ADHD and substance abuse – a tangled web

Recent studies suggest that there is significant overlap between adult Attention Deficit Hyperactivity Disorder (ADHD) and substance abuse (SA). It is estimated that between 25-40% of individuals with SA may also have childhood and/or adult ADHD. Since intoxication and withdrawal syndromes impact attention and cognition, ADHD tends to be underdiagnosed in this population.

The relationship between ADHD and SA is complicated and persistent. In childhood, undiagnosed ADHD can lead to low self-esteem, disappointment, and frustration in school. These critical thoughts can in turn lead to substance use to self-medicate these negative thoughts and feelings. Impulsive behavior is amplified in teens with ADHD, and can lead to experimentation with substances and difficulty staying sober. Complicating matters further, children and adolescents with ADHD are often prescribed stimulant medications which can be easy to abuse, share, and sell, encouraging further SA.

Adults with untreated ADHD tend to have problems with achieving long-term goals in education, work, and relationships. They can also be impulsive and have poor organization skills which contribute to a level of functioning lower than expected for their intelligence. Adults also have negative self-critical thoughts and poor self-esteem, leading to depression and anxiety, which in turn can lead to SA. Making things more complicated, if an adult with SA is diagnosed with ADHD, most doctors will not prescribe stimulant medication for fear that the ADHD medication will itself become a substance of abuse.

I often work with individuals who have never met with a psychiatrist before and are presenting with this complicated triad of ADHD / SA / mood symptoms. I try to untangle this web by first treating the substance abuse, then the mood problems, then the ADHD symptoms. Of course, while treating particular symptoms with psychotherapy and/or medication, we remain aware and sensitive to all the components of the tangled web. If you are an adult living with ADHD and SA, try to find a therapist or doctor who is able to understand your symptoms in a holistic manner, and then work with you on specific issues to improve your symptoms.

Live Mentally Healthy,
Cognitive Psychiatry of Chapel Hill

Cognitive Psychiatry of Chapel Hill

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