ADHD – What substance abuse treatment programs are missing

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that begins in childhood. It is usually recognized in children who are overactive or have trouble paying attention. Because ADHD directly affects the brain, it affects how natural chemical hormones, like dopamine, interact with the brain. More importantly, studies show that folks with ADHD start experimenting with drugs and alcohol earlier, are more likely to use excessively, and more easily develop a substance use disorder.

Why you are more likely to have alcohol and drug problems if you have ADHD

1. Having ADHD means that your brain responds to reward differently. It means that you need heightened levels of stimulation to feel positive or more relaxed >> > Drugs and alcohol can, and often are, used to alleviate boredom and create more stimulation.
2. ADHD comes with a lot of uncomfortable feelings, especially by the time someone gets to adulthood >>> Substance use is a widely accepted coping mechanism for uncomfortable feelings.
3. Folks with ADHD can often have stronger emotional reactions in their bodies >>> So not only can there be many uncomfortable feelings, but these feelings can be felt more intensely.
4. The hyperactive-impulsive version of ADHD means that you struggle with impulsivity, where the gap between having a thought and moving to action can seem nonexistent >>> Widening this gap is very difficult without specific training, support and often medication
5. Along the same lines, digging your way out of addiction requires pausing after having a thought (about using or drinking) and redirecting to another action (like calling someone or distracting yourself) >>> The mental flexibility required to do this is one of the executive functioning skills often affected by ADHD.

Unfortunately, substance abuse interventions often don’t recognize the critical importance of concurrent treatment and support for ADHD and addiction.

Why is ADHD not treated along with substance abuse?

Sometimes it is; however, there are some limitations in identifying and treating ADHD that make connecting it with substance abuse treatment more difficult. 

Only a small percentage of folks with ADHD (less than half) are diagnosed. There is a general perception that ADHD only affects children, so ADHD in adults can often go unrecognized. It is difficult to treat something that hasn’t been recognized, and when it does seem like a good idea to find out, the diagnostic process can be long and have lengthy waitlists. 

More importantly, there is a degree of separation between addiction and mental health services, which makes it challenging to navigate for anyone, let alone struggling clients. Assessments for neurodevelopmental disorders such as ADHD are infrequent, and the much-needed, holistic wrap-around service required would increase the cost and complexity of treatment.

Moving forward – Navigating ADHD and substance abuse

The first step in understanding ADHD and its role in substance abuse is identifying individuals who may have ADHD. Although diagnosis in teens and adults is complex, the key indicators for diagnosis are the following at frequent and disruptive levels for longer than six months:

Inattention (DSM-5)

• Inaccurate work – missing or overlooking details
• Difficulty focusing during conversations and meetings
• Doesn’t appear to be listening – mind seems elsewhere
• Doesn’t follow through – fails to finish tasks
• Has difficulty organizing self, work, desk and online documents
• Avoids paperwork or report writing
• Loses important things – e.g., cellphone, wallet, glasses, keys
• Forgets appointments or misses deadlines

Hyperactive-impulsive (DSM-5)

• Fidgety, difficulty remaining seated
• Body feels restless or is always on the go
• Is chatty or makes noises during recreational activities
• Interrupts, talks a lot, blurts out comments
• Finishes other people’s sentences 
• Has difficulty waiting in line or for their turn

Other signs and symptoms of ADHD that are not part of the diagnostic criteria

1. Emotional reactivity – stronger reactions to feelings like anger, sadness and even happiness
2. Sensory sensitivity – more sensitive to things like bright lights, abrupt or loud noises
3. Rejection sensitivity – more difficulty with rejection or perceived rejection
4. Lower executive functioning stamina – tires easily with planning, using short-term memory, problem solving, time management and organization
5. Hyperfocus – the ability to hyperfocus when something is interesting or it feels important
6. Low tolerance for boredom
7. Sleep problems or irregularities

The next article will build on the diagnostic stage and discuss how treatments can accommodate both ADHD and substance abuse to increase success.

Amanda Rallings is a counsellor at the Aclestra Centre where she specializes in ADHD, concussion and the impact of neurological issues on mental health and thriving in adulthood. She can be reached at amanda@aclestra.ca.