As if we don’t have enough to deal with already.
Confession: I have an unhealthy relationship with alcohol.
I know it, I don’t do much about it, and if you ask me I’ll deny it.
I don’t drink a huge amount and I don’t drink during the day, but I drink more than I should more often than I should. I can go a few days without drinking, but then when I do drink I make up for lost time.
Alcohol helps soothe my nerves and calm my overactive brain — albeit, temporarily. I know the data shows alcohol makes these things worse in the long run, in addition to the negative health effects, yet I happily forget all of that after the first couple drinks.
I have ADHD, anxiety, and C-PTSD.
If you also have ADHD, I’m sorry to tell you that you’re at a higher risk for addictions as well (Moura et al., 2013), especially if your ADHD is untreated (Ohlmeier et al., 2008).
There are a number of reasons, some social and some biological, and most are a mixture of both.
People with ADHD are more likely to have co-morbid conditions, anxiety being the most common (Mohammadi et al., 2021), which can result in using substances to self-medicate for our ADHD and anxiety symptoms.
Neurodiverse people tend to experience increased life stressors in comparison to our neurotypical peers (Hartman et al., 2019), which in turn increase our underlying symptoms, making us more likely to self-medicate.
It will come as no surprise then that people with undiagnosed, untreated, or under-treated ADHD are indeed more likely to self-medicate (Wilens et al., 2007; Frodl, 2010).
Three very specific aspects of ADHD cause us to be highly susceptible to addictions: genetics, impulsivity, and reward deficiency.
Both ADHD and addictions are highly heritable (Wang, 2013), meaning they are commonly passed down through genetics.
Researchers have discovered similar genes associated with both ADHD and addictions, and have determined that there are similar genetics responsible for both disorders (Wimberley et al., 2020).
In essence, many of the neurological differences associated with ADHD are the same neurological processes that make us more susceptible to developing addictions.
As always, there is a combination of nature and nurture at work. If we grow up in a household where one or more of our parents role-model addictive behaviours then we’re more likely to follow suit. Those same genetics that predisposed our parents to addiction have also been passed down to us.
I believe that is what they call a double-edged sword.
I prefer to call it a “screw you” sandwich.
One evening in high school I was enjoying a few underage beverages with some friends. A friend-of-a-friend showed up peddling LSD (a.k.a. acid). When he offered it around I was the first — okay, the only — one to say “sure, I’ll give it a try!” without any consideration of the consequences.
That, my friends, is the definition of impulsivity. (I really don’t understand why I wasn’t diagnosed with ADHD until the age of 36, but I digress).
Impulsivity is a key feature of ADHD. As mentioned previously, this is primarily because people with ADHD have an under-developed Prefrontal Cortex (PFC), which is largely responsible for impulse control.
While a neurotypical person might think the offer through and decide um no thanks, my fast-forward brain just jumped right in without giving it any thought.
When someone is trying to curb a bad habit, or addictive behaviour, a less impulsive person might be able to exert some level of self-control*. If there’s a cold beer in my fridge and I feel like having one, I just have one. Someone without ADHD may stop and think “y’know, I’ve had a few already this week, I should probably take a day off”.
*Individual results may vary.
ADHD brains process less dopamine than neurotypical brains (Barkley, 2015; Volkow et al., 2009; Bowirrat & Oscar-Berman, 2005). As I’ve mentioned previously, dopamine is known as a reward chemical: it’s a neurotransmitter our brains release when we anticipate something good is going to happen.
Dopamine is the most widely known neurotransmitter implicated in both ADHD and addictions (Solinas et al., 2019). If feeding an addiction gives us those good feelings that dopamine releases, and people with ADHD have a malfunctioning reward system, then it makes sense that we would be at higher risk for developing and sustaining addictions.
Not only are people with ADHD at higher risk for developing addictions, but once we do, our addictions are also harder to treat (Moura et al., 2013).
Now for some good news.
The good news is that when ADHD is properly treated, this significantly reduces the risk for addiction (Tardelli et al.,2020). When ADHD is treated beginning in childhood, and effective treatment is continued throughout adolescence, our risk of addiction is the same as the general population (Barkley, 2015).
Other important protective factors, for those of us who have children with ADHD, are the home environment and parenting styles. Generally speaking, a healthy family environment free of substance misuse and abuse, will lower anyone’s risk of developing addictions.
One of the most widely recommended parenting styles with respect to ADHD is authoritative parenting. This parenting style is characterized by warmth, communication, and clear boundaries for our children. Not only was authoritative parenting found to have more positive results for children with ADHD, this same parenting style was also found to lower the risk of addictions for all children later in life (Weissenberger et al., 2017).
Other than that, I don’t really have any cheerleading, go get ’em type statements for my fellow ADHDers. What I can say is that knowledge is power, and understanding ourselves and our conditions help us figure out what strategies work best for us.
Bowirrat, A. and Oscar-Berman, M. (2005). Relationship between dopaminergic neurotransmission, alcoholism, and reward deficiency syndrome. American Journal of Medical Genetics, 132(B): 29–37. https://doi.org/10.1002/ajmg.b.30080
Frodl, T. (2010). Comorbidity of ADHD and Substance Use Disorder (SUD): A Neuroimaging Perspective. Journal of Attention Disorders, 14(2), 109–120. https://doi.org/10.1177/1087054710365054
Hartman, C. A., Rommelse, N., van der Klugt, C. L., Wanders, R., & Timmerman, M. E. (2019). Stress Exposure and the Course of ADHD from Childhood to Young Adulthood: Comorbid Severe Emotion Dysregulation or Mood and Anxiety Problems. Journal of Clinical Medicine, 8(11), 1824. https://doi.org/10.3390/jcm8111824
Levy, S., Katusic, S., Colligan, R., Weaver, A., Killian, J., Voigt, R., Barbaresi, J. (2014). Childhood ADHD and Risk for Substance Dependence in Adulthood: A Longitudinal, Population-Based Study. PLOS ONE. https://doi.org/10.1371/journal.pone.0105640
Mohammadi, M.-R., Zarafshan, H., Khaleghi, A., Ahmadi, N., Hooshyari, Z., Mostafavi, S.-A., Ahmadi, A., Alavi, S.-S., Shakiba, A., & Salmanian, M. (2021). Prevalence of ADHD and Its Comorbidities in a Population-Based Sample. Journal of Attention Disorders, 25(8), 1058–1067. https://doi.org/10.1177/1087054719886372
Moura, H., Faller, S., BStat, D., Szobot, C., von Diemen L., Stolf, A., Souza-Formigoni, M., Cruz, M… Kessler, F. et al. (2013). The Effects of ADHD in Adult Substance Abusers. Journal of Addictive Diseases, 32(3), 252–262. https://doi.org/10.1080/10550887.2013.824359
Ohlmeier, M., Peters, K., Te Wildt, B., Zedler, M., Ziegenbein, M., Wiese, B., Emrich, H., Schneider, U. (2008). Comorbidity of alcohol and substance dependence with attention-deficit/hyperactivity disorder (ADHD). Alcohol and Alcoholism, 43(3), 300–304. https://doi.org/10.1093/alcalc/agn014
Schellekens, A., van den Brink, W., Kiefer, F., Goudriaan, E. (2020). Often Overlooked and Ignored, but Do Not Underestimate Its Relevance: ADHD in Addiction — Addiction in ADHD. European Addiction Research, 26, 169–172. https://doi.org/10.1159/000509267
Solinas, M., Belujon, P., Fernagut, P.O. et al. (2019). Dopamine and addiction: what have we learned from 40 years of research. Journal of Neural Transmission 126, 481–516. https://doi.org/10.1007/s00702-018-1957-2
Tardelli, V.S., Bisaga, A., Arcadepani, F.B. et al. (2020). Prescription psychostimulants for the treatment of stimulant use disorder: a systematic review and meta-analysis. Psychopharmacology 237, 2233 – 2255. https://doi.org/10.1007/s00213-020-05563-3
Volkow ND, Wang G, Kollins SH, et al. (2009). Evaluating Dopamine Reward Pathway in ADHD: Clinical Implications. JAMA, 302(10):1084–1091. https://doi.org/10.1001/jama.2009.1308
Wang K. S. (2013). Relationship between attention deficit hyperactivity disorder and alcohol dependence: a genetic view. International Journal of High Risk Behaviours & Addiction, 1(4), 192–193. https://doi.org/10.5812/ijhrba.9629
Weissenberger, S., Ptacek R., Klicperova-Baker M., Erman A., Schonova K., Raboch J., Goetz M. (2017). ADHD, Lifestyles and Comorbidities: A Call for an Holistic Perspective — from Medical to Societal Intervening Factors. Frontiers in Psychology, 8, 454. https://doi.org/DOI=10.3389/fpsyg.2017.00454
Wilens, T.E., Adamson, J., Sgambati, S., Whitley, J., Santry, A., Monuteaux, M.C. and Biederman, J. (2007). Do Individuals with ADHD Self-Medicate with Cigarettes and Substances of Abuse? Results from a Controlled Family Study of ADHD. The American Journal on Addictions, 16: 14–23. https://doi.org/10.1080/10550490601082742
Wimberley, T., Agerbo, E., Horsdal, H. T., Ottosen, C., Brikell, I., Als, T. D., Demontis, D., Børglum, A. D… Dalsgaard, S. et al. (2020) Genetic liability to ADHD and substance use disorders in individuals with ADHD. Addiction, 115: 1368– 1377. https://doi.org/10.1111/add.14910