ADDiction Origin Stories

In part one I explored the challenges ADHDers in recovery from substance abuse face and shared my opinions on how we in the healthcare field can address them. But why is it so common for those with ADHD to struggle with addiction in the first place? Here are some theories.

1. ADHD symptoms lead to substance abuse. The hallmark symptoms of impulsivity and distractibility lend themselves to risky behavior of all kinds (we’re also more likely to engage in reckless driving, for example), so it makes sense that a tendency to act before thinking might land us in drugs, alcohol, and other addictions. Other symptoms that might contribute to the risk, though, are:
   • Executive functioning deficits like judgment and planning. Not being able to factor future possibilities into current decisions can certainly contribute to the development of any addiction.
   • Our brains struggle to learn from consequences. We tend to make the same mistakes repeatedly because our brains can’t effectively absorb temporary consequences in order to effect permanent changes in behavior.
   • Difficulty sustaining motivation/focus over an extended period of time makes the process of recovery, like the 12 Steps, especially challenging for ADHDers.
2. The environmental consequences of ADHD lead to increased vulnerability to substance abuse. Growing up with ADHD can easily chip away at your sense of self worth and, directly or indirectly, lead to other challenges:
   • We’re more likely to be subjected to constant correction.
   • We have heightened sensitivity to criticism.
   • We tend to struggle more than our peers with social skills and interpersonal relationships, which can lead to feelings of isolation and social rejection.
   • ADHD can coexist with school difficulty and/or other learning disabilities, and some theorize that kids with below average academic performance are at an increased risk for SUDs.
3. ADHD frequently causes or accompanies other mental disorders. ADHD presents in a lot of “chicken or the egg” conundrums. While for some people other psychiatric conditions like anxiety or depression may be secondary to ADHD for the reasons mentioned above, there are also mental illnesses that commonly appear alongside ADHD that we call “comorbid,” which each carry their own correlation to substance abuse. Most common:
   • depression
   • anxiety
   • obsessive-compulsive disorder
   • post-traumatic stress disorder
   • bipolar disorder
   • conduct disorders
4. The ADHD brain’s dopamine deficiency causes stronger urges for addictive substances and behaviors than the average person. Just as our brains lead us to crave sugar, carbs, adrenaline rushes, and conflict, it can also lead us to seek out substances as a way to supplement the dopamine we lack. Substances can throw anyone’s reward center off balance by flooding the brain with dopamine, resulting in a cyclical search for a return to normal (read the NY Times’ “Visual Journey Through Addiction” for a powerful representation of this). ADHDers are even more susceptible to this cycle because our reward center is already off balance. ADHD and substance abuse share the trait of low hedonic tone, which means it is more difficult for us to feel pleasure. Compared to others, we need more of something to feel the same amount of reward.
5. Predisposition to ADHD and substance abuse are caused by the same genes. Genetic research is complicated, and studies have found multiple genes that may increase one’s vulnerability to both ADHD and SUD. One of them is the dopamine D2 receptor gene, which makes sense given how large a role dopamine plays.
6. The “ADHD Itch.” One anecdotal pattern I see in my ADHD clients is an especially low tolerance for boredom or discomfort. And I don’t mean this in a flippant “Ok I’m bored now” way that we see in various mockeries of ADHD. I mean this in a bone-deep, restless, thoroughly dissatisfied way that is really challenging to understand unless you’ve felt it. It’s kind of like a powerful urge to strip off all your clothes as if they were filled with fire ants…except the fire ants are invisible and your clothes is actually your skin. However you articulate it, it’s easy to see how the sensation can propel us toward action with little premeditation, no matter how destructive it may be. You don’t care that you’re naked if the alternative is being bitten by fire ants. Dr. Hallowell describes this unique feeling as an “all-but-unscratchable lifelong itch” that appears strongly and without warning:

It is difficult to describe exactly what they don’t like about how they feel, except to say that they feel bored, or off, or logy, or at sea.

What can begin as a mildly unpleasant feeling can escalate in seconds into a veritable crisis. They feel they must do something to change how they feel. Within moments, they are operating on a level beyond their rational control.

Dr. Edward M. Hallowell, Delivered from Distraction

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