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Quandary in a Conundrum: Addiction and ADHD

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By Dr. John Dyben, DHSc, MCAP, CMHP – Chief Clinical Officer 

Attention Deficit Hyperactivity Disorder (ADHD) and addiction may have a cozier relationship than many realize, at least according to much of the scientific literature.

Recent studies have presented estimates that the prevalence of ADHD in adults with Substance Use Disorders (SUD) might be around 20% as opposed to 2.5% in adults without SUD. The actual incidence is difficult to estimate, given the fact that some symptoms of addiction can look just like symptoms of ADHD.

Still, there is evidence that people diagnosed with ADHD are more likely to develop SUD and that if they do enter treatment, they are more likely to do poorly if the symptoms are not addressed. And this is where things start to get sticky. You see, in people without SUD who have ADHD, the prevailing intervention is medicine, with the usual type being psychostimulants such as Ritalin and Adderall, for example. While 40% to 75% of adults with ADHD respond well to this pharmacological treatment with little problem, this does not seem to be the case for individuals who also have SUD.

The first problem is that stimulants do not provide significantly measurable results in improving ADHD or SUD symptoms in most cases where they are co-occurring. The second, and perhaps more critical problem, is that these drugs have a very high abuse potential and present a barrier to patients’ recovery.

So, we find ourselves in a situation where two conditions commonly occur together, they each make the other worse, and the standard treatment is less effective for one of the conditions and is an inherent risk factor for the other. Now that’s a quandary in a conundrum!

Fortunately, there is more than one avenue for addressing ADHD in adults with SUD. This becomes especially relevant as most of these tools will benefit patients whether they have ADHD or not.

Individual and group cognitive and behavioral therapy benefits patients with both conditions. Therapy provides a safe emotional space where patients can learn to access the parasympathetic nervous system and decrease a sense of constant stimulation. Biofeedback and neurofeedback provide opportunities for individuals to essentially retrain the brain, increasing calm and focus. Physical exercise, particularly cardio, has been demonstrated to facilitate acute improvement in ADHD symptoms and may even have long term benefits in mitigating symptoms. Also, making improvements in sleep habits and diet have positive effects on decreasing ADHD symptoms.

The best part is that all of these interventions benefit individuals, whether they have ADHD or not! And along with these approaches, some medicines have been used to treat ADHD in adults that are not stimulants and have little to no documented abuse potential.

The research on adults with ADHD and SUD is in no way congruent, and there remains much to be clarified. For those with SUD, especially addiction, who believe they also have ADHD, it is critical to recognize that addiction is terminal, and recovery must be a priority. This does not mean to ignore ADHD or anything else. Instead, get well assessed by a psychologist or psychiatrist who understands and treats both conditions. Engage in therapy, try biofeedback and neurofeedback, increase physical exercise, and work with professionals to help improve your sleep and diet. And if you want to talk about medications, be sure your psychiatrist is certified in addiction psychiatry. Your quality of life is worth every one of these actions!

References:

Carpentier, P. J., & Levin, F. R. (2017). Pharmacological treatment of ADHD in addicted patients: what does the literature tell us? Harvard review of psychiatry25(2), 50.

Crunelle, C. L., van den Brink, W., Moggi, F., Konstenius, M., Franck, J., Levin, F. R., van de Glind, G., Demetrovics, Z., Coetzee, C., Luderer, M., Schellekens, A., ICASA consensus group, & Matthys, F. (2018). International Consensus Statement on Screening, Diagnosis, and Treatment of Substance Use Disorder Patients with Comorbid Attention Deficit/Hyperactivity Disorder. European addiction research24(1), 43–51. https://doi.org/10.1159/000487767

Den Heijer, A. E., Groen, Y., Tucha, L., Fuermaier, A. B., Koerts, J., Lange, K. W., Thome, J., & Tucha, O. (2017). Sweat it out? The effects of physical exercise on cognition and behavior in children and adults with ADHD: a systematic literature review. Journal of neural transmission (Vienna, Austria: 1996)124(Suppl 1), 3–26. https://doi.org/10.1007/s00702-016-1593-7

Schellekens, A. F., van den Brink, W., Kiefer, F., & Goudriaan, A. E. (2020). Often Overlooked and Ignored, but Do Not Underestimate Its Relevance: ADHD in Addiction–Addiction in ADHD. European Addiction Research26(4-5), 169-172.