By James J. Crist, Ph.D., author of What’s the Big Deal About Addictions?
While estimates vary, about 5 percent of children and 2.5 percent of adults are thought to have attention deficit hyperactivity disorder (ADHD). Symptoms can include inattention, distractibility, hyperactivity, impulsivity, interrupting others, forgetfulness, disorganization, and difficulty starting and completing tasks. While some kids outgrow most or all of their symptoms by the time they reach adulthood, others continue to experience impairment in functioning throughout their lives.
Only about 20 percent of adults with ADHD were properly diagnosed and treated as children. The remaining 80 percent may have struggled more in school and on the job due to untreated symptoms. Many adults are not aware that their difficulties, which can include addictions, may be related to undiagnosed ADHD.
It’s not just the symptoms of ADHD that cause problems. Often, people with ADHD have a co-occurring disorder. For example, children and teens with ADHD are more likely to be diagnosed with oppositional defiant disorder and/or conduct disorder. Mood disorders, such as depression or bipolar disorders, and anxiety disorders are also more common in kids and adults with ADHD. Having co-occurring disorders can complicate diagnosis and treatment. For example, inattention can be a symptom of ADHD, anxiety, and depression.
ADHD in Adulthood
About a third of children with ADHD will have residual symptoms as adults. While hyperactivity typically fades, problems with inattention, disorganization, and impulsivity can persist.
The academic and social challenges that many people with ADHD experience can contribute to the development of other disorders. People with ADHD often have a harder time being successful and feeling good about themselves. Negative reactions from others, such as yelling at your behavior, criticizing you for being disorganized, blaming you for being forgetful, and accusing you of not “trying your hardest” in school, at home, and on the job all take a toll and can increase risk for mood and anxiety problems in people with ADHD.
The Link Between ADHD and Substance Addictions
Half of all adults with untreated ADHD will develop a substance use disorder at some point in their lives. It is estimated that more than 25 percent of people with substance use problems also have ADHD. Several factors contribute to this link.
Emotional dysregulation is more common in people with ADHD. People with ADHD may struggle to regulate their emotions and express them in positive, rather than destructive, ways. Their distractibility makes it harder to read body language and monitor the effect of their actions on others. Their impulsivity makes it harder to think before saying hurtful things and to react calmly when others are upset with them. Their hyperactivity makes it harder to sit still in class, complete homework, finish tasks, or sleep at night.
Being easily bored is a common symptom of ADHD. People with ADHD need more stimulation to stay interested in a task. This is thought to be the result of lower levels of dopamine, a brain chemical that makes actions feel rewarding. Use of certain drugs, such as alcohol, cocaine, LSD, and marijuana, can provide some of the stimulation craved by people with ADHD. Life becomes more fun and exciting when they’re getting drunk or high with friends.
People who use or abuse drugs in order to cope with symptoms of other disorders, such as ADHD, anxiety, or depression, are self-medicating. For a while, it may seem to help. But many people develop tolerance, meaning that they need more and more of a substance to feel the effects. This can lead to addiction. Once addiction sets in, it becomes harder to regulate substance use, even when it causes problems such as not getting up for work or school, skipping homework, or even stealing from others to buy drugs or alcohol.
When ADHD co-occurs with an addictive disorder, both are more difficult to treat. Being impulsive means that you are less likely to think about consequences, both short-term and long-term, of drug or alcohol use. Substance use makes it harder to pay attention. Alcohol can interfere with the quality of your sleep.
Most adults who use alcohol or drugs started as teenagers. Research shows that the later in life you start using drugs or alcohol, the less likely you are to become addicted. This is why it’s important to discourage teens from using alcohol and drugs. For those unable or unwilling to stop, getting them to use less or use less often, thereby reducing harm, is a goal worth pursuing.
Having ADHD also puts people at higher risk for nicotine addiction. Nicotine can help you focus and calm you down at the same time. While some teens and adults think vaping is less risky, this may not be the case. Long-term studies on the safety of vaping have not been conducted. Some people have suffered serious damage to their lungs as a result of vaping. Using pods that contain THC is also risky. The higher concentration of THC that is often present in the pods make vaping much more addictive, and even dangerous.
ADHD and Behavioral Addictions
Most people think of drugs or alcohol when they talk about addictions. But behaviors can also be addictive. Brain imaging shows that the same areas of the brain (the reward centers) are activated by certain behaviors as are activated when alcohol or drugs.
Behavioral addictions include surfing the internet, gambling, playing video games, using social media, and texting. Success in gaming or interacting with others on social media can help compensate for not succeeding in other areas of life. Shopping, spending, sex, watching porn, and overeating can also become addictions. The instant gratification that comes with these activities can interfere with meeting other responsibilities, such as doing schoolwork, helping with chores, or even finding and keeping a job.
The Importance of Seeking Treatment Early
We know that people with ADHD are at risk for multiple negative outcomes. They often are underachievers in school, have trouble finding and keeping a job, and have trouble maintaining positive relationships. Kids and adults with ADHD and oppositional defiant disorder and/or conduct disorder are more likely to get trouble with the law. Substance use increases their risk for being arrested. It is estimated that 25 percent of incarcerated people meet the criteria for ADHD. Once in the legal system, people with these disorders are more likely to be repeat offenders. Identifying and treating ADHD in kids and teens is critical to avoid the many problems that are more likely to occur in this population when ADHD goes untreated.
Using Medications for ADHD When Addictive Disorders Are Also Present
Parents and other adults often express concerns that taking medication for ADHD (or other disorders) will make it more likely that they will use alcohol or other drugs. Actually, research shows that the opposite is true. When medication for ADHD makes it easier to focus, improves self-control, and helps with completing tasks successfully, the drive to use drugs decreases.
Stimulant drugs, such as Ritalin, Concerta, Adderall, Vyvanse, and Focalin, are usually the most effective drugs for treating ADHD. Research shows that using these drugs to treat ADHD doesn’t lead to using illegal drugs. If that is a concern, use of long-acting (extended-release) medications such as Concerta are considered safer choices, as it is harder to abuse these drugs. Vyvanse, an extended-release formulation of Adderall (a combination of amphetamine and dextroamphetamine), has to be broken down in your digestive tract in order for it to begin working, and this makes it less likely to be abused. Strattera, Wellbutrin, guanfacine, and clonidine are nonstimulant medications that can also treat ADHD.
The Risks of Not Treating ADHD
While there may be some risks of using medication for treating mental health or addictive disorders (most medications do have side effects), it is important to also consider the risks of not treating disorders such as ADHD. As noted above, teens and adults with undiagnosed and/or untreated ADHD are more likely to have trouble maintaining consistent employment, often switching jobs repeatedly after they get bored or getting fired for performing poorly or inconsistently. They earn less money than non-ADHD adults and are more likely to be incarcerated. The stress of these outcomes increases the risk for developing addictive disorders.
Coping Strategies for Managing ADHD and Addictions
The key to reducing the risks of addiction when ADHD is present is to find other stimulating activities that are enjoyable so that addictive behaviors are less likely to occur. Pursuing these activities also makes it easier to prevent relapse in those already struggling with addictive disorders. Exercise is one such activity, whether that means participating in organized sports or doing other physical activities. Skateboarding or biking, for example, can be a lot of fun for kids and teens. For adults, finding a job one enjoys is especially important. For all people with ADHD, engaging in hobbies such as art or music can be helpful. Getting enough sleep and maintaining a healthy diet are also important.
Peer support groups such as Alcoholics Anonymous or Narcotics Anonymous can provide support for those wanting to slow or stop their substance use. The social aspect of these self-help groups can be a lifesaver. Children and Adults with Attention Deficit Hyperactivity Disorder (CHADD) is an organization that provides help and support for people with ADHD.
Not everyone who uses substances is ready to stop. Many therapists use a harm-reduction model to help keep people safe. For example, using less often can lower the risk of negative consequences. Some people set limits on quantity or frequency of use. However, people with more serious addiction problems may not be able to reduce their use, in which case abstinence is safer.
People with ADHD are more likely to experience mental health and substance use difficulties. This can make it harder to treat both disorders. Having untreated ADHD puts people at risk for a number of negative outcomes. Getting evaluated and treated for ADHD can make a big difference in achieving goals.
Dr. James J. Crist is the clinical director and a staff psychologist at the Child and Family Counseling Center (CFCC) in Woodbridge, Virginia, and a substance abuse counselor, working with addictive disorders in teens and adults. At CFCC, he provides psychological testing and individual, couples, and family psychotherapy for children, adolescents, and adults, specializing in children with ADHD, depression, and anxiety disorders. Visit his website at jamesjcrist.com.
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