It is common for people with ADHD to turn to addictive substances such as alcohol, marijuana, heroin, prescription opiates and anti-anxiety medication, nicotine, caffeine, sugar, cocaine, and street amphetamines in attempts to soothe their restless brains and bodies. Using substances to improve our abilities, help us feel better, or decrease and numb our feelings is called self-medicating.
Putting Out Fires With Gasoline
The problem is that self-medicating works at first. It provides the person with ADHD relief from their restless bodies and brains. For some, drugs such as nicotine, caffeine, cocaine, diet pills and “speed” enable them to focus, think clearly, and follow through with ideas and tasks. Others chose to soothe their ADHD symptoms with alcohol, marijuana, meth, prescription and illegal opiates.
People who abuse substances or have a history of substance abuse are not “bad” people. They are people who desperately attempt to self-medicate their feelings and ADHD symptoms.
Self-medicating can feel comforting. The problem is that self-medicating brings on a host of addiction related problems which over time make people’s lives much more difficult. What starts out as a “solution” can cause problems including addiction, impulsive crimes, domestic violence, increased high-risk behaviors, lost jobs, relationships, families, and death. Too many people with untreated ADHD, learning, and perceptual disabilities are incarcerated, or dying from co-occurring addiction.
Self-medicating ADHD with alcohol and other drugs is like putting out fires with gasoline. You have pain and problems that are burning out of control, and what you use to put out the fires is gasoline. Your life may explode as you attempt to douse the flames of ADHD.
According to The National Institute of Health, “In 2013, an estimated 22.7 million Americans (8.6 percent) needed treatment for a problem related to drugs or alcohol, but only about 2.5 million people (0.9 percent) received treatment at a specialty facility” (National Institute of Drug Abuse 2015).
Who Will Become Addicted?
Everyone is vulnerable to abusing any mind-altering substance or compulsive behavior to diminish the gut wrenching feelings that accompany untreated ADHD.
There are a variety of reasons why one person becomes addicted and another does not. No single cause for addictions exists; rather, a combination of factors is usually involved. Genetic predisposition, neurochemistry, perinatal exposure to alcohol, drugs and toxins, family history, trauma, life stress, and other physical and emotional problems contribute.
Part of what determines who becomes addicted and who does not is the combination and timing of these factors. People may have genetic predispositions for alcoholism, but if they choose not to drink they will not become alcoholic. The same is true for drug addictions. If an individual never smokes pot, snorts cocaine, shoots or smokes heroin or meth, he or she will never become a pot, coke, heroin or meth addict.
The bottom line is that people with ADHD as a whole are more likely to medicate themselves with substances and compulsive behaviors than those who do not have ADHD.
Doctors Hallowell and Ratey estimate that 8 to 15 million Americans suffer from ADHD. Other researchers estimate that as many as 30-50% of them use drugs and alcohol to self-medicate their ADHD and other co-occurring conditions (Hallowell, pg 237).
This does not include those who use food and compulsive behaviors to self-medicate their ADHD brains and the many painful feelings associated with ADHD. When we see ADHD it is important to look for substance abuse and addictions. And when we see substance abuse and addictions, it is equally important to look for ADHD.
Prevention and Early Intervention
For some, their biological and emotional attraction to drugs is so powerful that they cannot conceptualize the risks of self-medication. This is especially true for the person with ADHD who may have an affinity for risky, stimulating experiences.
This also applies to the person with ADHD who is physically and emotionally suffering from untreated ADHD restlessness, impulsiveness, low energy, shame, attention and organization problems, and a wide range of social pain.
It is very difficult to say no to drugs when you have difficulties controlling your impulses, concentrating, and are tormented by a restless brain or body.
The sooner we treat children, adolescents, and adults with ADHD the more likely we are to help them to minimize or eliminate self-medicating. Many well meaning parents, therapists and medical doctors are fearful that treating ADHD with medication will lead to addiction. Not all people with ADHD need to take medication. Medication, which is closely monitored can actually prevent and minimize the need to self-medicate. When medication helps people to concentrate, control their impulses, and regulate their energy level, they are less likely to self-medicate.
Untreated ADHD and Addiction Relapse
Untreated ADHD contributes to addictive relapse, and at best can be a huge factor in recovering people feeling miserable, depressed, unfulfilled, and suicidal. Many individuals in recovery have spent countless hours in therapy working through childhood issues, getting to know their inner child, and analyzing why they abuse substances and engage in addictive behaviors. Much of this soul searching, insight, and release of feeling is absolutely necessary to maintain recovery. But what if after years of group and individual therapy, and continued involvement in addiction programs your client still impulsively quits jobs and relationships, can’t follow through with their goals, and has a fast, chaotic, or slow energy level. What if, along with addiction, your client also has ADHD?
Treating Both ADHD and Addictions
It is not enough to treat addictions and not treat ADHD, nor is it enough to treat ADHD and not treat co-occurring addiction. Both need to be diagnosed and treated for the individual to have a chance at ongoing recovery. Now is the time to share information so that addiction specialists and those treating ADHD can work together. It is critical that chemical dependency practitioners understand that ADHD is based in one’s biology and responds well to a comprehensive treatment program that sometimes includes medications. It is also important for practitioners to support the recovering person’s involvement in 12-Step and other recovery programs.
It is essential to treat people with ADHD and addiction according their stage of recovery. Recovery is a process that can be divided into four stages: pre-recovery, early recovery, middle recovery, and long term recovery.
Pre-recovery: Is the period before a person enters treatment for their addictions. It can be difficult to sort out ADHD symptoms from addictive behavior and intoxication. The focus at this point is to get the person into treatment for their chemical and/or behavioral addiction. This is NOT the time to treat ADHD with psycho stimulant medication.
Early Recovery: During this period it is also difficult, but not impossible to sort out ADHD symptoms from the symptoms of Post Acute Withdrawal which include distractibility, restlessness, mood swings, confusion, and impulsivity.
Much of what looks like ADHD can disappear with time in recovery. The key is in the life long history of ADHD symptoms dating back to childhood. In most cases early recovery is NOT the time to use psycho stimulant medication, unless the individual’s ADHD is impacting his or her ability to attain sobriety.
Middle Recovery: By now, addicts and alcoholics are settling into recovery. This is usually the time when they seek therapy for problems that did not disappear with recovery. It is much easier to diagnose ADHD at this stage, and medication can be very effective when indicated.
Long Term Recovery: This is an excellent time to treat ADHD with medications when warranted. By now most people in recovery have lives that have expanded beyond intense focus on staying clean and sober. Their recovery is an important part of their life, and they also have the flexibility to deal with other problems such as ADHD.
Medication and Addiction
“Research has shown that the majority of individuals with ADHD – roughly 80% – benefit from stimulant medication” (Rabiner). In general, stimulant medicines improve symptoms in about 70 out of 100 people who have ADHD (Greenhill LL, Hechtman LI).
These medications include methylphenidate preparations such as Ritalin, Concerta, and Daytrana, and dexedrine preparations such as Dextrostat. Vyvanse induces the release of dopamine and norepinephrine as do some other stimulant medication. Vyvanse is unique in that it needs to be broken down by stomach enzymes to be effective. Because of this delivery system Vyvanse can not be diverted to be injected or smoked. Adderall is a combination of dexedrine and amphetamine, and can be prescribed as immediate release or extended release.
It is important to note that when these medications are used to treat ADHD the dosage is much less than what addicts use to get high. When people are properly medicated they should not feel high or “speedy,” instead they will report increases in their abilities to concentrate, control their impulses, and moderate their activity level. The route of delivery is also quite different. Medication to treat ADHD is taken orally, where street amphetamines are frequently injected and smoked.
Non-stimulant medications such as Wellbutrin (bupropion), Strattera and Nortriptyline can also be effective in relieving ADHD symptoms for some people. Recovering alcoholics and addicts are not flocking to doctors to get psychostimulant medication to treat their ADHD. The problem is that many are hesitant for good reasons to use medication, especially psycho stimulants. It has been my experience that once a recovering person becomes willing to try medication, the chance of abuse is very rare. Again, the key is a comprehensive treatment program that involves close monitoring of medication, behavioral interventions, ADHD coaching and support groups, and continued participation in addiction recovery programs.
There is Hope
For the past twenty years I have witnessed the transformation of lives that were once ravaged by untreated ADHD and addiction. I have worked with people who had relapsed in and out of treatment programs for ten to twenty years attain ongoing and fulfilling sobriety once their ADHD was treated. I have Witnessed people with ADHD achieve recovery once their addictions were treated.
“Each day I understand more about how pervasive ADHD is in my life. My clients, friends, family and colleagues are my teachers. I wouldn’t wish ADHD and addictions on anyone, but if these are the genetic cards that you have been dealt, your life can still be fascinating and fulfilling” (Richardson).
“Nationwide Trends.” DrugFacts: Nationwide Trends | National Institute on Drug Abuse (NIDA). N.p., 2015. Web. 11 Feb. 2017.<https://www.drugabuse.gov/publications/drugfacts/nationwide-trends>.
Hallowell, E. M., & Ratey, J. J. (2011). Driven to distraction: recognizing and coping with attention deficit disorder from childhood through adulthood. New York: Simon & Schuster.
Greenhill LL, Hechtman LI (2009). Attention-deficit/hyperactivity disorder. In BJ Sadock et al., eds., Kaplan and Sadock’s Comprehensive Textbook of Psychiatry, 9th ed., vol. 2, pp. 3560-3572. Philadelphia: Lippincott Williams and Wilkins.
Rabiner, D., Ph.D. (2006). Medication Treatment for ADHD. Retrieved from http://www.helpforadd.com/medical-treatment/
Richardson, W. (2005). When too much isn’t enough: ending the destructive cycle of AD/HD and addictive behavior. Colorado Springs, CO: Piñon Press.