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ADHD and AddictionADHD and AddictionPresentation by Tom Rue, M.A., CASAC, CCMHC, NCC

Richard C. Ward Addiction Treatment CenterRichard C. Ward Addiction Treatment CenterCreated in April 2001 for clients and staff of

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What is ADHD?What is ADHD?

Attention Deficit Hyperactivity Disorder is a neurologically-based developmental disorder of both children and adults.

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By any other name…By any other name…

Minimal Brain Damage, or Minimal Brain DysfunctionHyperkinesias: Hyperkinetic Reaction in Childhood Hyperkinetic Impulse Control Hyperactivity Hyperactive Child Syndrome

Attention Deficit Disorder (with or without hyperactivity)

Since 1937, ADHD has been known by various names, including:

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DSM-IV (1994) DSM-IV (1994)

The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders classifies ADHD with “disruptive behavior disorders” that are observed in childhood.

ADHD often persists into adulthood.

DSM-IV 314

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ADHD DefinedADHD DefinedCriteria include persistent symptoms of inattention or hyperactive impulsivity that are maladaptive and inconsistent with developmental level.

Between 15 and 50% of ADHD children naturally outgrow their problems as adults.

The remainder do not.

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Symptoms of ADHD…Symptoms of ADHD…

Inattentiveness

Impulsivity

Deficient rule-following

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InattentionInattention

Poor sustained attention or effort – particularly to tasks that are relatively tedious and protracted. Easily bored Distractible Shifts from one incomplete activity to

another Frequently loses concentration during

lengthy tasks Fails to complete routine assignments

without supervision

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ImpulsivityImpulsivity

Impaired impulse control or delay of gratification. Difficulty stopping and thinking

before acting Difficulty waiting one’s turn, such

as in playing or talking Difficulty working toward longer-

term rewards Prefers immediate gratification…

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Deficient rule-following…Deficient rule-following…

Difficulty following through on instructions or assignments, particularly without supervision. Not due to poor language

comprehension Not due to defiance Not due to memory

impairmentInstructions do not regulate behavior as well in people with ADHD.

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SymptomsSymptoms

People suffering from ADHD may . . .

Show a significant difference between verbal and performance abilities on intelligence testing

Self-medicate with street drugs (e.g. marijuana, cocaine, alcohol, etc.)

Feel emotionally depressed after a success or other high emotional stimuli

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Substance abuseSubstance abuse

Substance abuse is often a secondary outcome if ADD is not identified and treated.

Social and emotional immaturity are chronic.

Poor peer acceptance and loneliness tend to increase with age and with the obvious display of symptoms.

Children with primary inattention tend to have academic problems only.

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Do these symptoms sound Do these symptoms sound familiar? familiar?

Do signs of ADHD resemble common traits or experiences of drug addicts?

What do you think?

erratic results

acts out

beaks rules

does not fit

wants it

NOW!

restless

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Learned helplessness…Learned helplessness…

Dysfunctional cycles in families can contribute to ADHD-like behavior in children and adults.

ADHD traits may be reinforced by learning, as well as being biologically inherited.

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Family process in which ADHD Family process in which ADHD worsensworsens

Parental pathology (e.g. mood disorders, alcoholism, anti social behavior) lead to…Negative mood states in the parents lead to…Increased perception of deviant behavior in their ADHD child lead to…

Continued…

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Family process in which ADHD Family process in which ADHD worsensworsens

Increased negative behavior toward the ADHD child and decreased positive statements and social interactions with ADHD child lead to...Child’s increased negative behavior and decreased compliance with parental requests and commands lead to…Development of oppositional defiant or conduct disordered traits in the child.

Continued…

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Who has ADHD?Who has ADHD?

ADHD is 5 to 7 times more common in boys.

ADHD occurs in people of every level of intelligence.

ADHD tends to run in families.

There is an association with a family history of alcoholism and/or depression.

Asthma may be more common in children with ADHD.

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Some famous people believed Some famous people believed to have had ADHD…to have had ADHD…

Hans Christian AndersonF. W. WoolworthBeethovenGeorge BurnsHarry BelafonteAndrew CarnegieLewis CarrollPrince CharlesAgatha ChristieWinston ChurchillSergei RachmaninoffMariel HemingwayWright BrothersErnest HemingwayBill CosbyLeonardo da VinciSalvador DaliEdward Hallowell, MDDwight D. EisenhowerF. Scott FitzgeraldHenry Ford

Benjamin FranklinGalileoDanny GloverWilliam Randolph HearstJohn F. KennedyZsa Zsa GaborMicheal JordanRobert KennedyJohn LennonAbraham LincolnMozartSteve McQueenNapoleonNasserIssac NewtonNostradamusLouis PasteurPicassoEdgar Allan PoeRonald Reagan

Dan QuayleJohn D. RockefellerGen. WestmorelandEleanor RooseveltBabe RuthAnwar SadatPete RoseCharles SchwabGeorge B. ShawSteven SpielbergSylvester StalloneJames StewartHenry David ThoreauLeo TolstoyVan GoghThomas ThoreauJules VerneWilliam Butler YeatsRobin WilliamsStevie Wonder

Source: about.com

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ADHD and recovery…ADHD and recovery…

Adaptive behavior strategies can help.

How can one cope with tendencies to inattention and impulsivity?

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For starters . . .For starters . . .

Admit Identify Let Go

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Recognize ADHD as a distinct disability.

Acknowledge that it is possible to live with ADHD and be in recovery.

Accept help when needed, including medication if prescribed by a psychiatrist.

Admit

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What actions can you take to cope with your natural tendency to forget things, or to be distractible or disorganized?

How have ADHD behaviors contributed to your addictive lifestyle?

Do you think ADHD can contribute to a relapse of alcohol or drug abuse?

Identify

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. . . of unwillingness to try new approaches.

. . . of shame, self-blame, and resentments.

. . . of the idea that medication is unhealthy.

Let Go

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A few strategies for successful A few strategies for successful living:living:

DeadlinesUse a

Date-book

Prioritize Listen to Feedback

Support Network

BreakingTasks up

Task Lists

Prioritize

Laugh atYourself

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Medication treatment. Medication treatment.

It is believed that stimulant drugs act on ADHD by affecting the catecholamine neurotransmitters (especially dopamine) in the brain.

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Medication can help.Medication can help.

Under a doctor’s direction (usually a psychiatrist or neurologist), medications sometimes prescribed to help improve the functioning of people with ADHD include the following…

Ritalin Dexedrine Benzedrine Tegretol Cylert

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How stimulants How stimulants workwork

ADHD is believed caused by a maturational delay in the development of the nervous system. Drugs can treat the condition by stimulating the mid-brain, balancing it with the outer cerebral cortex. This may be an oversimplification, but it’ s a start. The exact therapeutic mechanism of stimulant action on ADHD is still unknown.

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When taken as directed…When taken as directed…

Stimulants, used under medical supervision, are considered quite safe. Though they can be addictive to teens and adults if misused, these medications are not addictive when taken as directed. Stimulents seldom make patients "high" or jittery. Nor are not sedatives. Rather, the stimulants help the ADHD person focus on and control his or her hyperactivity, inattention, and other target behaviors.

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MedicationMedication

ADHD is a chemical imbalance, in a similar way that depressive illness or diabetes are chemical imbalances.

Prescribed medications, taken as directed, should not be confused with drugs of abuse.

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Most drugs have side-Most drugs have side-effectseffectsFor example, some side-effects of Ritalin may

include:

sleep disturbances (insomnia)

depression or sadness

headache

stomachache

appetite suppression

elevated blood pressure

appetite suppression

growth reduction.

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You are what you eat.You are what you eat.

Some believe that sugar or food additives contribute to hyperactivity and other ADHD symptoms.

There is little research to confirm this hypothesis. However, there is no question that a healthy diet improves physical and mental functioning.

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A lifestyle of sobriety will lead A lifestyle of sobriety will lead to . . .to . . .

Healthier interpersonal relationships

More organized, productive functioning

Fully conscious experience of life

Less conflict with self and others

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Where to Get More Where to Get More InformationInformation

Talk to your doctor and your counselor

Advocacy organizations

Internet searches

Local public library or school library

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NADDANADDA

Guiding Principles for the

Diagnosis and Treatment of ADHD

 1.     Evaluate and treat the whole person.

 2.     ADHD should be suspected but not presumed.

3.     ADHD may present across the life span.

 4.     A comprehensive assessment is necessary for an accurate diagnosis.

 5.     Evaluation and treatment of ADHD should be by a qualified professional.

 6.     Response to medication should not be used as the basis to diagnose ADHD.

continued…

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Guiding Principles, continued

7.     Diagnosis should be based primarily upon the DSM-IV ADHD criteria.

 8.     Diagnosis and treatment of ADHD should involve others familiar with the person undergoing the evaluation.

 9.     Treatment should often involve more than one discipline working cooperatively.

 10.   Stimulant medications are the benchmark of treatment for most ADHD patients.

 11.   Practitioners should become familiar with current research and diagnostic tools.

Source: National Attention Deficit Disorder Association

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References and LinksReferences and Links

ADHD Fact Sheet for Parents and Teachers, Guilford Press, 1991.

ADDult Support of Washington for Adults With Attention Deficit Disorder, on the web at http://www.addult.org/

ADDvance: A magazine for girls and women with Attention Deficit Disorder, on the web at http://www.addvance.com/ADDvance/ADDvanceMag.htm

Attention Deficit Disorder, on the web at http://add.about.com/health/add/

Children & Adults with Attention Deficit/Hyperactive Disorder (ChADD), on the web at http://www.chadd.org