Addiction is often misunderstood as just a lack of willpower or bad choices. In reality, it's a complicated mental health condition influenced by many factors like brain chemistry, genetics, childhood experiences, and life events. It's a mix of biological, psychological, emotional, cultural and social factors that make it hard to understand or control.
However, we can't always expect people affected by the behaviour of someone suffering from addiction to be particularly understanding of this. Likewise, a casual observer might think, "Why can't he just fucking stop?!" without understanding the nuances, the compulsion, and the sheer impossibility of stopping that addicted people face. But that's another story…
In some of our Empathy For The Devil podcasts, we explore the stories of individuals who perhaps suffered from both addiction, and ADHD. This article is a further explanation of what happens when "the gruesome twosome" appear together, and what can be done about it.
Co-occurring Conditions
Addiction often co-exists with neurodiversity or mental health issues, making matters worse. Symptoms or attributes of these other conditions can lead to self-medication, which in turn can create dependence and, eventually, addiction. Recognising these overlapping conditions is essential for understanding and addressing addiction effectively. When a co-occuring condition is untreated, relapse is a hell of a lot more likely. This was my story.
I had a number of co-occuring conditions. But this article will focus specifically on the link between addiction and ADHD, or ADD.
It took me many years, a lot of pain, and multiple attempts, to get into recovery from addiction. Once I did, my life changed unrecognisably. Yet even as I settled into a decade of sobriety, certain emotional challenges just didn’t let up - despite my best efforts in therapy, the 12 steps fellowships and strong peer network. I still felt like something was really wrong, and blamed it on my “lack of high-quality recovery.” I went from an alcoholic/addict with low-self esteem, to an individual in long term recovery with low self esteem! Don’t get me wrong, recovery was, and is, awesome, with or without an ADHD diagnosis.
But this diagnosis provided some much-needed additional clarity, explaining, among other things, my heightened emotional sensitivity and behavioural patterns that I believed simply being in recovery should have cured—and, most of all, helping me to realise once again that I wasn’t a “flawed individual”—just someone who needed a bit more help and better coping mechanisms.
Step Into ADHD
It’s widely believed that ADHD is limited to not being able to pay attention, and being “hyperactive,” with the archetypes being schoolkids who are either staring out of the window or running around shouting and screaming.
What’s less commonly known is that ADHD also severely affects executive functions—simply put, our ability to “do things.” It also affects emotional regulation—our ability to manage and regulate behaviour and emotions. And also that ADHD without the H - Attention Deficit Disorder - is almost as common.
These lesser-known makes both task management and emotional management particularly challenging.
Dopamine - The Satisfaction Signal
It's now well-established that both ADHD and addiction are linked to issues in the brain's reward system, especially involving dopamine.
Dopamine works by releasing chemicals that signal pleasure, guiding our motivation and anticipation. For example, after a good meal, dopamine tells your brain you're full and satisfied, so you stop eating.
An insanely clever survival mechanism, Dopamine made essential activities like eating, drinking, and sex feel good, rewarding us for doing things that kept us alive and motivating us to do them again. Without dopamine, there would probably be no human race.
Imagine it as a satisfaction signal that needs to be correctly sent and received. If the signal is disrupted, the brain doesn't register satisfaction. So we carry on doing whatever it is, waiting for satisfaction to come. And it never does!
This can lead people with addiction to be unable to stop their behaviour, while those with ADHD constantly seek new stimulation, to produce more dopamine.
Inevitably then, the reason drugs and alcohol, along with other pleasurable activities, feel enjoyable, is that they all trigger the release of dopamine, making them very attractive options for individuals with dopamine dysfunction.
But although these substances and activities feel good, they are not necessarily good for us and can lead to harmful patterns of behaviour, particularly for those struggling with ADHD and addiction.
My Sensitivity Dial Goes to 11: The Role of Rejection Sensitive Dysphoria (RSD)
One of the most crippling aspects of ADHD is RSD.
Rejection Sensitive Dysphoria, better described as a horrific oversensitivity to rejection, criticism, or worse, perceived rejection/criticism, can lead to intense emotional reactions.
It basically means someone can ask you what time it is, and you might believe they are actually saying “isn’t it time you left?”
It is one of the lesser-known but most dominating symptoms of ADHD. This condition can drive individuals to seemingly unexplainable emotional rock bottoms, where they will seek relief through whatever means necessary - which often includes alcohol and drugs use.
Addressing RSD in addiction recovery is massively important, as it is this very over sensitivity that can lead to relapse.
Emotional Dysregulation and Overstimulation
Dealing with ADHD can be super stressful and anxiety-inducing, especially with all the emotional ups and downs. The constant emotional rollercoaster is very hard to navigate, leading to exhaustion, overwhelm, and often over-reaction.
Not being able to do the simplest things, forgetting your keys every day, complete simple tasks, constantly being late, feeling like everyone is having a go and criticising you….
Imagine trying to navigate life with all this going on—it's no wonder we turned to quick fixes to make us feel better, even just for the shortest time.
The problem was that for many of us, these quick fixes can turned into habits that were hard to break and eventually contributing to addiction. So recognising these patterns early on is really important. By spotting them, we can come up with better, healthier ways to help people manage their ADHD symptoms and emotional struggles without falling into the trap of addiction.
This really highlights how crucial it is to tackle self-esteem issues when treating addiction. If we can help people feel better about themselves and build some self-esteem, we can make a big difference in their recovery journey.
The Paradox of Stimulant Use
Stimulants, often used for ADHD, are a bit of a paradox because they can also be addictive. Prescribing these meds for addiction might feel like using a hammer to fix a headache, but with careful use, this 'hammer' might actually boost long-term recovery chances. Research seems to point to this. With medical supervision in an addiction dual-diagnosis informed setting, using them in a controlled way can tackle ADHD symptoms and addiction, leading to a greater chance of recovery.
Challenges in Treating ADHD in Recovery
Treating ADHD in individuals recovering from addiction requires careful consideration and a nuanced approach. The benefits of stimulant medications, which are commonly prescribed for ADHD, must be weighed against the potential risks of addiction, particularly in a population already vulnerable to addiction. This balancing act is critical to ensure effective treatment without compromising the individual's recovery journey.
Treatments such as cognitive-behavioral therapy (CBT) and lifestyle changes with an ADHD Coach can play a significant role in managing ADHD symptoms for those in recovery. CBT can help individuals develop coping strategies, improve emotional regulation, and address negative thought patterns that may contribute to both ADHD and addiction. Lifestyle changes, including regular exercise, healthy nutrition, good sleep hygiene, and a suite of productivity and motivational tools, can also have profound effects on managing ADHD symptoms and supporting overall emotional and mental well-being - again, reducing the chance of relapse.
Ongoing support from healthcare providers, mental health professionals, coaches and support groups is essential. These resources can offer guidance, monitor progress, and make necessary adjustments to treatment plans.
A comprehensive, individualised approach that includes medical, psychological, and social support is crucial for effectively treating ADHD in those recovering from addiction.
Ultimately, understanding and addressing the unique challenges faced by individuals with co-occurring ADHD and addiction can lead to more effective treatments and improved long-term outcomes. By adopting a holistic and well-rounded approach, we can better support individuals on their path to recovery and help them achieve a balanced and fulfilling life.
Ongoing Research and Perspectives
Continued research into ADHD and addiction reveals their intertwined nature, emphasising the need for comprehensive treatment strategies. Understanding and managing ADHD is crucial for preventing and addressing addiction, requiring tailored, holistic approaches.
As our knowledge of the relationship between ADHD and addiction deepens, so must our strategies for support and intervention. Recognising the complex interplay of these conditions enables more effective and compassionate approaches to treatment, fostering long-term recovery and well-being.
I have found that living with ADHD can bring incredible strengths like creativity, hyper-focus, and original thinking. I have also found that being in recovery from addiction has brought out characteristics in me I was never really aware of - resilience, empathy, and a deep capacity for change. Combined, they can make some pretty powerful lemonade. Non alcoholic of course.
I hope you find something that works for you.
Matt Thomas
If you need help with ADHD or addiction, or a combination of both, please contact us.
