Attention deficit hyperactivity disorder, or ADHD, affects millions of people each year.
The Centers for Disease Control and Prevention (CDC) reported that as of 2011, approximately 11 percent of all children in the United States between ages four and 17 had been diagnosed with ADHD. While ADHD is primarily thought of as a childhood illness since it presents as early as age four and often improves over time, ADHD symptoms may persist into adulthood as much as 60 percent of the time, according to the Cleveland Clinic. The National Institute of Mental Health (NIMH) reports that 4.1 percent of American adults over the age of 18 suffer from ADHD a year. Unfortunately, this disorder is often misdiagnosed or undiagnosed, which can lead to a host of other potential issues.
ADHD may increase the risk factors for substance abuse and addiction. The American Academy of Pediatrics estimates that children with ADHD are 2.5 times more likely than their peers without ADHD to develop a substance use disorder.
This may be due to a variety of factors, including genetics, environmental triggers, or an attempt to self-medicate ADHD symptoms. A substance abuse disorder is characterized by compulsive and drug or alcohol-seeking behavior, an inability to refrain from abusing substances regardless of any negative consequences, self-isolation or withdrawal, and an excessive amount of time spent obtaining drugs or alcohol, abusing them, and recovering from their effects. Between 20 and 40 percent of adults with ADHD have a history of a substance abuse disorder while 20 to 30 percent of adults battling a substance abuse disorder also suffer from ADHD, which can complicate treatment and diagnoses for both disorders, as published by CNS Drugs.
What Is ADHD?
ADHD has three main types: inattentive, hyperactive-impulsive and a combination of the two. Each subtype contains a variety of symptoms, and according to the American Psychiatric Association’s most current Diagnostic and Statistical Manual of Mental Disorders (DSM-V), children must have at least six of the following symptoms while adolescents, and adults over age 17 need only five of the following to be present for a diagnosis of ADHD:
- Acting without any regard for consequences
- Interrupt others often
- Trouble taking turns or waiting
- Difficulties focusing or organizing
- Easily distracted
- Daydreams often
- Trouble completing tasks or learning new things
- Difficulties following instructions
- Appears to not be listening
- Easily bored
- Trouble processing information rapidly or correctly
- Constantly in motion
- Trouble sitting still
- Runs from one activity to another
- Nonstop talking
- Difficulties with quiet activities
These symptoms must be present for at least six months, and in adult diagnoses, some must be present before age 12. ADHD is a disorder characterized by a pattern of behaviors that interfere with everyday life, with symptoms present in at least two settings (e.g., work or school and home). Adult ADHD may manifest differently than childhood ADHD, and symptoms may include trouble juggling multiple tasks, procrastination and avoidance of difficult or high-priority tasks. Adults may also be ashamed of these symptoms, becoming frustrated and feeling inadequate and incompetent. A pervading sense of instability and an inability to rely on themselves may also be symptoms of adult ADHD, which may lead to a mood, anxiety, or substance abuse disorder. One study reported that 75 percent of patients being treated for adult ADHD also suffered from at least one additional psychiatric disorder, as reported by Current Psychiatry. When two disorders occur in the same person at the same time, the disorders are said to be co-occurring.
Links Between Substance Abuse and ADHD
Impulsivity and poor decision-making skills or judgment as well as risk-taking behaviors are indicative of ADHD and may make it more likely for someone with ADHD to abuse drugs or alcohol without regard to any future consequences. Since ADHD commonly occurs in young people, this can be particularly problematic as trying drugs or alcohol at a young age may increase the risks for developing a substance abuse disorder later in life. The National Survey on Drug Use and Health (NSDUH) reported that 15.4 percent of adults aged 18 or older in the United States in 2013 who had tried alcohol before age 14 were classified with alcohol abuse or dependence as opposed to the 3.8 percent with the same classification who waited until they were 18 to drink alcohol. The prefrontal cortex, which is partially responsible for decision-making, impulses and emotional regulation, is not fully developed in adolescents, which may increase the odds for substance abuse. This can cause damage to undeveloped regions of the brain. ADHD also may affect similar regions of the brain.
Dopamine, a neurotransmitter responsible for feelings of pleasure, may also be involved in symptoms of ADHD. Stimulant medications are often used to treat ADHD, which serve to increase, or stimulate, dopamine production in the brain, increasing energy levels, focus and attention, and elevating moods. Abusing drugs or alcohol can also stimulate the production of dopamine, and regular abuse can interfere with the natural reward circuitry in the brain. Chronic abuse of drugs or alcohol makes chemical changes in the reward pathways and the brain will begin to rely on the artificial stimulation and cease to produce the normal levels of dopamine naturally. The user may then become dependent on the substance in order to feel what the body now perceives as its new normal.
This dependence may be both psychological and physical as the brain will require the substance in order to feel balanced, creating cravings and withdrawal symptoms when the substance is removed. Addiction is considered a chronic disease that involves the motivation and reward functions in the brain. Someone with ADHD may be at an increased biological risk for substance abuse as the levels of dopamine may already be affected by the disorder. While drugs or alcohol may provide a temporary relief, substance abuse can quickly devolve into addiction.
ADHD may also separate someone from peers academically, socially, or occupationally as poor performance at work or school may create low levels of self-esteem.
Low grades and trouble maintaining a successful job can increase stress levels and heighten the temptation to abuse drugs or alcohol as an escape method.
Anxiety and depression may be side effects of undiagnosed or untreated ADHD, leading to substance abuse as a coping mechanism. A Harvard study of young adults found that around 70 percent of ADHD sufferers who abused substances were thought to do so to improve symptoms of the disorder while only 30 percent did so to get high, according to ADDitudemag. While drugs or alcohol may be a temporary balm for difficult ADHD symptoms, substance abuse can actually make ADHD worse and harder to treat in the long run.
Medically Managing ADHD and Substance Abuse
ADHD is a highly treatable disorder, and early intervention can prevent future substance abuse, dependency or addiction. A proper diagnosis is generally the first step to successfully managing ADHD at any age or stage, and it is usually given by a primary care physician. Treatment models with the highest success rates most often include both medications and behavioral therapies.
Often, the treatment of a co-occurring substance use disorder will require that the drugs or alcohol are first removed from the system via detox before the ADHD symptoms can be addressed. Detox may be medically managed in order to regain physical stabilization and smooth out withdrawal symptoms and cravings. This may be best performed in a specialty facility offering 24-hour medical care and support.
Prescription ADHD medication is often abused by those without the disorder in order to stay awake longer, to increase focus, attention, or energy in order to study, or to get high. A professor at the University of Kentucky estimates that as many as 30 percent of the students there had used a stimulant, or “study drug,” like Ritalin or Adderall, at some point, as reported by CNN. Students diagnosed with ADHD may also abuse their medications, or legitimate prescriptions, as one study published in Pediatrics indicated that 26.7 percent of university students diagnosed with ADHD used more of their medications than prescribed, which is considered abuse. Taking more of a prescription than intended may build up a tolerance to the drug, which will require the user to take even more in order to feel the same effects. The abuse of prescription medications can increase the risks for developing a substance abuse disorder, as tolerance is one of the symptoms of addiction.
When a substance abuse disorder is suspected, the medical management of ADHD symptoms needs to be closely monitored, and some medications may need to be avoided altogether. For instance, stimulant medications are used most often to treat ADHD, but they have a high incidence of diversion and abuse. In someone with a substance abuse disorder, these medications may need to be avoided or highly regulated.
Many times, long-acting stimulants, like Concerta, may be substituted for short-acting stimulants, such as Ritalin, since they have a lower potential for abuse as they stay in the bloodstream longer and are released more slowly. Non-stimulant medications and other mood-stabilizing agents may be used in some cases as well.
Some 12-Step programs discourage the use of any mind-altering substance during recovery. Long-term treatment of ADHD may require medications, however, which can be used safely when a comprehensive risk/benefit assessment is performed, and proper follow-up care is provided.
Spotting Addiction and Getting Help for Co-occurring Disorders
The National Alliance on Mental Illness (NAMI) reports that mental health disorders co-occur with substance abuse one-third of the time while half of drug abusers and one-third of alcohol abusers also suffer from mental illness. Co-occurring disorders require specialized treatment by teams of medical professionals who work together to create a comprehensive care plan that addresses both the substance abuse and the mental illness. Recognizing the warning signs of addiction can help you determine when to seek professional help. Someone suffering from addiction may display:
- Mood swings or shifts in personality
- Changes in sleep patterns
- Drug or alcohol tolerance
- Withdrawal symptoms
- Weight fluctuations
- Lack of personal hygiene
- Trouble with interpersonal relationships
- Financial difficulties
- Risk-taking behaviors
- Isolation or social withdrawal
- Drop in school or work performance
You may also notice an increase in anxiety, stress, depression, agitation, hostility, or irritability in someone battling a substance abuse disorder. ADHD symptoms may be exacerbated by substance abuse as well. Substance abuse and ADHD regularly co-occur, and each increases the potential risk-factors associated with both disorders, requiring integrated care in a specialized facility. ADHD and substance abuse share many of the same side effects and symptoms; therefore, they can be treated concurrently most of the time.
Behavioral therapies, especially Cognitive Behavioral Therapy (CBT), may be extremely effective at retraining the brain’s response to stressors. Highly trained professionals utilize CBT to modify dysfunctional negative responses into more positive ones, rebuilding and increasing self-esteem and successfully treating both ADHD and substance abuse disorders. It may also help to keep a structured schedule with planned meal and sleeping times in order to keep on track and manage ADHD symptoms.
The medical and mental health team at The Oaks at La Paloma work to help clients develop new life skills and coping mechanisms that will equip them to better handle anxiety and stress in a healthy manner as well as learn new organizational skills. Support groups, individual therapy and group therapies all play important roles in the healing process. Call an admissions coordinator at The Oaks at La Paloma today for more information on the multiple individualized programs offered at our secluded and serene respite where you or your loved one can recover in comfort and peace.