Addiction and ADD/ADHD
Addiction and ADHD are common co-occurring disorders. They have similar risk factors, including family history, which helps to explain why they often occur together. Another reason is that the symptoms of ADHD and the complications it causes in a person’s life can lead to substance use as a way to find relief and self-medicate. This is a self-destructive cycle that only makes both issues worse. To truly overcome both addiction and ADHD requires addressing both, getting accurate diagnoses, and committing to long-term treatment.
What Is Addiction and ADD/ADHD?
Attention deficit hyperactivity disorder (ADHD) is the currently accepted term for what was previously called attention deficit disorder (ADD). ADD and ADHD are often used interchangeably, but the latter is more correct. The newer name reflects the fact that hyperactive behavior is an important characteristic of this condition.
ADHD is considered to be a brain disorder and behavioral and developmental condition. Although it is not well understood, there are some changes in the brain that cause a child (or less commonly an adult) to struggle to focus, pay attention, sit still, and control impulsive and hyperactive behaviors. This is a chronic condition that may persist into adulthood and cause a number of complications, like low self-esteem, poor academic performance, and poor social skills.
The symptoms and the lasting complications of ADHD are the likely reasons that someone with this condition is at an increased risk of misusing substances and developing an addiction. Someone with ADHD, especially if it has not been well managed or treated, may turn to alcohol or drugs to try to self-medicate. This use of substances can quickly get out of control and lead to a serious substance use disorder, or addiction. A common treatment for ADHD is the use of stimulant medications, which have a high potential for abuse. So the treatment for this condition can also lead to a substance use problem.
Types of ADD/ADHD
There are three types of ADHD that may be diagnosed, depending on which types of symptoms are predominant:
- Inattentive. For someone with this type of ADHD, the main struggle is focusing, paying attention, and avoiding getting distracted from tasks.
- Hyperactive-Impulsive. With this type, individuals struggle to control their impulses or to manage hyperactive tendencies. They often act out and get in trouble in school.
- Combined. The combined type includes equal symptoms of inattention, hyperactivity, and impulsivity.
Facts and Statistics
ADHD and substance use disorder as co-occurring disorders is not uncommon. Drugs or alcohol may exacerbate ADHD symptoms, but more often a person struggling with those symptoms may turn to substances in an attempt to get relief. Substance use may also be a consequence of trying to cope with the complications of living with ADHD, like low self-esteem or struggling to fit in with peers.
- Between five and six percent of children are thought to have ADHD.
- Children with ADHD are at a greater risk when compared to their peers of developing any type of substance use disorder.
- They are three times as likely as peers to become addicted to nicotine as teenagers.
- They are twice as likely as their peers to abuse alcohol or become dependent on alcohol.
- Children with ADHD are 1.5 times more likely to match the diagnostic criteria for a marijuana use disorder.
- Nearly a quarter of adults getting treatment for alcohol or substance use disorder are also found to have ADHD.
- When ADHD is untreated, the risk of turning to substance abuse is even higher.
Symptoms and Diagnosis of Addiction and ADD/ADHD
To diagnose someone with ADHD, symptoms must persist for six months or more and have a negative impact on school, work, home, or social life. Symptoms used to diagnose ADHD include:
- Not paying attention to details
- Struggling to stay focused on tasks
- Being unable to follow through on instructions
- Difficulty organizing and multi-tasking
- Having poor planning skills
- Getting distracted easily
- Difficulty with time management
- Fidgeting or moving a lot and struggling to stay still
- Being in motion all the time, even when it is dangerous or inappropriate
- Talking too much, blurting things out, and interrupting others
- Being unable to do an activity quietly
- Experiencing mood swings, or having a temper and getting frustrated easily
The symptoms of ADHD are essentially the same in children and adults, although they are seen in different contexts. Many of these symptoms are normal to some degree, for a child at a certain developmental stage or even for an adult occasionally. It is when the symptoms are severe, persistent, and interfere with life that they may be considered signs of ADHD.
A substance use disorder can be diagnosed by observing even just two or three of the following symptoms:
- Using a substance for longer or in larger amounts than intended
- Trying and failing to cut back
- Putting a lot of time into getting, using, or recovering from a substance
- Craving a substance
- Failing at responsibilities because of substance use
- Giving up activities because of substance use
- Using a substance even when it causes relationship problems
- Using a substance even when it causes harm or worsens health
- Using a substance in risky situations
- Developing a tolerance
- Experiencing withdrawal
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Causes and Risk Factors
What causes ADHD is unknown, but the condition is related to neurological and brain development. Factors that affect this development, such as environmental exposures or illnesses may play a role. There is also a strong genetic component, as ADHD is known to run in families. Having a close family member with ADHD is a major risk factor, as is exposure to toxins in the environment, drug or alcohol use by the mother during pregnancy, and being born prematurely.
The exact causes of substance abuse in people with ADHD are similarly impossible to pin down. However, it is possible to identify risk factors and reasons why the risk of turning to substance use is higher for someone with this condition. Even before the connection was studied, researchers knew that the behaviors associated with ADHD could be used to predict substance misuse. Children who are more impulsive and hyperactive and who struggle with attention have long been known to be at a greater risk for substance use.
This connection, according to researchers, may be attributed to the fact that the behaviors cause other problems: poor performance in school, conflict at home, difficulty making friends. These in turn may then lead to substance abuse. Another important factor is that both ADHD and substance abuse are strongly related to family history. Genetics and home environment may be reasons that they co-occur so often.
ADHD and substance use disorder together in one person at the same time are considered co-occurring disorders. There are other possible co-occurring disorders that someone with either of these two conditions may have. Two out of three children with ADHD also have one or more other mental or behavioral conditions. One of two children also has a behavioral conduct disorder. And one of three kids with ADHD also struggles with anxiety. Other possible co-occurring disorders include autism spectrum disorders and depression.
Treatment and Prognosis of Addiction and ADD/ADHD
Treating addiction and ADHD is possible, but it is important that both are addressed and managed along with any other co-occurring disorders. Not treating all conditions can lead to relapses in those that are treated. For instance, if someone is treated for alcohol use disorder but the signs of ADHD are not addressed, he or she is more likely to relapse and drink again after treatment.
The treatment of ADHD typically involves the use of stimulant medications like Adderall or Ritalin as well as behavioral therapies and lifestyle changes. Using stimulants when a person also struggles with addiction may not make sense. It is a choice that the individual and his or her doctor must make together, weighing the benefits and risks.
Addiction treatment also involves using therapy along with medications when they are appropriate. Important to treating both conditions is learning how to recognize and manage negative thoughts and behaviors. This is an important aspect of behavioral therapy and its use in treatment for addiction and ADHD. Additional elements of treatment may include health and nutrition, treatment for other mental illnesses, lifestyle changes, group support, and family psychoeducation.
ADHD and addiction together can be challenging to manage, but it is possible. For someone who gets good treatment that is tailored to his or her specific needs and that addresses both conditions, the prognosis for long-term health is good. It is important to remember that these are chronic conditions and to manage them over the long-term and avoid relapse, ongoing care is necessary.