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Dual Diagnosis: ADHD

    Dual Diagnosis: ADHD

    ADHD is a condition that increases an individual’s hyperactive and impulsive behaviours, commonly manifesting in a need to be constantly moving and an inability to slow down and focus.

    Individuals struggle with instructions, often lose or forget things, and tend to develop other mental health conditions in later life, such as anxiety and depression.

    Those with ADHD are also at a higher risk of succumbing to substance abuse, usually as a result of them wanting to soothe their symptoms through self-medication. Their impulsive traits also increase the probability of this.

    What is ADHD?

    Attention Deficit Hyperactive Disorder (ADHD) is a neurological condition that tends to make an individual hyperactive and impulsive, often reducing their ability to keep their attention on one thing at a time.

    Very common in young children, the disorder continues to influence behaviour as they grow into adults. While symptoms can be managed with early diagnosis, ADHD can sometimes be missed and left untreated going into adulthood.

    An adult with ADHD is also likely to develop other conditions as a result of their disorder, including depression and anxiety, both of which can impact their behaviour and mental health.

    Types of ADHD

    ADHD can manifest in three different ways, with each type causing an individual to present slightly different symptoms of the disorder.

    Firstly, there is hyperactive/impulsive ADHD. This causes an individual to always want to be active. They talk a lot, move a lot, and are constantly fidgeting. Sitting still is very difficult, as is showing self-control. Those with hyperactive ADHD tend to interrupt people and come across as rude to others.

    Next, there is inattentive ADHD. This type causes an individual to struggle to pay attention to things, often causing them to leave tasks unfinished and make mistakes. Information gets forgotten and things go missing.

    Finally, there is combined ADHD, which involves traits of the other types manifesting in one individual’s behaviour.

    What are the signs and symptoms?

    As described above, the symptoms of ADHD are behavioural. A child with the condition is likely to:

    • Constantly feel the need to move
    • Talk quickly, loudly, or constantly
    • Run or be active where inappropriate
    • Struggle to concentrate on a task
    • Show disinterest when being spoken to
    • Be uncomfortable when asked to sit still
    • Forget things or lose items
    • Struggle with instructions
    • Fidget

    What symptoms an individual demonstrates will depend on the form of ADHD they have. They may only have some of the behavioural traits listed above, or all of them. In many cases, these traits will have an impact on both the educational and social development of a child.

    For adults with the condition, traits of childhood ADHD can remain, alongside more serious ones. With family and employment placing more responsibility on an individual, such traits can also threaten to disrupt their day-to-day life.

    Adults with ADHD can demonstrate some of the following behaviours:

    • Leaving work tasks unfinished
    • Being distracted, unorganised, or messy at work or at home
    • Forgetting events, names, or tasks
    • Struggling to concentrate
    • Insomnia
    • Anxiety
    • Difficulty in relationships
    • Depression

    Risk factors

    When it comes to the chances of an individual developing ADHD, there are several theories as to what factors may play a role.

    As with other conditions, it is thought that ADHD is partially a genetic disorder, meaning that there are certain genes that hold the potential for it to develop. However, the specifics of this link are not very well understood.

    One notable area of the brain, however, is the frontal lobe. It is responsible for things such as memory, decision-making and paying attention, and so there may be a genetic component regarding how it functions in those with ADHD.

    Environmental factors have also been suggested to play a role in ADHD. For example, the substances an unborn baby is exposed to are known to influence brain development. A baby whose mother smokes or drinks during pregnancy has a higher chance of developing the condition.

    ADHD and addiction

    Many individuals with ADHD also struggle with substance abuse, consuming excessive amounts of a certain material to the point where they become dependent on it. Research suggests that those with ADHD are more likely to develop an addiction than those without it [1].

    It is thought that this occurs as a result of individuals looking to self-medicate and relieve some of their ADHD symptoms with the sedative effects of a certain substance. This usually works in the beginning, but their body can quickly develop a dependency.

    When this happens, they experience withdrawal symptoms when they do not consume the substance, and they also find that their tolerance requires them to consume larger quantities in order to achieve its sedative effect.

    Those with ADHD often struggle to control their behavioural impulses, and so addiction can also begin from them using a substance without having much restraint.

    What substances can be abused?

    An individual with ADHD can find themselves becoming addicted to similar substances to those without the condition, such as alcohol and drugs. The appeal of these materials largely stems from their ability to calm or negate the symptoms of their condition.

    However, they may also become addicted to the medicinal substances prescribed to them to help their disorder. Stimulants, designed to help an individual concentrate, can become addictive, as can antidepressants, which look to ease depression or anxiety.

    1. Alcohol

    When it comes to alcohol, an addicted individual with ADHD may soon find that their dependence upon the substance begins to eventually worsen the traits of their condition.

    While it can act as a sedative, in the beginning, alcohol is ultimately a depressant. It is prone to disturbing brain chemistry and causing individuals to experience erratic thoughts and feelings.

    For an individual with ADHD, this effect will work to exacerbate their impulsive and inattentive tendencies. To overcome this, they consume greater amounts of alcohol, sending them down the destructive cycle of addiction.

    2. Treatment

    The effectiveness of treating ADHD largely depends on when it is diagnosed, as spotting it early allows for management strategies to be developed during childhood. If substance abuse is also being experienced, it is essential that both conditions be treated simultaneously.

    The reason for this stems from the interconnected nature of addiction and ADHD. The cause of addiction often lies in a desire to self-medicate for ADHD symptoms, and persistent symptoms often fuel continued substance abuse.

    3. ADHD

    There is no single way of clearly diagnosing whether an individual has ADHD. Instead, a medical professional will assess each case individually, often looking to identify at least 6 of the symptoms and behavioural tendencies listed above [2].

    Once the condition has been diagnosed, treatment can often take the form of a combination of several methods.

    Firstly, a medical professional may choose to prescribe medication to help an individual cope with everyday life. This may include small, measured doses of stimulants designed to aid concentration, or possibly antidepressants.

    In the event that the individual is also struggling with substance abuse, this may be avoided until they have weaned themselves from their current dependency.

    Therapies can also be provided, often taking the form of Cognitive Behavioural Therapy (CBT). CBT looks to help an individual identify what situations most provoke their impulsive behaviour, and develop alternative ways of reacting to them.

    This work can be assisted by support groups, family or couple therapy, and stress management classes. For children or young adults with ADHD, sessions may be held which look to improve their social skills and educational development.

    4. Substance abuse

    When it comes to substance abuse, the primary focus of treatment will be to wean the individual’s body from its dependency on the substance. This will involve a medically assisted detox.

    With the help of medical professionals, an individual will discontinue their use of a substance. They will be monitored and prescribed medicinal substitutes, such as benzodiazepines, to ease withdrawal symptoms if needed.

    Detox can often be very difficult when attempted alone, and in the instance of alcohol addiction, it can even be fatal. It is therefore essential that those who need to wean their bodies do so with the supervision and assistance of a dedicated rehab centre.

    Alongside this physical treatment, an individual will undergo therapy. CBT can also be employed here to work through why an individual chooses to abuse their chosen substance.

    This treatment method will tend to focus on an individual’s substance abuse and ADHD at the same time, working through why one leads to the other, and developing alternative methods of responding to their ADHD symptoms.

    How to get more information

    If you or someone you know is struggling with ADHD and may benefit from medical assistance, it is important to seek help. Developing strategies for handling symptoms can greatly improve quality of life, so speak to your GP to discuss what options are available.

    It is also important to seek help if an ADHD sufferer is struggling with substance abuse. If this is the case, speak to a GP or substance abuse organisation to discuss what treatment methods are most appropriate.

    [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4414493/

    [2] https://www.cdc.gov/ncbddd/adhd/diagnosis.html

     

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