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
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