ADHD and Addiction

Overcoming the odds

The big question: Do ADHD drugs make you more prone to addiction? Leading ADHD addiction experts say no. One major study from Massachusetts General Hospital in Boston found that adolescents on ADHD medication were less likely to abuse drugs or alcohol. Likewise, the symptoms that drive addiction (restlessness, impulsivity, boredom) may subside with treatment. And doctors often do not prescribe immediate-release stimulants to recovering addicts. They’ll opt for non-stimulants or slow-release formulas.

However, Carol Watkins, MD, a Baltimore-based psychiatrist who specializes in ADHD, says “The road is a little more difficult for people who have ADHD and an addiction.” Here are some risk factors, and ways to find help.

The drug dilemma
Research shows that people with ADHD face a higher risk for addiction than the general population. But they’re not necessarily looking to get high. One study found that the majority of young adults with ADHD who abuse substances do it to alleviate their symptoms. Addictions of any kind—alcohol, drugs, sex, nicotine, caffeine, food, the Internet, gambling—can make you feel more focused, less anxious or wired, and sleepy at night. Yet “self-medication” can morph into self-destruction. Over time, an addiction can jeopardize your family, job, relationships, and your health. An ADHD expert outlines the signs to look for—and where to find help:

The risk factors
Dr. Watkins considers the following to be cause for concern:

• Family history. If an immediate relative abuses drugs or alcohol, you may be genetically prone to addiction.
• Weak support network. Some people with ADHD use alcohol or drugs to ease social awkwardness. Or they turn to solitary addictions such as online pornography. In both cases, a lack of support from family and friends may fuel the behavior.
• Depression/anxiety. Mental health issues often co-exist with ADHD. If you can’t shake your sadness or worry, you may turn to drugs, alcohol, or other addictions to boost your mood.
• High impulsivity. The desire for quick excitement may lead to sexual thrill-seeking or experimenting with substances.
 
A combination of these factors likely is at play, says Watkins. A general rule of thumb: A behavior is an addiction if it adversely affects your life but you can’t stop. If your health, finances, self-esteem, work or home life is suffering, consult a doctor or ADHD professional, says Wendy Richardson, MA, MST, a certified addiction specialist.

Getting help
Richardson recommends a “comprehensive” approach that treats the addiction and the ADHD. A psychotherapist and/or an ADHD coach can help sort out the issues behind your addiction. Professional input also can improve your stress, organization, and social skills.

Typically, your doctor will suggest an addiction program before prescribing medication for your ADHD. This could involve a rehab facility or 12-step meetings such as Alcoholics Anonymous (go to www.addandaddiction.com/links.htm for a list of support-group links). Online ADHD forums are a warm, supportive way to meet others working to beat addictions (click on “ADDiction and Substance Abuse” at www.addforums.com). Once your addiction is under control, your physician will decide if you’re a candidate for ADHD medications.

Just as addiction doesn’t happen overnight, neither does relapse. The more help you get — ideally, a mix of medication, monitoring, and support — the stronger your chances.

References

1. Richardson, W. (n.d.). ADD and addiction. Retrieved May 14, 2008, from http://www.addandaddiction.com/articles.htm
2. Addiction and Substance Abuse Forums. Available at http://www.addforums.com/forums/forumdisplay.php?f=78 
3. Robbins, T.W. (2002). ADHD and addiction. Nature Medicine, 8, 24-25.
4. Barkley, R.A. (2005). The most effective medicines. In: Taking charge of ADHD: The complete authoritative guide for parents (Rev. ed., pp. 269-290). New York: Guilford Press.
5. Hallowell, E.M., & Ratey, J.J. (2006). ADD, addictions, and a new use of the 12 steps. In: Delivered from distraction: Getting the most out of life with attention deficit disorder (pp. 160-170). New York: Ballantine Books.
6. Hallowell, E.M., & Ratey, J.J. (1994). Parts of the elephant. In: Driven to distraction: Recognizing and coping with attention deficit disorder from childhood through adulthood, (pp. 172-176). New York: Touchstone/Simon & Schuster.
7. Hazelden Foundation. (2007). Facts about addiction and ADHD. Retrieved May 14, 2008, from http://www.hazelden.org/web/public/document/mh_adhd.pdf
8. Wilens, T.E., & Upadhyaya, H.P. (2007, August). Impact of substance use disorder on ADHD and its treatment. Journal of Clinical Psychiatry, 68, 20.
9. Richardson, W. (2000). The link between ADHD & addiction. Retrieved May 14, 2008, from http://www.addconsults.com/articles/full.php3?id=1013
10. Wilens, T.E., Adler, L.A., Adams, J., Sgambati, S., Rotrosen, J., Sawtelle, R., et al. (2008, January). Misuse and diversion of stimulants prescribed for ADHD. American Academy of Child and Adolescent Psychiatry, 4, 21-31.
11. W. Richardson (personal communication, January 23, 2008)
12. Sherman, C. (2007, February/March). Addiction and ADHD adults. Retrieved May 14, 2008, from http://www.additudemag.com/adhd/article/1868.html
13. C. Watkins (personal communication, January 18, 2008)
14. Wilens, T.E., & Fusillo, S. (2007, October). When ADHD and substance abuse disorders intersect: Relationship and treatment applications. Current Psychiatry Reports, 9(5), 408-414.