Do you or a loved one have trouble focusing on a single task, sitting still, or controlling your impulses? A persistent pattern of inattention, physical hyperactivity, or impulsive behavior may be signs of ADHD, a neuropsychological disorder that begins in childhood and can continue through adulthood. ADHD, or Attention deficit hyperactivity disorder, affects up to 9 percent of children between the ages of 13 and 18, according to the National Institute for Mental Health, and over 4 percent of American adults are affected.
The symptoms of ADHD typically appear for the first time in children around the age of 7; however, the condition often goes undiagnosed.
Many older adolescents and adults struggle with the personal and social effects of ADHD for years before they discover that they have this disorder. Some of the common personal and social ramifications of ADHD include:
- Poor performance at school or work
- Difficulty getting along in social situations
- Low sense of self-worth
- Antisocial behavior
- A history of disciplinary or legal problems
- More accidents and altercations than average
- A high risk of substance abuse
- A high risk of co-occurring depression or anxiety
Substance abuse affects a significant percentage of individuals who have ADHD. For people who suffer from low self-esteem or who believe that they can’t succeed in mainstream society, drugs and alcohol can provide a source of comfort or validation. But in fact, combining substance abuse with ADHD only makes both disorders worse. The only way to heal effectively from the effects of addiction and ADHD is to receive integrated treatment for both disorders through a dual diagnosis treatment program.
ADHD doesn’t follow a single pattern in every individual, and the disorder is not easily diagnosed. The mental health community has identified three basic forms of this disorder, which may change over the course of a person’s lifetime:
- Predominantly inattentive. These individuals are easily distracted, unfocused, and tend to have trouble finishing tasks or sticking with daily routines. They may seem flighty or dreamy, and their attention may float quickly from one subject to another. This form of the disorder is also known as attention deficit disorder, or ADD. ADD is not necessarily associated with physical hyperactivity or poor behavioral control.
- Predominantly hyperactive. These individuals move around a lot and have trouble controlling their behavior. They may fidget, jump up in the middle of an activity, or interrupt other people in a conversation. They find it difficult to curb their impulses, actions, or emotional responses. People with a high level of hyperactivity are at high risk of accidental injuries.
- Combined inattention and hyperactivity. These individuals display symptoms from both forms of ADHD.
According to Neurotherapeutics, inattentive ADHD is the most common subtype of this disorder, yet more people with combined inattention and hyperactivity seek help for their symptoms.
Identifying ADHD isn’t as easy as it might seem. There is no single, standardized test to inform parents or teachers that a child has this disorder. Before a diagnosis can be given, other medical or psychiatric conditions that cause the same symptoms must be ruled out. Anxiety disorders, learning disorders, brain injuries, and sensory disabilities are just a few of the conditions that might cause excessive activity or poor attention. A child or adult must go through several phases of testing before ADHD can be accurately diagnosed.
How can you tell if you or a loved one has ADHD? The disorder can manifest itself in every aspect of a person’s life, from appearance and behavior to personal relationships to academic or professional success. Listed below are a few of the most common red flags of ADHD:
Symptoms of inattention:
- Lack of mental focus
- Failure to finish assigned tasks
- Difficulty following directions
- Inability to stay with routines or schedules
- Difficulty organizing things
- Frequently losing personal belongings
Symptoms of hyperactivity and impulsivity:
- Running, jumping, or fidgeting at inappropriate times
- Difficulty playing quietly or reading for extended periods of time
- Frequently interrupting other people’s conversations
- Inappropriate outbursts of anger or frustration
- Feelings of restlessness or agitation
- Difficulty controlling sudden urges
- Frequently engaging in risky behavior
In order to meet the diagnostic criteria for ADHD, these symptoms must be present for at least six months and must have a negative impact on the individual’s quality of life. For children and teens, ADHD increases the risk of depression, social isolation, bullying, antisocial behavior, and suicidal thoughts. For adults, ADHD is associated with higher rates of drug or alcohol abuse, unemployment, and relationship conflicts. Getting appropriate treatment can make an enormous difference in the individual’s chances of leading a happy, successful life.
The exact cause of ADD/ADHD remains unknown. But there are several potential causes and risk factors that may contribute to the disorder:
- Heredity. Studies suggest that the disorder runs in families. If you have a close relative with ADD/ADHD, you or your children may be at higher risk for the condition.
- Brain structure.ADHD has been linked with structural differences in certain areas of the brain, such as those regions that regulate attention and impulse control.
- Chemical exposure. Environmental factors like an exposure to tobacco smoke, lead, or other pollutants have been associated with a higher risk of ADHD in children.
- Sweeteners and food additives. The relationship between foods and ADHD is controversial, but many scientists believe that children who consume large quantities of sugar, food dyes, or preservatives in their diet may be at higher risk of behavioral disorders like ADHD.
- Neurological damage. A history of brain injury in childhood may increase the risk of an individual having the symptoms of ADHD.
There is a strong association between ADHD and drug or alcohol dependence. WebMD states that up to one-fourth of adults receiving treatment for substance abuse meet the criteria for ADHD. Children and teens with ADHD are more likely to engage in risk-taking behavior like drinking, smoking marijuana, and experimenting with drugs. According to the Partnership for Drug-Free Kids, a study of teens with ADHD showed that 35 percent of 15-year-old adolescents with this disorder used at least one drug. Only 20 percent of those without ADHD had tried drugs or alcohol.
What puts kids and adults with ADHD at higher risk of substance abuse? The answer is complicated, with several possible explanations:
- ADHD is characterized by low impulse control, which makes the individual vulnerable to substance abuse in spite of the negative consequences.
- ADHD can cause low self-esteem and social isolation, which increase the risk of depression and alcohol or drug abuse.
- Teens who feel like social or academic failures may gravitate toward kids who smoke, drink, or use drugs as a way to fit in.
- Adults who have trouble paying attention or sitting still may use drugs or alcohol as a way to calm down or get focused.
Drugs and alcohol might initially seem like an effective coping mechanism for dealing with the social struggles and emotional pain of ADHD. But in the end, alcohol and drugs only make the symptoms of ADHD worse. Substance abusers with ADHD may have even higher rates of anxiety, agitation, poor concentration, forgetfulness, and impulsivity. In addition, substance abuse poses a risk to physical health, personal relationships, financial resources, and professional status.
Treating ADHD and Addiction
Treating ADHD can be challenging, especially for someone with a drug or alcohol problem. Stimulant medications like Ritalin or Concerta (methylphenidate), and Adderall, Dexedrine, or Vyvanse (amphetamine) are often prescribed as frontline treatment for ADD/ADHD. However, because these medications have a high potential for addiction, there is a risk of chemical dependence. Less addictive medications can be prescribed to patients who have a history of substance abuse, such as:
- Strattera (atomoxetine)
- Intuniv (guanfacine)
- Wellbutrin (bupropion)
- Pamelor (nortriptyline)
- Tofranil (imipramine)
- Catapres (clonidine)
When psychostimulant medications are prescribed, providers may choose to prescribe extended-release drugs that have a lower potential for abuse. Alternatively, stimulants may be prescribed in combination with medications with a lower abuse potential to reduce the risk of dependence and addiction.
Along with pharmacotherapy, non-pharmaceutical treatments like counseling, behavioral modification, and psychosocial education have proven to be effective at treating ADHD and substance abuse. The American Journal on Addictions lists the following approaches as most effective for treating co-occurring ADHD and addiction:
- Education. Many adults live with the symptoms of ADHD for years without understanding the disease or its implications. The same is true for the disease of addiction. Teaching these patients about both substance abuse and ADHD can help them understand how to live successfully after treatment.
- Cognitive behavioral therapy (CBT). CBT is one of the most effective, evidence-based treatments for substance use disorders. This behavioral modification therapy has also been applied to people with ADHD. CBT helps the individual change destructive behaviors by changing the way he or she thinks. CBT can be applied to individual therapy sessions or to peer group counseling.
- Motivational coaching. One-on-one coaching with a therapist experienced in ADHD treatment and substance abuse can help these individuals build confidence. A coach can work closely with the patient to teach valuable life skills like time management, personal organization, and effective communication.
- Family and couples counseling. In order for clients with co-occurring ADHD and substance abuse to lead productive, fulfilling lives, their partners and families must support their recovery. Family counseling helps everyone in the household understand the disease of addiction, so they can create a healthy, sober environment at home.
- 12 step programs. Self-help support groups like Alcoholics Anonymous, Narcotics Anonymous, and Cocaine Anonymous provide therapeutic interventions based on 12-step principles. Most 12-step groups offer specialized “dual diagnosis” meetings for members who have co-occurring addictions and neuropsychological disorders. In many communities, a 12-step group called Dual Recovery Anonymous is dedicated to supporting members with co-occurring conditions.
Dual Diagnosis Rehab for ADHD and Substance Abuse
Integrated rehab programs can maximize your chances of long-term success in recovery. An integrated treatment center provides therapeutic services that address both the symptoms of ADHD and the challenges of recovering from alcoholism or drug addiction. Dual diagnosis treatment programs are conducted by a multidisciplinary team of professionals who are cross-trained in addiction services and mental health care. Classes and therapy sessions are held at a single facility, with a focus on continuity of care.
Rehab programs for ADHD must meet the needs of these individuals without compromising their quality of care. Patients with this disorder have specific hurdles to overcome in rehab, such as:
- Difficulty paying attention in longer individual or group sessions
- A higher risk of relapse due to low impulse control
- Difficulty staying focused on written or visual materials
- Low motivation due to poor self-esteem
Individually tailored treatment plans can be modified to accommodate the client’s needs, increasing their chances of completing the program successfully. Ongoing support and motivation are extremely important for people living with ADHD and substance use disorders. After rehab, these clients can benefit from a strong aftercare program, including alumni support groups, sober living homes, medication management, occupational counseling, and marriage or couples therapy.
At Axis, we specialize in helping clients with complex co-occurring disorders succeed at recovery.
If you or someone you love has a problem with drugs or alcohol, call our admissions counselors at any time to learn more about our innovative, personalized treatment plans.