Dual Diagnosis Treatment for ADHD and Addiction
Attention deficit hyperactivity disorder (ADHD) and substance use disorders affect countless people throughout the United States each year. Both mental health disorders are widely diagnosed throughout the country. It is estimated that at some point in their lives approximately 15% of American adults will develop substance use disorders. In a 2016 survey, researchers determined that 9.4% of all children in the United States have been diagnosed with attention deficit hyperactivity disorder. However, ADHD affects 4% of American adults as well.
These two mental health conditions are prevalent in and of themselves, but they also have a strong relationship. In fact, ADHD in early childhood is widely associated with the development of addictions later in life. Similarly, substance abuse can significantly worsen the symptoms of ADHD. As such, the co-occurence of these two conditions can cause people to fall prey to a vicious cycle that can wreak havoc in their lives.
People who develop substance use disorders alongside other mental health conditions are often termed by clinicians “dual diagnosis.” This term refers to individuals who suffer from two or more comorbid mental health conditions. People who suffer from comorbid ADHD and substance use disorders often find it more difficult to recover from both conditions than people who suffer from just one.
They also often experience more severe symptoms, including legal problems, academic and work difficulties, financial issues, and conflicts in relationships with friends and family. Understanding the close relationship between ADHD and addiction is crucial to treating these two conditions. It is highly recommended that dual diagnosis individuals suffering from ADHD and substance use disorders enroll in an outpatient program that offers comprehensive integrated treatment programs.
What is Attention Deficit Hyperactivity Disorder?
Attention deficit hyperactivity disorder, also known as ADHD, is a neurodevelopmental disorder that affects millions of people in the United States and throughout the world. Individuals with this condition often have difficulty managing their emotions and have impaired executive function, the set of cognitive processes responsible for controlling behavior and making decisions.
The condition, which generally first manifests in early childhood, can cause excessive activity, impulsivity, and make it difficult if not impossible for a person to pay attention, focus, or stay on task. These symptoms can make it difficult for people to function in their everyday lives, especially in the context or work and school.
Attention deficit hyperactivity disorder is not the same as inattention or having high energy, which are both states of mind that affect just about everyone at times. Rather, people with ADHD experience these symptoms to such a severe degree that they often struggle to complete daily tasks. Many develop unhealthy coping skills to make up for their impaired attention.
Contemporary research on ADHD suggests that some people with the condition, especially adults, are sometimes able to enter a state known as “hyperfocus,” during which every other concern fades into the background. These focused states occur most commonly during activities that provide constant neurochemical rewards, including video games, online chatting, and drug and alcohol abuse. As such, both the inattention and the hyperfocus that characterize ADHD can cause significant problems in a person’s life.
ADHD affects people of all ages, classes, and ethnic backgrounds. It is most commonly diagnosed in children, and statistics suggest that it may be more common in boys. However, some analysts believe that the condition may simply be more noticeable and therefore more frequently diagnosed in boys, since they tend on average to engage in more violent and antisocial behaviors.
The symptoms of ADHD are generally divided into two different subcategories, inattention and hyperactivity-impulsivity. The most common signs and symptoms of attention deficit hyperactivity disorder include:
- Difficulty holding attention on tasks
- Difficulty paying close attention to details
- Losing things that are necessary for tasks
- Trouble organizing tasks and activities
- Shorter attention span and being easily distracted
- Appearing forgetful during daily activities
- Problems completing tasks that are tedious or time-consuming
- Problems with structured work or schoolwork
- Fidgeting, squirming in seat
- Difficulty sitting still
- Leaving seat or walking around in inappropriate situations
- Feeling “on the go” or driven constantly
- Taking risks with no consideration of the dangers
- Answering questions rapidly
- Talking more than other people
- Interrupting or intruding on conversations
- Difficulty waiting ones turn, general impatience
What is Substance Use Disorder?
Clinicians use the term “substance use disorder” to refer to a wide range of addictions. A substance use disorder is a generalized umbrella term that encompasses a variety of drug and alcohol addictions.
People who are addicted to opiates like heroin or fentanyl can be diagnosed with opioid use disorder, whereas those who find it difficult to stop drinking despite dire consequences meet the conditions for alcohol use disorder. While substance use disorders go by a variety of names, depending on an individual’s substance of choice, they all share common traits and causal factors.
Substance use disorders are mental health conditions that have genetic, neurological, and psychosocial foundations. When a person has a substance use disorder, they generally experience a wide range of negative consequences from their drug or alcohol abuse but are unable to manage their use on their own.
Many people with addictions recognize their harmful consequences of their behavior, but the nature of addiction makes it impossible to quit for longer than a short period. This inability to quit or manage one’s substance abuse is the primary quality of a substance use disorder.
While tv shows and movies continually depict addicts and alcoholics as derelict and unkempt people living in poverty, the fact is that not all people with substance use disorders experience the same degree of devastation or consequences. In fact, it is very possible to have a two car garage and a sports car and suffer from addiction. Substance use disorders affect people of all classes, ethnic backgrounds, and genders.
One common misconception about substance use disorders is that people with addictions are simply not trying hard enough. It is essential to understand that substance use disorders are legitimate and widely recognized mental health conditions that absolutely require treatment. The misconception that they arise from personal weakness or failure of will power is highly damaging.
This stigma causes a high percentage of people with substance use disorders to avoid seeking treatment and instead try to manage their condition on their own. Unfortunately, due to the neurological and psychological effects of substance use disorders, staying sober without outside help is generally all but impossible. Addictions, by their very nature, deprive people of the ability to choose or make decisions.
Substance use disorders generally occur alongside physical dependence, but it is important to note that these two conditions are not the same. Physical dependence occurs when a person’s body and brain have acclimated to the effects of a drug, causing them to require higher quantities and also leading to withdrawal symptoms when they stop using it.
However, addicted individuals can sometimes get through withdrawal and curb their physical dependence for a period of time. However, this is not the same as treating an addiction. Individuals with substance use disorders will likely continue to obsess over their substance of choice long after they have withdrawn from it, even when they rationally understand that negative impact of relapsing. For this reason, it is absolutely essential for people with addictions to get treatment to address the underlying issues, which can range from anxiety disorder to ADHD.
Common symptoms of a substance use disorder include:
- Having intense urges to use a drug that make it impossible to think about anything else
- Needing higher and higher quantities of a drug over time in order to achieve the same effects
- Feeling that drug use needs to be engaged in regularly, daily or even many times a day
- Needing the guarantee that a steady supply will always be available
- Taking higher quantities of a drug than intended
- Failing to meet obligations at work or school because of substance abuse
- Failing to meet obligations to friends and family
- Reduced involvement in social or recreational activities
- Engaging in out of character behavior in order to obtain drugs, such as stealing
- Using drugs long after one has understood the negative consequences
- Suffering from withdrawal symptoms after one stops taking the drug
- Repeatedly failing in attempts to stop abusing the drug
Without outside help, addictions tend to get progressively more severe and damaging over time. Many drugs are directly harmful to people’s physical and mental health, while others alter people’s behavior in ways that negatively impact their lives. It is worth noting that beyond the effects of any individual drug, the phenomenon of addiction itself is often the cause of the greatest devastation.
Individuals who develop physical dependence and addiction prioritize substance abuse over just about everything else in their lives, including work, school, and relationships. The antisocial behavior that characterizes addiction can destroy relationships, causing conflicts or simply social isolation. Most people with addictions end up developing money issues, physical health issues, legal problems, and issues at work or school.
Consistent substance abuse is also associated with the development of comorbid mental illnesses, including attention deficit hyperactivity disorder. When mental health disorders like ADHD become more severe, substance abuse often becomes more attractive, given that it offers temporary relief from symptoms of emotional distress.
Understanding the Comorbidity of ADHD and Substance Use Disorder
Is ADHD a Factor in Addiction?
Adolescents and adults who suffer from ADHD are statistically more likely to develop substance abuse problems. The most common drugs of abuse are alcohol and cannabis. Research suggests that people with ADHD have a predisposition toward drug addiction because of neurochemical make-up of their brains. People with ADHD have altered reward pathways in their brains.
These altered reward pathways cause individuals with ADHD to produce less dopamine than other people. Dopamine, a neurotransmitter that is sometimes known as the brain’s reward chemical, is responsible for reinforcing behaviors. ADHD can cause people to depend on activities that produce surges in dopamine, including video games and psychoactive substances.
In fact, the reason that people develop physical dependence on drugs and alcohol is that these substances produce enormous quantities of dopamine. When a person drinks alcohol, takes an opiate, or snorts a line of cocaine, the main source of the euphoric feelings that people know as a “high” is dopamine. When dopamine is released, that causes a person to be more motivated to repeat the behaviors associated with it.
Each time a person uses a drug or takes an alcoholic drink, they release more dopamine and strengthen their behavioral pattern. Given the quantity of dopamine that most recreational drugs release, they can quickly take over the brain’s motivation and decision-making centers. While everyone who abuses drugs is susceptible to this kind of neurological damage, people with ADHD who already lack dopamine are especially vulnerable.
Why Do People With ADHD Abuse Drugs and Alcohol?
There are a number of reasons that drug and alcohol abuse are particularly appealing to people with ADHD. Like many mental health conditions, ADHD can lead to a significant amount of stress, anxiety, and dysfunction. People with ADHD often have difficulties engaging in activities that other people handle with ease, and this can cause them to feel alienated from others.
Many also find that their ability to function at school or at their jobs is impaired by their ADHD. It is no surprise, then, that many choose to pursue the escapism offered by drugs and alcohol. Recreational drugs offer temporary relief from the emotional distress that is often experienced by people suffering from mental illnesses like ADHD. Individuals who are not receiving treatment for their ADHD are even more likely to develop unhealthy reliance on recreational drugs.
Over time, however, no matter what kind of relief drugs and alcohol offer initially, they ultimately only exacerbate the symptoms of ADHD. While depressant drugs like alcohol and opioids, for instance, can calm the nerves of people with ADHD, when the effects wear off most people find that their central nervous systems are overstimulated.
While withdrawing from any drug, or when taking a substance in high quantities, it is all too common for people to have difficulty focusing, concentrating, and applying themselves — all of which are symptoms of ADHD. In cases of severe drug abuse, people can become disoriented, confused, suffer from memory and cognitive problems, and even have psychotic episodes. Once an individual has developed a drug addiction, however, they are likely to turn to substances to solve the very problems that drugs caused. As a result, ADHD and substance abuse can become a vicious cycle from which it is difficult to escape.
ADHD Medications and Addiction
The medications that physicians and psychiatrists prescribe to treat ADHD generally fall under a class of drugs known as stimulants. Prescription stimulants, including Adderall, Ritalin, Dexedrine, and Vyvanse, work by increasing the activity of the central nervous system (CNS). While prescription stimulants are highly effective at reducing the symptoms of ADHD, they come with a number of risks. Prescription stimulants are highly addictive.
Even people taking these drugs as prescribed have a high risk of developing physical dependence. While many people think of prescription drugs as inherently safer than so-called “street drugs,” the reality is that prescription stimulants are not any less dangerous than other stimulants, like crystal meth and cocaine. In fact, ADHD medications, which are composed of amphetamine, are almost identical on a chemical level to methamphetamine. While there is no denying the efficacy of ADHD medications for treating mental health problems, the fact remains that people with ADHD are exposing themselves to a drug that is widely abused.
Over time, people with legitimate prescriptions for drugs like Adderall and Ritalin may be tempted to abuse them. For many, this begins innocently enough, with perhaps a slight increase in dosage. College students in particular are likely to abuse prescription stimulants, since these drugs provide temporary cognitive boosts that are widely perceived as beneficial for studying. It doesn’t take long for such drug experimentation to lead to physical dependence, however.
Once addiction develops, many people feel trapped in an untenable situation. They may recognize a need to stop taking prescription stimulants as a result of their addiction, but they also need these drugs in order to treat the symptoms of ADHD. Many stay trapped in this catch-22 for years, while others turn to other substances like alcohol, exchanging one drug addiction for another.
Addiction and the Developing Brain
It is crucial to note that ADHD is more common in children than older adults. A number of studies have shown that children with ADHD have a higher likelihood of abusing alcohol in their adolescence. Not only do higher quantities of children with ADHD develop substance use disorders, they also tend to begin abusing alcohol at an earlier age than their peers. One study found that 40% of children with ADHD begin to abuse alcohol at the age of 14.
Unfortunately, one of the most important risk factors for the development of substance use disorders is beginning substance abuse at an earlier age. The developing brain is particularly good at reinforcing new skills and habits. This neurological pliability is the reason why children can learn languages faster than adults, but it is also the reason why children often struggle with drugs and alcohol more than people who begin in adulthood.
Researchers believe that the reason young people with ADHD begin abusing substances earlier is because of the effects of ADHD on their impulse control. Children with ADHD often struggle to control their own behavior. Most children with ADHD are prone to rash decisions, impulsivity, and hyperactivity. While many young people recognize the dangers of abusing drugs and alcohol, those with ADHD are more likely to act before they think. As a result, they may find themselves unintentionally paving the way for an addiction.
Do Drugs Cause ADHD?
Recreational drugs are known to increase the symptoms of many mental health disorders. In fact, people who develop addictions often develop mental health conditions as a result of their substance abuse. Common mental illnesses that arise from substance abuse include major depression and anxiety disorder. There is not much research that suggests that drug or alcohol abuse on its own can cause people to develop ADHD. However, there is no doubt that consistent substance abuse can exacerbate the symptoms of pre-existing mental health conditions, including ADHD.
Treating Alcoholism and Drug Abuse in People with ADHD
It is important to recognize that dual diagnosis individuals who suffer from substance use disorder alongside ADHD require a higher level of care. According to the National Institute on Drug Abuse, roughly 7.7 million people in the United States suffer from comorbid addictions and mental illnesses. Most people with addictions avoid seeking treatment. However, among the people who do reach out for help, a tragically low 9% of them receive treatment for both conditions.
The remaining 91% are likely to relapse, no matter how high quality their treatment program was. The reason for this is that ADHD, left untreated, is likely to trigger a relapse on drugs or alcohol. Likewise, people who continue to abuse drugs and alcohol will be effectively counteracting the positives of their ADHD treatments. For this reason, treating comorbid ADHD and addiction requires a comprehensive integrated treatment program.
Dual Diagnosis Program For ADHD and Addiction at NuView Treatment Center
Outpatient treatment programs are often the most effective option for individuals experiencing both addiction and ADHD. Outpatient programs offer treatment for a finite length of time every day, allowing individuals to return home each day to their social support systems.
Outpatient programs’ flexibility can be helpful for those who have commitments to family, school, or work. Outpatient programs also encourage residents to rebuild their lives in the outside world. By teaching people new coping tools for dealing with their ADHD and avoiding relapse, outpatient treatment centers provide dual diagnosis individuals with opportunities to put their newfound skills into practice in the real world.
NuView Treatment Center, a treatment center located in Los Angeles’ Westside, provides outpatient treatment at all levels of care. The programs we offer include:
- Partial hospitalization programs (PHPs)
- Intensive outpatient programs (IOPs)
- Outpatient programs (OPs)
- Aftercare planning
At NuView Treatment Center, we understand that recovering from addiction involves more than just abstaining from drugs and alcohol. Addictions are associated with a vast array of underlying issues, from economic problems to mental health conditions like ADHD. We recognize that treating an addiction successfully involves treating these other issues as well.
NuView Treatment Center’s individualized treatment plans involve holistic evidence-based methods. It is our goal to ensure that anyone who walks through our doors learns that coping tools and skills they need to remain sober and meet the challenges ahead. Recovering from addiction and ADHD is a lifelong process, but it is immensely rewarding.
At NuView Treatment Center, you will come to a better understanding of yourself, pursue new goals in sobriety, and develop a strong sober social support system.
There’s no need to suffer alone. If you are ready for a change, contact us today.