ADHD in Adults and Self-Medication

Attention Deficit Hyperactivity Disorder (ADHD) is often thought of as a childhood disorder, but ADHD is common in adults as well, although it often goes undiagnosed. Adults with ADHD have an increased risk of substance use disorders (SUDs), in large part because they turn to substances to self-medicate their ADHD symptoms.

What Is ADHD?

ADHD is characterized by an inability to focus and hyperactivity or impulsivity that interferes with a person’s ability to function normally. It often onsets in childhood and continues into adulthood, although sometimes onset comes in adulthood.

No single cause of ADHD has been identified, but it’s thought to be caused by a combination of genetics, differences in brain structure, and environmental factors.

Symptoms of ADHD

Symptoms of ADHD can be divided into three categories.

Inattention symptoms

• Disorganization
• Forgetfulness
• Lack of attention to detail

Hyperactivity symptoms

• Excessive talking
• Fidgeting
• Trouble keeping still

Impulsivity symptoms

• Impatience
• Interrupting

Some people have only inattention symptoms, others have only hyperactivity/impulsivity symptoms, and some have a combination of all the symptoms.

ADHD and Substance Abuse

Much research shows that people with ADHD have a higher rate of substance use disorders than the rest of the population. Many reasons for this have been hypothesized, including:

• Self-Medication: People with ADHD may use substances to ease their symptoms. Commonly abused substances include stimulants, alcohol, and marijuana.
• Neurobiological Factors: People with ADHD have deficits in dopamine transmission. Dopamine is a brain chemical associated with pleasure. Substance use boosts dopamine, thus compensating for the deficits associated with ADHD. However, the brain changes with substance use, needing the substance to produce feelings of pleasure, which leads to addiction.
• Impulsivity: The impulsivity that comes from ADHD can lead to risky behaviors, such as substance use.
• Genetics: Some research shows that certain genes may hold an increased risk for both ADHD and addiction.
• Environment: Because ADHD impairs normal functioning, it may lead to problems in a person’s life that are stressful. They may then turn to substance use to cope with that stress.

Is ADHD Medication Addictive?

ADHD is often treated with prescribed stimulants including Adderall and Ritalin. When taken as prescribed, they do not usually lead to addiction. However, these medications are often misused. Misuse can include taking more than prescribed or snorting or injecting them for faster effect. This misuse can lead to addiction.

In adults with undiagnosed ADHD who have not been prescribed medication, substance use disorders may involve alcohol or marijuana that’s used to relieve the stress that ADHD symptoms may cause. They may also involve illegal stimulants like cocaine which can temporarily increase focus in those with the inattention symptoms of ADHD.

Treating ADHD and Addiction

When someone has ADHD and an addiction at the same time they are known as co-occurring disorders. Treating one has to include treatment for the other in order for recovery to be possible. It’s not uncommon for people with substance use disorders to seek treatment and be diagnosed with ADHD or another mental health disorder upon their initial assessment at an addiction treatment facility.

In these cases, a personalized treatment plan must be created to address both disorders.

The first line of treatment for ADHD is medication, so when co-occurring disorders are identified, prescribing medication may be the first step. People with ADHD also can benefit from cognitive behavioral therapy (CBT), which is the most commonly used therapy to treat SUDs, as well as other types of therapy.  In treatment, a combination of medication and various types of therapy can thus concurrently treat the ADHD and the substance use disorder.

In CBT, patients learn ways to cope with their ADHD or other mental health disorder without abusing substances, as well as strategies to control their negative or irrational thoughts and emotions.

Dialectical behavior therapy (DBT) is another type of therapy that may be used in treatment. It is similar to CBT, but focuses on mindfulness and challenging intense emotions with realistic thoughts.

Group therapy is an important part of SUD treatment, and can also be effective for ADHD. Peers in treatment are often suffering from other mental health disorders as well, and can offer share support and strategies. With regular group interaction, patients also feel less isolated and can develop and can develop mutually supportive relationships.

Treatment Structure

Treatment may be inpatient or outpatient, generally offered in one of three structures.

Inpatient Treatment

Substance use disorder treatment ideally starts with a period of inpatient treatment that lasts for 30 to 90 days. This starts with a period of detox, in which the patient is kept comfortable and safe as they withdraw from the substance. Medications for the ADHD will start during this period as well, along with intensive therapy, both individually and in groups. Throughout the inpatient stay, therapy will continue and medications may be adjusted as necessary.

Partial Hospitalization Program (PHP)

A partial hospitalization program (PHP) allows you to live at home while attending treatment for four to six hours per day, usually five days a week. The program may last anywhere from four weeks to ten weeks. The treatment consists of therapy similar to that of inpatient treatment, both in groups and individually. A PHP can still include medication for the ADHD.

More often than not, a PHP program is a transitional step that occurs after inpatient treatment, although it can be an alternative to inpatient treatment.

Intensive Outpatient Program (IOP)

An intensive outpatient program (IOP) consists of two to three hours of therapy several days a week for eight to twelve weeks. Often, sessions are held in the evenings so that you can still go to work or attend school. Treatment, again, involves individual and group therapy.

IOPs can be standalone treatments, or they can be attended after inpatient treatment, PHPs, or both.

Comprehensive Treatment

The most effective treatment for SUDs, particularly if they are severe, is a comprehensive treatment program that consists of an inpatient program, a PHP, and an IOP. Research shows that success rates increase the longer the treatment program. Even after IOP, support should continue through support groups, individual therapy, or both. This can support both the ADHD and addiction recovery.

In Closing

ADHD is a complex mental health disorder that can increase the risk of developing a substance use disorder in part because of a desire to self-medicate ADHD symptoms. However, treatment for both can lead to lasting recovery. If you are suffering from ADHD and substance abuse, Bridges of Hope is here to help. We are committed to providing comprehensive, individualized, compassionate care. Give us a call today to learn more.