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Adults and adolescents with ADHD face substance abuse struggles in alarming numbers. Why? And what treatment options are available?

Ben was, in school, labeled easily distracted, disorganized, unable to follow through on his assignments, and frankly a bit naughty. He always had to be doing something with his hands and legs. His brain never kept still either, moving on to greener pastures soon after his teachers started talking. He wasn't able to wait his turn and was always ready to talk about things that interested him — usually completely unrelated to whatever topic he was actually meant to be answering questions about. Ben often got into trouble. 

At 13, Ben discovered nicotine. It helped his mind slow down, he said, drowning out the multitude of things going on in there so he was able to concentrate better. By the end of his twenties, Ben was still smoking like a trooper but had also dabbled in countless other substances, from speed to cocaine. When he started seeing a therapist after his dad passed away, Ben discovered that he had ADHD — and that his substance abuse issues could, effectively, be described as self-medication. 

Ben is not unique. An estimated 11 to 35 percent of adults with substance use disorders also have attention-deficit/hyperactivity disorder — ADHD. While some of them will be aware they have the disorder, many remain undiagnosed and seek a way out of the most debilitating symptoms by abusing substances. 

What do you need to know about ADHD?

Often seen as a fancy diagnostic label stuck on bratty and annoying children so they can be drugged to calm down, it's not that hard to find people who don't believe attention-deficit/hyperactivity disorder exists at all. ADHD is, nonetheless, a very real disorder — and it doesn't just affect kids. Up to five percent of adults are believed to meet the diagnostic criteria for ADHD, which would include:

  • An inability to pay attention to small details and often making mistakes others may describe as "careless". 
  • Trouble concentrating on the same task for long periods of time. 
  • Avoiding tasks that need your full attention for a long time. 
  • Being easily distracted, which can result in challenges with completing tasks. 
  • Forgetting and losing things. 
  • A need to fidget, often with hands and legs, and a general need to always be doing something physical.
  • Talking a lot, including blurting things out in situations where it's unexpected or before your turn.

As a child with ADHD grows up, they may lose some of their "hyperactive edge", but remain inattentive, impulsive, and restless. ADHD can, in adolescents and adults, interfere with work and school responsibilities as well as social relationships. The symptoms may also be tiresome for the person, who is always bombarded with thousands of different thoughts and struggles with executive functioning. 

How people with ADHD may self-medicate with substances

People with ADHD who seek treatment for their symptoms — or children whose parents do that for them — may wind up attending a variety of cognitive therapies and learn stress management techniques. They may also be prescribed non-stimulant medications. But stimulants like methylphenidate, better known as Ritalin, are the most common choice. This is because these prescription stimulants boost levels of the neurotransmitters dopamine and norepinephrine, which increase a person's ability to concentrate and relieve many of the most burdensome symptoms of ADHD quite effectively. 

Other stimulants — including caffeine, nicotine, and cocaine — can mimic these effects. Like Ben, 36 percent of adults with ADHD turn to stimulants not to get high but to improve their ability to concentrate and to relieve their other ADHD symptoms.

Some will use legal and illegal stimulants alongside prescribed ADHD meds, while others will stop relying on this form of self-medication when they are diagnosed and offered prescription medication. 

Other reasons for the link between ADHD and substance abuse

While there's no doubt that many adults with ADHD self-medicate with stimulants to relieve their symptoms, other reasons also contribute to the high rate of substance abuse in adults and adolescents with attention-deficit/hyperactivity disorder:

  • Some posit that the impulsive component of ADHD makes people more vulnerable to substance abuse — not thinking through the consequences of an action can make using a drug or taking up smoking a good idea. 
  • Because ADHD makes it harder to function well in educational, work, and social settings, people with ADHD have a higher risk of things like poor academic achievement, under-employment, and depression. These factors in turn increase the risk of substance abuse. 
  • Some have even proposed that using prescription stimulants for ADHD makes it more likely that a person will later seek out illicit stimulants. This hypothesis has not been proven to be true — rather, appropriate pharmacological treatment can prevent the risk that a person will seek out self-medication. 

What treatments are available for people with ADHD who have a substance addiction?

It's important for people with ADHD who have been abusing substances to receive treatment for both the substance use disorder and ADHD. That poses a bit of a challenge, because, as one study explains: "ADHD symptoms (eg, impulsivity, poor planning) will interfere with substance use disorder treatment, and substance use will limit the benefit of ADHD treatment."

The answer may lie in substance abuse treatment and cognitive behavioral therapy, followed by the prescription of either non-stimulant medications (usually antidepressants) or slow-release stimulants once you have been clean and sober for a while. If you receive stimulants to manage your ADHD after you have already faced a substance abuse disorder, it's essential to use them exactly as instructed. 

If you either already know you have ADHD or suspect that you do and you are self-medicating with substances, seek help — better options exist, an

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