ADHD and Addiction
By Kristen Schaer, LMHCA
Addiction can be an often overlooked aspect of ADHD, and its relationship to many aspects of ADHD symptoms and treatment is worth exploring, especially for those getting diagnosed as adults.
Symptoms like distraction, boredom, emotional hyperarousal, sensory processing problems, executive dysfunctions, and difficulties with all manner of relationships can be exacerbated by substance abuse. Substance abuse can also delay the diagnosis of ADHD and mask comorbid disorders. For some, the shame of struggling to manage ADHD symptoms can be compounded by the shame of admitting that an addiction has gotten out of control.
As a therapist diagnosing clients, I am charged with figuring out differential diagnoses and determining a treatment plan. Differential diagnosis is the process of differentiating between two or more conditions which share similar signs or symptoms.
Let’s say I have a client that I believe consumes an excessive amount of alcohol, and that it might be problematic and detrimental to their health. I could diagnose them with Substance Use Disorder and build a treatment plan around the symptoms that I am seeing. But what if I failed to ask more questions in the course of my assessment?
What if I learned, three or four sessions into our counseling sessions, that the client admits that the drinking is out of hand, but they have often used it to help slow their racing thoughts down in order to sleep at night? Or to numb the emotional hyperarousal they feel from interactions with family and friends? Or to deal with aspects of Rejection Sensitive Dysphoria that consume their thoughts? I might have missed some very important indicators of what could very well be ADHD and only treated part of what is causing them great emotional distress.
Often, adults who were not diagnosed with ADHD as children have found ways of self-medication to cope with symptoms of ADHD. Think: drinking many cups of coffee a day to be able to focus one’s thoughts or taking up smoking to alleviate boredom and have something to fidget with, or using stimulants like cocaine. This self-medicating may mask ADHD symptoms temporarily, but it can do a great disservice in diagnosing other mental health conditions the client may have.
According to the ADDitude Magazine article, “ADHD Comorbidity: an Overview of Dual Diagnoses,” 70% of people with ADHD will be treated for depression, 50% will be treated for alcoholism/substance abuse, and 5-7% will experience bipolar disorder. In some cases, these diagnoses can be genetic in nature, and some of them can develop over time due to untreated ADHD, trauma, or incorrect diagnosis.
In the Journal of the American Academy of Child and Adolescent Psychiatry article “Age of Onset, Duration, and Type of Medication Therapy for Attention Deficit/Hyperactivity Disorder and Substance Use During Adolescence: A Multi-Cohort National Study” from June 2016, a study concluded:
“Individuals who initiated stimulant medication therapy for ADHD later (aged 10–14 years and 15 years and older) and for shorter duration (2 years or less and 3–5 years) as well as those who reported only nonstimulant medication therapy for ADHD had significantly greater odds of substance use in adolescence relative to individuals who initiated stimulant medication therapy for ADHD earlier (aged 9 years or less) and for longer duration (6 or more years).”
Put even more poignantly, an American Journal of Psychiatry article from May 2009 found that, “the failure to document that childhood treatment with stimulant medication decreases the high risk of substance use in adulthood is distressing.”
Shame and stigmatization, however, might be the biggest barrier to proper diagnosis and treatment. Often those who have struggled with finding the right diagnosis may start to feel hopeless and that their addiction is due to lack of willpower or being a bad person. Self-medicating is often a maladaptive attempt to develop coping mechanisms for painful emotions, fear, and untreated symptoms. It just happens to be that these coping mechanisms are harmful and destructive to the person wanting to find some relief.
Self-compassion and giving one’s self grace are important tools in seeking help and reframing the stories we tell ourselves into a narrative that befits the many qualities that we don’t see in our darkest moments.
If you think you might be exhibiting self-medication behaviors, please refer to the National Alliance on Mental Illness (NAMI) website for a review of what self-medication looks like, and take a quiz to find out if you are engaging in self-mediation behaviors:
https://heartsandminds.nami.org/articles/self-medicating/
The Substance Abuse and Mental Health Services Administration (SAMHSA) provides a helpline (1-800-662-4357) as well as a site to find treatment services in your area (findtreatment.gov).
About the Author
Kristen (she/her/hers) is a Licensed Mental Health Counselor Associate. She graduated with a Bachelor's Degree in Writing, Literature, and Publishing from Emerson College in Boston and then went on to get her Master's Degree in Counseling from Cambridge College, in Cambridge, Massachusetts.
She is also a sex and relationship therapist, helping couples and individuals dealing with a variety of relational, intimacy, communication, sexuality, desire discrepancy, sensuality, and attachment related goals. She enjoys working with folx from a the LGBTQIA+, BIPOC, neurodivergent, polyamorous, and gender spectrum communities.
Her approach is humanistic, collaborative, sex positive, creativity-oriented, and goal centered. She enjoys working with folx using a holistic, bio/psycho/social model and a non-ableist approach, seeing each person's abilities and perspectives as a strength to build on.
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