Attention deficit hyperactivity disorder affects approximately 9 percent of children and 4 percent of adults in the United States each year, per Healthline.
The disorder isn’t all-inclusive, but rather has three subtypes. They are inattentive type, hyperactive-impulsive type and combined type. Symptoms, and likewise diagnostic criteria, vary across these three subsets.
The diagnostic criteria for inattentive type ADHD require that individuals suffer from at least six of the following symptoms:
- Difficulty following instructions
- Seems like they are off somewhere else mentally or just aren’t listening when someone is speaking to them
- Avoids engaging in tasks that are going to require endurance and mental effort
- Makes careless mistakes and neglects details
- Lack of organization
- Easily confused
- Struggles to pay attention or daydreams frequently
- Easily distracted by outside noises, lights, or other stimulants
- Struggles with staying on track when working on assignments and may have problems completing them
- Forgetfulness or frequently misplacing things
Diagnosing someone with hyperactive-impulsive type ADHD requires the presence of six or more of the following symptoms:
- Squirming in one’s seat and inability to stop fidgeting
- Blurting out speech in the middle of someone else speaking or intruding on others’ activities
- Difficulty staying seating when expected to
- Trouble waiting one’s turn for something
- Restless feelings or behaviors
- Offering answers to inquires before the full question has even been asked
- Trouble keeping quiet during play time or relaxation
- Chatty demeanor, often speaks rapidly
- Very busy – seems as if one can’t slow down
The combined type of ADHD means the individual exhibits six or more signs of both inattentiveness and the hyperactive-impulsive type of the disorder. Combined type is the most common form of ADHD among the three, per WebMD.
There are concerns that this type of ADHD may be harder to manage. As such, there is the potential for it to cause an increased risk of negative effects for individuals suffering from it. The Chicago Tribune reported on a study of females aged 17-24, with various diagnoses. In the group with combined type ADHD, 23 percent had tried to commit suicide as of a 10-year follow-up check. The attempted rate of suicide among those with inattentive type ADHD was only 8 percent, and for those girls without ADHD, just 6 percent.
Screening for ADHD is fairly straightforward. Most therapists take advantage of self-rating worksheets that ask specific questions geared toward diagnosis. Some treatment facilities screen their clients for a variety of common mental health disorders upon intake. Others stick to a more generalized interview process and only complete in-depth screening if there are any immediate warning signs of mental illness.
When observing a client for signs of ADHD, the therapist may look for telltale symptoms, such as those listed above. When it is suspected that ADHD may be an issue, further questioning and observation can help to determine which subtype diagnosis best fits the individual in treatment.
The rate of diagnosis continues to rise. Between 2003 and 2011, the number of people being diagnosed with the disorder increased by around 5 percent each year, per the Centers for Disease Control and Prevention.
Diagnosing ADHD isn’t always as cut and dry as it appears. It can be quite difficult in adults since diagnostic criteria require symptoms be present by the age of 12. As such, any diagnosis rendered during the later years of life must be based on both current and retrospective symptoms. Furthermore, symptoms aren’t the same throughout a person’s life. For example, in school-aged children, impulsivity presents as hyper behavior or an inability to wait their turn, while it may look more like restlessness in a teenager or adult.
What Causes ADHD?
The precise cause of ADHD isn’t fully understood. Once thought to be a problem of attention, we now know ADHD is actually the result of faulty neurological development in areas of the brain that control impulses and inhibition. Research on the disorder is still in its early stages. However, some of it does point to the possibility of the illness being hereditary. Generally, when someone has ADHD, there is a 25-35 percent chance a relative does too, the Fairleigh Dickinson University Magazine reports. Parents Magazine states 40 percent of children who have ADHD also have a parent who is affected by the disorder.
In addition, even more research supports environmental factors influencing the development of the disorder. There is some evidence that the presence of heavy metals in the bloodstream is linked to the concurrent presence of ADHD. Other research supports the idea that prenatal exposure to drug abuse may contribute to the development of ADHD in children. The Journal of Pediatrics reports both tobacco exposure and lead exposure prenatally were linked to higher rates of ADHD in exposed children, especially when both were simultaneous factors.
There may also be ties to gender where ADHD is concerned. The CDC notes males are more than twice as likely to ever be diagnosed with ADHD as females are, at 13.2 percent compared to 5.6 percent.
While drug and alcohol abuse can certainly inflict someone with behaviors and feelings that are akin to those exhibited by someone affected by ADHD, the disorder cannot be substance-induced. Rather, certain substances might cause side effects that appear to be ADHD symptoms. For example, those who abuse amphetamines or other stimulants may experience periods of heightened activity that seem uncontrollable. These people may not even be aware of just how ramped up their energy levels are or that they fidget and speak rapidly. However, once the substance of abuse is removed, those symptoms dissipate. These are not cases of ADHD.
When ADHD Meets Addiction
Many people assume that ADHD is primarily a childhood affliction, but it is not. While it generally appears initially during childhood, the disorder persists throughout an individual’s lifetime. In fact, Everyday Health notes 30-70 percent of people who are diagnosed with ADHD during their formative years are still affected by symptoms of the disorder during adulthood.
Often, the late adolescent and teenage years can make the symptoms of ADHD transform from the hyperactive behavior and inattention symptoms of childhood into restlessness that presents as anxiety. In an effort to cope with these changes, many people will find relief in substance abuse. According to the Science Daily, a study of youths showed that experimentation and use of drugs and alcohol were reported by 35 percent of teens with ADHD, compared to only 20 percent of those who were not affected by the disorder.
Of course, teenagers aren’t the only demographic abusing drugs and alcohol, nor are they the only people affected by ADHD. The Anxiety and Depression Association of America accounts for 8 percent of adults being affected by this disorder. In 2012, 1,629,528 people aged 18 and older were admitted to rehab facilities across the nation, per the Substance Abuse and Mental Health Services Administration. This accounts for a very small portion of those who are misusing and abusing drugs and alcohol. An American Journal on Addictions review notes 15.2 percent of adults diagnosed with ADHD also fit the criteria for a substance use disorder, compared to just 5.6 percent of adults without the psychiatric diagnosis. In addition, the Partnership for Drug-Free Kids reports 10 percent of adults admit to having past problems with an addiction that they are now in recovery from. Regardless of a person’s age, addiction and ADHD can be a troubling combination.
Substance abuse can definitely worsen symptoms of ADHD when the disorder is present and underlying. For those who are unaware that they have ADHD or are avoiding treating it, illicit substances can increase the occurrence of ADHD symptoms. Abusing stimulants may increase symptoms of restlessness in those who suffer from the hyperactive-impulsive or combined types of ADHD. Depressants like marijuana, alcohol, and opiates may dull the senses, thereby causing those affected by inattentive type symptoms to have even more trouble paying attention in class or completing work assignments on time.
Another group of people who are at increased risk of adverse effects are those who are treating their disorder and also engaging in substance abuse. Sometimes, they are abusing the very medications prescribed to them for the treatment of ADHD. NBC News reports sales for Adderall XR alone reached $9.5 million in 2007. Mental Health Daily states more than 8.8 million prescriptions were filled for Concerta in 2014.
Still, many of these drugs make their way onto the street market, too. In 2011, there were approximately 13,697 cases of ADHD stimulant treatment drugs submitted to American state and local forensic labs, per the Drug Enforcement Administration.
Prescription stimulants like Ritalin, Concerta, and Adderall are heavily abused drugs that come with serious side effects. Adderall is one of the most abused prescription drugs on the market. It has become popular among many demographics. Women are using it as a weight loss aid, often feigning symptoms of ADHD to get their hands on a legal prescription or swiping pills from their children’s prescription. College students are using these drugs to stay awake and cram for tests. SAMHSA reports around 6.4 percent of students aged 18-22 in college on a fulltime basis admitted to past-year misuse of Adderall. In 2013, the rate of misuse for this drug alone was 7.4 percent among America’s high school seniors, per the Partnership for Drug-Free Kids
There is also concern that the abuse of these drugs can lead to the abuse of even harder substances. The Foundation for a Drug-Free World notes teenagers who engage in the abuse of prescription drugs are 12 times more likely to abuse heroin, 15 times more likely to abuse ecstasy, and 20 times more likely to abuse cocaine.
Still, others may abuse illicit drugs or alcohol on top of the regular use of these treatment drugs. The simultaneous abuse of these substances can seriously intensify the effects of medications like Concerta, Ritalin, and Adderall. This comes with risks, such as sensations of bugs crawling under one’s skin, paranoia, and even death. A 22-year-old male from Ohio died following the abuse of Adderall and alcohol in late 2014, WLWT News reports.
Just as it isn’t uncommon for ADHD to co-occur with substance abuse, many people affected by this disorder are diagnosed with other mental illnesses, too. Fox News notes the results of one analysis in which 57 percent of children diagnosed with ADHD also had another psychiatric illness when they reached adulthood; only 35 percent of the control group did.
Treatment for substance abuse can be managed alongside ADHD with a few precautions. Seeking both forms of treatment in the same treatment center is ideal. This allows therapists and physicians to coordinate with one another and make sure medications prescribed during medical detox don’t have the potential to interact with ADHD treatment meds.
It’s imperative that clients treat their mental health conditions before they are released from rehab. Not much will send someone into relapse faster than being ill-equipped to manage a mental health disorder after detox. Therapy should be used in tandem with medication for the treatment of ADHD and substance abuse.
Cognitive Behavioral Therapy is the most widely prescribed method of therapy for ADHD clients. This treatment modality works to help clients retrain their minds to react to a stimulus that would normally upset them in a more positive way. In a Psychiatric Clinics of North America review of adult clients treated for ADHD with CBT methods, 69 percent saw significant improvements in their symptoms.
Inpatient treatment is generally not needed for standalone ADHD diagnoses, but it may be needed for treatment of co-occurring disorders. Furthermore, those who are struggling to manage ADHD symptoms without illicit substances may need more intensive care for a period of time. Anyone who battles both substance abuse and ADHD is encouraged to seek help at one of the 5,104 treatment facilities that can manage their care in the United States, per SAMHSA. Without rehab, persistent substance abuse can lead to an exacerbation of ADHD symptoms.
In addition, long-term drug and alcohol abuse comes with its own consequences. People who abuse heroin or prescription opiate painkillers for lengthy periods of time may suffer from chronic anxiety, low libido, infertility, and even an increased risk of osteoporosis. A study published in the Iranian Red Crescent Medical Journal notes an alarming comparison of the rate of osteoporosis between those who are addicted to opiates, at 56 percent, and those who are not, at 26 percent.
Those who are abusing prescription amphetamines that were given to them as treatment for ADHD will have to switch to other treatment drugs or forego medication altogether in favor of alternative treatment options, like dietary changes and neurofeedback training. People who abuse cocaine – an illicit stimulant – may still have the option of treating their illness with prescription stimulants. In a study by the Journal of the American Medical Association Division of Psychiatry, clients with co-occurring ADHD and problems with cocaine abuse were treated with prescription extended-release mixed amphetamine salt drugs. Those in the 80 mg treatment group experienced at least a 30 percent reduction in symptoms, compared to those in the 60 mg treatment group.
Long-term abuse of drugs like Adderall and Ritalin can cause memory loss, psychosis, hallucinations, insomnia, and anxiety. Abuse of these drugs may also interfere with the body’s natural metabolism and increase the risk of cardiac events. In addition, they can increase dopamine density levels by 24 percent after just one year of use, per a Healthline study. Over time, the brain stops producing adequate levels of dopamine on its own.
Alcohol consumption also increases the production of dopamine. Prolonged abuse of the drink can interfere with the production of the feel-good chemical, which can intensify the symptoms of ADHD. If dopamine levels are depleted, symptoms of depression may also arise. Among adults with ADHD, depression is 2.7 times more likely to occur, ADDitute Magazine reports.
Outside of the individuals struggling with addiction and ADHD, ongoing substance abuse damages relationships – sometimes permanently. Loneliness is no stranger to those who are dependent on illicit substances, and those feelings may only perpetuate substance abuse behaviors. The harm drugs and alcohol cause aren’t limited to intimate relationships either. Often, people lose cherished friendships and secure employment in the wake of an addiction, too.
Addressing ADHD in a Loved One
There are a few primary ways most people end up in rehab. Some are ordered to attend by a court, a portion chooses to seek help on their own, and others need encouragement to make that decision. Sometimes this comes in the form of a loved one urging a person to seek help. Of course, it’s not always as easy as suggesting treatment and getting a positive response. Most who have watched someone they love battle addiction understand this all too well. It is normal for the person to behave defensively and insist a problem doesn’t exist.
In cases in which a person won’t listen to reason directly from a relative or friend, an intervention might be needed. Crisis interventions may be of assistance to families struggling with more dire substance abuse situations, such as cases of untreated ADHD coupled with depressive symptoms, like suicidal ideation. Most interventions used by substance abuse treatment professionals are also applicable to cases of co-occurring disorders.