Attention Deficit Hyperactivity Disorder (ADHD) is a developmental disorder affecting approximately 3.4% of adults. Symptoms vary, but amongst the most common are distractedness and impulsivity as well as hyperactivity.
The number of children being diagnosed with ADHD in the US has been increasing in recent years. ADHD however, may also be diagnosed in adulthood, with many adults realising that the lifelong difficulties they have faced may be due to something more underlying.
Given the lower prevalence of ADHD worldwide, it is remarkable that approximately 25% of those treated for alcohol and substance abuse problems also have co-occurring ADHD. The link between ADHD and substance abuse is well-documented but the reasons behind it are less understood.
WHY IS THERE A LINK?
This is a complex question as it is unclear whether the qualities of ADHD lead to addiction, or whether the way ADHD is treated (medication etc.) may lead to substance abuse.
There is little evidence for the latter. Treating ADHD with medications like Adderall does not increase the abuse of other substances, but reduces risk. Engaging with medication and treatment programmes has been found to reduce the likelihood of becoming involved in criminal behaviour. Another study which followed children with ADHD into adulthood found that stimulant medications did not increase the risk of drug and/or alcohol abuse into adulthood.
The evidence therefore, seems to indicate that the actual traits associated with ADHD – like hyperactivity, impulsivity etc. may make individuals vulnerable to substance use.
An interesting study conducted by Harvard Medical school, found that out of those with ADHD who were abusing substances, only 30% were doing it for enjoyment only. The other 70% used it to improve sleep, mood etc. This tells us that individuals with ADHD may be self-medicating to treat the problems they may be experiencing.
The restlessness and hyperactivity associated with ADHD makes concentrating on repetitive tasks difficult. Therefore, those with ADHD are prone to boredom, which substance use can help them to deal with. Without a diagnosis, those enrolled in programmes of study may turn to substances to help them cope with study stress or an inability to concentrate during lectures.
ADHD, particularly when left undiagnosed and untreated, can be a stressful disorder to live with. Tasks that may take a person without difficulties two hours may take an individual with ADHD four. This can make schoolwork or the working environment extremely stressful, with self-esteem often suffering as a result.
Those with ADHD tend to be less successful academically, and this in time can lead to difficulties holding down jobs and earning money. Again, this leads individuals vulnerable to substance abuse.
Treating Co-occurring Disorders
ADHD, when undiagnosed, also makes substance abuse harder to treat. The difficulties associated with it make engaging in regimented treatment programs more difficult. Individual talk-therapy, often requiring long, concentrated sessions, can be difficult to focus on and the impulsivity associated with the disorder may make relapse more likely.
What Can Be Done to Help?
It is extremely important for those with ADHD to be diagnosed. An experienced professional will have a range of clinical interviews and measures at their disposal in order to accurately assess whether ADHD is present.
This often requires the professional to take case history and they may also call on a parent or sibling to ascertain how long symptoms have been present and the effects they have had at various stages of the individual’s life.
Often, when those with ADHD and addiction issues present for treatment, it is primarily due to the addiction problems. The realisation that ADHD is also present can be a remarkable moment for the addict, as the complicated tapestry of difficulties and addiction problems they have faced can begin to make sense.
Once diagnosis has been made, treatment can be tailored to take the comorbid ADHD into account. This is far more effective than treating the addiction only.
Simple changes and learning how to better organise time and money can all make a massive difference to adults with ADHD. With time coping strategies can be developed to help minimize distractions and improve attention spans.
In terms of prevention for those already diagnosed with ADHD, exercise has been found to be an effective habit for those with ADHD to adapt. Regular exercise provides structure and stimulates the brain, making it less likely that those with ADHD will turn to substance abuse.
The strong relationship now evident in the scientific literature means that it can be stated with some certainty that ADHD places individuals at risk of abusing substances. It may be helpful for parents of children with ADHD to speak to them about the risks they may encounter in the future, and the added complications they may face when experimenting with substances.
By: Dr. Syras Derksen
Registered Psycholog and Winnipeg Therapist
Conners, C. K., Erhardt, D., Epstein, J. N., Parker, J. D. A., Sitarenios, G., & Sparrow, E. (1999). Self-ratings of ADHD symptoms in adults I: Factor structure and normative data. Journal of Attention Disorders, 3(3), 141-151.
Lee, S. S., Humphreys, K. L., Flory, K., Liu, R., & Glass, K. (2011). Prospective association of childhood attention-deficit/hyperactivity disorder (ADHD) and substance use and abuse/dependence: a meta-analytic review. Clinical psychology review, 31(3), 328-341.
Mannuzza S, Klein RG, Truong NL, Moulton JL 3rd, Roizen ER, Howell KH, Castellanos FX. Age of methylphenidate treatment initiation in children with ADHD and later substance abuse: Prospective follow-up into adulthood. American Journal of Psychiatry. 2008; 165: 604-609
Wilens, T. E., Biederman, J., Mick, E., Faraone, S. V., & Spencer, T. (1997). Attention deficit hyperactivity disorder (ADHD) is associated with early onset substance use disorders. The Journal of nervous and mental disease, 185(8), 475-482.
A recent study published by the Journal of the American Medical Association highlights some extremely alarming current trends. This 15 year study, which recorded emergency room visits from 66 hospitals around the country has found that the number of teenage girls admitted for nonfatal self-harm has risen since 2008. Curiously, before 2008 rates were stable, so it is important to examine why this rise is taking place. Although suicide rates are on the rise for both boys and girls in the US, the rise in self-harming behaviours is limited to girls.
Self-harming behaviours including cutting, poisoning and overdosing on drugs are strong indicators of suicidal intentions or co-occurring mental illness such as anxiety or depression. Amongst the self-harming behaviours recorded, ingesting pills or poison was the most common method.
Self-harming is more common than many people may be aware. Prevalence rates are estimated to lie around the 10% mark and is not limited to young people.
It is also worth noting that the data discussed as part of this study involves admissions to emergency rooms only. It does not include injuries that were treated in doctors’ offices or that were never treated at all. As a result, the worrying findings highlighted by this study may not even reflect the full scope of the problem.
Why is This Happening?
One theory which has been put forward by researchers is that teens are spending too much time on their smartphones. It has been found that teens who spend five hours a day or more on their smartphone are 71% more likely to be at risk of suicide than those who spend an hour or less.
Although smartphone use may not be the actual cause of self-harm, it may put already vulnerable teenagers at further risk as it leads to increased social isolation (spending time alone scrolling through social media) and detracting from healthier behaviours such as exercise.
A more sinister reason that smartphone use may have a role to play in the rise of self-harm amongst girls is the growing online culture where teenagers encourage each other to self-harm and share photos and videos of the practice.
Social media may be normalising a behaviour that is extremely dangerous. It would be remiss to attribute all the blame to social media platforms, but it is certainly likely to be a factor, and with numbers rising it may be pertinent for parents and educators to speak openly to teenagers about self-harming behaviour.
Signs of Self-Harming
It can be hard to tell if someone has been self-harming, but often family members or friends will have a sense that something is not right. If you are worried someone you know may be self-harming then look out for any of the following signs:
Why Do People Self-Harm?
Self-harm is an extremely complicated behaviour which may be rooted in a myriad of issues. Often the individual who is self-harming may be experience emotional issues for which they require an outlet. It would be impossible to list all the possibilities but the following are some of the more common causes:
Social Problems: This encapsulates all the interpersonal difficulties an individual may be having. This could be being bullied at school, difficulties with co-workers or coming to terms with their sexuality.
Psychological problems: There is a link between self-harming and borderline personality disorder. Sometimes, those who self-harm have heard voices telling them to do so or have been disassociating (losing touch with their surroundings).
Trauma: Individuals who self-harm may often (but not always) have a history of trauma. This could be a bereavement, a history of physical or sexual abuse or any incidence which causes a high level of distress.
These issues, whether alone or combined, can lead to a build-up of negative emotions such as anger or self-hatred. The individual will often feel like they cannot speak openly of these feelings or turn for help, and so self-harm becomes an alternative method through which to express this.
What Can You Do if You Suspect That Your Child or Someone You Know is Self-Harming?
It is important not to respond in a negative manner to suspected self-harm. Don’t react in anger or disgust, or minimize the behaviour as “attention seeking”.
Ask what is going on in their life generally, and try to ascertain whether there is anything which may make him/her want to self-harm. Let them know that you are there to listen or to give any help that they may need right now.
Although it is difficult, it does not help to “confiscate” any tools that are being used to self-harm without prior agreement. The individual will find a way around this, ultimately eroding the trust you are trying to build.
It’s also important to express to them that this is a worry for you and something which needs a plan of action.
The first point of contact will often be your GP who can put you in touch with the relevant services. Schools may also have a child protection officer, or someone qualified who you may speak to.
Treatments include individual, group and family treatments and the family often have an important role to play in recovery.
The following resources may be helpful when a family member or friend is self-harming.
It is also important to remember to look after yourself when dealing with a loved one who is self-harming. This will ultimately be distressing for you too and make sure to speak to someone you trust or seek help when needed.
Mercado, M. C., Holland, K., Leemis, R. W., Stone, D. M., & Wang, J. (2017). Trends in Emergency Department Visits for Nonfatal Self-inflicted Injuries Among Youth Aged 10 to 24 Years in the United States, 2001-2015. Jama, 318(19), 1931-1933.
NHS Choices. (2015, June 04). Self-harm. Retrieved December 07, 2017, from https://www.nhs.uk/conditions/self-harm/