Helping a Family Member with ADHD and Addiction Issues


Someone who has attention-deficit/hyperactivity disorder (ADHD) has a pattern of hyperactivity-impulsivity, inattention, or both that persists and gets in the way of the individual’s development or functioning.1 A few kinds of ADHD exist: predominantly hyperactive-impulsive presentation, predominantly inattentive presentation, and combined presentation.1,2

Predominantly Inattentive Presentation

Some possible symptoms of this presentation include:1

  • Frequently not following through with directions as well as not completing work responsibilities, chores, or schoolwork
  • Frequently losing items needed for activities or tasks
  • When directly talked to, frequently not appearing to be listening
  • Frequently not paying attention closely to details or, at work, in schoolwork, or while doing other things, making careless errors
  • Frequently disliking, being disinclined to engage in, or avoiding tasks that necessitate sustained mental exertion
  • Frequently being forgetful in everyday activities
  • In recreation or tasks, frequently having trouble maintaining attention
  • Extraneous stimuli easily distracting the individual frequently

Specific criteria for this presentation is in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, also known as the DSM-5.1

Predominantly Hyperactive/Impulsive Presentation

Some possible symptoms of this presentation include:1

  • Frequently not being able to engage in recreation quietly
  • Frequently blurting out a response prior to the completion of a question
  • In circumstances when there is an expectation to stay seated, frequently getting out of seat
  • Frequently talking too much
  • Frequently intruding on or interrupting people
  • Frequently climbing or running around in circumstances where that is not appropriate
  • Frequently having trouble waiting one’s turn

Specific criteria for this presentation is in the DSM-5.1

Combined Presentation

This presentation involves having symptoms of both other presentations; specific criteria for this presentation is in the DSM-5.1

Diagnosing ADHD

One ADHD criterion in the DSM-5 requires that before the individual was 12 years old, several hyperactive-impulsive or inattentive symptoms existed.1

Complete diagnostic criteria for ADHD is in the DSM-5; however, utilizing the DSM to diagnose anyone requires clinical training as well as experience.1

The Centers for Disease Control and Prevention (CDC) conveys that boys have a higher probability of ADHD diagnosis than girls: 2016 estimates were 12.9% versus 5.6%.3

What Causes ADHD?

Factors that might contribute to an individual developing ADHD include:4

  • Genetics
  • Exposure before birth and/or when young to environmental toxins
  • Maternal use of alcohol, cigarettes, and/or drug(s) while pregnant with the individual
  • Low weight when born
  • Injury to the brain

For instance, a study published in Pediatrics found that having been exposed to tobacco before birth as well as being exposed to lead in childhood (evaluated with current levels of lead in the blood) were linked to ADHD in American children, especially in ones who were exposed to both.5

A substance of abuse might produce effect(s) that are the same as ADHD symptom(s) (e.g., stimulant use may alter a person’s activity level and capability to pay attention).6 If substance intoxication explains the symptoms better, however, then ADHD is not diagnosable based on the DSM-5.1

When ADHD Meets Addiction

From surveying persons, it was estimated that in 2001-2003, 4.4% of American persons ages 18-44 currently had ADHD.6,7 From this survey, it was discovered 15.2% of persons with adult ADHD also fulfilled criteria in the DSM-IV for a substance use disorder (SUD), whereas just 5.6% of persons without it also fulfilled SUD criteria.6

An individual might use substance(s) to try to alleviate the individual’s symptoms of ADHD.6

Stimulants, which could be used to treat ADHD, might be abused, but this does not mean that they should never be used for treating it, even for individuals who also have SUD; a personalized risk-benefit assessment is necessary if deciding to use a stimulant for treatment in someone who has SUD as well as ADHD.6

Among individuals who have ADHD, other conditions are prevalent, for instance depression and learning disabilities.4

Addressing Substance Use Disorder in a Loved One

If you think a loved one has an addiction but the individual resists getting help, try to at least persuade the individual to be assessed by a healthcare provider.8

You could look for a suitable healthcare provider and then give your loved one that information.8

If your loved one’s healthcare provider has received authorization from your loved one to talk with you, discuss with the healthcare provider how you could provide support.8

Addressing ADHD and Substance Use Disorder in a Loved One

There ought to be simultaneous treatment of all co-occurring issues.8 So if a loved one has a substance use disorder and ADHD, try to make sure they are getting some type(s) of treatment for both.

Treatment for ADHD and Substance Use Disorder

Cognitive-behavioral therapy (CBT) may decrease an individual’s ADHD symptoms.6,9 CBT also might be helpful for an individual with a substance use disorder.10 Other interventions also might help with ADHD and/or SUD.4,11

A stimulant medication might still be an option for treating ADHD in someone who also has a substance use disorder; as mentioned previously, a personalized risk-benefit assessment is needed if deciding to use a stimulant for treatment in a person who has SUD as well as ADHD.6,12 For someone who has both cocaine use disorder and ADHD, a stimulant might actually help with both of these: a study published in JAMA Psychiatry found that among people with cocaine use disorder as well as ADHD (based on fulfilling criteria in the DSM-IV-TR for both), favorable results were more common in those who either got 60 mg or got 80 mg of extended-release mixed amphetamine salts each day than in those who received placebo each day (people in all groups participated in CBT individually each week).12

 

 

Sources:

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
  2. Centers for Disease Control and Prevention. (2019). What is ADHD?.
  3. Centers for Disease Control and Prevention. (2019). Data and statistics about ADHD.
  4. National Institute of Mental Health. (2019). Attention-deficit/hyperactivity disorder.
  5. Froehlich, T. E., Lanphear, B. P., Auinger, P., Hornung, R., Epstein, J. N., Braun, J. & Kahn, R. S. (2009). Association of tobacco and lead exposures with attention-deficit/hyperactivity disorder. Pediatrics, 124(6), e1054-e1063.
  6. Mariani, J. J. & Levin, F. R. (2007). Treatment strategies for co-occurring ADHD and substance use disordersThe American journal on addictions, 16(Suppl 1), 45–56.
  7. National Institute of Mental Health. (2017). Attention-deficit/hyperactivity disorder (ADHD).
  8. National Institute on Drug Abuse. (2019). Step by step guides to finding treatment for drug use disorders.
  9. Knouse, L. E. & Safren, S. A. (2010). Current status of cognitive behavioral therapy for adult attention-deficit hyperactivity disorderThe Psychiatric clinics of North America, 33(3), 497–509.
  10. McHugh, R. K., Hearon, B. A. & Otto, M. W. (2010). Cognitive-behavioral therapy for substance use disordersThe Psychiatric clinics of North America, 33(3), 511–525.
  11. Substance Abuse and Mental Health Services Administration (US); Office of the Surgeon General (US). (2016). Facing addiction in America: The surgeon general’s report on alcohol, drugs, and health [internet]: Chapter 4: Early intervention, treatment, and management of substance use disorders.
  12. Levin, F. R., Mariani, J. J., Specker, S., Mooney, M., Mahony, A., Brooks, D. J., Babb, D., Bai, Y., Eberly, L. E., Nunes, E. V. & Grabowski, J. (2015). Extended-release mixed amphetamine salts vs placebo for comorbid adult attention-deficit/hyperactivity disorder and cocaine use disorder: A randomized clinical trial. JAMA Psychiatry, 72(6), 593–602.


About The Contributor

Sophie Stein, MSN
Sophie Stein, MSN

Clinical Editor

Sophie Stein received her master’s of science in nursing from Vanderbilt University School of Nursing. She previously worked as an advanced practice registered nurse at an outpatient psychiatric practice providing mental health care for children,... Read More


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