Managing ADHD can be a challenge, and the presence of additional co-occurring disorders, such as substance use, can make it far harder. Individuals with ADHD already grapple with difficulties in attention, impulse control, and hyperactivity, and when substance use disorders (and other mental health issues) are present, the complexity of managing ADHD and addiction intensifies.
Research indicates that individuals with attention-deficit/hyperactivity disorder (ADHD) are indeed more likely to face addiction issues such as alcohol and substance abuse.[1] While it’s not entirely clear how ADHD contributes to increased involvement in addictive behaviors, both ADHD and substance abuse are linked to certain personality traits such as impulsivity, seeking rewards, anxiety, and negative emotions.
Today Clear Behavioral Health will explore the link between ADHD and addiction issues, focusing on the potential misuse of ADHD medications and the need for a supportive, holistic, continuum of care in managing these potentially interconnected challenges.
What is Attention Deficit Hyperactivity Disorder (ADHD)?
ADHD stands for attention deficit hyperactivity disorder. Categorized as a neurodevelopmental disorder by the Diagnostic and Statistical Manual of Mental Disorders (DSM),[2] it can affect both children and adults, though symptoms often first appear in childhood.
ADHD is characterized by persistent patterns of inattention, hyperactivity, and impulsivity that can interfere with daily functioning and quality of life.
The three main types of ADHD are:
- Predominantly inattentive: Individuals with this type often struggle with paying attention to details, sustaining attention in tasks or play, organizing activities, and completing tasks.
- Predominantly hyperactive-impulsive: This type is characterized by hyperactivity and impulsive behavior, such as fidgeting, talking excessively, interrupting others, and difficulty waiting for one’s turn.
- Combined presentation: This type involves a combination of both inattentive and hyperactive-impulsive symptoms.
The exact cause is not well understood, but it likely involves a combination of genetic, neurological, and environmental factors.[3] An ADHD diagnosis is typically based on a thorough assessment by a qualified healthcare professional, and treatment often involves a combination of behavioral therapy, counseling, and, in some cases, medication.
Symptoms of ADHD
Many people who have ADHD do not realize they suffer from the condition. Even if they are aware they have an issue with alcohol, they may blame that for the behaviors and thoughts that are attributable to ADHD. Signs and symptoms of ADHD come mainly in the form of being inattentive, experiencing hyperactivity, and difficulty controlling impulses. Symptoms can include:
- Being easily distracted
- Having a short attention span
- Interrupting others
- Problems sitting still
- Poor organizational skills
- Talking a lot
- Forgetting things
- Mood swings
- Fidgeting and constant movement
- Difficulty concentrating on or completing tasks
- Difficulty following instructions
- Acting impulsively
- Changing activities quickly
- Trouble predicting dangerous activities
What Medications Are Typically Prescribed for ADHD?
Several medications are commonly prescribed to manage the symptoms of ADHD. The choice of medication depends on factors such as the individual’s specific symptoms, medical history, and response to treatment.
Stimulant Medications
- Methylphenidate: This includes brand names such as Ritalin, Concerta, and Daytrana
- Amphetamine-based medications: Such as Adderall, Dexedrine, and Vyvanse
Stimulant medications are often considered the first line of treatment for ADHD.[4] They work by increasing the levels of certain neurotransmitters in the brain, such as dopamine and norepinephrine, and can help improve attention, focus, and impulse control. However, they may have side effects and are classified as Schedule II controlled substances due to their high potential for abuse.
Non-Stimulant Medications
- Atomoxetine (Strattera): This non-stimulant medication affects norepinephrine levels in the brain and is particularly useful for individuals who cannot tolerate stimulant medications or have a history of substance abuse
- Guanfacine (Intuniv) and Clonidine (Kapvay): These are alpha-2 adrenergic agonists and are sometimes used to treat ADHD symptoms, especially in cases where stimulants are not effective or well-tolerated
It’s important to note that prescribed medication is only one component of a comprehensive ADHD treatment plan. Behavioral therapy, counseling, and support from educators, family, and friends are all common factors in managing ADHD. The choice of ADHD meds and the overall treatment plan should be tailored to your needs and monitored closely by a qualified healthcare professional.
The Potential Dangers of ADHD Medication
The improper use of ADHD medication can pose significant dangers and can lead to various adverse effects.[5] Self-prescribing, or obtaining ADHD medication without a legitimate prescription, is not only illegal but also carries serious risks:
Health Risks
ADHD medications, particularly stimulants, can carry unintended side effects, including increased heart rate, elevated blood pressure, insomnia, and appetite suppression. Self-prescribing individuals may lack awareness of their medical history or underlying health conditions, potentially exacerbating these side effects.
Moreover, stimulant medications pose a risk for misuse and abuse, as they can induce feelings of euphoria and heightened energy. Individuals who self-prescribe may be particularly vulnerable to developing substance abuse issues due to the potential for the medication’s rewarding effects. These risks emphasize the importance of proper medical supervision and adherence to prescribed treatment plans for individuals with ADHD.
Incorrect Dosages
ADHD medications require careful titration and adjustment to find the most effective and tolerable dose for each individual. Self-prescribing individuals are at risk of taking incorrect dosages, leading to either insufficient symptom control or an increased likelihood of adverse effects.
Additionally, proper ADHD treatment involves regular monitoring by a healthcare professional to assess the medication’s effectiveness and manage any potential side effects. Self-prescribing individuals lack this crucial oversight, which can result in missed opportunities for necessary adjustments or to give attention to any dual diagnosis issues.
Legal Consequences
Obtaining and using prescription medications without a valid prescription is against the law. Individuals caught engaging in self-prescribing may face legal consequences as a result, including fines and potential criminal charges.
Masking Underlying Issues
Self-prescribing ADHD medication can mask underlying mental health conditions that may require different interventions. It may delay the identification and treatment of coexisting disorders that contribute to ADHD symptoms.
Dependency and Withdrawal
Stimulant medications have the potential for dependence, and abrupt discontinuation can lead to withdrawal symptoms. Self-prescribing individuals may not be aware of the risks of dependency or may struggle with managing withdrawal symptoms.
Risk Factors for ADHD Medication Abuse
ADHD medications, particularly stimulants, carry a risk for abuse and misuse. While many individuals with ADHD benefit significantly from these medications when prescribed and monitored, there are certain risk factors that may contribute to the misuse and abuse of these substances:[6]
- Personal or family history of substance abuse: Individuals with a personal history of substance abuse or those with a family history of substance use disorders may be at a higher risk of misusing ADHD medications.
- Coexisting mental health conditions (dual diagnosis/co-occurring): Individuals with coexisting mental health conditions, such as depression, anxiety, or substance use disorders, may be more susceptible to the misuse of ADHD medications as a form of self-medication.
- Peer pressure and social influence: Pressure from peers or social influences can play a role in the misuse of ADHD medications, especially among students or young adults who may perceive these medications as performance-enhancing or recreationally enjoyable.
- Academic or occupational pressures: High academic or occupational pressure may lead individuals to misuse ADHD medications in an attempt to enhance focus, concentration, and productivity.
- A lack of knowledge: Limited awareness of the potential risks and side effects of ADHD medications, as well as the legal consequences of misuse, can contribute to unintentional abuse.
- Accessibility and availability: Easy access to ADHD medications, whether from one’s own prescription, sharing with others, or obtaining them illicitly, increases the risk of misuse.
- Financial incentives: In some cases, individuals may misuse ADHD medications for financial gain, such as selling the medications to others seeking a performance boost.
- Unmet treatment needs: Individuals with undiagnosed or untreated ADHD may be more prone to self-medication with stimulant medications, seeking relief from the challenges associated with the disorder.
The presence of these risk factors does not guarantee that an individual will abuse ADHD medications. However, recognizing these factors allows healthcare professionals, educators, and families to implement preventive strategies, such as education, monitoring, and support, to minimize the risk of medication misuse and promote the safe and effective management of ADHD.
Are People With ADHD Prone to Addiction?
Individuals with ADHD may have an increased susceptibility to developing substance use disorders, although not everyone with ADHD experiences this. The connection between ADHD and addiction can be attributed to factors such as impulsivity, risk-taking behavior, and challenges in executive functioning.[7] The impulsivity characteristic of ADHD can lead to engaging in risky behaviors, including substance misuse. Additionally, the tendency for individuals with ADHD to seek stimulation and engage in risk-taking activities may contribute to experimenting with substances, leading them to abuse drugs.
Some individuals with ADHD may turn to substances as a form of self-medication to alleviate symptoms associated with the disorder. Challenges in executive functioning, such as planning and self-regulation, can also contribute to difficulties in managing substance use. Furthermore, the coexistence of ADHD with other mental health conditions, like depression or anxiety, may elevate the risk of drug abuse as individuals cope with emotional distress.
ADHD Often Coexists With Addiction
A study reported by the National Institutes of Health looked into the correlation between ADHD and alcohol abuse. The dramatic results included finding that almost half of adults with symptoms of ADHD also have a substance use disorder. Other findings from the study showed that individuals dealing with both ADHD and alcoholism:
- Developed alcoholism four years earlier than others
- Were twice as likely to have alcoholism in their family history
- Drank more per day on average
- Had three times the rate of developing an antisocial personality disorder
- Had suicidal thoughts more than twice as often
- Were seven times more likely to end up in court
In many cases, a person who has ADHD ends up using alcohol to try to control their symptoms. They also may end up addicted due to seeking relief from the mental distress that ADHD causes them, such as symptoms of anxiety and depression.
ADHD and Addiction Statistics
Global studies reveal that around 5 percent of children and adolescents grapple with ADHD,[8] a figure that decreases to 2 to 3.5 percent among adults. Notably, one study demonstrated that 38 percent of people diagnosed with cannabis use disorder also exhibited ADHD, and 23% of young adults with any substance use disorders also had ADHD.[9] Other studies show that about one out of four people who get treatment for alcohol abuse disorders also have ADHD. Kids who have ADHD are more likely to begin abusing alcohol while teenagers; before they turn 15 years old, 40% of children with ADHD start using alcohol. Of kids ages 15-17 who have ADHD, 14% go on to develop alcohol dependence or abuse as adults.
In academic settings, up to 1 in 4 students were reported to misuse ADHD medications.
How Impulse Control Contributes to the Problem
Many studies have been done to determine if genetics can cause a person to develop both ADHD and an alcohol abuse disorder. While results are not conclusive, more studies are being done. While genes cannot be pointed to as an absolute cause for the co-occurring conditions in people, one factor may come into play. People with ADHD have difficulty with impulsivity; something that often happens when a person drinks or uses drugs excessively.
Often a young person, who by definition has a lack of experience controlling impulsive behaviors, enters the world of alcohol and drug use because of poor impulse control. If they already have ADHD, that can make it more difficult for them to resist behavioral urges or understand how dangerous some can end up becoming.
Once substance abuse begins for someone, poor impulse control can make it quite difficult for them to resist using larger amounts of drugs or alcohol and using them more often. Even when the person attempts to become sober, the temptation to drink or use drugs again can be particularly overwhelming for someone not accustomed to exercising healthy impulse control.
Treatment Options For Co-Occurring ADHD and Substance Use
Individuals with co-occurring ADHD and substance use benefit from a comprehensive and integrated treatment approach. Addressing both the ADHD symptoms and the substance abuse problems simultaneously is essential for more successful treatment outcomes. Treatment should be tailored to the unique needs of each individual and may involve collaboration between mental health professionals, addiction specialists, and other healthcare providers.
Ethical Medication Management
In cases where medication is indicated for ADHD, careful medication management by a qualified healthcare provider is vital. This involves determining the appropriate type and dosage of medication, monitoring for potential side effects, and adjusting the treatment plan as needed.
ADHD Dual-Diagnosis Programs
A dual-diagnosis approach integrates mental health care and substance use disorder treatment, providing a holistic strategy for recovery.[11] Behavioral therapy, such as cognitive-behavioral therapy (CBT), has been shown to be particularly effective. CBT helps individuals identify and modify maladaptive thought patterns and behaviors, while contingency management provides positive reinforcement for healthy behaviors.
Inpatient Substance Abuse Treatment
Treatment for individuals facing substance use disorders often involves a graduated and comprehensive approach. Inpatient rehabilitation, or residential treatment, provides intensive, 24/7 care within a structured environment. In most cases, it is recommended that individuals start the treatment process with a supervised medical detox. At Clear Behavioral Health, our detox and withdrawal management facility is in a home-like setting identical to our rehab. This setting is suitable for those requiring a high level of support to address acute substance dependence and related issues.
Outpatient Programs
Outpatient programs offer flexibility, allowing individuals to attend therapy sessions while maintaining their daily routines. Intensive Outpatient Programs (IOP) provide a more concentrated level of care than standard outpatient services, with multiple weekly sessions. Partial Hospitalization Programs (PHP) offer a step down from inpatient care, providing structured therapy and support during the day while allowing individuals to return home in the evenings.
Aftercare
After completing a higher level of care, aftercare programs become crucial for sustained recovery. Aftercare may involve ongoing outpatient therapy, support groups, and continued monitoring to prevent relapse. A comprehensive approach recognizes the need for individualized plans, addressing the unique challenges each person faces.
Access Quality Care for ADHD and Substance Abuse
Coordinated care for co-occurring issues, involving mental health professionals, substance abuse counselors, and other specialists, is vital to the healing process. This kind of integrated approach not only acknowledges the intricate relationship between ADHD and co-occurring disorders but also enhances the effectiveness of your specific interventions, providing individuals with a more comprehensive and tailored path toward improved well-being.
Clear Behavioral Health is invested in offering a full spectrum of care from withdrawal management and residential treatment to dual-diagnosis outpatient programs and aftercare for ongoing support. Our model is designed to address the unique challenges posed by co-occurring issues like ADHD and substance use. We believe that integrated, coordinated care is the key to unlocking a brighter and healthier future for people facing the complexities of co-occurring disorders.
The choice is Clear—give us a call and let’s work together and explore your path to recovery.
References:
- Davis, C., Cohen, A., Davids, M., & Rabindranath, A. (2015). Attention-Deficit/Hyperactivity Disorder in Relation to Addictive Behaviors: A Moderated-Mediation Analysis of Personality-Risk Factors and Sex. Frontiers in Psychiatry, 6. https://doi.org/10.3389/fpsyt.2015.00047 on December 30, 2023
- Substance Abuse and Mental Health Services Administration. (2018, June). Table 7, DSM-IV to DSM-5 Attention-Deficit/Hyperactivity Disorder Comparison. Nih.gov; Substance Abuse and Mental Health Services Administration (US). https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t3/ on December 30, 2023
- CDC. (2023, September 27). What Is ADHD? Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/adhd/facts.html on December 30, 2023
- Attention Deficit Hyperactivity Disorder (ADHD) Treatment & Management: Approach Considerations, Medical Care, Diet. (2023). EMedicine. https://emedicine.medscape.com/article/289350-treatment?form=fpf on December 31, 2023
- ADHD Medications: How They Work & Side Effects. (2022, October 6). Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/11766-adhd-medication on December 31, 2023
- Zulauf, C. A., Sprich, S. E., Safren, S. A., & Wilens, T. E. (2014). The Complicated Relationship Between Attention Deficit/Hyperactivity Disorder and Substance Use Disorders. Current Psychiatry Reports, 16(3). https://doi.org/10.1007/s11920-013-0436-6 on December 31, 2023
- Wilens, T. E., Martelon, M., Fried, R., Petty, C., Bateman, C., & Biederman, J. (2011). Do Executive Function Deficits Predict Later Substance Use Disorders Among Adolescents and Young Adults? Journal of the American Academy of Child & Adolescent Psychiatry, 50(2), 141–149. https://doi.org/10.1016/j.jaac.2010.11.010 on December 31, 2023
- Adults With Attention Deficit Hyperactivity Disorder and Substance Use Disorders. (n.d.). Retrieved December 31, 2023, from https://store.samhsa.gov/sites/default/files/sma15-4925.pdf on December 31, 2023
- ADHD and addiction: Relationship, signs, and treatment. (2022, January 31). Www.medicalnewstoday.com. https://www.medicalnewstoday.com/articles/adhd-and-substance-abuse#adhd-and-addiction-risk on December 31, 2023
- McCabe, S. E., Schulenberg, J. E., Wilens, T. E., Schepis, T. S., McCabe, V. V., & Veliz, P. T. (2023). Prescription Stimulant Medical and Nonmedical Use Among US Secondary School Students, 2005 to 2020. JAMA Network Open, 6(4), e238707. https://doi.org/10.1001/jamanetworkopen.2023.8707 on December 31, 2023
- SAMHSA. (2022, September 27). The Case for Screening and Treatment of Co-Occurring Disorders. Www.samhsa.gov. https://www.samhsa.gov/co-occurring-disorders on December 31, 2023
