How to Prevent Your ADHD Child from Becoming an Addict

By Cathy Cassata 04/07/16

The pleasure meter of ADHD sufferers is set differently than it is for other people, so they feel like they need to resort to extraordinary means to get ordinary pleasure.

Image: 
adhdkid.jpg
Shutterstock

As if you don’t have enough worries for your child with ADHD, experts say a high risk for addiction should be on your mind, as well.

“Addiction and use problems are eight times more common in the ADD population,” said Edward Hallowell, MD, child and adult psychiatrist and author of Superparenting for ADD: An Innovative Approach to Raising Your Distracted Child.

"People with ADD are way more prone to all kinds of issues related to addiction and compulsion," said Hallowell. "Besides misusing drugs and alcohol, they may compulsively shop, eat, gamble and have sex." 

Timothy Edwin Wilens, MD, chief of child and adolescent psychiatry at Massachusetts General Hospital for Children, agrees. Wilens says the following are risk factors for general substance abuse among children and adolescents with ADHD:

Genetics: There is a higher rate of substance use disorder in parents of kids with ADHD than those without ADHD, suggesting that there may be a genetic relationship between substance use disorder and ADHD.

Co-occurring Problems: Those with ADHD who also have delinquency, anger management issues or mood disorders, such as depression, are at risk for substance problems. “They find that substances calm them in the short-term, but then become problematic in the long-run,” said Wilens.

Academic Underachievement: Wilens says that ADHD kids who are not treated properly “academically underperform and subsequently have self-esteem issues or don't feel good about themselves.” The low self-esteem and self-doubt can lead to substance use.

Hallowell adds that people with ADD are predisposed to self-medicate because they have a need to change their inner state. “Their pleasure meter is set differently than it is for other people, so they feel like they need to resort to extraordinary means to get ordinary pleasure, feel more alive and engaged,” he explained.

Substance Abuse May Mean Undiagnosed ADHD

Research conducted over the past few years has shown that 50 to 60 percent of adolescents with substance use disorder also have ADHD. “In our Addiction Recovery Management Service program at Mass General, we find that 65 percent of them have ADHD,” Wilens said.

Moreover, in many cases, Wilens says the symptoms of ADHD appear before substance abuse begins, indicating that a lot of kids use drugs and alcohol as a way to cope with the consequences of having ADHD.

Hallowell stresses that if you discover your child has a substance use disorder, you should automatically consider the possibility of ADD. “He or she could be self-medicating untreated ADD. So instead of just assuming he has an addiction problem and sending him off to Hazelden, you should look into ADD. When the ADD is treated, you have a real good way of controlling the addiction,” he said.

Misuse of Stimulants - Cause for Concern

Misuse or abuse of stimulant medications, such as Ritalin and Adderall—which are often effective in managing ADHD symptoms—has been a controversial issue.

“It’s a common misunderstanding that if you’re prone to addiction, you can’t be put on stimulants, but that’s so self-defeating because it’s what [people with ADHD] need so they won’t self-medicate with the wrong things,” says Hallowell. “By being put on stimulant medication, those with ADHD dramatically reduce the risk of abusing alcohol or cocaine or gambling or whatever they lean toward. Some doctors won’t prescribe stimulants to those with ADHD who have a history of addiction, which is sort of saying ‘we’re going to punish you for using the wrong medication by refusing to give you the right medication.’ Then these patients are left with sub-standard intervention.”

Diagnosing properly, prescribing the correct medication, and monitoring ADHD patients appropriately can help ward off stimulant use, Hallowell adds.

Wilens concurs, and points out that large European studies have shown that taking stimulants may actually decrease the risk of addiction in those with ADHD.

“Having said that, studies I’ve worked on have shown that while most people use their medications appropriately, there’s still 10 to 20 percent of adolescents and young adults who misuse their medicines—either escalate the dose or take at times when they’re not supposed to, or sell it, which then gets diverted to other people,” he said.

Whether to give short-acting versus long-acting stimulants has also received debate. 

“If you give the same amount of short-acting stimulant that lasts four hours and just repeat it more often than an extended release, which lasts 12 hours, it acts differently in the brain,” Wilens said. “A study we did a decade ago showed that both types treated the ADHD, but those who took the short-acting liked it more, meaning they got a little bit of a high. If that occurs with a therapeutic dose, imagine what it would do if they were taking more than they should.”

Still, while Wilens says taking extended release stimulants greatly reduces the risk of misusing the drug, it doesn’t mean you’re immunized against the risk for substance use disorders or misusing stimulants.

Signs of Substance Abuse

Wilens and Hallowell say general signs of substance abuse in children or adolescents may include the following:

• Academic decline

• Acting more secretive, isolated, or withdrawn

• Sleeping a lot

• Bad hygiene

• Hanging out with a different peer group than usual

• More moody than normal

• Looking high, intoxicated, or spaced out

• Going through money quickly

• Taking booze or drugs you have in the house

Signs of Stimulant Misuse

In addition to the above, Wilens says those who are addicted to or misusing stimulant medication may do the following:

• Look wired, nervous, or anxious

• Lose weight

• Finish their prescriptions earlier

• Try to buy samples of stimulants

What Can Parents Do?

Substance abuse tends to increase in those with ADHD around age 12. If your child is diagnosed with ADHD, Wilens says talk to them about substance abuse about a year before then, around the time they reach 5th grade. While you may not straight out ask them if they’re smoking weed or drinking alcohol, he suggests posing questions in the following way:

• Are any of your friends smoking cigarettes or doing anything like that?

• Have you ever been in a car with someone who took any sips of alcohol?

“If they answer yes to any of your questions, tell them that you’re worried and want to keep them away from any kind of substances because having ADHD makes it very dangerous to do so,” said Wilens.

In terms of misuse and diversion of prescribed stimulant medication, Wilens says talk to your child about this when they’re 13 or 14 years old.

“I tell my patients that while having ADHD is nothing to be ashamed of, they shouldn’t advertise that they take medicines because some kids may want them to give or sell them their medications to get high,” he said.

He points out that parents should tell their child that other kids could get sick from their medication and that they could get into trouble for giving or selling it to them.

For college aged children, Wilens informs them that because they’re over 18, they could get kicked out of college and even serve jail time for giving away or selling their medications.

Hallowell says he routinely talks to his adolescent patients and their parents about subtance abuse and compulsion. 

“ADD is like having a Ferrari for a brain with bicycle breaks. You have this really powerful brain, but your braking system isn’t strong enough,” said Hallowell. “I tell my ADD patients and parents that because of this, they’re at risk for addiction,” he said. “Medication strengthens your brakes and gives you more control over the power of your mind.”

In addition to medication, he adds that psychotherapy, on-going monitoring, nutritional intervention, and exercising, among other things, should also be part of ADHD treatment.

If you discover your child has a substance abuse issue, whether it’s with stimulant medication or another substance,  Hallowell leaves you with this final thought. 

“Parents should be proactive. Don’t think ‘my son is a drug addict. I can’t do anything.’ Take it seriously, of course, but know that this is one of the causes of addiction that is really treatable, if you get the right help to treat addiction and the ADD.”

Please read our comment policy. - The Fix
Disqus comments
cathy-cassata.jpg

Cathy Cassata is a freelance writer who writes about health, mental health and human behavior for a variety of publications and websites. She is a regular contributor to Everyday Health and Healthline. View her portfolio of stories at https://cathycassata.contently.com. Connect with her on Twitter at @Cassatastyle.

Disqus comments