ADHD and Substance Abuse
Although it is most commonly associated with children, ADHD – attention deficit hyperactivity disorder – is also seen in adults. The Anxiety and Depression Association of America estimates that 60 percent of adults with ADHD were diagnosed as children, which amounts to around 8 million adults in America with an ADHD diagnosis.
ADHD is characterized by inattention, impulsiveness, and hyperactivity, either alone or in a combination, though hyperactivity may disappear by adulthood. Other symptoms include:
- An inability to focus
- Strained personal relationships
- Being easily distracted
- Poor listening skills
- Zoning out
- Trouble starting tasks
- Lack of punctuality
- Failure to properly prioritize
To receive a diagnosis of ADHD, individuals must be thoroughly evaluated by a medical professional. Individuals can contact their primary care physician, but should not expect to be diagnosed within a matter of minutes. There are multiple questions that need to be answered and screening tests to be taken. Individuals must have multiple symptoms associated with ADHD’s DSM-5 listing to receive a diagnosis.
When individuals have been diagnosed with both a mental illness and a substance use disorder, they are said to have a dual diagnosis. At times, it is unclear whether the mental illness or the substance use disorder came first, but the National Alliance on Mental Illness estimates that about half of individuals who have been diagnosed with severe mental illness are also living with substance abuse. In addition, more than half of the individuals in the United States who are dependent on drugs and/or alcohol also experience mental illness.
Some of the symptoms that can be seen with a dual diagnosis of ADHD and substance abuse include:
- Using drugs and/or alcohol to manage ADHD symptoms
- Developing a tolerance to drugs and/or alcohol (needing more of the substance to achieve the desired effect)
- Experiencing withdrawal symptoms, including strong cravings, when one doesn’t use the substance
- Withdrawing from family members and friends
- Strained relationships
- Changes in behavior
- Needing to use drugs and/or alcohol to function
- Continuing to use drugs and/or alcohol despite negative consequences from use
- Inability to manage responsibilities at home, work, and school
An article in ADDitude Magazine states that many individuals who have been diagnosed with ADHD are concerned about the risk of addiction in regards to some popular ADHD medications, methylphenidate and amphetamine, which are controlled substances. While these medications do carry addictive potential, if individuals who are prescribed these medications take them as prescribed, they are not likely to become addicted to them. Addiction generally develops from abuse of these drugs. This abuse comes in many forms, such as upping dosages, altering the method of ingestion (e.g., crushing pills and then snorting the resulting powder), and mixing the medications with other substances, such as alcohol. It is imperative that individuals who are prescribed medication for ADHD take their medications as they were prescribed by their physician.
As is the case for everyone with co-occurring disorders, those who have been diagnosed with both ADHD and a substance use disorder will find that each disorder complicates treatment for the other disorder. As a result, treatment that addresses both disorders simultaneously is recommended. If a person seeks treatment for only the substance use disorder, it’s likely that the untreated ADHD will trigger a substance use relapse at some point.
The specific treatment plan chosen will depend on both the severity of the ADHD and the substance use disorder. Generally, both medication and therapy are used to manage ADHD.
In some instances, medications may be used in substance abuse treatment, particularly in cases of alcohol or opiate addiction. In other instances, medications may be prescribed on an as-needed basis to address specific withdrawal symptoms, such as depression and anxiety. Comprehensive therapy should be part of all addiction treatment programs.
Another large part of treatment for individuals with both ADHD and substance abuse is education. As previously stated, many individuals fear becoming addicted to certain ADHD medications, particularly if they have struggled with substance abuse in the past. In such cases, there are non-stimulant medication options that may be prescribed, in addition to other therapies.
Some individuals will benefit from inpatient substance abuse treatment, especially if medical detox is needed. In an inpatient setting, individuals will be monitored and kept safe during the medical detox process. After the detox process has been completed, they will begin therapy to treat the underlying issues that led to the initial substance abuse. Cognitive Behavioral Therapy is commonly used and beneficial, as it can help with both ADHD and substance abuse.
In the outpatient setting, individuals with ADHD and substance abuse issues will benefit from a structured treatment program in which they attend scheduled treatment sessions during the day but return home each night. Generally, outpatient care is recommended for those with less severe or short-term addictions. If participating in outpatient treatment, it’s important that the person has a supportive home environment that is safe and free from substances of abuse.
As is the case for everyone with a chronic mental health issue, continuing care is needed for those who suffer from ADHD and substance abuse. This ensures that any prescribed medications are taken as directed, and the person stays involved in recovery services, such as 12-Step meetings or periodic sessions with a therapist. With proper resources, co-occurring ADHD and substance abuse can be successfully treated and managed for life.