View Full Version : ADHD and Addiction


Kunga Dorji
10-19-13, 01:25 AM
A brief extract from Appendix II of "In The Realm of The Hungry Ghosts", by Dr Gabor Mate:

Note the reference down the bottom- it is one of our best defences when we are confronted with absurd arguments about stimulant treatment of ADHD predisposing to drug addiction.

These are important arguments, as there are many ignorant people with excessive influence on public policy who would like to see stimulant treatment for ADHD shut down.

As individuals being treated for ADHD we have a responsibility to others to ensure that such ignorance does not control public policy.



<style type="text/css">P { margin-bottom: 0.21cm; }</style> The personality traits of people with ADHD and addiction are often identical: poor self regulation, deficient impulse control, poor differentiation and a constant need to find distractions from distressing internal states. These distractions can be internal, as in tuning out, or external, as in the need to be stimulated by activities, food, other people, or substances.


Thus people with ADHD are predisposed to self medicate.


The implications are twofold. First, it is important to recognize ADHD and treat it appropriately in childhood. As I point out in Scattered Minds, such treatment need not involve medication in every case, and in no case should medication be the only treatment.
ADHD is not a disease, inherited or otherwise:it is primarily a problem of development. The key question is not how to control symptoms, but how to help the child (adult) develop properly.


The studies are clear that those children with ADHD who are not treated are at higher risk for later addiction than those who receive stimulants.
T.E. Wilens et al “Does Stimulant Therapy of Attention-Deficit/Hyperactivity Disorder beget Later Substance Abuse? A meta analytic review of the literature,” Pediatrics 111(1) (January 2003) 179-185
So- here you have a hard reference from a doctor who is not obsessively pro-stimulant who still emphasises the value of stimulant treatment for ADHD and can reference it.

mildadhd
10-19-13, 10:49 AM
Diagnosing AD(H)D in cocaine and amphetamine addicts is tricky, because the drugs themselves will drive the physical and mental hyperactivity and diorganization.

Under the influence of cocaine or crystal meth, a normally sedated person may resemble someone with severe AD(H)D.

The other complicating factor is that, from adolescence onward, people with ADHD are at an elevated risk for addiction to cocaine and other stimulants.

It becomes difficult to sort out what came first: the addiction or the ADHD.

Having attention deficit myself, I have an intuitive feel for recognizing the condition in others, but the diagnostic key is the history of ADHD symptoms since childhood, predating drug use.

ADHD is a major predisposing factor for addiction, but it is frequently missed by physicians.

I have been struck by how often addicted patients of mine with self-evident ADHD traits have eluded diagnosis through out childhood and well into their adult years.

Some others were diagnosed as children but never seem to have received consistent treatment.

In very few cases have any of them been treated for the condition as adults.

A Yale University study has shown that among cocaine users with ADHD, those who are treated only for their addiction but not for their predisposing ADHD don't do so well.

In this Yale study as many as 35 per cent of of cocaine users who presented for treatment met the diagnostic criteria for childhood ADHD. (*1)

In another study, as many as 40 per cent of adult alcoholics were found to have underlying attention deficit (hyperactivity) disorder. (*2)

People with ADHD are twice as likely as others to fall into substance abuse and nearly four times as likely as others to move from alcohol to other psychoactive drugs. (*3)

People with ADHD are also more likely to smoke, to gamble and to have any number of other addictive behaviors.

Among crystal meth addicts a significant minority, 30 per cent or more, also have lifelong ADHD.(*4)


-Gabor Mate M.D., "In the Realm of Hungry Ghosts", (Appendix II), A Close Link: Attention Deficit Disorder and Addictions, P 414.


Notes

(*1) K.M.Caroll and B.J. Rousnaville, "History and Significance of Childhood Attention Deficit Disorder in Treatment-Seeking Cocaine Abusers," Comprehensive Psychiatry 34(2) (March-April 1993) : 75-82

(*2) D. Wood et al., "The Prevalence of Attention Deficit Disorder, Residual Type, in a Population of Alcoholic Patients," American Journal of Psychiatry 140 (1983) : 15-98

(*3) J. Biederman et al., "Does Attention-Deficit Hyperactivity Disorder Impact the Development Course of Drug and Alcohol Abuse and Dependence?" Biological Psychiatry 44(4) (15 August 1998) : 267-73.

(*4) Dr. Richard Rawson, Associated Director of the Integrated Substance Abuse Program, University of California at Los Angeles, Teleconference, 26 April 2006. Available from U.S. Consulate, Vancouver, B.C.

Nate W
10-19-13, 12:12 PM
I can personally attest that I self-medicated with alcohol to relieve my ADHD. I knew from age 6 or 7 I had it because I was utter chaos and completely disrupted everyone and thing I was near (I was tested in 1967 or so and diagnosed with "minimal brain dysfunction", the archaic term for ADHD). But I was never put on medication.

Life was a complete bore and sucked big time until I discovered alcohol. It was the elixir of life. The reliever of boredom, the only thing that quieted my racing mind and made me feel mostly normal and social.

I never drank to get drunk, just a good buzz and I drank every day of my life from 18 up to about 36. I quit because of the extreme problems drinking was causing. Not drinking was hell. I got too board again (restless, irritable and discontented as they say in the Big Book) and started up again because of that ease and comfort alcohol brings. And aI drank from about 40 to 45 until I hit my bottom--The place where I could not live with, or without, alcohol. That is a very dark place to be. I steadily increased my dose so at the end I was pounding 15 beers a day, every day. I lost a lot too. A lot. Hung over all the time when I I was not drinking (first thing in the morning mainly).

After 6 years of sobriety (through AA) I began dextroamphetamine medication for my ADHD and that is when it hit me. I had a revelation: I solely drank to self medicate my ADHD. You see, alcohol raises dopamine (along with doing a bunch of other bad things), but it raises it too quickly and drops off too quickly, so it is addictive, and especially if it does something very positive for you. Us with ADHD have either a dopamine defeciency, or the dopamine does not activate the neurons like it should.

Non-alcoholics don't get much benefit from alcohol when they drink. They can take it or leave it. After my first drink I knew I could not leave it alone. It did something magical for me until it turned on me and kicked my ***.

Oh, and my mother was alcoholic too and only later in life did I realize she had ADHD too.

--Nate

Twiggy
10-19-13, 12:21 PM
For some weird reason, I've never been addicted/dependent to any drugs/substances.

Supposedly Nicotine is a very addictive chemical, but I used it for a month or two straight (everyday) and never said to myself "Oh gosh, I need some more Nicotine to get through the next few hours"
Nope, I casually stopped taking it without any ill effects.

Maybe there's a few people in the world that don't get addicted to drugs/substances even if they tried.

mctavish23
10-19-13, 03:40 PM
On November 1st, I'll be presenting to our local Drug Court team on how the appropriate

use of stimulant medication, prescribed by an informed physician, for the treatment of

ADHD, actually DECREASES THE RISK OF A SUBSTANCE USE DISORDER (SUD), as well as

DOES NOT CONSTITUTE A RELAPSE. Thus far, the Team has changed their policy and

now permits those clientele on ADHD meds from an informed physician, to continue taking the

medication. Previously, they did not. The remaining problem to address now is to allow those

clients who successfully complete the program, to receive their Recovery medallions at Graduation.

As of now, they're denied the privilege. I'm optimistic they'll be able to "see the light," and acquiesce.


tc

mctavish23

(Robert)

Rebelyell
10-19-13, 08:29 PM
Im like that myself twiggy I could party it up smoke drink get high and not feel I needed it again till I wanted to do it again like another party 6 months a Year later etc

Kunga Dorji
10-20-13, 02:44 AM
On November 1st, I'll be presenting to our local Drug Court team on how the appropriate

use of stimulant medication, prescribed by an informed physician, for the treatment of

ADHD, actually DECREASES THE RISK OF A SUBSTANCE USE DISORDER (SUD), as well as

DOES NOT CONSTITUTE A RELAPSE. Thus far, the Team has changed their policy and

now permits those clientele on ADHD meds from an informed physician, to continue taking the

medication. Previously, they did not. The remaining problem to address now is to allow those

clients who successfully complete the program, to receive their Recovery medallions at Graduation.

As of now, they're denied the privilege. I'm optimistic they'll be able to "see the light," and acquiesce.


tc

mctavish23

(Robert)

Good work-- we all have to keep pushing on this one.

There are real neurological issues behind attention problems and associated addiction issues (regardless of whether the neurological problems are primarily genetic in nature or arise as a defect in development for one reason or another),
and that message just does not compute for people who are hooked into the"just say no" model of old style addiction recovery programs.

Unfortunately the people who hold these ideas also hold significant positions of power in our society and also suffer from the new DSM disorder (coming for DSM VI if I have my way ;)) of "Cognitive Rigidity Disorder".

So- what you are doing really counts Robert.

mctavish23
10-20-13, 06:05 PM
ty my friend.

In this particualr case, the "problem" rests with one of the Drug Court Team, who insists

on "thumping" the AA Big Book at the issue of ADHD Treatment with Stimulants. Based

strictly on that mindset, my own 25 1/2 + years of daily 12 Step Recovery wouldn't

"count." I've entitled my presentation ...

"Attention Deficit Hyperactivity Disorder (ADHD) : The Cloak of Invisibility and the

Paradox of Treatment."

All that's left to do is to finish the References page.

tc

Robert

DichotOhMy
12-20-13, 04:29 PM
Maybe there's a few people in the world that don't get addicted to drugs/substances even if they tried.

I think that ADHD is a disorder that's very emotional in nature, so a big reason why we feel compelled to do things is based on the way it makes us feel.

In my case, alcohol and all manner of stimulants and disassociatives make me feel great because they have a very noticeable way of making me feel relaxed and together. Opiates and psychedelics on the other hand make me feel even more restless, loopy and scattered, so I feel bad when using them. Nicotine makes me feel more relaxed and focused, but this is outweighed by the respiratory issues I quickly get when I smoke tobacco.

Guess why alcohol, stimulants and disassociatives have always been my drugs of choice and why I can leave the others I mentioned.

Twiggy
12-21-13, 04:04 AM
The only thing that I'm strongly addicted to is the Internet. I'm on the Internet almost the whole day, everyday.