by Wendy Richardson, MA, LMFCC
It is common for people with ADD to turn to addictive substances such as alcohol, marijuana, heroin, prescription tranquilizers, pain medication, nicotine, caffeine, sugar, cocaine and street amphetamines in attempts to soothe their restless brains and bodies. Using substances to improve our abilities, help us feel better, or decrease and numb our feelings is called self-medicating.
Putting Out Fires With Gasoline
The problem is that self-medicating works at first. It provides the person with ADD relief from their restless bodies and brains. For some, drugs such as nicotine, caffeine, cocaine, diet pills and "speed" enable them to focus, think clearly and follow through with ideas and tasks. Others chose to soothe their ADD symptoms with alcohol and marijuana.
People who abuse substances, or have a history of substance abuse are not "bad" people. They are people who desperately attempt to self-medicate their failings, and ADD symptoms. Self-medicating can feel comforting. The problem is that self-medicating brings on a host of addiction-related problems that over time make our lives much more difficult. What starts out as a "solution" can cause problems in-cluding impulsive crimes, domestic violence, addictions, increased high risk behaviors, lost jobs, relation-ships, families, and death. Too many people with untreated ADD, learning and perceptual disabilities are incarcerated, or dying from co-related addiction.
Self-medicating ADD with alcohol and other drugs is like putting out fires with gasoline. You have pain and problems that are burning out of control, and what you use to put out the fire is gasoline. Your life may explode as you attempt to douse the flames of ADD.
An article in American Scientists tells us that, "In the United States alone there are 18 million alcoholics, 28 million children of alcoholics, 6 million cocaine addicts, 14.9 million who abuse other substances, 25 million addicted to nicotine."(1) That adds up to at least 63.5 million Americans addicted to substances.
Who Will Become Addicted?
Everyone is vulnerable to abusing any mind-altering substance to diminish the gut wrenching feelings that accompany ADD. There are a variety of reasons why one person becomes addicted and another does not. No single cause for addictions exists; rather, a combination of factors is usually involved. Genetic predisposition, neuro-chemistry, family history, trauma, life stress, and other physical and emotional problems contribute. Part of what determines who becomes addicted and who does not is the combination and timing of these factors. You may have a genetic predisposition for alcohol, but if you choose not to drink you will not become an alcoholic. The same is true for drug addictions. If you never smoke pot, snort cocaine, shoot or smoke heroin, you will never become a pot, coke or heroin addict.
The bottom line is that people with ADD as a whole are more likely to medicate themselves with substances than those who do not have ADD. Drs. Hallowell and Ratey estimate that 8 to 15 million Americans suffer from ADD; other researchers estimate that as many as 30-50% of them use drugs and alcohol to self-medicate their ADD symptoms.(2)
This does not include those who use food and compulsive behaviors to self-medicate their ADD brains and the many painful feelings associated with ADD. When we see ADD, it is import to look for substance abuse and addictions. And when we see substance abuse and addictions, it is equally important to look for ADD.
Prevention and Early Intervention
"Just Say No! may sound simple, but if it was simple, we would not have millions of children, adoles-cents and adults using drugs every day. For some, their biological and emotional attraction to drugs is so powerful that they cannot conceptualize the risks of self-medication. This is especially true for the person with ADD who may have an affinity for risky, stimulating experiences." (3)
This also applies to the person with ADD who is physically and emotionally suffering from un-treated ADD restlessness, impulsiveness, low energy, shame, attention and organization prob-lems, and a wide range of social pain." It is very difficult to say no to drugs when you have difficulties controlling your impulses and concentrating and are tormented by a restless brain or body. The sooner we treat children, adolescents and adults with ADD, the more likely we are to help them to minimize or eliminate self-medicating.
Many well-meaning parents, therapists and medical doctors are fearful that treating ADD with medication will lead to addiction. Not all people with ADD need to take medication. For those who do, however, prescribed medication that is closely monitored can actually prevent and minimize the need to self-medicate. When medication helps people to concen-trate, control their impulses, and regulate their energy level, they are less like to self-medicate.
Untreated ADD and Addiction Relapse
Untreated ADD contributes to addictive relapse, and, at best, can be a huge factor in recovering people feeling miserable, depressed, unfulfilled, and suicidal. Many individuals in recovery have spent countless hours in therapy, working through childhood issues, getting to know their inner child, and analy-zing their behaviors and why they abuse substances.
Much of this soul searching, insight and release of feelings is absolutely necessary to maintain recovery. But what if after years of group and individual therapy, and contin-ued involvement in addiction programs, you still impulsively quit jobs and relationships, cannot follow through with your goals and dreams, and have a fast, chaotic or slow energy level? What if, along with you addictions, you also have ADD?
Treating Both ADD and Addictions
It is not enough to treat addictions and not treat ADD, nor is it enough to treat ADD and not treat co-related addictions. Both need to be diagnosed and treated for the individual to have a chance at ongoing recovery. Now is the time to share information so that addiction specialists and those treating ADD can work together. It is critical that chemical dependency practitioners understand that ADD is based in one's biology and responds well to a comprehensive treatment program that sometimes includes medications. It is also important for practitioners to support the recovering person's involvement in Twelve-Step programs and help them to work with their fear about taking medication.
A Comprehensive Treatment Program includes:
Stages of Recovery
It is important to treat people with ADD and addictions according to their stage of recovery. Recovery is a process that can be divided into four stages:
- early recovery,
- middle recovery and
- long-term recovery.
Pre-recovery: This is the period before a person enters treatment for their addictions. It can be difficult to sort out ADD symptoms from addictive behavior and intoxication. The focus at this point is to get the person into treatment for their addictions or eating disorders. This is not the time to treat ADD with psycho-stimulant medication.
Early Recovery: During this period it is also difficult, but not impossible, to sort out ADD from the symptoms of abstinence which include, distractibility, restlessness, mood swings, confusions, and impulsivity. Much of what looks like ADD can disappear with time in recovery. The key is having a life long history of ADD symptoms dating back to childhood. In most cases early recovery is not the time to use psycho-stimulant medication, unless the individual's ADD is hindering their ability to attain sobriety.
Middle Recovery: By now addicts, alcoholics, and people with eating disorders are settling into recovery. This is usually the time when they seek therapy for problems that did not disappear with recovery. It is much easier to diagnose ADD, and medication can be very effective.
Term Recovery: This is an excellent time to treat ADD with medications when warranted. By now most people in recovery have a life that has expanded beyond trying to stay clean and sober. Their recovery is an important part of their life, and they now have the flexibility to deal with other problems, such as ADD.
Medication and Addiction
Psychostimulant medication, when properly prescribed and monitored, is effective for approximately 75-80% of people with ADD. These medications include Ritalin, Dexe-drine, Adderall, and Desoxyn. It is important to note that, when these medications are used to treat ADD, the dosage is much less than what addicts use to get high. When people are properly medication, they will not feel high or "speedy," instead they will report an increase in their abilities to concentrate, and control their impulses and activity level. The route of delivery is also quite different. Medication to treat ADD is taken orally, while street amphetamines are frequently injected or smoked.
Non-stimulant medications, such as Cylert, Effexor, Nortriptyline, Prozac, Wellbutin, and Zoloft, can also be effective in relieving ADD symptoms for some people. These medications are frequently used in combination with a small dose of a psychostimulant.
Recovering alcoholics and addicts are not flocking to doctors to get stimulant medication to treat their ADD. The problem is that many are hesitant, for good reasons, to use medication, especially psycho- stimulants. It has been my experience that once a recovering person becomes willing to try medication, the chance of abuse is very rare. Again, the key is a comprehensive treatment program that involves close monitoring of medication, behavioral interven-tions, ADD coaching and support groups, and continued participation in addiction recovery programs.
There is Hope
In the last few years I have witnessed the transformation of lives that were once ravaged by untreated ADD and addictions. I have worked with people who had relapsed in and out of treatment programs for ten to twenty years attain ongoing and fulfilling sobriety once their ADD was treated. I have seen people with ADD achieve recovery once their addictions were treated.
"Each day I understand more about how pervasive ADD is in my life. My clients, friends, family and colleagues are my teachers. I wouldn't wish ADD and addictions on anyone, but if these are the genetic cards that you have been dealt, your life can still be fascinating and fulfilling." (3)
Wendy Richardson, MA, LMFCC, and an addiction specialist, is the author of the new book, The Link Between ADD and Addiction: Getting the Help You Deserve. Wendy is a consultant, trainer and speaker at national and international ADD and learning disability conferences and may be contacted at 408-479-4742 or fax 408-684-1615.
- Bum, Cull, Braverman and Comings, "Reward Deficiency Syndrome," American Scientist, March-April (1996), p. 143.
- Maureen Martindale, "A Double-Edged Sword," Student Assistant Journal (November-December, l965).
- Wendy Richardson, MA, LMFCC.
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Wendy Richardson is the author of the recently released book, The Link Between ADD and Addiction: Getting the Help You Deserve. She has also produced an outstanding four hour video on the connections between ADD, alcoholism and other addictions. To purchase the book or video, see our Order Form.