Jeremy Didier’s transparency about her personal and professional experience with the intersection of ADHD and alcoholism is inspiring and empowering. This is the second in a series on ADHD and Addiction, Fighting Fire with Fire. The first article in the series is: Addiction and ADHD.

Where There’s Smoke, There’s Fire

Our family boasts the genetic jackpot for all things fabulous, psychological, and pharmaceutical. We have an exciting track record of success, over-achievement, brilliance, and creativity. We also have more than our fair share of ADHD, alcoholism, addiction, autism, depression, and bipolar disorder. You might say that ADHD treatment and recovery go hand in hand for most of our family.

That history didn’t stop my husband and me from adding five more kids to the human race. But it did help us make some quick and easy decisions when our offspring were diagnosed with ADHD.

If you’ve ever watched a loved one struggle with a substance use disorder, you know that you’ll do almost anything in your power to protect your kid from going through that pain. Fortunately, with growing research to reinforce a medical path for treatment, stimulant medication was a relatively straight-forward decision.

Stimulant Medication Can Prevent Substance Abuse

The truth is that the use of stimulant medication and therapy to treat kids with ADHD may actually help prevent future substance abuse and risky behavior. Research shows that early diagnosis, intervention, and treatment dramatically increase the likelihood that a child with ADHD will grow into a “successful” adult (such as staying out of jail, graduating from high school or college, getting and holding down a meaningful job, having healthy relationships, maintaining a positive self-image, and being a safe driver).

Unfortunately, the “unsuccessful” adults in our family – who went through many of the yucky things listed above – didn’t have the benefit of our improved understanding of ADHD. They are adults who, for whatever reason, weren’t diagnosed or weren’t successfully treated for their ADHD. Instead, they “self-medicated” (typically with alcohol and illegal drugs) in an attempt to stabilize their brain chemistry and feel “normal.” Many crossed the line into full-blown alcoholism and addiction, only to discover that they actually had ADHD.

In fact, the stats are sobering (pun intended):

• ADHD is 5 to 10 times more common among adult alcoholics than it is in people without the condition* (WebMD).
• Half of all adults with untreated ADHD will develop a substance use disorder at some point in their lives. (Yes, you read that right: half of all adults with untreated ADHD will become addicts or alcoholics at some point in their lives, according to Harvard Medical School’s Dr. Timothy Wilens*).
• Forty percent of teenagers with unmanaged ADHD start drinking heavily and/or smoking marijuana under the age of 15.
• Neurotypical kids who start drinking under the age of 15 are six times more likely to become addicted to drugs and alcohol later in life. Factor in unmanaged ADHD and kids with ADHD are even more likely to develop a substance use disorder.

Adults are currently the fastest growing group of people to be diagnosed with ADHD. Many are getting diagnosed at the same time their children receive an ADHD diagnosis. For most, learning they have ADHD can be validating, often providing an explanation for why they felt compelled to do some of the risky and destructive things they did growing up.

Still, an adult diagnosis of ADHD does not override or cancel out the fact that many of these adults have been struggling with alcohol and/or other addictions for many years.

Treatment Options for Adult ADHD in Recovery

As you may imagine, there is a great deal of controversy about how to best treat an adult with ADHD who is also an addict or an alcoholic. I’ve spoken with many physicians across all specialties who aren’t willing to even diagnose adults with ADHD, let alone treat them with stimulant medication, regardless of their sobriety status.

So, what treatment options are there for adults with ADHD in recovery?

1. ADHD in adults can be effectively managed with myriad non-pharmaceutical choices. Exercise, mindfulness, cognitive behavioral therapy, ADHD coaching, and healthy lifestyle habits all benefit adults with ADHD, and are often basic tenets of sobriety programs, as well.
2. Several non-stimulant medications (like anti-depressants, blood pressure meds, and pharmaceutical foods) have been shown to help adults manage their ADHD.
3. Many medical professionals are willing to prescribe stimulant medication to their patients with co-morbid SUD (substance use disorder) and ADHD.

ADHD Meds for People with Addiction?

Dr. Anne Clark, adult and adolescent psychiatrist in Olathe, Kan., says,

‘The current thinking about treatment for addiction is that if you don’t treat all the person’s problems, then they’re much more likely to relapse. If they have ADHD, you really should treat that. Granted, looking at what their addiction was and how it affected them is important, but I also have people in my practice who were addicted to meth and cocaine who are much more stable when their ADHD is managed. Anytime people can feel more effective with their lives, they are less likely to get derailed.”

Dr. Stephanie Swords, internal medicine and pediatric physician in Liberty, Mo., says she deals with this question all the time.

“50% of patients with ADHD have comorbid depression and anxiety. The likelihood of these patients using other substances to treat those symptoms if they are not properly medicated or receiving treatment is high. Often these conditions are diagnosed after a substance dependency is recognized. My feeling is that by treating the underlying disorder and getting patients the appropriate support, either with counseling or behavior modification therapy, we actually could lessen their abuse and or relapse potential.

 …A lot of times I’ll use a long-acting stimulant like Vyvanse ^® or one of the stimulants that’s designed to have low abuse potential. Sometimes I don’t have a choice and I feel like it’s the lesser of two evils. If their moods or ADHD are uncontrolled and they’re in recovery, they have an increased chance of using other drugs or alcohol and relapsing, in an attempt to manage ADHD symptoms. So I monitor these patients closely and I often put them on contracts. They agree to be compliant and follow up with me, and in some cases I ask them to agree to drug screens… I need to know what else they’re taking in case they aren’t seeing any benefits from the stimulant medication.”

In other words, things are changing – and it’s all about progress, not perfection.

Getting the proper diagnosis and finding a physician confident in innovative treatment approaches are the first steps in managing ADHD treatment and addiction recovery. (Don’t worry – there aren’t going to be 12 steps in this series.) But they are giant steps not to be underestimated!