Scott’s life did not truly begin to spiral out of control until he finally started to pursue sobriety. He had been addicted to pornography for the better part of 10 years. He finally confessed to his soon to be bride before they got married. Through his own willpower, he was able to maintain an extended period of sobriety. In the years that followed there would be a number of relapses, but bigger issues such as frequent unemployment, procrastination, poor time management, and difficulty with attention to detail began creeping into his marriage. It was not until Scott and his wife began marriage counseling six years into their union that ADHD (attention deficit hyperactivity disorder) would be diagnosed.
Scott functioned well during his time as an addict. It turned out that he was using his addiction as a coping mechanism for ADHD. When the addiction was removed, so was his ability to cope with the ADHD. His story is not uncommon. Many people today who suffer from addiction also suffer from ADHD.
Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that causes individuals to have bouts of hyperactivity that affect their everyday life. Colloquially, a lot of people refer to this disorder as ADD (Attention Deficit Disorder). However, the Diagnostic and Statistical Manual Fifth Edition (DSM-5, DSM-V) recognizes the disorder as ADHD due to the significance of the inattentive part of the condition. As a result, ADHD has become the medically recognized term. Adolescents with ADHD often have difficulty combating boredom, sitting still, paying attention or controlling impulsive behaviour. People with adult ADHD may have poor communication skills, a tendency for distraction and procrastination, and difficulty managing complex projects.
Though no knows exactly what causes ADHD, research indicates that ADHD patients have lower levels of neurotransmitters like dopamine, a chemical in the brain that is released when something positive happens. As a result, it tells someone that what they have just done or experienced is positive. This is also why those with ADHD can be at higher risk of drug abuse or misuse, since substances such as stimulant drugs, amphetamines and alcohol provide a strong surge of dopamine that the brain is lacking.
It is important to work with your healthcare professional when diagnosing ADHD as many of the signs and symptoms can be difficult to distinguish from regular behaviour, especially in children and adolescents. The DSM-5 (DSM-V) describes three different presentations of ADHD symptoms:
Predominantly Inattentive Presentation:
Predominantly Hyperactive-Impulsive Presentation:
(Please note this list is not exhaustive, and you should always work with a trained medical professional for an accurate diagnosis.)
Scott always thought that those with ADHD had trouble sitting still or talked excessively. He did not suffer from these traits and never considered ADHD as a possible contributor to his addiction. His ADHD presented more in the predominately inattentive category as he often struggled with completing tasks (jumping from task to task), poor memory, time management, and procrastination among others.
Approximately 25% of adults that enter a treatment centre for alcohol or substance abuse also suffer from ADHD. ADHD is five to 10 times more common among adult alcoholics than it is in the general population. Studies also indicate that 14% of adolescents aged 15-17 with ADHD also suffered from alcohol abuse. Distraction, impulsiveness, inattention, and boredom can all be commonalities between ADHD and addiction. Both ADHD and addiction can make even the simplest task labourious. So, why do so many with ADHD also suffer from a dependency?
Dopamine is one of several neurotransmitters your body makes to send messages between nerve cells and to determine how we interact with the world around us. It plays a role in how the body feels pleasure, thinks and plans, strives, focuses, and finds things interesting. It is the body’s motivation reward centre. In essence, your body receives an input, your brain uses transporter cells to spread dopamine across four major pathways in the brain, your brain perceives it as good, you feel joy and pleasure.
ADHD and addiction both play a role in how the body interacts with dopamine. In those with ADHD, dopamine levels are often lower than those without ADHD, and the body’s nervous system is easily overloaded with incoming stimuli. This can lead to typical traits of inattentiveness, fidgeting, impulsive behaviour, or extreme restlessness (as described above). For those suffering from addictions, elevated dopamine levels are often associated with the ‘high’ an addict feels after drug use or engagement in an addictive behaviour. Those with untreated or unmedicated ADHD may turn to illegal drugs or other addictive behaviours, in spite of negative consequences or side effects, to raise the dopamine levels in their bodies.
Addiction is often used as a coping mechanism for those who suffer with untreated ADHD because it has a calming effect on the mind and body. Those with ADHD may use drugs, alcohol and nicotine, not to get high, but to improve their executive function. ADHD medications such as Ritalin, Adderall, and atomoxetine stimulate the body’s production of dopamine the same way cocaine does. Hence why those with undiagnosed or untreated ADHD may turn to substance abuse to give themselves the increased dopamine levels that their body needs. The only difference is that ADHD medications raise dopamine levels (and other neurotransmitters, depending on the medication) much more slowly. They work over hours versus seconds.
Studies have shown that stimulant medications are less likely to be addictive in children and adults as long as they are administered under the care of a healthcare practitioner and the recommended dosages are followed. One study followed 100 boys who took medication for ADHD for 10 years. The study concluded that the boys had no greater risk for substance abuse disorders than those who did not take the drugs. Once an ADHD diagnosis has been confirmed, the earlier stimulant medications such as Ritalin, atomoxetine and Adderall are started, the lower the risk of substance abuse issues during adulthood.
Our genes shape who we are. They determine our hair colour, eye colour, and skin colour. Additionally, they shape our personalities, traits, and interests among many other things. Genetically, if there is a family history of substance abuse or a psychiatric or mental health disorder (like ADHD), the risk of addiction increases. Research indicates that both conditions tend to run in families, and they may even stem from the same genes.
An individual with ADHD is four times more likely to have a relative who was also diagnosed with attention deficit disorder. Scott suspects that his father, a high functioning alcoholic, has undiagnosed ADHD and used alcohol to self-medicate his symptoms.
Additionally, NIDA scientists have found that genetic makeup can influence the probability that an individual may experience a substance use disorder (SUD) during adolescence or adulthood. When the genes for both ADHD and addiction are present it can prove to set the stage for a chemical or behaviourial dependency. The research is ongoing into the role our genes play on ADHD and addiction, but there are links that could contribute to a predisposition. However, an ADHD diagnosis is far from a guarantee of an addiction, and the opposite is true as well.
If you or a loved one has received the dual diagnosis of ADHD and addiction, it is recommended that an integrated treatment plan that addresses both disorders be developed. In children or adolescents, proper ADHD diagnosis at an early age can reduce the risk factors for future drug or alcohol dependence. There are several medication options available, including stimulant and non-stimulant options, in addition to a variety of other tools that can be used in recovery, such as cognitive behavioural therapy, lifestyle coaching, exercise programs, and stress management strategies, among others.
Every individual is unique in their genetic makeup and so is their recovery. In some cases, the addictive behaviour becomes repulsive once the ADHD symptoms are treated. In others, the addiction should be managed first before treatment of ADHD can begin. It is important to work closely with your healthcare practitioner or therapist, and potentially a rehabilitation facility, to ensure that treatment progress is monitored closely.
While there is currently no cure for ADHD, the right treatment program and outlook on life can make it manageable. Many celebrities and athletes alike have struggled with ADHD including Howie Mandel, who has become an advocate for ADHD, OCD, and other comorbid conditions, as well as Justin Timberlake who has been diagnosed with OCD and ADHD. Athletes such as Michael Phelps, MLB pitcher Scott Eyre, and NFL Hall of Famer Terry Bradshaw all have confirmed ADHD diagnosis. Visit the CCFA blog on celebrities and addiction (and you will discover that you are not alone in a diagnosis of ADHD or addiction. Not only can ADHD and addiction be conquered, but any individual can go on to lead a successful and prosperous life. Recovery is always possible.
About ADHD – https://chadd.org/about-adhd/overview/
Adults and ADHD – https://chadd.org/for-adults/workplace-issues/
ADHD and Dopamine – https://jamanetwork.com/journals/jama/fullarticle/184547
Signs and Symptoms of ADHD – https://chadd.org/about-adhd/overview/
ADHD and Addiction Statistic – https://www.addictioncenter.com/addiction/adhd/
ADHD and Addiction Statistics – https://www.webmd.com/add-adhd/adhd-and-substance-abuse-is-there-a-link#1
What is dopamine – https://www.webmd.com/mental-health/what-is-dopamine#1
Dopamine regulation and ADHD – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2626918/
Addiction as a Coping Mechanism – https://www.webmd.com/add-adhd/adhd-and-substance-abuse-is-there-a-link#2
Celebrities with ADHD – https://www.additudemag.com/successful-people-with-adhd-learning-disabilities/
Photo credit: Marco Verch. This picture has a Creative Commons attribution license.— ADHD, Behavioural Addiction, Drug Abuse & Drug Addiction, Drug Use, Dual Diagnosis, Impulse Control Disorder, Substance Abuse