ADDictions

In my Integrated Model of ADHD, I relate the experience of being ADHD to that of being in a desert without water. The research is quite clear that ADHD impacts our regulation of dopamine, leaving adults with ADHD short of the neuro-chemical responsible for interest, reward and stimulation. So we are under-stimulated, easily distracted by more engaging thoughts, daydreams or activities; more easily bored and dis-engaged; and less rewarded by positive outcomes and pastimes. There is a thirst for stimulation in ADHD and a constant seeking for any oasis of interest and reward.

Let's explore this concept further: imagine two people walking side by side in the desert. One (non-ADHD) has a sporty backpack containing several litres of water with a tube ending just by their mouth, the other (the ADHD one) has no backpack and is thirsty. As they walk through the desert their behaviours will significantly differ. The one with the back-pack can take their time, watch the camels crossing the dunes and amble calmly through the sands perhaps trying to engage their thirsty companion in idle conversation. But the ADHD desert-walker with no back-pack is parched, in fact they feel they may die of thirst very soon. They are distracted, constantly scanning the horizon looking for an oasis, they struggle to hear what their dull water-tube-sipping partner is saying. They are on a mission, they need water - from anywhere, it really doesn't matter - if they see an oasis they will start running. They might decide to fight their H2O guzzling companion for their water-tube or perhaps lick at  puddles in the muddy patch where the camels drank their water. If they find oasis they will drink deeply and relax. Now that they have finally found water they will not lightly consider leaving the palm trees and watering hole again.

Replace the desert with our ADHD lives and the water with stimulation and the analogy holds up very well. We are less stimulated, always looking for stimulation, interested and reward. This hunt for stimulation may be conscious or unconscious but it is one of the primary imperatives in humans, along with the desire for food, safety and sex. So what does a strong desire for stimulation have to do with addiction? Well pretty much all the substances that ADHD people become addicted to: caffeine, alcohol, nicotine, cannabis and cocaine specifically release large amounts of dopamine in the brain and give the reward and stimulation that is "missing". It's not just drugs that give this dopamine release: video games, Internet browsing, fast driving, TV, gambling, sex, food (to a lesser extent), dangerous pursuits, arguments, even approaching deadlines give us a major dopamine boost. Addiction is certainly not unique to people with ADHD but it looks likely that there is a far greater risk of addiction if you start from a lower point of reward than others. 

Here's some scientific support for this theory: According to studies of addicts (thanks to Pete Quily for details here), the probability of being ADHD if already addicted to drugs may exceed 80% in some cases: 35% of Cocaine Abusers in Comprehensive Psychiatry 1993, 24% of Psychoactive Substance Abusers in Jour Clin Psychiatry 2000, 32% of Cocaine Users and Alcoholics in American Journal of Drug Alcohol Abuse 1999, 70% of Crystal Meth (Methamphetamine) Inpatients had ADHD in Journal of Addiction Disorders 2005, 83% of Inhalant & 55% of Methamphetamine abusers in Japan in Psychiatry Clinical Neuroscience 2005. The Florida Detox Clinic is a leading US drug rehabilitation clinic, their web site states "our clinical research demonstrates that over 70 percent of our addicted patients, including cocaine and alcohol dependencies, suffer from undiagnosed/untreated ADD or ADHD. Many of these patients “feel more normal” when using Oxycontin, Vicodin, alcohol or cocaine. These drugs produce a temporary increase of dopamine in the prefrontal cortex (ADD area) of the brain."

Of course other ADHD issues also lead us to be more prone to addiction: failure, depression, anxiety, impulsive behaviour, lack of restraint and novelty-seeking all play a part too. But the situation is far from hopeless, despite all these challenges - far from it. Many of my clients have never had a problem with addiction, some clients have had substance issues in the past but have either controlled them or given them up. I fall into that category and have had to part with several addictions along the way, a couple that I can mention are cigarettes and alcohol. I still have some addictive behavioral tendencies and have to control my video game playing! Some ADHD adults that I coach have wrestled with minor or major drug, alcohol, food, coffee and Internet addictions but were helped when they started ADHD medications. Since the medications increase available dopamine, many people lose that "something is missing" feeling and find restraint comes much more easily. ADHD children on ADD meds are statistically 50% less likely to abuse substances (becomes the same risk as non-ADHD). There are many successful detox clinics and programs like the 12-steps of AA that help many people free themselves from addiction. If you are still struggling then perhaps reading the book reviewed below, might be a good place to start.