The prevalence of children diagnosed with attention deficit hyperactivity disorder (ADHD) greatly exceeds the prevalence of this diagnosis among the adult population. This could be, perhaps, because the disorder is more difficult to diagnose in adults. Research suggests that one to five percent of adults suffering from ADHD are unaware that they have it or that it affects their daily lives.
Natalie Jeanne Champagne is the author of The Third Sunrise: A Memoir of Madness. Natalie regularly contributes to mental health and addictions publications and is an advocate for mental health. She currently lives in British Columbia, Canada. The Third Sunrise is her first book.
Editor: Nadeem Noor
Complications of Diagnosing ADHD in Adults
- Adult symptoms vary and are harder to diagnose than those present in children.
- It is less well known that adults can have ADHD. Those who suspect they have it may be reluctant to seek help or be unaware that they should.
- General practitioners often attribute ADHD symptoms to more commonly diagnosed disorders such as depression, bipolar disorder, anxiety disorders or common negative lifestyle issues such as poor diet. Improper diagnosis ensures that ADHD remains untreated.
- Adults with ADHD may adapt to symptoms over time. In fact, some may enjoy or feel a benefit from the energy that can define the hyperactivity part of this disorder. Those who have lived with the illness, undiagnosed, for a long time—often since childhood—may not even be aware of their own erratic behavior.
Adults with undiagnosed ADHD also exhibit a much more frequent incidence of addictive behavior than those who do not suffer from the disorder. Reasons vary, but substance abuse often is connected to a need to self-medicate untreated ADHD symptoms.
The Prevalence of Addiction in Adults with Undiagnosed ADHD
Oxford University Press, on behalf of the Medical Council on Alcohol, published an investigative research paper focusing on ADHD patients and nicotine and alcohol dependence. The findings reported, “Several studies have shown that attention-deficit/hyperactivity disorder (ADHD) represents a significant risk factor for the onset and development of addiction” (Ohlmeier et al., 2007).
Although this research focused primarily on nicotine and alcohol addiction, the rate of addiction for all substance abuse, specifically drugs with stimulant properties, is much higher for ADHD sufferers than in the general populace. Carl Sherman, PhD, explains, “A recent survey found that more than 15 percent of adults with the disorder had abused or were dependent upon alcohol or drugs during the previous year. That’s nearly triple the rate for adults without ADHD” (2007).
Often, those abusing any form of negative or illicit substances are not properly treated for the disorder or the resulting addiction — because they are unaware that they have ADHD and treatment for it is available.
Living with Undiagnosed Adult ADHD
I was not diagnosed with ADHD until age 24, so I have firsthand knowledge of the pain and difficulty that adults with ADHD face. I began to abuse stimulant drugs when I realized that they were able to slow me down — a paradoxical effect. For example, while cocaine speeds most people up, adults with undiagnosed, untreated ADHD often are slowed down. Illegal drugs affect the brain in a way similar to the medication commonly prescribed for ADHD — it is no wonder those unaware of their condition often turn to self-medication.
I abused alcohol for the same reason. It was a vicious cycle: My untreated disorder led to impulsive behavior (abusing drugs and alcohol). The relief they brought encouraged me to continue my substance abuse. This is far too common a problem among adults living with undiagnosed ADHD.
Why Is Addiction Such an Issue for Adults with Undiagnosed ADHD?
In his insightful article, “Addiction and ADHD Adults,” Carl Sherman quotes a study by Timothy Milens, MD: “In our study…only 30 percent [of participants] said they used substances to get high… Seventy percent are doing it to improve their mood, to sleep better, or for other reasons” (2007). Sherman goes on to elaborate that abuse of substances, when connected to adult ADHD, often is based on a need to self-medicate the symptoms: “…This kind of ‘self-medication’ seems especially common among individuals whose ADHD remains undiagnosed or who have been diagnosed but have never gotten treatment” (2007).
Stimulant drugs such as cocaine can provide temporary relief. Alcohol has a similar effect on the central nervous system. The medication used to treat ADHD has stimulant properties and affects the same area of the brain as stimulant drugs, though to a lesser degree. Primarily because of this, the potential for abuse among those being treated with adult ADHD, especially those who have a history of substance abuse, is difficult and requires a comprehensive approach.
Treating Adult ADHD When There is a History of Substance Abuse
Before I was prescribed medication for ADHD, I had to remain sober for a year—a reasonable amount of time. Once I was prescribed the proper medication (Concerta, a slow-release variety of Ritalin), I appreciated the ability to focus, and I found that recovering from addiction was easier, primarily because my impulsivity was lessened. Dr. Sherman also elaborated on the importance of this approach: “What’s the right way to get help? Recent studies suggest that it’s best to optimize the treatment for ADHD only after the individual has been sober for six weeks to a few months” (2007).
All stimulant-based drugs have the potential to cause addiction. For this reason, many doctors initially choose to prescribe non-stimulant medications. “Which ADHD medication is best for someone who has already battled substance abuse? For many doctors, the first choice is non-stimulant. These drugs may not be as effective as stimulants for treating certain symptoms… Other doctors choose to prescribe a stimulant…an extended-release formulation… These slow-acting meds are less likely to be abused” (Sherman, 2007).
Adults living with undiagnosed ADHD may engage in addictive behavior simply because they are medicating the primary diagnosis, which may be inaccurate. If they receive a proper diagnosis and proper treatment, they will be less likely to turn to drugs or alcohol and less likely to succumb to addiction.
Treating adult ADHD is difficult both for the primary caregiver and the patient. Because the incidence of addiction is so high among this population, treating the disorder with stimulant treatment regimens must be properly and thoroughly evaluated.