ADHD and Addiction
The condition known as hyperkinetic reaction of childhood first appeared in the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1968 (2nd edition), though reports of the related symptoms date back to the late 1700s. The third edition of the DSM, published by the American Psychiatric Association in 1980, changed the term to ADD (attention deficit disorder). Later editions, beginning in 1987 (4th edition) changed the diagnostic name to attention deficit hyperactivity disorder, which reflected new research findings. The most current edition (5th edition, published in May 2013) continues to use the term ADHD and added three sub-specifications: predominantly inattentive presentation, predominantly hyperactive Impulsive presentation, and combined presentation. If a person wants to be clinically accurate, the best practice is to use the term ADHD rather than ADD.
But what is ADHD? ADHD is a disorder that is defined largely by its symptoms. But, as Healthline explains, brain structure and function play a role in ADHD. Some studies have shown a difference in the way the brain looks and acts between children with ADHD and those who do have this disorder. For instance, some studies found that children with severe grade ADHD had smaller frontal lobes. This is significant because the frontal lobes are involved in concentration, inhibition, impulse control, and motor activity. It’s no coincidence then that the symptoms of ADHD include behavioral problems, poor concentration, fidgeting, and overactivity. Other studies have found that individuals with ADHD may have neural pathways that dispose them to have trouble paying attention, curbing impulses, and controlling behavior.
Facts and Statistics on ADHD
- ADHD is the most common mental health disorder that is diagnosed in children.
- An estimated 5 percent of adults in the US have ADHD, which represents 11 million individuals.
- When a person has been diagnosed with ADHD, the condition typically lasts a lifetime. There is no cure for ADHD.
- According to the Centers for Disease Control and Prevention, as of 2011, an estimated 11 percent of children in the 4-17 age group (6.4 million children) are living with a diagnosis of ADHD. The rates were 7.8 percent in 2003 and 9.5 percent in 2007.
- On average, children who have symptoms of ADHD will receive a diagnosis at 7 years of age.
- Surveys show that more men and boys get an ADHD diagnosis than women and girls. However, this may owe more to underreporting of females with ADHD than the true reality of the numbers.
The Link between ADHD and Addiction
An understanding of the basics of ADHD makes for a more informed discussion of ADHD and addiction. At the outset, however, it is critical to note that there is no evidence that one disorder causes the other. However, the two can coexist. A person who is experiencing a substance use disorder and has an ADHD diagnosis is clinically considered to have a co-occurring disorder. In any case of a co-occurring disorder, the best approach is to seek treatment at a rehab facility that can accommodate co-occurring disorders. As a rule, both conditions must be treated at the same time for either to be effectively healed or managed.
Research shows a connection between ADHD and addiction. According to some studies, when compared to the general population, children with ADHD face an increased risk of becoming dependent on alcohol or other drugs when they are adults. The following facts and statistics further support the linkage:
- Among adults who have an alcohol use disorder, ADHD is 5-10 times more common.
- Among adults who are receiving recovery services for alcohol or other substance abuse, about 25 percent have ADHD.
- Children who have ADHD are more likely than children without the disorder to initiate into alcohol abuse in their teens.
- Young adults (with an average age of 25) who have an ADHD diagnosis are more likely to use alcohol excessively compared to young adults who do not have this disorder.
- When individuals with ADHD are compared to those without this disorder, the ADHD group is more likely to start abusing alcohol and other drugs at an earlier age.
These facts and statistics beg one important question: Why do people with ADHD face an increased risk of drug abuse? According to research, the answer lies (in part) in the reduced impulse control and behavioral problems associated with ADHD in general. These side effects may contribute to a person initiating into drugs. The risks are layered. For example, let’s say a teenager with ADHD and behavioral problems skips school. By not being in school during the day, this teen may end up in a social situation that involves drugs. The poor impulse control that goes hand in hand with ADHD may lower this teen’s resistance to the drugs offered.
The risks are not environmental alone. Genes and family can also play a role.
Regarding alcohol abuse and ADHD, both conditions tend to run in families, and they may even stem from some of the same genes.
More on Mental Illness and Substance Abuse
- Psychotic Disorders
- Neurodevelopmental Disorders
- Trauma Stressor-Related Disorders
- Personality Disorders
- Sleep-Wake Disorders
- Dissociative Disorders
- Bipolar Disorders
- Anxiety Disorders
- Depression Disorders
Addiction to ADHD Medication
The medications that treat ADHD, if abused, can lead to addiction. The two most commonly prescribed ADHD medications are Adderall (an amphetamine/stimulant), Vyvanse (also an amphetamine) and Ritalin (also a central nervous system stimulant). As The Child Mind Institute highlights, it is critical to separate people who have ADHD from those who do not when talking about abuse of ADHD medication. Much of the media attention about Adderall and Ritalin abuse relates to students who don’t have ADHD but do harbor the false belief that taking these drugs can improve their concentration and exam performance. Regarding individuals who do have ADHD, a University of California, Los Angeles (UCLA) research study found that taking Adderall or Ritalin did not increase their risk of addiction to these drugs or other drugs.
Ultimately, the individual, or a parent/guardian, must decide what course of ADHD treatment to take. It is helpful to know that when a person is prescribed ADHD medication, it is always as part of a medically supervised treatment plan. This means that the prescribing doctor will regularly meet with the person. A doctor may not necessarily have training in screening for addiction, but if the patient is following the doctor’s orders, there is little chance that an addiction will develop.
The UCLA study helps to underscore that taking ADHD medication is likely not a risk factor for developing a drug addiction. But, to an earlier point, individuals with ADHD face an increased risk of substance abuse in general. In other words, the risk of developing a drug abuse problem relates to the ADHD itself and not to the pharmacological treatment of this disorder. Of course, one concern is that if these individuals are more prone to abuse drugs than the general population, is it smart to give them a prescription for a potentially addiction-forming drug?
Treatment for Co-Occurring ADHD and a Substance Use Disorder
For individuals with ADHD alone, psychostimulant medications, such as Adderall and Ritalin, are used as frontline treatments. In addition, individuals with ADHD may benefit from a host of supportive services when offered in conjunction with medication, including:
- Lifestyle coaching
- Parenting advice
- Exercise programs
- Nutritional guidance
- Diet management
- Stress management strategies
- Skill-building workshops
- ADHD education
An article published in Psychiatric Times addresses some of the complex issues involved in treatment for ADHD and substance abuse. For instance, on the one hand, studies show that a person who is taking ADHD medication may remain in treatment longer than someone who is not. But on the other hand, a person who is in treatment for substance abuse who has access to a stimulant drug, such as Adderall, may abuse it. The key is for the person with co-occurring ADHD and a substance use disorder to get treatment from a rehab that can accommodate this dual diagnosis under one roof, or by coordinating care with a local psychiatrist’s office. Both treatment tracks will need to be monitored, and each must appropriately factor the other into the type of treatments selected.
For example, the attending psychiatrist may factor in the risk of the recovering person’s addiction to Adderall or Ritalin and decide not to prescribe a stimulant drug during the first 120 days of substance abuse treatment. The doctor can then monitor the non-stimulant-based treatment plan and discuss the client’s progress with the attending addiction treatment specialists.
Treatment plans can always be modified as necessary.
The point is that there are options, and they extend beyond medication alone.
As the National Institute on Drug Abuse discusses, there are numerous therapies that were developed for, or have been applied to, the treatment of substance abuse. Some therapies, such as Cognitive Behavioral Therapy, can be applied both to ADHD and substance abuse. In therapy, treatment for ADHD and substance abuse often safely overlap within the same sessions.