Addiction Treatment for Adults with ADHD - Special Considerations
ADHD patients requiring drug treatment are varyingly estimated at between 10% and 30% of the total abusing population, and few dispute the causal link between the disorder and a greatly increased risk for abuse and addiction.
Drug treatment for ADHD patients requires that therapies be offered cognizant of the specific teaching and learning styles proven most beneficial to this subset of abusers. Ideally treatment should be undertaken within a homogenous group of fellow ADHD substance abusing peers, and pharmacological intervention used to diminish the severity of ADHD symptoms.
Trigger for substance abuse later in life?
Do stimulant ADHD drugs prescribed for children increase the likelihood of drug or alcohol abuse in adult ADHD sufferers?
Parents and researchers have long been concerned that the administration of effective stimulant drugs to young ADHD patients may be partially responsible for inducing this higher prevalence of substance abuse later in life. The concerns were that the administration of stimulants caused a sensitization to the reward effects of other stimulant drugs, and thus increased the probability of drug addiction; and also that by prescribing psychotropic substances to children we risked inducing a desire to continue to enjoy these drugs through a non clinical administration.
Research carried out by the National Institute on Drug Abuse (NIDA) has thankfully proven the safety of these stimulant drug treatments for the symptoms of ADHD, and although they remain very controversial, they have been proven to greatly diminish the likelihood of future substance abuse when compared to an untreated ADHD population. ADHD stimulant drugs for adult ADHD patients have proven effective in the treatment of stimulant addictions, but have shown little effect for stimulant addiction treatment in people not suffering from ADHD.
Therapy available for ADHD-related substance abuse
The therapies as offered need to be presented in an optimal manner for this group of recovering addicts, and often drug treatment for ADHD patients will take longer and require more intensive intervention than is normally mandated. Because ADHD symptoms seem to increase the risks of substance abuse behaviors, the management of ADHD symptoms is also necessary for relapse avoidance and long term sobriety
The therapies and programming as offered at any drug treatment facility can be beneficial for this group of dual diagnosis patients, but therapies need to be offered with an awareness of the limitations of ADHD patients, and therapeutic sessions may need to be altered slightly, using diverse presentation methods and less focused classroom time, to offer the best results.
Group therapies have proven very effective in drug treatment for ADHD patients. For best effect, these cognitive behavioral groups and support style therapy sessions should be offered in a homogenous group of other ADHD substance abusing patients; but if this is not possible, ADHD patients in drug treatment do benefit from inclusion into any peer group therapies.
Drug treatment for ADHD patients should also include a strong individual therapeutic component, and ADHD patients in drug treatment need to work with an addictions professional to develop an individualized and comprehensive relapse prevention plan.
Pharmacological intervention, therapy & aftercare
Although there have been concerns that the usage of powerful stimulant style drugs for ADHD symptoms control could increase the risks of later drug use and dependence, studies now indicate that the reverse is true, and that appropriately medicated patients have a far lower risk of developing addictions. Appropriate medication is not only crucial in preventing the expression of substance abuse, it seems also to be the most important factor in the treatment of adult patients exhibiting a dual diagnosis of substance abuse and ADHD. With medicated ADHD symptoms reduction, patients are better able to benefit from the lessons of drug treatment, and also better able control their cravings and compulsions towards drug seeking.
The two main facets of drug treatment for ADHD patients are appropriate pharmacological intervention, and appropriate therapy and aftercare tailored to the needs and learning styles of ADHD patients.
Anti-depressants & stimulants like Ritalin
Both stimulant drugs and certain anti depressant medications can be used in the control of ADHD symptoms expression. Although stimulant style medications such as Ritalin have proven most effective, because these medications have an abuse potential, substance abusers seeking to control their ADHD symptoms have often been directed towards second tier anti depressant style medications. Although these anti depressant style medications do have a lower abuse potential, they have not proven as effective in adult ADHD symptoms control, and they have also failed to greatly affect substance abuse rates.
Recent clinical trials have indicated that Ritalin shows great promise both as a symptoms control medication, and also as a medication that seems to limit the severity of cravings and drug seeking compulsions, especially amongst ADHD stimulant addicts.
Because these medications can be abused, addictions professionals recommend that they be prescribed in very limited dosages, and that patients using the medications be closely monitored for any signs that would indicate an abuse of the prescribed medications. To further reduce the abuse potential, the longer acting slow release form of Ritalin can be used.
ADHD can be the trigger
Why do people with ADHD have a greater risk for substance abuse and addiction?
It seems that the treatment drugs prescribed to children with the disorder are not responsible for the higher than average rates of substance abuse within ADHD populations. Addictions professionals cannot say with certainty what causes the increased rates of abuse, but they speculate that the learning and academic difficulties as experienced by adolescent ADHD sufferers increases their social isolation, can induce feelings of depression, and even expose them to some ridicule amongst their peers. The symptoms of ADHD may create a social environment conducive to substance use and abuse.
Additionally, some people who had remained undiagnosed with the disorder until drug treatment have stated that the use of stimulant drugs such as cocaine or meth amphetamine actually improved their ADHD symptoms expression, and through illicit stimulant drugs they were better able to focus and contribute productively at school or on the job. ADHD patients in drug treatment may have developed addictions as they used illicit stimulants as a way of self medicating their ADHD symptoms.
ADHD sufferers are also more likely to engage in risky and impulsive behaviors, and this symptom of the disorder may also promote further substance abuse.
Researchers are not certain what mechanisms are inducing the abuse, but they can say that a diagnosis of ADHD greatly increases the risks for later problems with substance abuse and addiction. Although between 3% and 5% of the population are afflicted with ADHD, the rates of substance abusers with ADHD are between 10% and 30%. Additionally, research has shown that adolescents with ADHD use drugs and alcohol at a younger age and with more frequency than normal, and that those ADHD patients with the severest symptoms expressions demonstrated the heaviest drug and alcohol abuse.
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