ADHD and Addictions

ADHD can make enjoyable activities even more engaging and pleasurable. This heightened sensitivity to reward can lead to intense focus on fun tasks, but also increases vulnerability to addiction.

Examples:

• Parties become incredibly exciting
• Building Legos for hours can be absorbing
• Video games and LAN parties can be extremely engaging

“It’s kind of weird, but the hardest thing about having ADHD is how incredibly fun life actually is. So I know it sounds kind of bizarre but the thing about ADHD is that the fun things in life are so much more fun.”

“Right parties are an absolute blast where you can go absolutely crazy. Even getting lost with playing Legos like you can get absorbed and putting together a Millennium Falcon for like six hours and man is a fantastic things like video games are such a blast LAN parties you know, binge like binge playthroughs, where you’re up all night.”

• How does the intensified enjoyment of activities affect daily life for someone with ADHD?
• In what ways can this heightened sensitivity to fun be both a blessing and a curse?
• How might understanding this aspect of ADHD help in managing its challenges?

Reward sensitivity, Hyperfocus, Addiction vulnerability

ADHD brains have different reinforcement circuitry compared to neurotypical brains. This alteration leads to increased pleasure from rewarding activities and difficulty incorporating potential costs into decision-making.

• Neurotypical brain: 5 units of reward from an activity
• ADHD brain: 7-8 units of reward from the same activity
• ADHD brains struggle to delay gratification and consider future consequences

“The first is altered reinforcement circuitry. So this is kind of simple, but essentially some activities just feel more fun to someone with ADHD. If we think about the reward that we get from a particular activity, a neurotypical brain may get five units of reward from a particular activity, whereas an ADHD brain may get seven or eight units of pleasure from that same activity.”

“The challenge is that in the brain of someone with ADHD, we know that they have a lot of difficulty delaying gratification. And if we look at their difficulty in delaying gratification, it’s essentially their inability or their difficulty in incorporating the negative into a particular behavior.”

• How does this altered reinforcement circuitry impact daily decision-making for someone with ADHD?
• In what ways might this heightened reward sensitivity be harnessed positively?
• How can individuals with ADHD develop strategies to better consider long-term consequences?

Delayed gratification, Decision-making processes, Reward system

People with ADHD often struggle with emotional regulation due to weaker connections between the frontal lobes and the amygdala/limbic system. This can lead to difficulty managing negative emotions and increased vulnerability to addiction as a form of self-medication.

• Frontal lobes typically regulate the amygdala and limbic system
• ADHD brains have weaker connections in this area
• Some hypothesize a subtype of ADHD specifically related to emotional dysregulation

“What we know through some scientific studies is that people who have ADHD have a weak connection there, and that their frontal lobes aren’t quite as effective at regulating their negative emotions. There are even some hypotheses that there’s a subtype of ADHD that actually is specifically emotional dysregulation.”

“If I’m feeling really bad about myself, and the only tool that I have to make myself better is to play a video game or drink alcohol or to get high. I will use those kinds of substances to sort of calm down by negative emotional circuits.”

• How does emotional dysregulation manifest in daily life for someone with ADHD?
• What strategies can individuals with ADHD use to improve their emotional regulation?
• How might understanding this aspect of ADHD help in developing more effective treatments?

Emotional intelligence, Self-Regulation, Frontal lobe function

The altered brain functioning in ADHD creates a perfect storm for addiction vulnerability. This is due to heightened reward sensitivity, difficulty considering future consequences, and challenges with emotional regulation.

Factors contributing to addiction vulnerability in ADHD:

1. Increased pleasure from rewarding activities
2. Difficulty incorporating costs into decision-making
3. Challenges with emotional regulation
4. Dopamine deficiencies in key brain areas

“So what we end up seeing clinically is that if you have ADHD, you’re much more prone to actually be vulnerable to addiction.”

“So it’s kind of interesting that what happens in the brain of someone who has ADHD is they’re actually dopamine deficient in acute a few key areas. And so originally, when someone with ADHD starts to use substances, it almost is like a self medication.”

• How can understanding this vulnerability help in developing prevention strategies for individuals with ADHD?
• What role might early intervention play in reducing addiction risks for those with ADHD?
• How can we balance treating ADHD symptoms while minimizing addiction risks?

Dopamine deficiency, Self-medication, Addiction prevention

ADHD and addiction have a complex, interconnected relationship. While ADHD increases vulnerability to addiction, substance use can exacerbate ADHD symptoms, creating a challenging cycle.

Key points:

• Initial substance use may temporarily “correct” dopamine levels
• Long-term use leads to tolerance and lower baseline dopamine levels
• Lower dopamine levels can worsen ADHD symptoms

“As we develop a tolerance to the substance. What actually happens is our dopamine level ends up lower than it originally was. And in the neurotypical brain that’s bad enough, but in the brain of someone with ADHD as we develop tolerance to a drug and our dopamine level tanks. What that actually does is exacerbates our ADHD”

• How does understanding this synergistic relationship impact treatment approaches?
• What strategies can be employed to break the cycle of ADHD and addiction?
• How might this knowledge influence early intervention and prevention efforts?

Dopamine regulation, Tolerance and addiction, Treatment integration

Growing up with ADHD often leads to feelings of shame due to academic and social struggles. This shame can contribute to the development of addiction as a form of self-medication.

Sources of shame in ADHD:

• Academic difficulties despite intelligence
• Social interaction challenges
• Less likely to be invited to social events

“So ADHD leads to a lot of shame growing up, which is why it’s actually a risk factor for developing depression in adulthood. What does that have to do with addictions? Well, what do we use substances for we use substances to drown out that shame?”

• How can we address and mitigate shame in individuals with ADHD, especially during childhood and adolescence?
• What role does self-compassion play in managing ADHD and preventing addiction?
• How can parents and educators support children with ADHD to build self-esteem and resilience?

Self-esteem, Social skills development, Shame resilience

Treating ADHD and addiction together can have synergistic benefits. Addressing one condition often helps improve the other, leading to more effective overall treatment.

Treatment strategies:

1. Psychotherapy to address underlying shame
2. Meditation to strengthen frontal lobe function
3. Cognitive Behavioral Therapy (CBT) for decision-making skills
4. Sobriety to improve ADHD symptoms

“The good news is that treatment for one is almost always treatment for the other getting sober will improve your attention and concentration. As you learn to meditate to sort of strengthen your frontal lobes. You’ll also improve your control over impulses and your ability to resist taking a drink or getting high.”

• How can healthcare providers better integrate ADHD and addiction treatments?
• What role might peer support groups play in addressing both ADHD and addiction?
• How can individuals with ADHD and addiction histories create personalized recovery plans that address both conditions?

Dual diagnosis treatment, Mindfulness-based interventions, Impulse control strategies