Although it is thought of primarily as a children’s disease, attention deficit hyperactivity disorder (ADHD) up to half of the cases diagnosed in childhood can extend into adulthood, and the disorder affects as much as 5% of the adult population as well. However, ADHD in adults is often harder to diagnose and even more commonly misdiagnosed, because its symptoms mimic other disorders such as bipolar disorder, anxiety, and depression.
Because those symptoms are similar to other disorders that often co-occur with addiction or alcoholism, the sufferers will likewise attempt to self-medicate in an attempt to gain relief from the worst of their untreated ADHD symptoms.
Again, as with other “dual diagnosis” mental disorders, self-medication can and will develop over time – first into an increased tolerance and eventually into a full-blown addiction.
People suffering from ADHD often have extreme difficulty controlling impulsive behaviors. These impulsive behaviors often take the form of drinking to excess, abusing illicit or prescription drugs, and other high-risk addictive behaviors.
“A recent survey found that more than 15% of adults with the disorder had abused or were dependent upon alcohol or drugs during the previous year. That’s nearly triple the rate for adults without ADHD”.
“… Only 30% (of participants) said they used substances to get high… 70% are doing it to improve their mood, to sleep better, or for other reasons. This kind of self-medication seems especially common among individuals whose ADHD remains undiagnosed, or who have been diagnosed but have never gotten treatment.” (Sherman, quoting Dr. Timothy Milens, the author of the study)
~Carl Sherman, PhD, Addiction and ADHD Adults
ADHD and Alcoholism
According to statistics quoted by WebMD, ADHD is up to 10 times more prevalent among adult alcoholics than in non-alcoholics. 25% of adults in treatment for addiction/alcoholism – 1 in 4 – also have ADHD.
Having ADHD as a child is also a very strong predictor of alcohol abuse as an adult:
- 14% of teenagers 15-17 who have ADHD go on to have problems with alcohol as adults – 1 in 7.
- At a mean age of 14.9, 40% of teenagers with ADHD start using alcohol, compared to 22% of those without a diagnosis of ADHD.
- Young adults with a mean age of 25 use alcohol at the same rate, regardless of an ADHD condition. However, those young adults with ADHD had a higher propensity for excessive alcohol use.
ADHD and Marijuana
ADHD is so common that it affects 9% of all children aged 13-19 years in the United States. At the same time, marijuana is the most commonly used illegal drug in the country.
In 2013, a study published in the Journal of the American Academy of Child and Adolescent Psychiatry showed that while only 7% of US teens with an average age of 17 abuse marijuana, 13% – almost double the percentage – of teenagers with ADHD use the drug.
ADHD and Other Illicit Drugs
The same study, which was conducted by the University of Pittsburgh School of Medicine in partnership with six other health centers across the country, reported results that were put in contrary to previous findings – specifically, that the current crop of medicines prescribed for ADHD do not reduce the risk of addiction/substance abuse among teenagers.
The study’s lead author, Brooke Molina, Ph.D., a Professor of Psychiatry and Psychology at the University of Pittsburgh School Of Medicine, said, “This study underscores the significance of the substance abuse risk for both boys and girls with childhood ADHD. These findings also are the strongest test to date of the association between medication for ADHD and teenage substance abuse.”
Some of the findings include:
- When the participating teenagers were an average of 15 years old, 35% of those with ADHD admitted to using at least one of an illicit drug. In only about 20% of those without ADHD used.
- Within the ADHD group, 1 out of every 10 teens can be described as having substance abuse or dependence disorder. Only 3% of the non-ADHD group meets the criteria.
Abuse of ADHD Prescription Medication
According to a recent survey by the Partnership for Drug-Free Kids, approximately 20% of all college students abuses commonly-prescribed prescription stimulants normally given to patients with ADHD. The drugs most often abused are Ritalin, Adderall, and Vyvanse.
The survey was conducted by Whitman Insight Strategies, an independent researcher, and had over 1600 young adult respondents. The findings were very revealing:
- Approximately 50% of the responding college students said that they took the stimulants to help them study or improve their school performance.
- About 67% of the students were of the belief that the medication helped them get better grades and become more competitive.
- 40% said they took the drug to stay awake.
- 25% and said they took the drug to improve their work performance.
Miami University staff psychiatrist Dr. Josh Hersh says, “These survey findings have confirmed a lot of the things I have seen clinically. Young adults are mainly using prescription stimulants to improve academic and work performance and to stay awake”
“The fact that students often use these drugs around deadlines, when their natural adrenaline is already high, elevates the risk even more. Sporadic use can lead to severe sleep deprivation and cause stimulant-induced psychosis, when a student gets paranoid and may hallucinate.”
The survey also found that 28% of those who have legal prescriptions for stimulants have over-stated their condition and symptoms in order to get prescribed a higher dosage. About the same number admits to sharing their medications with their friends.
Treating ADHD Patients with a History of Substance Abuse
Because ADHD medications have a potential for abuse, the pharmacological treatment of ADHD in patients with addiction histories has to be considered extremely carefully. Two approaches offer promise.
Regular amphetamine-based stimulants are often misused for recreational, rather than medical purposes. Delayed-release preparations, on the other hand, have a much lower abuse potential.
Firstly, the slower onset of the drug’s “good effects” means that they are less attractive to potential abusers, who typically look for more immediate gratification.
Secondly, because of the way they are manufactured, delayed-release medications are more difficult to use an alternate ways for which they were not intended – injecting or snorting.
Non-stimulant drugs may also be a good option for certain patients with ADHD. The biggest downside to this route, however, is that certain of these medications have a more gradual positive effect than do stimulant medication. In general terms, some of these are less effective than stimulant medications, so their use should be considered on a case-by-case basis.
Anytime there is a co-occurrence of a mental/behavioral disorder and an addiction, the challenge that arises is how to effectively treat both disorders simultaneously. Focusing on one before the other will result in an incomplete recovery that can actually trigger a relapse and reoccurrence of symptoms.