Attention Deficit Disorder and Addiction

Individuals with AD/HD have several

characteristics that make them more vulnerable to substance abuse: These may

include self-medication, impulsivity, social skills problems and a tendency to

associate with others who are not doing well in school.

Adult attention deficit disorder seems

to be related to earlier onset of substance abuse, a longer period of active

abuse, and a lower rate of recovery. (Wilens, Biederman and Mick, Am J Addict

1998) A study by Biederman et al Am J Psychiatry 1995 suggested found

that 52% of adults with AD/HD(versus 27% of controls) had met criteria for substance

abuse at some point in their lives. Other studies have found slightly lower rates but have still found that

the rates are significantly higher than those of individuals without AD/HD.

Appropriately prescribed stimulant

medication does not seem to increase the chance of later substance abuse. A

recent study published in Pediatrics Vol. 104, No.2 1999 suggested that

adolescents with AD/HD who were treated with stimulant medication, were less

likely to develop drug problems than those who were not treated. It is possible

that newly diagnosed adults have the higher rate of substance abuse because

their AD/HD was not treated when they were children.

Prevention: Parents of a child

with AD/HD should start talking about drug abuse and risky behavior early and

maintain an open dialogue. Children and adolescents who are aggressive or who

habitually break rules are at increased risk. If your child fits this profile,

consider more intensive individual or family therapy. Teach your child the

difference between legitimately prescribed drugs and illegal drugs. Look at your

own pattern of drug or alcohol use. Try to model a conscientious approach to

alcohol. If you the parent are is in recovery from drug or alcohol, consider

taking your adolescent with you to a few Alcoholics Anonymous (AA) or Narcotics Anonymous

(NA) meetings. If a child or adolescent has a AD/HD along with a strong family history

of substance abuse, he or she should probably never drink. It is important to be

honest with him about the family history so that he can understand the



If an individual

seems to have both AD/HD and a substance abuse problem, how do we treat him or

her? First, it is important to do an accurate diagnostic evaluation. Drug use

can sometimes shorten attention span and thus mimic AD/HD. We get an in-depth

history and often get information from family members. At some point, we like to

see the individual when he or she is sober and is not in acute drug withdrawal.

If this is not possible, we may need to make a tentative diagnosis and defer the

definitive diagnosis until later. 

It can be more difficult to treat

substance abuse in an individual with AD/HD than in a non-AD/HD individual. We

prefer not to treat an individual who has both AD/HD and substance abuse with

medications alone.

We often encourage group therapy in a

setting that encourages abstinence from drugs. Family therapy is also a good

idea. The individual may benefit from 12-step groups. Family members may benefit

from Alanon or Naranon. If impulsivity is part of the individuals AD/HD,

recovery may be more difficult. It might be good to have a Narcotics Anonymous

(or AA) sponsor who also has AD/HD. Such an individual may sometimes need more

intensive treatment during the early and also the later phases of recovery. The

substance abuse recovery program may, like many other aspects of the person’s

life, get boring after a while. The individual and the treatment team need to

watch out for this boredom factor.

Should we prescribe Schedule II

medications (e.g. stimulants) to individuals who are actively abusing drugs? We

prefer not to do so, especially if the individual refuses to participate in

other forms of treatment. We may consider using a Schedule II stimulant if the

individual is a minor, and the parents can tightly monitor the medication, and

get regular drug screens. In other cases, we may start with non-Schedule II

medications such as Wellbutrin. If active drug abuse is severe, or if close

monitoring is not possible, it may not be safe to prescribe any medication at

all. Once an individual is involved in treatment, actively working on sobriety,

we can be more confident about prescribing medication. However regular drug

screens, and close communication with other members of the person’s support

system, are useful.

The individual who has AD/HD

accompanied by persistent substance abuse may need intensive outpatient or even

residential treatment to break through denial and start treatment in a safe

environment. If the individual refuses treatment, we may start by bringing the

family into treatment so that they can learn to understand the situation and set