Attention-Deficit Hyperactivity Disorder (ADHD) is a real mental health condition. It’s not just kids misbehaving who need disciplined. Unfortunately, many people who suffer from ADHD and other mental health disorders develop a dependence on drugs or alcohol. ADHD and substance abuse co-occur in many cases. So, it is essential to make sure individuals have access to addiction treatment services that also address their mental health needs.
It is necessary, however, to address the myth that ADHD medication is a “gateway drug.” Actually, adolescents and adults who get treatment for this disorder are less likely to abuse alcohol and drugs than their undiagnosed, untreated peers. Even so, those who struggle with mental health disorders and challenges should receive support and guidance in order to avoid substance abuse and other harmful behavioral disorders.
Symptoms of ADHD
Although just about every child will indeed experience episodes of hyperactivity or difficulty paying attention, those problems may be signs of ADHD if they begin to increase either in frequency or severity. Also, if they begin to negatively affect their home life or schoolwork. Signs of hyperactive-impulsivity and inattention are the main categories of attention-deficit hyperactivity disorder.
Common signs of inattention include the following:
- Easily distracted
- Has problems organizing
- Trouble listening, even when spoken to directly
- Problems paying attention during specific tasks or during play
- Forgetfulness and trouble remembering where items were put
Common examples of hyperactivity and impulsivity:
- Excessive talking
- Constant fidgeting
- Difficulty waiting for their turn
- Difficulty playing or sitting quietly
- Constant feeling of restlessness
What’s the Difference Between Substance Use, Abuse, and Addiction?
When talking about the differences between these terms they can generally be described in these ways:
Use refers to experimentation or infrequent, irregular use of alcohol or illicit drugs.
Abuse refers to regular and/or compulsive use of substances. This is based on whether the use of alcohol or drugs has or hasn’t become an important part of a person’s lifestyle. Medical professionals diagnose substance abuse if the person is in one of the following situations related to drug use in a 12-month period:
- Encounters legal problems such as getting arrested
- Does not meet obligations, such as missing work or school
- Takes part in reckless activities such as driving while intoxicated
- Continues to use regardless of personal problems such as a fight with a partner
Addiction indicates physical dependence is more severe and involves tolerance. Tolerance is the increased need for the substance, in dosage or frequency, to achieve the altered state that was felt when first using. This also includes withdrawal symptoms, mental or physical symptoms after stopping use. Behavior patterns include:
- Being unable to quit once using starts
- Going beyond self-imposed limits
- Cutting back on time spent on other activities
- Spending excessive time using or getting drugs
- Taking a substance despite worsening health
The Dual Diagnosis of ADHD and Substance Abuse
Eventually, adults and adolescents with attention-deficit hyperactivity disorder often turn to alcohol or drugs. Even though there is no definite reason, experts suggest that people with ADHD have problems regulating the neurotransmitters (chemical messengers in the brain) such as dopamine and norepinephrine.
Dopamine and norepinephrine are both chemicals used by and produced by your central nervous system. Dopamine helps us focus, tackle problems, and find things interesting. Norepinephrine plays a part in a person’s mood and ability to concentrate.
Low levels of these chemicals make it more difficult for a person to focus, resulting in symptoms of ADHD. According to the American Academy of Child and Adolescent Psychology, ADHD can affect areas of the brain that help you solve problems, plan ahead, understand the actions of others, and control impulses.
Due to these effects, living with ADHD can cause the individual to have serious difficulties with mental or social goals. This includes poor school performance or even problems with maintaining personal relationships.
The Dual Diagnosis Issue
Frequently, people who suffer from ADHD also have problems with impulsivity, as noted above. This means that they are more likely to engage in unhealthy behaviors and/or substance abuse. The combination of ADHD and substance abuse is called a dual diagnosis. Dual diagnosis is sometimes referred to as co-occurring disorders or comorbidity. Comorbidity describes two or more disorders occurring in the same person.
Comorbidity also means that the interactions between the illnesses can make both of them worse. However, it can be difficult to find treatment for someone who has a mental illness and also uses drugs or alcohol. Often, programs that treat people with mental illness are not sufficiently prepared to treat substance use disorders (SUDs), and those that treat substance abuse are not well prepared to treat mental disorders. As a result, people with dual diagnoses often bounce around from one program to another or are refused treatment by single-diagnosis programs.
Some Facts about Dual Diagnosis
- Generally, the more severe the mental disorder, the greater the possibility that the individual will also use or abuse an illicit substance.
- The drug most likely to be used is alcohol, followed by marijuana and cocaine.
- 18 to 44-year-old males are at the highest risk.
- Adolescents with serious behavioral problems are 7 times more likely to have used or abused alcohol within the previous month.
- Substance abuse makes almost every part of care for a person with a mental disorder more complicated.
Why Do Mental and Substance Use Disorders Co-occur?
Researchers point to the following possibilities for this. For one, overlapping genetic susceptibility may have something to do with it. Genetic factors may make a person more susceptible to both addiction and other mental disorders. And also to have more of a risk of a second disorder once the first appears.
Another possible factor could be overlapping environmental triggers. Stress, trauma (physical or sexual abuse), and early exposure to drugs are common factors that can influence the buildup of addiction and other mental illnesses.
Adults and ADHD
Many people do not realize that adults can have attention-deficit hyperactivity disorder. This disorder lasts into adulthood about a third to half the time. And studies have shown that children with ADHD may be more likely than the general population to develop alcohol and substance abuse problems when they get older. Also, people with ADHD typically start having substance abuse problems at an earlier age than people without the condition.
It’s especially difficult for these adults because it has usually gone untreated for so long. It has been estimated that fully 25% of adolescents with substance use disorder (SUD) also fit the diagnostic standard for ADHD. Furthermore, only 20% of adults with ADHD have been properly diagnosed or treated.
If you have attention-deficit hyperactivity disorder, the use of intoxicants is very hazardous. Recently, a survey found that 15% of adults with ADHD had abused or were dependent on drugs or alcohol during the previous year. This is nearly three times the rate for adults without ADHD. The most commonly used substances are alcohol and marijuana.
Self-medicating through substance use appears to be especially common in people whose ADHD is undiagnosed or has been diagnosed but never treated. As sufferers of ADHD get older, the physically hyperactive part of the disorder often subsides. However, on the inside, they are just as hyper as always. They will look for something to calm their brain enough to be productive.
What Causes Attention-Deficit Hyperactivity Disorder?
The causes and risk factors are not known. But current research shows that genetics plays an important part. Studies of twins link genes with attention-deficit hyperactivity disorder. Additionally, scientists are studying other possible causes and risk factors including:
- Brain injury
- Low birth weight
- Premature delivery
- Alcohol and tobacco use during pregnancy
- Exposure to environmental toxins (for example, lead) during pregnancy or at a young age
There have been false popular beliefs that ADHD is caused by:
- eating too much sugar during pregnancy
- watching too much TV
- family turmoil
The evidence is not there to conclude that these are the main causes of ADHD. However, many things including these might make symptoms worse in some people.
Deciding if an individual has ADHD is done in several steps. First of all, there is no single test to diagnose ADHD. Other problems like anxiety, depression, sleep problems, and some learning disabilities can have similar symptoms. Additionally, ADHD often occurs in addition to these other disorders.
- About 5 in 10 children with ADHD had a behavior or conduct problem
- About 3 in 10 children with ADHD had anxiety
- Other co-occurring conditions include depression, autism spectrum disorders, and Tourette syndrome
Step one is a medical exam including hearing and vision tests to rule out other problems with similar symptoms to ADHD. Next, several areas of the individual’s behavior over a 3 to 6 month period need to be evaluated. The affected person must experience major issues with the way the disorder affects their everyday life. The disorder must also cross over into several areas of life—schoolwork, social life, and family responsibilities.
No single test can confirm the condition. That’s why physicians need various diagnostic tools to make sure they make the proper diagnosis. The doctor may also depend on the advice of psychologists and occupational therapists in making their final diagnosis.
Healthcare providers use the guidelines in the American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth Edition (DSM-5) to aid in diagnosing ADHD. After diagnosis, a course of treatment is arranged which may include the use of medication to manage the condition.
Internet Self-rating Scales
There are several internet sites concerned with ADHD that offer several types of questionnaires and lists of symptoms. These questionnaires are mostly not standardized or scientifically validated. They should not be used to self-diagnose or to diagnose others with ADHD. An accurate diagnosis can only be made by a qualified, licensed professional.
Treatment for ADHD and Substance Use Disorder
As mentioned, ADHD is a common co-occurring mental disorder among patients with SUDs. Medical professionals need to recognize the complicated nature of ADHD when it co-exists with SUD. Both conditions need to be treated at the same time to get either of them under control.
Pharmacotherapy (medication) is the main treatment for ADHD, although psychotherapy methods have been developed. Stimulant medications are the most commonly used medications to treat ADHD. But many clinicians are hesitant to prescribe stimulants to patients with SUD. It may put patients at risk for stimulant abuse or relapse into other substances.
In adults who have these comorbid conditions, doctors suggest treatment with nonstimulant medications. This includes:
- Atomoxetine (Strattera)
- Clonidine (Kapvay)
- Guanfacine (Intuniv, Tenex)
- Antidepressants such as Bupropion (Wellbutrin) and Desipramine (Norpramin)
Individual Therapy: Individual therapy sessions give the individual the chance to discuss problems confidentially with a trained professional. It helps them learn the tools needed to cope with their problems appropriately.
Group Therapy: During group therapy, patients meet in a group to describe and discuss their issues with the supervision of a therapist.
Behavioral Therapy: Behavioral therapy is a term for several types of therapy that treat mental health disorders. The goal is to identify and help change self-destructive behaviors.
12-Step Support Groups: This Alcoholics Anonymous model of self-help is one of the oldest programs around. Addicts and former addicts meet to discuss issues regarding sobriety, coping with stress, and avoiding relapse.
Do You Think You Need Help?
If you think you do, you probably do. If you think you are struggling with ADHD and substance abuse, you need a professional evaluation. If you are looking to treat and work through your mental issues with drugs or alcohol, allow us to help you. Without proper guidance and treatment, both disorders will only get worse. For yourself or someone you care about, contact Behavioral Health Centers.
We have experience and success in treating addiction and co-occurring mental health issues. Trust your health and mental health to people with comprehensive, evidence-based methods. We understand your struggles. Contact us today and begin your journey to recovery. With support from professionals who understand your struggles, you can find your way to total freedom!