Etiologies of ADHD and Substance Use Disorders

Etiologies of ADHD and Substance Use Disorders Approximately half of all individuals with mental disorders also have substance abuse issues (Dual Diagnosis, 2007). Likewise, it is estimated that up to 45% of adults with ADHD have a lifetime diagnosis of alcohol abuse or dependence (Wilens, 2006). Consequently, individuals with addictions who are also diagnosed with ADHD, characteristically have a extra severe course of addiction and greater difficulties in recovery. It is difficult to predict with any certainty which drinker or recreational drug user will develop serious substance abuse issues. It is also unfeasible to predict whose problems are situational and short-lived and whose will remain chronic and progressive. However, there are specific factors and influences that increase a person’s chance of developing a substance use disorder (SUD). Interplay between genetic familial predisposition and lifestyle manipulates the development of an SUD just as it may manipulate hypertension. Many clinicians believe that individuals may inherit a genetic susceptibility to substance abuse that may be fueled by a combination of family and social norms, traumatic events, pharmacodynamic effects, or environmental factors. At the same time, people with these inherent genetics may develop problems as a response to external stresses or internal discomfort if they continue using alcohol or other drugs over time (NAMI, 2011). While ADHD manifests itself earlier than an SUD, an SUD is unlikely to be a risk factor for ADHD. Both familial predisposition and psychological issues are most likely operational in causing SUD in individuals with ADHD (Wilens, 2006). However, ADHD has shown to influence SUD within a number of other attributes as well. Studies have suggested that the behavioral disinhibition components of ADHD might be particularly important for the development of substance use and SUD in adolescences (Molina & Pelham, 2003). Barkley & Murphy (2003) argue that disinhibition is the fundamental deficit in ADHD and accounts for most ADHD-related impairments which would include substance use disorders. In their longitudinal study, Molina and Pelham (2003) established that childhood ADHD, variability in underlying dimensions, and persistence of the disorder as risk factors for early substance use and the materialization of SUD in adolescence. Relative to other populations established as risk groups for early drinking and drug use, the risk associated with ADHD is comparable (Molina & Pelham, 2003). The exact mechanisms mediating the expression of substance abuse disorders and Attention Deficit Hyperactivity Disorder remains to be uncovered and are undoubtedly complex. One relatively simple and logical suggestion however is that substance abuse is a form of self-medication (Wilens, 2006). Individuals with substance abuse disorders often report relief of such symptoms such as anxiety, depression, and aggression. It is therefore logical that the individual with ADHD would self-medicate for the same reasons as well as dealing with other symptoms created by the diagnoses of ADHD. Some young adults with both ADHD and SUD have described a calming of internal restlessness (possibly the expiration of hyperactive symptoms) with marijuana and other substances. Another suggestion as well could be that individuals with ADHD use substances to ease the pain that is felt from the constant failure and demoralization.

References
Barkley, R. A., & Murphey, K. R. (2003). Attention Deficit Hyperactivity Disorder (3rd ed.). New York, NY: The Guilford Press.
Drug Abuse and Its Causes (Fact Sheet). (2011). Retrieved from National Institue on Drug Abuse: http://drugabuse.gov
Dual Diagnosis: Substance Abuse and Mental Illness (Fact Sheet). (2007). Retrieved from National Alliance on Mental Illness: http://www.nami.org
Molina, B. S., & Pelham, W. E. (2003). Childhood Predictors of Adolescent Substance Use in a Longitudinal Study of Children with ADHD. Journal of Abnormal Psychology, 112, 497-507. doi: 10.1037/0021-843X.112.3.497
Wilens, T. E. (2006). When ADHD and Substance Abuse Collide. In , The New CHADD Information and Resource Guide to ADHD (pp. 89-92). New York, NY: Children and Adults with Attention Deficit Hyperactivity Disorder.