ADD/ADHD (attention deficit disorder/attention deficit hyperactivity disorder) is one of the most frequently diagnosed pediatric mental health conditions, affecting up to 5 percent of children in the United States, according to the American Academy of Child & Adolescent Psychiatry. For many of these children, symptoms will continue into adulthood, interfering with job prospects, relationships and financial stability. The National Institute of Mental Health estimates that close to 4.5 percent of adults between the ages of 18 and 44 live with ADHD can lead to these negative outcomes:
- Poor results in school or on the job
- Social isolation
- Relationship conflicts
- Low self-esteem
- Substance abuse
In the school system, ADD/ADHD often goes undiagnosed or undertreated. As a result, many adolescents and adults living with ADD turn to substance abuse as a coping mechanism. Alcohol and drugs can help curb some of the symptoms of ADD/ADHD, such as distractibility, restlessness and impulsivity. Unfortunately, these substances can also make certain symptoms worse.
For a lot of people with ADD, alcohol and drugs become a form of self-medication for the depression and anxiety that come from living with a debilitating disorder.
Understanding ADD and ADHD
ADD and ADHD share many symptoms. ADD, also known as Inattentive ADHD, is characterized by a short attention span and an inability to concentrate. Children with ADD may seem dreamy, unfocused, and easily distracted at home or at school. In ADHD, cognitive symptoms of inattention and poor concentration are accompanied by excessive activity and poor impulse control. To meet the diagnostic criteria for ADD/ADHD, as established by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, signs of the disorder must be present before age 12. Children must have at least six symptoms, while adults must have five. Behaviors must occur in at least two settings, such as home and school, or home and the workplace, to rule out the possibility of a learning disorder or other psychiatric condition.
ADHD symptoms are divided into two categories: inattentive and hyperactive/impulsive. Inattentive symptoms include:
- Inability to concentrate
- Difficulty with organization
- Failure to notice details
- Frequent daydreaming
- Difficulty following instructions
- Difficulty comprehending information
Hyperactive/impulsive behaviors are often more noticeable than inattentive behaviors. Children with these symptoms have trouble sitting still and are often unable to control the impulse to move or speak at inappropriate times. Symptoms in this category include:
- Interrupting other people
- Inability to sit for extended periods of time
- Difficulty staying quiet
- Difficulty controlling impulses
In the psychiatric community, these symptoms have been used to define three major categories of ADD/ADHD:
ADHD/Inattentive Type (also known as ADD)
Attention deficit hyperactivity disorder predominantly inattentive (ADHD-PI) is the formal name for the inattentive type of ADHD. It is one of two types of ADHD, and an increasing number of children and adults are being diagnosed with the disorder today in the US.
When a person is diagnosed as having ADHD hyperactivity/impulsive type, it is because that individual experiences significant problems with attention, hyperactivity, and impulsivity. When left untreated, ADHD can be a debilitating disorder that negatively affects many aspects of a person’s life – from performance at school and work to general well-being. In some places, like the UK, the definition of ADHD is extremely narrow and subsequently, only 0.5 -1 percent of the population is considered to have ADHD. In other places, like the US, the diagnostic definition is broader, resulting in nearly 10 percent of the population being diagnosed as having ADHD.
For many sufferers of attention deficit hyperactivity disorder, their diagnosis is either inattentive type or hyperactive/impulsive type. But for some individuals with ADHD, their type is both inattentive and hyperactive/impulsive. When this kind of ADHD is seen, it is referred to as ADHD combined type. Boys are more likely to be diagnosed with ADHD than girls. Although ADHD combined type can develop in any person, no matter where in the world they live or what kind of class they belong to, it is thought that ADHD diagnoses might be more common among people of certain backgrounds where behavior is held to a strict standard.
In children with inattentive ADHD, symptoms of distractibility predominate, while in those with hyperactive ADHD, symptoms of excessive physical activity are most evident. Children with the combined type display symptoms from both categories.
In adults, ADHD symptoms often look different. Instead of running, jumping or squirming at the wrong times, they may be restless and edgy. Instead of having poor concentration at learning tasks, they may have difficulty organizing their work lives or finishing projects at home. The most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) has updated the diagnostic criteria for ADD/ADHD to make it easier for clinicians to diagnose older adolescents and adults with this disorder. ADHD tests and scales can be administered to children, adults, teachers or parents. These assessment tools can help individuals and their families develop a personalized approach to treating ADHD.
Causes of ADD/ADHD
Children with close family members who have the symptoms of ADD/ADHD may be more likely to develop the condition themselves.
One school of thought holds that ADD/ADHD is caused by the chemical toxins in our environment, such as lead paint or pesticides. Maternal exposure to certain chemicals during pregnancy can also have an effect on a child’s neuropsychological development.
Drug, alcohol or tobacco abuse in pregnant women can contribute to behavioral problems in children. It is possible that substance abuse in pregnancy may increase the risk of ADHD.
Babies born prematurely or born with a low birth weight may have a higher risk of behavioral disorders like ADD/ADHD.
There has been some discussion in the psychiatric community about whether early childhood head injuries can increase the risk of ADD/ADHD. A study published in the British Medical Journal indicates that the rate of ADHD in children who sustained head injuries before age 2 was no higher than average. The journal added that there might be a non-causal relationship between ADHD and childhood head trauma. For instance, children with ADHD may be more likely to suffer injuries than children who don’t have the disorder. Although substance abuse often co-occurs with ADD/ADHD, drugs and alcohol do not cause this disorder. However, substance abuse can worsen some of the neurological and psychological effects of ADHD, such as edginess, poor concentration, depression and anxiety.
Increases Risk of Poor Outcomes
Substance abuse also increases the risk of poor outcomes like chronic health problems, unemployment, relationship conflicts, and isolation from others.
There is currently no single test to determine whether or not someone has ADHD. Instead, a psychologist or psychiatrist makes the diagnosis in the following ways:
- By interviewing the patient and/or family members
- By determining when the symptoms started and how long they have lasted
- By finding out where and when the behaviors appear
- By gauging the impact of the symptoms on the patient’s life
There are several neuropsychological tests and rating scales that can be helpful in the diagnostic process. Intelligence tests like the Wechsler Adult Intelligence Scale (WAIS-IV) test cognitive skills like working memory, problem solving, processing speed, and abstract reasoning. The following tests and scales are designed specifically to help diagnose or assess the severity of ADHD:
- ADD-H Comprehensive Teacher’s Rating Scale
- ADHD Rating Scale IV
- Attention Deficit Disorders Evaluation Scale
- Vanderbilt ADHD Diagnostic Parent Rating Scale
ADHD tests and scales can be administered to children, adults, teachers or parents. These assessment tools can help individuals and their families develop a personalized approach to treating ADHD.
Can ADHD Be Treated?
When ADD/ADHD is identified and diagnosed, it can be treated successfully. Treatment should be tailored to the needs of the child or adult with ADHD, and should draw from a variety of resources:
- Behavioral modification therapy
- Individual psychotherapy
- Social skills training
- Family education and training
- ADD/ADHD medication
ADD/ADHD medication is only one component of a comprehensive treatment program for this challenging disorder. Medications like Ritalin (methylphenidate), Adderall XR (dextroamphetamine-amphetamine) and Strattera (atomoxtine) can help correct the chemical imbalances in the brain that cause hyperactivity, inattention and impulsivity. Many of the most popular ADHD medications are based on amphetamines – central nervous system stimulants with a high potential for abuse and addiction. When prescribed in controlled doses and taken under a doctor’s supervision, these drugs can sharpen mental focus and reduce hyperactive behavior.
According to the Journal of Child Psychology and Psychiatry, stimulant ADHD medications are not associated with an increased risk of substance abuse. In fact, in a study of adults with ADHD, the rate of substance abuse was over 30 percent lower in individuals who took medication. The longer they took the medication, the less likely they were to abuse drugs or alcohol. A successful treatment plan empowers and motivates the individual with ADD to make positive changes in his or her life. Parents, spouses and partners should be actively included in the therapeutic process. If substance abuse is involved, recovery services must be integrated with psychiatric treatment to ensure the best outcomes.
Prevalence of Substance Abuse
Clinical research has shown that there is a strong link between ADHD and the risk of drug or alcohol addiction. The National Alliance on Mental Illness (NAMI) states that children with ADHD have higher rates of substance abuse and begin to abuse drugs or alcohol at an earlier age. For instance, in one study conducted at Massachusetts General Hospital, 21 percent of boys with ADHD had symptoms of a substance use disorder, compared with 16 percent of boys without ADHD. NAMI estimates that between 13 and 21 percent of teenagers are also struggling with an addiction to alcohol or drugs. What makes children and adults with ADHD more vulnerable to substance abuse?
Here are a few factors that may predispose people with this condition to abuse drugs or alcohol:
- Problems with impulse control
- Feelings of isolation at home or school
- Attempts to fit in with peers
- Depression or anxiety as a result of the disorder
- Feelings of low self-esteem
ADD/ADHD can have a profoundly negative impact on a young person’s self-esteem. The Journal of Attention Disorders notes that both boys and girls with ADHD are significantly more likely to be held back a grade in school or to drop out of school altogether. ADHD symptoms may also make children vulnerable to criticism by adults and parents, as well as bullying by peers. Substance abuse can be a way to escape temporarily from a highly stressful social environment. For children or adults who aren’t being treated for ADHD, alcohol or drugs can become a form of self-medication. According to Alcohol Research and Health, there may be a neurological connection between alcohol abuse and brain chemistry. Low levels of dopamine, a neurotransmitter, may be responsible for certain symptoms of ADHD, such as poor impulse control and problems with judgment and decision-making. Similarly, low dopamine levels have been linked to a predisposition to alcoholism.
Dual Diagnosis Treatment
Treating ADD/ADHD and substance abuse requires a multidimensional approach to recovery. The cognitive symptoms of ADHD — inattention, impulsivity and distractibility — can interfere with therapy, making rehab more difficult. A successful treatment program must take these challenges into account, so that the individual has a greater chance of success.
Integrated dual diagnosis therapy for ADHD and substance abuse includes:
- A self-paced treatment program that accommodates the client’s needs
- Motivational therapy to empower the client and build self-esteem
- Behavioral modification training to improve impulse control
- Group therapy to enhance social skills and build a support network
- Family counseling to engage parents and spouses in the healing process
- Medication management to provide pharmaceutical support
The addiction treatment specialists at Futures of Palm Beach are dedicated to helping individuals overcome the challenges of mental illness and addiction. We understand that the co-occurrence of psychiatric disorders and substance abuse is far from uncommon — in fact, a high percentage of people struggling with addiction have undiagnosed mental health issues.
Our exclusive treatment center in Palm Beach County, Florida is uniquely equipped to help our dually diagnosed clients achieve a successful recovery from drug or alcohol addiction. Contact our toll-free number to learn more about our innovative, evidence-based rehab programs.