More than 6 million American children between the ages of 2 and 17 have been diagnosed with attention deficit hyperactivity disorder (ADHD), according to data provided by the Centers for Disease Control and Prevention (CDC). Additionally, two out of every three of these kids (64 percent) also have some other type of mental, emotional, or behavioral disorder.
Conduct disorders tend to appear most often as the secondary condition (52 percent), says the CDC. It’s followed by disorders related to:
- anxiety (33 percent),
- depression (17 percent),
- autism spectrum disorder (14 percent),
- and Tourette syndrome (1 percent).
The National Institute of Mental Health (NIMH) adds that one out of every three of those children will continue to have ADHD in their adult years. This equates to roughly 4.4 percent of American adults between the ages of 18 and 44.
For this older group, several studies have found a link between ADHD and addiction, which can include drugs or alcohol, an internet or gaming addiction, or some other type of addictive behavior.
What exactly is ADHD and why is it so intermingled with many of these other mental and physical health issues?
ADHD: A Complex Condition
The American Psychiatric Association (APA) says that ADHD is a condition characterized by trouble focusing, excessive movement behaviors (like fidgeting or not being able to sit still), and being impulsive. All of these can create issues for children and adults alike, whether at school, work, or at home.
Additionally, there is no known clear and specific cause of ADHD, and there is no lab test that can diagnose it either. Instead, it is a condition that requires gathering a lot of behavioral data while also ruling out other medical issues that could be contributing factors.
According to the APA, there are three types of ADHD:
- Inattentive type. Symptoms of this type include not paying attention to detail, not listening when spoken to, not following through, having difficulty organizing, often losing things, being easily distracted, and forgetting daily tasks. Six of these types of symptoms must be present on a regular basis during the preceding six months for a child to be diagnosed with inattentive type ADHD, whereas only five need to exist for individuals 17 and over.
- Hyperactive/impulsive type. With hyperactive/impulsive ADHD, symptoms often include fidgeting, moving around when it’s not appropriate, always being “on the go,” talking a lot, having trouble waiting your turn, and constantly interrupting others. To be diagnosed as hyperactive or impulsive, a child must exhibit at least six of these symptoms on a frequent basis, and an adult need only exhibit five.
- Combined type. This type of ADHD is a combination of both inattentive and hyperactive/impulsive. As a result, the child or adult would need to exhibit symptoms from both types for at least six months to receive this particular diagnosis.
The NIMH further reports that the average age of onset for ADHD depends largely on how severe it is, though typically it’s first noticeable at a fairly young age. For instance, while most children with this condition are diagnosed at 6 years old, in severe cases, the median age of diagnosis is 4. And if the ADHD is mild, it typically isn’t diagnosed until around age 7.
The Connection Between ADHD and Addiction
For children with ADHD that continues into their adult years, there is a risk of developing an addiction as pointed out by research connecting these two issues.
For example, a 2014 study published in Drug and Alcohol Dependence looked at 1,276 individuals from seven different countries (Hungary, Norway, Switzerland, France, Netherlands, Sweden, and Spain). These participants ranged in age from 18 and 65, and all were seeking help for their substance abuse.
Researchers found that while the average rate of ADHD in the general population is between 6 and 9 percent, the number of addicted study participants with this condition was sometimes much higher. For instance, 31.3 percent of addicted persons from Norway were also diagnosed with ADHD.
One common area of study is the connection between ADHD and alcohol abuse. And use of this particular substance tends to start early, with one piece of research indicating that teens around 14 years of age who have ADHD are almost two times more likely to use alcohol than teens without this condition (40 percent versus 22 percent).
While being cautious about determining cause and effect—whether the ADHD may lead to the increased alcohol use or the alcohol use is instigated by the ADHD—these researchers did conclude that there’s “a meaningful correlation” between the two issues.
Other studies have found a potential correlation between ADHD and internet addiction, and one assessed this issue for adolescents specifically. It involved 2,114 students who were asked to complete a questionnaire about their levels of depression, ADHD symptoms, social phobia, and hostility. Then, it compared their answers to how much time they spent online.
The results, which were published in the Journal of Adolescent Health, revealed that a connection likely exists between internet addiction and both ADHD symptoms and depressive disorders. Again, it’s unclear which is the cause and which is the effect, but, regardless, the two do seem to be connected.
Sadly, the 2014 Drug and Alcohol Dependence study also found that individuals with both ADHD and addiction tend to have more severe substance abuse and poorer treatment outcomes. This makes treating these two conditions even more difficult.
Risk Factors for Addiction and ADHD
What places someone at risk of developing ADHD and an addiction?
The National Institutes of Health (NIH) says that it is unclear what exactly causes ADHD, but there are a few factors that may lead to the appearance of its symptoms. They include:
- Genetics. ADHD often runs in families, according to the National Human Genome Research Institute.
- Environment. Environmental considerations for ADHD include exposure to cigarette smoke or alcohol while in the womb, or high levels of lead while at a preschool age.
- Diet. The NIH points to sugar specifically as a potential cause of ADHD symptoms, but Harvard Medical School also indicates that exposure to artificial colors and additives and a low intake of omega-3 fats and micronutrients may negatively impact this condition.
- Brain injury. Although most children with ADHD have not had a traumatic brain injury, the NIH does say that kids with this particular injury often have symptoms similar to children with ADHD.
Some of these are also the same risk factors for addiction. For instance, Healthline reports that “heredity is a major risk factor for addiction.” The same goes for environment because lack of parental involvement, exposure to peer pressure, and increased substance availability all contribute to substance use and abuse.
Does ADHD Medication Contribute to Addiction?
Some people question whether it is the ADHD treatment drugs themselves that are behind an increased risk of addiction, especially if the person actually ends up abusing the drugs themselves. In order to see how one could possibly affect the other, it helps to understand what ADHD medications do to and for the body and brain.
MedicineNet shares that, on a biological level, ADHD is a neurochemical and neuroanatomical disorder. In other words, this condition appears when the levels of certain brain chemicals (namely dopamine and norepinephrine) are off and not where they should be.
That’s why most ADHD medications work by increasing the amounts of these two neurotransmitters. The end result of this increase is that the person has better focus and greater control over many of the symptoms he or she has that are associated with this condition.
Some of the most common medications prescribed for the management of ADHD include Ritalin, Adderall, Dexedrine, Focalin-XR, Concerta, and Vyvanse. While these can come in pill form, liquid form, or be applied to the skin via a topical patch, MedicineNet goes on to say that “when taken in excess or snorted, stimulants that treat ADHD can produce euphoria and result in addiction.”
The National Institute on Drug Abuse also warns that sometimes a prescription stimulant addiction occurs because long-term use of these drugs increases a person’s tolerance to them. So, to get their desired feelings, they must take them more often or in higher amounts.
There’s also a concern of withdrawal if these medications are suddenly stopped due to substance abuse. Feelings of fatigue and depression, or even sleep issues, can arise and make it even more unappealing to discontinue their use.
Treating ADHD and Addiction Together
ADHD that is coupled with addiction is a very complex issue, not only from a causal standpoint, but also potentially from a treatment point of view. This is especially true if there are concerns over addiction to the medication. So, what options exist?
ADHD Treatment options
We’ve already discussed the various medications commonly prescribed for treating ADHD, but the CDC reports that there are many other things people can do to help them manage and/or treat their ADHD. The agency recommends trying these options before medication, even for young children, largely because of the medicine’s potential side effects.
One is behavior therapy or, for adults, psychotherapy. The APA explains that psychotherapy, which is also known as talk therapy, can help individuals with ADHD learn how to better cope with life events or deal with any other mental disorders that may be present, such as anxiety or depression.
This can be helpful for those with ADHD especially because, as you may recall, two out of three have other mental, emotional, or behavioral disorders as well. This enables a healthcare practitioner to treat the ADHD from a number of angles by working to resolve the issues that co-exist with this condition.
Sometimes education and training are part of an effective ADHD treatment program as well. This may involve teaching the person skills that enable him or her to better handle common life events, situations, or issues without aggravating ADHD symptoms.
Addiction Treatment Options
Addiction comes with its own set of treatment options, and the methods and strategies used will likely depend on what type of addiction the person faces.
For instance, if the person is addicted to stimulants, such as those found in ADHD meds, Harvard Health reports that behavioral therapies often provide a positive response. This may include attending cognitive therapy sessions to learn how to recognize common drug triggers in addition to the ways to avoid them. Coping strategies are also often taught in these sessions.
Harvard Health says that contingency management is also used regularly in behavioral therapy settings, which involves encouraging drug abstinence through rewards or incentives. Other stimulant addiction therapy programs follow the Matrix Model, which is a combination of treatments including behavioral therapy, individual counseling, family education, and more.
And if the person’s addiction is to alcohol, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) shares that treatment often occurs via methods such as counseling, medications designed to reduce drinking and prevent relapse, and support groups like AA (Alcoholics Anonymous) and other 12-step programs.
For people with both ADHD and addiction, a dual-diagnosis treatment response is often best.
The Dual-Diagnosis Treatment Response
The National Alliance on Mental Illness (NAMI) explains that dual diagnosis occurs “when someone experiences a mental illness and a substance use disorder simultaneously.” Additionally, one does not necessarily have to occur before the other. In other words, it doesn’t matter if the ADHD leads to the addiction or if the addiction creates ADHD symptoms, because they both need to be treated at the same time to provide the best results.
NAMI reports that dual diagnosis situations are rather common, with 7.9 million Americans currently having two concurrent conditions: one related to mental health and the other to substance abuse. This is also seen more often in men, according to NAMI, as males account for 4.1 million of those with these two types of conditions.
Oftentimes, treating both issues involves first detoxifying the individual from the substance being abused. The next step is rehabilitation, which sometimes involves inpatient treatment centers and other times may include living in group homes or sober homes to help prevent a relapse.
And just as psychotherapy is helpful for both ADHD and addiction individually, NAMI adds that this type of treatment is “usually a large part of an effective dual diagnosis treatment plan.” Other remedies typically used in dual diagnosis scenarios include medications and support groups.
Lifestyle Changes for ADHD and Addiction
A few lifestyle changes can sometimes help those struggling with ADHD and addiction.
For ADHD specifically, Medical News Today (MNT) suggests getting on a regular exercise program, cutting down on your consumption of sugar and caffeine, and prioritizing adequate sleep.
MNT also states that, for someone with ADHD, it is beneficial to reduce distractions when working on something important by doing things like turning off the television or silencing social media notifications. Developing organizational habits and using daily planners can help as well.
Lifestyle changes that can potentially reduce addictive tendencies include many of the same actions. For instance, research has found that engaging in exercise can help improve alcohol abuse recovery and reduce incidences of relapse.
Some addiction experts, like David Wiss, MS, RDN, founder of Nutrition in Recovery, suggest that eating a nutritious diet free from artificial sweeteners, fried foods, sodas, and energy drinks can help support recovery as well.