First, if you struggle with persistent symptoms of inattention (e.g., not paying close attention to details, making careless mistakes at work, losing important items), and have symptoms of hyperactivity and impulsivity (e.g., being fidgety, feeling restless, talking excessively), you might have Attention-Deficit/Hyperactivity Disorder (ADHD). If you also use substances despite the negative consequences they bring, it is possible you have developed a substance use disorder. Having both at the same time is known as a dual diagnosis or co-occurring disorders. To ensure you get the best treatment for both, it’s important to have all the facts.
If you also use substances despite the negative consequences they bring, it is possible you have developed a substance use disorder.
What Is Adult ADHD?
Attention-Deficit/Hyperactivity Disorder is a developmental disorder that is characterized by a persistent pattern of inattention or hyperactivity that has a negative impact on your functioning or development.1 To be given a diagnosis of ADHD, symptoms must be present in more than one setting—such as at home and at work.1 Typically, you’d complete an assessment with a mental health therapist to determine if you meet the criteria for an ADHD diagnosis. In some cases, further psychological testing may be needed to make a definitive diagnosis.
While ADHD begins in childhood, it may continue into adulthood—this is true for approximately 10–60% of those diagnosed as children.2 And while some people don’t meet the full criteria for the disorder, an estimated 4.4% of the US adult population presents with clinically significant ADHD symptoms.3
Adult ADHD looks similar to childhood ADHD; however, symptoms often decrease in intensity, especially those related to hyperactivity.2 Some examples of hyperactivity in adulthood are restlessness or wearing others out with activity, rather than running around like children do.1
Other examples of how adult ADHD may manifest itself include:1
- Not paying close attention to details.
- Making careless mistakes at school, work, or during other activities.
- Difficulty sustaining attention during tasks.
- Not seeming to listen when spoken to.
- Failing to follow through on instructions.
- Difficulty with organization, especially tasks and activities.
- Avoiding, disliking, or being reluctant to participate in tasks that require sustained mental effort, such as completing forms.
- Regularly losing important items, such as keys, wallet, eyeglasses, or cell phone.
- Being easily distracted.
- Often forgetful in daily activities, such as running errands, returning calls, paying bills, or keeping appointments.
- Hyperactivity and impulsivity:
- Being constantly fidgety.
- Inability to stay in your seat in situations when staying seated is expected, such as in the office.
- Struggling with engaging quietly in leisure activities.
- Talking excessively.
- Struggling with waiting, such as for a turn in line or in a conversation.
- Interrupting or intruding on others, such as taking over what others are doing.
- ADHD has also been found to be associated with:
- Reduced academic attainment (e.g., highest degree of education to be successfully completed).
- Poorer occupational performance, attainment, and attendance.
- A higher probability of unemployment.
- Elevated interpersonal conflict.
- A hesitation to engage in tasks that require sustained effort, which can lead to vocational, social, and interpersonal issues.
- Impulsivity and elevated novelty seeking.
- A higher risk of substance use disorders.
Research has shown certain neurobiological causes underlying ADHD. For instance, the area of the brain that controls working memory, and involves the ability to retain information while processing new information, tends to be smaller in those with ADHD.4 It is believed that this is one reason for difficulties with goal-directed and on-task behavior.4 Research has also found that there is a genetic component to ADHD, so if a first-degree relative has the disorder, you have a higher risk for developing it too.4
What Is Addiction?
Many people drink alcohol, or recreationally use marijuana in states where it’s legal, so it can be tricky to know when social use has become problematic. A substance use disorder (the diagnostic term given to drug or alcohol addiction) can be roughly conceptualized as continued use of a substance despite significant problems related to that use (e.g., legal issues, relationship problems, issues at work).1 Symptoms of a substance use disorder can be cognitive, behavioral, or physiological, so it’s best to have an assessment done by a chemical dependency or mental health counselor to get the most accurate diagnosis.1
Know when social use has become problematic.
US prevalence rates for problematic use vary among different substances:1
- Alcohol use disorder is approximately 4.6% in 12- to 17-year-olds and 8.5% among adults 18 years and older.
- Cannabis use disorder is around 3.4% in 12- to 17-year-olds and 1.5% in adults.
- Cocaine use disorder is 0.2% among 12- to 17-year-olds and 0.3% for those 18 and older.
- Amphetamine-type stimulant use disorder is estimated around 0.2% in 12- to 17-year-olds and 0.2% in adults.
As mentioned before, having both a mental health and a substance abuse disorder is known as a dual diagnosis. And for people with ADHD, addictions to certain substances seem more common.
For instance, adolescents and adults with ADHD smoke cigarettes at twice the rate of those who do not have the disorder, and 9–30% of adults with ADHD have issues with substance abuse or dependence.4 Those with adult ADHD also tend to engage in more severe substance abuse and have addictions that persist longer compared to their peers who do not have ADHD.3,4
Interestingly, when both disorders are present, they may serve to reinforce each other. For example, someone who struggles with ADHD may self-medicate with alcohol or marijuana in an attempt to relax or reduce their hyperactivity. However, continued substance use can lead to problems like legal issues, poor work attendance, and interpersonal conflict, which can exacerbate ADHD symptoms, such as the inability to focus on a task. This, in turn, may encourage that person to continue using to temporarily reduce these symptoms, which continues the cycle. Proper treatment for each disorder can help put an end to such a feedback loop.
Treating Both Disorders
Historically, someone presenting with both ADHD and a substance use disorder was treated for the drug or alcohol addiction first.3 However, within the substance abuse and behavioral health treatment spheres, there has been an increased move to address both issues simultaneously, taking into consideration the symptoms of each disorder and how they interact with each other.
Prescription stimulant medications such as Ritalin and Adderall are frequently the first line of treatment for ADHD. Diligent treatment professionals will take extra caution with pharmaceutical approaches if they know that a substance use disorder also exists. Non-stimulant medications such as atomoxetine (Strattera), bupropion (Wellbutrin), and certain tricyclic antidepressants) may actually be preferred for those with ADHD and an addiction.3 However, if non-stimulant medications do not prove effective, stimulant medications may be used with caution and close monitoring.3 There has been some concern that adults with ADHD abuse their stimulant ADHD medication, which then leads to an addiction, but research does not support this.3,4 In fact, studies show that using stimulant medication to treat ADHD generally reduces the risk for substance use disorders.3,4
In addition to medication, psychoeducation is important in treating both disorders. This allows a patient to learn about each disorder and get the help they need to address any related problems, such as:3
- Poor time management.
- Poor organizational skills.
- Poor problem-solving skills.
- Social concerns.
- Problems with self-esteem.
- Interpersonal conflict.
- Poor coping skills.
These concerns may be addressed by learning specific skills and acquiring tools that can be applied to daily life to help them become more aware of and better manage their symptoms. Cognitive behavioral therapy (CBT) has been found to be especially helpful in accomplishing this. CBT not only allows a person to focus on the thoughts, behaviors, and emotions that are related to their ADHD and substance abuse symptoms, it also provides a structure to learn in, which is particularly important for those with ADHD.3 Another advantage of CBT is that it can be done both individually and in group settings.
Family therapy can help everyone within the patient’s closest circle to understand the co-occurring disorders and learn how best to help and encourage their loved one. It may open up lines of communication that can lead to the patient getting the support they need, encourage behavior that is beneficial to their health and wellbeing (such as practicing coping skills more often at home), increase empathy, and reduce conflict within the family.
If you would like support or more information about ADHD and substance use disorders, these organizations are a good start:
- Attention Deficit Disorder Association: The ADDA provides information, resources, and networking opportunities for adults with ADHD.
- Children and Adults with Attention-Deficit/Hyperactivity Disorder: CHADD is a national non-profit organization that provides education, advocacy, and support for those with ADHD.
- Substance Abuse and Mental Health Services Administration’s National Helpline: SAMHSA’s National Helpline is a free, confidential, 24/7, 365-days-a-year service that provides treatment referrals and information for individuals and families struggling with mental health and substance use disorders.
- Volunteers of America: VOA is a non-profit organization that provides services to those with mental health and substance use concerns.
- National Alliance on Mental Illness: NAMI is a national organization that provides education, advocacy, and support to those who have been impacted by a mental health disorder, including ADHD. NAMI offers a toll-free help line as well.
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition. Arlington, VA: American Psychiatric Publishing.
- Gentile, J.P., Atiq, R., & Gillig, P.M. (2006). Adult ADHD. Psychiatry, 3(8), 25–30.
- Kolar, D., Keller, A., Golfinopoulos, M., Cumyn, L., Syer, C., & Hechtman, L. (2008). Treatment of Adults with Attention-Deficit/Hyperactivity Disorder. Neuropsychiatric Disease and Treatment, 4(2), 389–403.
- Wilens, T.E. and Spencer, T.J. (2010). Understanding Attention-Deficit/Hyperactivity Disorder from Childhood to Adulthood. Postgraduate Medical Journal, 122(5), 97–109.