Episode 14 – ADHD And Addiction
Dr. Ashish Bhatt ❘
Many people with ADHD suffer from substance use problems. Dr. Bhatt talks about why that is and what kind of intervention can be done.
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Hayley: Hello everyone. My name is Hayley, and you’re listening to Straight Talk With The Doc, a podcast that takes an in-depth look at addiction, mental health, and rehab. I’m here today with our content director, Jeff and our medical director, Dr. Bhatt, to talk about a topic that has affected pretty much everyone in the entire world. And that of course is the coronavirus pandemic. I know my life has been altered because of it. Jeff and Dr. Bhatt, how has it impacted your lives?
Dr. Bhatt: Jeff, I’m going to give you an opportunity to speak.
Jeff: Yeah, I’ll go first. I have not had it. I know a lot of people who have, luckily all of them have made a full recovery. A lot of my friends, a lot of my close friends were out of work for many months because everything was shut down. Everyone has felt the economic consequences of this thing. It’s effected my mental health; I’m not going to lie. Can’t imagine that there isn’t a single person whose mental health hasn’t been affected, by this. It’s affected everybody and everything. It just has.
Dr.Bhatt: Yeah, it has. As a physician, as an addiction medicine doctor, as a psychiatrist, I I’ve looked at it from multiple ways and this is of course, as a human being, dealing with it, just like everybody else, it has been extremely stressful and how it relates to people’s mental health and substance use. I think that’s where Hayley’s going with this, right. This is what we’re going to be talking about. It’s really been a huge, huge trigger for many people in many different ways, I guess. We’ll explore that a little bit more.
Hayley: Yeah. And everyone’s been impacted, like Jeff mentioned, it’s not even if you get sick, but your mental health is impacted. A lot of us have struggled with the lockdown and the isolation and how that affects our mental health. I’d also like to talk about the connection of how all of this is linked or possibly linked to the development of substance use disorders. But I wanted to start by asking you Dr. Bhatt, in what ways has COVID impacted some people’s mental health?
Dr.Bhatt: Well, I think if you weren’t anxious in the first place, definitely people’s anxiety has gone up. I think we look at things as human beings, we want to control things. We want to at least have the illusion that we can control things or things that are modifiable. We can, we have some influence on it. I think in our lifetime for most people, we haven’t seen anything like this before. So when a new disease comes out and people don’t know how to identify it, what to do about it. And there’s so many, I can list off all the unknown variables. It creates a lot of stress and anxiety and worry. Am I going to get it? Are my kids going to get it? Who can I see? Who can’t I see? We look to experts for direction.
We look to what we see on TV. We look to government agencies, we look for heads of States. We look for our local doctors to guide us. And I think the unfortunate part of it, and again, not pushing or pointing blame or responsibility on anybody, but there was truly a lot of unknowns. So, being that there was a lot of unknowns in the beginning, or even mixed messaging, let me say it that way. It created a lot of stress. So, for those who have underlying mental health conditions, depression, anxiety, that’s a risk factor, right? And the additional stress to exacerbate your already fragile mental health in the first place. And for those who weren’t, it probably created a sense of significant uneasiness. And I think it persists. And I think, and I know I’m getting a little wordy here, but it can range anywhere from even a small amount of adjustment disorder with anxiety or depression to a full-blown even post-traumatic stress disorder because people probably can envelop this so much of almost like, wow, I’m am I gonna die from this? And viewing this as an imminent threat to oneself, being alive or not tomorrow.
Hayley: Yeah absolutely. You mentioned depression, anxiety, for some people maybe they’ve just developed it, for some people this time may have made it a lot worse. Can you kind of talk about the connection between those mental health disorders and substance abuse?
Dr.Bhatt: Well, if we look at substance abuse in general, having a mental health illness co-morbidity in itself is a risk factor for somebody to develop an addictive disorder. I mean, to be somewhat broad, genetics plays a 40 to 60, so 50% chance of one’s risk of developing an addiction and the other 50% is everything else. So, if you have some sort of mental health condition, depression, or anxiety, some might seek out a drug to help mitigate or to get rid of that anxiety to get rid of that depression. So, yeah, definitely, there’s a correlation and a connection between having any sort of physical ailment mental health element that increases your risk factor for substance use.
Hayley: Okay. During this time, have rates of substance abuse changed, have they gone up or down compared to before the pandemic?
Dr. Bhatt: Yeah, I think I was reading somewhere recently that sales of alcohol had gone up. I mean, I don’t know if they looked at it, if that was only because that liquor stores were considered an essential business in many areas. So that would be something that’s there, but people who suffer from addiction, loneliness, isolation, boredom, these are all triggers. These are all risk factors to use. So those who suffered from addiction right there, when we were asked to social distance and quarantine and isolate ourselves, I mean, those people who are suffering from those issues that put them at risk for using in the first place, push them many of them over the edge to relapse. And for those who didn’t suffer from addiction, they went out and they probably misused and had maladaptive patterns to help cope. So, we did see in certain areas in certain populations an increase amongst those who did suffer from addiction and substance use issues. And those who did not, who turned to more maybe increase usage.
Hayley: Right. What are the risks of using drugs or alcohol to cope during this time?
Dr. Bhatt: Well, it doesn’t make anything better. It’s like when we look at using drugs or alcohol to cope with anything, aside from the pandemic, drinking or using drugs is not going to make the pandemic go away. It’s just masking their feelings, masking their emotions. And I kind of have this weird analogy that in order for us to be healthy in life, if we have to eat as nutrition, we have to process that food and we have to digest it and then absorb it in order for us to gain anything from that food that we eat, similarly with us with experiences in our life, although they might not be the best tasting or they might be the best feeling, they might not be the best emotion. And again, I’m not matching all the metrics exactly.
But the point being is that, if we don’t process and digest an experience, even from a negative one or a good one, if we don’t process it, it’s just going to linger there and it’s going to be an obstruction. And unfortunately when you end up dropping down the barrier, the drugs or alcohol, when you remove them, that is still going to be there for you to ultimately process later. And it’s not going to be any more comfortable, if anything, it could be worse and more damaging to your physical or mental health. Hopefully that made sense what I was explaining there, but it doesn’t help at all.
Hayley: That makes sense. As someone who’s in addiction medicine, is there a certain substance that has been abused more than others in this time? I know you mentioned alcohol earlier.
Dr. Bhatt: I think we’ve been in a opioid … I mean, I think it’s been there and there’s other drugs that have been there, but there’s somewhat more recognition of opioids as an increased epidemic. And again, yes, there has been, we’ve seen in the early 2000s to the mid 2010, 11 and 12, we saw increased rise and transition from opioid analgesic medicine to heroin and deaths that came afterwards. And it caught a lot of attention and rightfully so. So that’s been there and we’ve been really cognizant, I think, in the media of this opioid crisis, but lets not forget, alcoholism and other drugs that are there. It didn’t just go down. So, like I mentioned before, there have been noted higher rates in certain populations of increased alcohol usage and other illicit substance use over this time.
And it, it’s sad because many people are sitting at home they’re alone, they can’t communicate or can access those people that normally are normally support systems for them. So they tend to go and use alcohol or drugs as a crutch as a way to suppress those negative feelings. And for many people, using drugs, especially certain drugs like alcohol, which is not illegal, but it is something that alters our state of mind it’s often used in a social setting. So there could be that conditioning feeling that, Hey, at least I am substituting and I’m going to go out and grab that drink. And unfortunately, though it doesn’t replace somebody, but people are drinking alone and it gets worse and worse. And we’ve seen that rise, especially in that.
Jeff: You just mentioned something that I thought was very interesting about people drinking alone instead of drinking socially. Do you feel in general that solo use or solo drinking is more dangerous than social drinking or is that just kind of a symptom of a problem?
Dr. Bhatt: I think ultimately the short answer would be, it really depends on how it’s affecting your entire life, drinking alone or drinking with others. If ultimately you’re still able to function properly. I’m not going to quote and list the rattle off the scientific definitions of heavy drinking or binge drinking quantified that way, which is like, if you drink more than 14 drinks per week as a male, you’re considered at higher risk or heavy drinking, or more than 2 drinks per day. At the end of the day, if you’re doing it one way or the other within a group, or by yourself, if you’re doing it in a way that affects your health, negatively, your relationships negatively, your work and employment, all those different domains that we have in our lives, if it starts to negatively impact, I think it’s, it’s irrelevant if you’re drinking alone or with others.
I think it depends on all those other metrics, if you’re screwing up your life as a result of drinking or using drugs alone or with others I think the impact, quality of life, and the functionality and the consequences are what we look at. Being alone could be a risk factor or being around your friends could be a risk factor, a trigger that I think is there, but to just say is one more or less worse than the other? No, I think it just really depends on what the consequences are of being alone and drinking or being with others that drink.
Hayley: Okay. So for someone say who before COVID maybe they didn’t really drink, they didn’t use drugs, but during this time they’ve started to. What are some signs that they should pay attention to that may mean that they have a serious problem?
Dr. Bhatt: I think it’s hard for people to gauge themselves sometimes. Especially when you’re talking about a substance that alters the way you think. So that’s a question often we can answer properly when we’re thinking rationally. Hopefully someone has the wherewithal and has the ability to ask those questions about how it’s affecting their lives in a moment of sobriety, sometimes it’s hard. I think most of us when things negative haven’t occurred, we don’t ask ourselves are we doing it in any maladaptive or excessive way? So that’s often the difficulty here is are we able to monitor and check ourselves before something bad happens?
To answer your question is, recognizing the increased amounts is one thing. And if you have friends or family members who are suffering with addiction or alcohol or substance use disorders, do you look like them? Are you behaving like that? Has somebody made a comment about it, but then doing these screening questions for yourself, has my behavior changed where I feel I need to, there’s a CAGE questionnaire, do I need to cut down? Do I have that feeling that I need to cut down? Do I get annoyed? That’s the A. Because somebody tells me that I am using too much. Am I feeling guilty? That’s the G in the CAGE screening, am I feeling guilty about my substance use? And then E, do I need it in the morning? Do I get up and need it as an eye-opener? And often this is used as a screening questionnaire for alcohol, but I’m just thinking in general, if you see patterns of behavior that are causing you to feel the need to cut down or you’re getting annoyed or feel guilty or needed in the morning to function, or there’s negative things happening at work, or you got arrested, or your family’s calling you out on it. Well, obviously these are signs and these are ways to, to look at yourself, wait a minute. Do I need to stop? Is this affecting me? And do I need to seek help?
Hayley: Right. And I know another sign is also wanting to stop or attempting to stop and not being able to. And in that case right now, have you seen that more or less people are seeking treatment because you mentioned there’s been an increase in substance abuse, but are people going to treatment or less?
Dr. Bhatt: I think that’s subjective based on probably the geographical region, the access to treatment, are we talking inpatient or outpatient? Me being in South Florida where there just happens to be a higher density of, of treatment centers, and some of the ones that I work for that are larger, reputable facilities, we have seen an uptick. Probably initially that was a slow down when the pandemic was first alerted and people were restricted in the way they could move around. But, as a healthcare facility, as healthcare providers, as essential providers to the community, we did see an uptick of people seeking out treatment. And I think that correlates a lot to people probably having multi-factorial issues.
One did they relapse and two, I hate to say it, them being alone and isolated, was it easier to cope while being in treatment than being alone in your apartment and not being able to go to work and not being able to see your friends or even able to hang out and do nothing. What about access to your drug dealer or access to your sponsor? These are all issues. So if you’re using it might be easier to come and get into treatment just because I was not going to have to worry about getting food or seeking shelter. So depending on the perspective, if it’s a primary or secondary gain, we’re not digging into that. I know that you didn’t ask me that question, but I think about all of these things, as to why, what we saw and have seen. So, just to answer quickly, yeah, we saw an uptick in some of the larger, more reputable treatment centers and people seeking help.
Hayley: Okay. I want to jump back a little bit to the mental health and depression. Has there been an increase in suicides or attempted suicides during this time?
Dr. Bhatt: I don’t have the raw numbers off the top of my head. But I think as we’ve seen in many other societal stressful events or times in our lives, whether it be where there’s financial consequences, the great depression and recent recessions, we do see some correlation with increase in suicide, it’s happened. But off the top of my head, I don’t think I have that number or statistic that I can provide to you. Especially cause I have moved somewhat away from acute inpatient, psychiatric care and inpatient primary mental health, more into substance abuse. I don’t necessarily mix with that population, but I am sure when there’s more devastating events in history there’s often been an increase in people who unfortunately do take their lives.
Hayley: Right. And I’m sure that’s also something that we will see in years to come when we can look back at numbers. Back to treatment, you mentioned the fear, the anxiety, what are some of the reasons that somebody would hesitate seeking treatment when they know that they have a substance abuse problem?
Dr. Bhatt: That really depends on the individual. I think people would ask themselves despite the fact that they might be injecting themselves with very dangerous doses of illicit drugs or drinking to the point where their cirrhosis or health is just continuing to get worse. People are afraid that if I go to seek treatment, am I going to catch COVID? If I’m not supposed to go out of the house, am I going to get sick? Who am I going to run into? Unfortunately, with addiction, we tend to rationalize what we want to in order to continue to use, so even if this means a true reason, meaning that if you go out, you could risk getting COVID if you go unprotected, or if you go in large social situations or gathering crowds, or if you take proper precautions. But I do believe regardless of the underlying motive behind it, there is probably that thinking, Hey, am I going to get sick? Am I going to be around people who are sick? And I don’t want to get sick, and I don’t want to catch this infectious disease. And that stops people from going out and seeking help and seeking treatment.
Jeff: I just wanted to say, there’s always a million reasons to not seek treatment. If you look hard enough, and you won’t have to look that hard, you can find some justification for not seeking treatment.
Dr. Bhatt: Exactly. And that was my point. And I appreciate you Jeff, you’re saying it straight up like that and that’s the truth. People are always going to find a reason not to go on and get the help that they need.
Jeff: If you could just go into treatment in the morning and then come back an hour later and then not ever want to use drugs and alcohol again, everyone would just do that. But you will find a reason if you are determined enough to find a reason not to go, you will, but you really have to look at the benefit of really taking control of your life back, or getting yourself out of whatever situation you’re in.
Dr. Bhatt: Exactly. And I’ve seen many treatment centers for those individuals, for example, that are having true hesitation to seek treatment because of this, there are many centers out there that have gone above and beyond to make their setting as safe as possible. Centers are out there doing multiple enhanced cleanings. They’ve gotten consultants from hospitals to help and figure out ways to do infection control better. They have procured testing and COVID swab testing and affiliated themselves with labs and have people wearing a mask and provide non-alcoholic hand sanitizers. And there’s so many different things that treatment centers and healthcare facilities have done to help just like other healthcare entities have done to limit infectious disease transmission.
And most of these bigger centers and many of these treatment entities they are licensed by their local state agencies. And many are accredited by higher accreditation bodies that also credit hospital systems and other healthcare entities. So they have a certain standard that they have to maintain in order to stay active. I think what you said, Jeff, is correct. If you want to have a reason not to go get help, if you want to have a reason to continue using for sure, but you could do your due diligence and investigate the treatment centers that you are thinking about going to and ask them, Hey, what have you done? What are you guys doing to keep people safe who want to come to treatment? Have your loved ones call, do whatever you need to do, to get those questions answered. And of course, without that, whatever rationalization you can make to avoid going to treatment, but all that aside make that legitimate effort. Yeah. I’m sure that treatment center will be happy to provide the answers about what they’re doing to help keep those individuals who come safe.
Hayley: You mentioned a lot of this already, but the questions that somebody should ask before they go into treatment. During this time, you shouldn’t just walk in completely blind, what other kinds of research should I do beforehand? If I was entering treatment.
Dr. Bhatt: I would ask them as much as I could. I would make a list of things that I would ask about, like what are you doing to keep people safe from getting COVID-19 specifically, I would ask them, how many people am I going to be in a room with? If I need to get tested, how do you guys have access to testing? How long does it take for me to get the testing results back on average? I know that’s a big one, right? And when we have state and government agencies that can’t promise you a turn around time and adequate time, but I think we’ve moved a little bit further along in that system where some of these private agencies are actually getting test results back pretty quick.
And what are you doing to screen others to make sure you’re limiting people coming in who have the chance of having COVID from temperature checks to asking about how they traveled to different areas, different histories that they might be asking of individuals coming in and screening questions. I would be asking a ton of questions, on how are they keeping individuals safe in this time. Even about dining and groups, how many people, how are you guys controlling that, how are my individual sessions going to be, how often do I get to see a doctor? How is my temperature checked? Reasonable questions you should ask right up front. If a facility is going to be taking you on, they should be able to provide you all those answers.
Hayley: Absolutely. And the list is a great idea. So, you just have that right in front of you and you can get these questions answered.
Dr. Bhatt: I’ve seen both sides, but a lot of times people who suffer from mental illness, we tend to feel guilty about what we’re doing and how we’ve done. We almost feel great if somebody accepted us, but at the same time I’ve seen the flip side, so many people are coming through different treatment centers, and to be very honest, they feel very entitled and they’re not serious about their treatment and about the care that they should be receiving. And that’s another way to deviate from and focus on their real recovery and seeking sobriety. And they bring on all these red herrings and distract from what’s really going on, but at the same time, nobody should feel bad about asking these questions. These are things that are legitimate things that we are worried about throughout the world. And if you’re going to take that step to go on to treatment, anybody has a right to know all of that stuff.
Hayley: Yeah, absolutely. Is there anything else on this topic that we didn’t talk about that you think it’s important for people to know?
Dr. Bhatt: I think at the end of the day as we’ve spoken about and Jeff kind of hit it very plainly that people are gonna come up with whatever reason to not go and seek treatment and COVID being a legitimate thing out there. It worries everybody, but you really got to weigh the risks versus the benefits, because another hit of crack or another injection of heroin, it can kill you tomorrow. And if you go and ask all those questions and take the proper precautions, I think it’s a better bet to go to treatment.
Jeff: I just wanted to add you’re probably more likely to catch COVID in a dark bar with a bunch of people than you are at a properly socially distanced rehab. Regardless of COVID, addiction will kill you. I mean, if you let it go unchecked, it will. That’s a sure thing.
Dr. Bhatt: At the end of the day, I think regardless of the pandemic being here or not, that’s exactly right. If we wagered, are you going to be better off with or without drugs, they’re going to be better off without drugs. And I think that’s the take home message. And if that means going to treatment to get that help, like you said, if you’ve done the investigation and you’ve tried to do the proper vetting. Most likely the behaviors you’re doing while using drugs are a lot more unsafe than going to seek treatment at someplace that has put the proper precautions in place.
Hayley: Yeah, absolutely. And addiction is dangerous and I think it’s such a vital time to support the people in your life. If it seems like someone’s struggling, don’t hesitate to reach out, help them find resources and explore their options. We have some great resources on www.addictioncenter.com and you can also write in to Dr. Bhatt on Addiction Center and ask him your questions. Our other podcast episodes are up on the site as well. And you can listen to those for free anytime. So, make sure you check those out if you haven’t already. Thank you, Jeff and Dr. Bhatt, for going over this, and thank you everyone who tuned in. We hope you join us next time on Straight Talk With The Doc.
Dr. Ashish Bhatt
Addiction Center’s Medical Content Director, Dr. Ashish Bhatt, MD, MRO is an accomplished physician, addiction medicine specialist, and psychiatrist with over 20 years of medical and administrative leadership.