Are ADHD And Addiction Associated?

In the practice of addiction medicine, Attention Deficit Hyperactivity Disorder (ADHD) is a common dual diagnosis. This leads people to wonder if ADHD is a risk factor for future substance use or if undiagnosed or untreated ADHD is associated with future addiction.

This is a hard question to answer, as ADHD is often diagnosed during the treatment of substance use disorders (SUDs), like when someone is in detox or rehab.

Therefore, an important question arises: is it the drugs that are causing these symptoms, or is it ADHD? This question needs to be asked by both the patient and the clinical practitioner. It could apply to any condition that substance abuse mimics or is the result of, from depression to bipolar disorder or psychosis.

Breaking Down ADHD

ADHD is a neurodevelopmental disorder where the prevailing symptoms of inattentiveness and/or hyperactivity cause impairment of functioning in two or more major areas of someone’s life. This is often seen first in children, who (after passing through stages of life where being hyperactive, restless, or inattentive is part of development) are subsequently identified as being persistently more hyperactive and/or inattentive than their peers. Because of these traits, their academic performance and other areas of life can be affected.

It is possible to receive an ADHD diagnosis in adulthood; however, current diagnostic criteria maintains that a person has to have some symptom onset in childhood to receive one.

ADHD And Addiction

Before assuming an ADHD diagnosis, it’s important for those who suffer from addiction to receive an assessment by a professional who specializes in diagnosing mental health conditions. Psychiatrists, certain neurologists, psychologists, and clinicians proficient in mental health diagnosis can all conduct assessments that will take into consideration symptoms that occur while not under the effects of substance use.

Criteria for the diagnosis has to be met, and those symptoms which occur exclusively during substance use do not qualify. Many conditions other than ADHD can cause someone to feel or be “inattentive,” as manifested by having difficulty concentrating, focusing, sustaining attention, and struggling to stay on task. Feelings of restlessness, fidgetiness, or hyperactivity may occur as well. These conditions can include depression, anxiety, bipolar disorder, metabolic conditions, neurological conditions, and even stress.

During my time in practice, I have assessed many people who report having ADHD because someone else diagnosed them or they feel they have it. After proper evaluation, their symptoms were purely secondary to alcohol or substance. However, it becomes difficult for the patient to give up the identity they had connected to ADHD.

Mind you, many patients do have ADHD and need to be appropriately treated, but the caveat here is that drug and alcohol abuse affects our brains, which must be taken into account when diagnosing ADHD. Unfortunately, addiction is hallmarked by specific characteristics, such as the inability to abstain from drugs/alcohol, behavioral loss of control, cravings, dysfunctional recognition of negative consequences, and emotional ups and downs. Additionally, those suffering from addiction often have the inability to tolerate negative situations and the inability to delay one’s self-gratification. This can be a dangerous combo when mixing an inaccurate diagnosis of ADHD with an SUD, as impulse control is needed to refrain from substance use.

If you are diagnosed with ADHD or believe you have ADHD and are struggling with substance use, please speak with your doctor who can properly assess and diagnose you.

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Diagnostic Criteria For ADHD

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), the following criteria exist regarding ADHD.

ADHD symptoms and/or behaviors need to have persisted for six or more months in two or more different settings (e.g., school, home, church) and have negatively impacted academic, social, and/or occupational functioning.

Six or more symptoms are necessary for diagnosis in patients 17 years and younger; in those 17+ years, five or more symptoms are necessary. Symptoms are classified as mild, moderate, or severe based on severity.

Additional Requirements for Diagnosis:

  • Symptoms present before age 12.
  • Symptoms would not be better accounted for by a different psychiatric disorder (e.g., mood disorder, anxiety disorder) and do not occur exclusively during a psychotic disorder (e.g., schizophrenia).
  • Symptoms are not exclusively a manifestation of oppositional behavior.

The three types of ADHD (Inattentive, Hyperactive/Impulsive, and Combo) share many of the same criteria while also having unique aspects.

Inattentive Type Diagnosis Criteria

  • Displays poor listening skills.
  • Loses or misplaces items needed to complete activities or tasks.
  • Sidetracked by external or unimportant stimuli.
  • Forgets daily activities.
  • Diminished attention span.
  • Lacks the ability to complete schoolwork and other assignments or to follow instructions.
  • Avoids or is disinclined to begin homework or activities requiring concentration.
  • Fails to focus on details or makes thoughtless mistakes in schoolwork or assignments.

Hyperactive/Impulsive Type Diagnosis Criteria Hyperactive Symptoms:

  • Squirms when seated or fidgets with feet/hands.
  • Marked restlessness that is difficult to control.
  • Appears to be driven by “a motor” or is often “on the go.”
  • Lacks the ability to play and engage in leisure activities quietly.
  • Incapable of staying seated in class.

Combined Type:

The patient meets both inattentive and hyperactive/impulsive criteria for the past six months.

Help Is Available

If you are struggling with ADHD and substance abuse, many treatment and therapy options are available. Explore our online therapy directory or contact a treatment provider to find out more information on treatment for ADHD and addiction.

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Dr. Ashish Bhatt

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  • Dr. Ashish Bhatt, MD, MRO is an accomplished physician, addiction medicine specialist, and psychiatrist with over 20 years of medical and administrative leadership.

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