medication-assisted treatment for opioid, tobacco, or alcohol addiction.
- Evaluation and treatment of co-occurring mental health issues.
- Long-term follow-up to prevent relapse.
ADHD and Addiction Treatment Options
AAC is the leading treatment provider for those suffering from a substance use disorder and in the treatment of co-occurring conditions in the state of Nevada and the United States. At AAC, you will receive an individualized treatment that is right for you. One of our helpful and professional staff will guide you through the process of your treatment plan and help you get started. Your information is kept 100% confidential, so call our toll-free 24/7 helpline to get started today.
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