Substance Abuse and AD/HD
The possible connection between substance abuse and attention deficit/hyperactivity disorder (AD/HD) is of significant concern within the public and scientific community, and one that requires further investigation. Research done in this area suggests that individuals with AD/HD are at greater risk for developing a substance use disorder as compared with those without AD/HD.1 Additionally, research has suggested that age of first substance use is a well-established predictor of later substance abuse.2 It is therefore important to consider the association between substance use and AD/HD when treating the disorder and in educating parents and children to inform them of the potential for substance abuse problems, risk behaviors or other issues.
Research has shown that substantial overlap exists between AD/HD and substance abuse, which means that many individuals who have one of the disorders also have the other.3,4,5 One study estimates that between 15 percent to 25 percent of adults with a lifetime history of substance abuse disorder may have AD/HD.6 Studies that have looked at the relationship between these two conditions suggest AD/HD and substance use disorders both appear to have genetic contributions and tend to occur in many members of a family.7,8,9
Two recent studies suggest that AD/HD is associated with an increased risk of developing substance use disorders.10,11 Additionally, the presence of AD/HD may make it more difficult to overcome a substance use disorder12.
Substance Use
There are five categories of involvement with substances:
- Abstinence - Some people choose to abstain from substance use for cultural, medical or religious reasons. Others adapt a lifestyle of abstinence because of previous substance abuse or addiction, including those in recovery.
- Experimental use - This means experimenting with alcohol or drugs one or two times. Frequently, parents report that their teenaged child is experimenting when in fact he or she is using substances on a regular basis.
- Social or recreational use - This includes drinking or using drugs at social occasions with other people. Social drinkers and recreational users rarely lose control, experience blackous, or have personality changes. They can more easily take or leave alcohol or other drugs.
- Abuse - Substance abuse takes place when the individual is using alcohol and other drugs to alter thoughts, feelings, or the mental state. Some individuals can abuse substances during a difficult or painful period in their lives and then return to social use. Returning to social use is impossible for the person who crosses over the line from substance abuse to addiction.
- Addiction - Addiction is also referred to as dependency and differs from substance abuse in three ways:
- the alcoholic or addict needs to use more of the substance to achieve the desired state
- the physical symptoms of withdrawal vary from one substance to another and range from discomfort to seizures and death; and
- use of the substance continues despite clear-cut negative consequences in the individual's life
Substance use becomes a significant problem when it interferes with one or more of the following areas of life: self-esteem, work or school, relationships, health, finances, or involvement with the law.
For more information on the stages of substance use or abuse, see Substance Use Disorders: Assessment and Treatment by Charles E. Dodgen and W. Michael Shea, Academic Press, 2000
Treatment of Substance Abuse and AD/HD
Accurate diagnosis and comprehensive treatment of both AD/HD and substance abuse is essential. It is important to consider each disorder when the other is being addressed. The presence of AD/HD often makes recovery from a substance use disorder more difficult. Likewise, it is important to consider a person's stage of recovery from substance abuse when treatment for AD/HD is being considered.
Recovery from alcohol and other drug abuse is a voluntary process, and a strategy to reach recovery should include professional help and a detailed treatment plan designed to meet the individual's specific needs. According to the Center for Substance Abuse Treatment (CSAT), "treatment" is defined as in or outpatient services that focus on initiating and maintaining an individual?s recovery from alcohol or drug abuse and on preventing relapse.
A combination of support groups, 12-step programs, psychotherapy, and medication appears optimal, but very little controlled research has been done on the use of these combined approaches. A recent, promising controlled study using methylphenidate plus a comprehensive behavioral intervention to treat cocaine-dependent adults with AD/HD has provided some initial data supporting the efficacy and safety of using stimulant medication with such a population.13 A great deal more controlled research is needed to replicate and extend the results of this study to adolescents and adults with AD/HD and other substance abuse difficulties.
For more information on substance abuse and treatment options:
1 Wilens, T.E. (2004). Impact of ADHD and its treatment on substance abuse in adults. Journal of Clinical Psychiatry, 65, 38-46.
2 Molina, B.S., Pelham, W.E. (2003). Childhood predictors of adolescent substance use in a longitudinal study of children with ADHD. Journal of Abnormal Psychology, 112, 497-507.
3,4,5 Wilens, T.E. (1998). AOD use and attention-deficit/hyperactivity disorder,? Alcohol Health Res World, 22, 127-130. Wilens, T.E., Spencer T.J., Biederman, J. (1995). Are attention-deficit hyperactivity disorder and the psychoactive substance use disorders really related? Harvard Review of Psychiatry, 3, 160-162. Biederman, J., Wilens, T., Mick, E., Milberger, S.; Spencer, J.J., Faraone, S.V. (1995). Psychoactive substance use disorders in adults with attention deficit hyperactivity disorder (ADHD): effects of ADHD and psychiatric comorbidity. American Journal of Psychiatry, 152, 1652-1658.
6 Wilens, T.E. (2004). Impact of ADHD and its treatment on substance abuse in adults. Journal of Clinical Psychiatry, 65, 38-46.
7,8,9 Cantwell, D.P. (1972). Psychiatric illness in the families of hyperactive children. Archives of General Psychiatry, 27, 414-417. Stanger, C., Higgins, S.T., Bickel, W.K., et al. (1999). Behavioral and emotional problems among children of cocaine- and opiate-dependent parents. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 421-428. Earls, F., Reich, W., Jung, K.G., Cloniger, C.R. (1988). Psychopathology in children of alcoholic and antisocial parents. Alcohol Clin Exp Res, 12, 481-487.
10,11 Molina, B.S., Pelham, W.E. (2003). Childhood predictors of adolescent substance use in a longitudinal study of children with ADHD. Journal of Abnormal Psychology, 112, 497-507. Katusic, S.K., Barbaresi, W.J., Colligan, R.C., (2003). Substance abuse among ADHD cases: a population-based birth cohort study. Paper presented at the Pediatric Academic Society Annual Meeting, May 3-6, 2003, Seattle, Washington.
12 Wilens, T.E., Biederman, J., Mick, E. (1998). Does ADHD affect the course of substance abuse? Findings from a sample of adults with and without ADHD,? American Journal of Addiction, 7, 156-163).
13 Wilens, T.E. (2004). Impact of ADHD and its treatment on substance abuse in adults. Journal of Clinical Psychiatry, 65, 38-46.
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