Treating Addiction and ADHD

The risk of addiction and substance abuse tends to be much higher among those with ADHD than in the general population. Because those with ADHD are at higher risk, it is especially important to develop a treatment approach that addresses both of these coexisting conditions. There is a growing body of evidence that addiction recovery is very difficult when undiagnosed or untreated ADHD is part of the picture.

The Chesapeake Center is working to develop an addiction treatment model that addresses both addiction issues and ADHD issues simultaneously. Our treatment model is not intended as a substitute for other treatment approaches. Instead, we focus on helping individuals with ADHD address their ADHD-related challenges and how those challenges, if not met, can lead to addiction and to relapse from recovery. Our ADHD/addiction treatment approach focuses on:

Addiction as self-medication for untreated ADHD — Individuals with ADHD are often unaware of their diagnosis and need for treatment. In other cases, they are resistant to treatment or seek to self-medicate. Often, when ADHD is effectively treated with medication (and/or psychotherapy), the dependency upon unhealthy forms of self-medication is significantly reduced. Treatment for ADHD becomes a critical part of the recovery process.
Coexisting anxiety and depression — the great majority of adults with ADHD also struggle with coexisting conditions including anxiety, depression, and/or bipolar disorder. In many cases, substance abuse develops because these very troubling coexisting conditions are untreated, leading the individual to self-medicate. Alcohol and marijuana are commonly abused substances among individuals with untreated or under-treated ADHD with anxiety and/or depression.
Stress management — the challenges commonly associated with ADHD — disorganization, poor time management, poor money management, under-employment, and relationship problems — all lead to chronically high stress levels that often, in turn, lead to substance abuse as individuals try to relieve intense feelings of anxiety that are the product of chronic stress related to ADHD. These individuals benefit from psychotherapy that focuses on improving coping skills so that they can tolerate anxiety without turning to unhealthy substances.
Life management — we have learned that one of the most critical elements of helping individuals with addiction and ADHD is to help them better manage their daily lives. As long as their lives are chaotic and high-stress, the risk of relapse is high. Our approach is goal-oriented and skill-based — helping individuals to gain and maintain employment, helping them to better manage their money, helping them bring greater order to their daily lives, and helping them to develop and maintain healthy relationships that will help support them in recovery.
Reducing impulsivity — Impulsive behavior patterns are often deeply ingrained in those with lifelong ADHD. We work to help individuals learn to avoid situations in which they are likely to make impulsive decisions that will have a negative impact.
Developing better emotional regulation — often addictive patterns develop in response to poor emotional self-regulation. Individuals who have intense reactions of anxiety or anger are more likely to turn to addictive substances to provide instant relief from these intense negative emotions. We work to help people learn how to better regulate their negative emotional reactions — through learning more constructive thought patterns as well as learning meditation and other self-calming techniques that can reduce the intense feelings that lead to substance abuse and other addictive patterns.

Particular care and caution must be used when evaluating treatment options for addicts in early recovery. Although medication treatment can be very effective for those with ADHD, there are potential risks in using certain medications for recovering addicts. A history of Amphetamine addiction or abuse is common among substance abusers with untreated ADHD. ADHD treatment using stimulant medication is not appropriate for these individuals as it only invites a relapse, however non-stimulant medications can be helpful in addressing their ADHD. In fact, treatment of ADHD with non-stimulant medication may be a critical part of relapse prevention for these individuals.

Because of the potential for abuse, misuse, and dependency on stimulant medication for recovering addicts, we emphasize psycho-education and psychotherapy the treatment approach for these individuals. Additionally, our clinicians work closely with the prescribing psychiatrist to ensure safe and appropriate treatment. For those individuals who are concerned about their stimulant use, our addiction specialist, Haniya Silberman LCSW-C will work closely to help find a healthier treatment option that better complements the individual’s recovery program.

Alcoholics with ADHD who have been able to achieve sobriety and remain in recovery for a period of time may possibly be good candidates for psychostimulant medication as an integral part of their treatment approach. Decisions regarding medication to treat ADHD and related conditions such as anxiety and/or depression must be made by the individual’s psychiatrist in collaboration with Chesapeake staff involved in the individual’s treatment.

In addition to drugs and alcohol, in our experience, individuals with ADHD with strong addictive tendencies are also often at risk for multiple addictive patterns including:

Food addiction — compulsive over-eating, binge eating
Gambling addiction
Shopping addiction
Internet addiction
Video game addiction
Pornography/sex/love addiction
Cigarette addiction

As someone with ADHD and strong addictive tendencies begins to tackle a substance abuse issue, there is often a strong risk that addictive patterns may shift to other destructive patterns as a substitute. Our treatment focuses on these multiple risks. We work to help individuals develop healthy daily living patterns that enable them to manage anxiety, reduce stress, and better regulate their emotional reactions so that they are less prone to multiple addictive behaviors.

Medication management is a complex issue for those with patterns of substance abuse and ADHD. While we do not prescribe medications at the Chesapeake ADHD Center, we can work closely with your prescribing physician to help manage both your ADHD treatment and your recovery.

Our ADHD/substance abuse treatment approach may involve both individual and group psychotherapy. In addition, we strongly support each individual seeking a higher level of support outside of treatment through participation in other recovery programs.