Today, more than ever before, addiction treatment professionals are finding that their clients come to them with dual diagnoses -- the co-occurance of a psychiatric diagnosis with an addictive disorder. One psychiatric diagnosis that treatment centers are seeing in increasing numbers is Attention Deficit/ Hyperactivity Disorder (AD/HD). In the most recent diagnostic manual of the American Psychiatric Association, AD/HD is coded based on type. The three types are:
There is also a coding for "AD/HD disorder not otherwise specified," which is a category for disorders with prominent symptoms of inattention or hyperactivity-impulsivity that do not meet criteria for AD/HD.
For a diagnosis of AD/HD, criteria must be present for at least six months, "to a degree that is maladaptive and inconsistent with developmental level." In addition, some symptoms that caused impairment must have been present before the age of 7, some impairment from the symptoms must be present in two or more settings, there must be clear evidence of clinically significant impairment in social, academic or occupational functioning. Diagnosis also requires that the symptoms not be better accounted for by another disorder.1
Obviously, it is not an easy task to make a diagnosis. Many times busy physicians use a trial of Ritalin or other stimulant medications to confirm a suspected diagnosis. If the medication helps, then the diagnosis is confirmed and everyone is satisfied, at least for the short-term. The problem with this "quick fix" approach is that the individual with AD/HD and the family does not generally receive comprehensive services. Many times the "quick fix" does not hold up over the long-term. Often, there is strong resistance by parents and adolescents to using prescription medications to help manage the symptoms of the condition.
An article by Thomas B. Cole in the Journal of the American Medical Association titled, "Identifying Substance Abusers at Preschool Age," explains the role of early identification and comprehensive treatment in helping children with AD/HD learn to manage their symptoms and behaviors. " 'Prescribing Ritalin is only part of the treatment for AD/HD,' noted Marie E. Armentano, M.D., an instructor in the psychiatry department at Harvard Medical School. 'In fact, Ritalin can do a child a disservice,' she said, 'if a family problem has been mistaken as solely a problem for the child, or if use of the drug lulls parents, school officials and health teams into complacency.' " A comprehensive treatment program for AD/HD should emphasize parenting skills, classroom management, social skills training, and drug therapy.2
Many parents and healthcare providers are concerned by the dramatic increase in the number of prescriptions being written for Ritalin and other stimulant medications to treat AD/HD. One common concern is that using stimulant medication will cause their child to become addicted or become an abuser of other drugs. Some adolescents do abuse their stimulant medications; but according to Patricia Quinn, M.D., a developmental pediatrician in Washington, D.C., "there is actually less substance abuse in people diagnosed with AD/HD who take medication and do well than in the general population."3
"Properly taken, Ritalin in and of itself is not addictive," says Wendy Sharp, M.S.W., a social worker and researcher at the National Institute of Mental Health's child psychiatry branch.3 The key phrase is "properly taken." The entire issue of proper diagnosis and comprehensive treatment is complicated and time consuming. It is easy to understand why so many opt for the "quick fix." Later, when the individual changes and the fix no longer works, the untreated or undertreated AD/HD individual begins to self-medicate to avoid the pain their condition produces in them.3
In "The Link Between ADD and Addiction Getting the Help You Deserve," Wendy Richardson states: "If you have ADD, you understand how it permeates every area of your life. You know what it's like to space out in the middle of a conversation. You live with the embarrassment and shame of your disorganization or your compulsive attempt to appear organized. You live with the consequences of being controlled by your impulses. You experience the pain you cause others when you fly into spontaneous rages. You feel the shame of not being able to think and live like others."4
Richardson says that there are three main reasons why individuals self-medicate. One is to numb those painful feelings; another is the belief individuals have that they function better under the influence of a chemical; and finally, they self-medicate because it feels good when they do it. "Unfortunately," Richardson says, "self-medicating ADD is like putting out a fire with gasoline."4
What exactly does a comprehensive treatment program for AD/HD look like? The first step is an accurate and thorough assessment. Information on the individual needs to be obtained from more than one source. Possible sources include: parents, teachers, employers, counselors, and the individual being treated. It is important to be sure the professional providing the diagnosis has the experience and expertise to evaluate AD/HD, particularly in diagnosing and treating adults. Wendy Richardson suggests asking the following questions of the person making the diagnosis:
Behavioral interventions include: training in impulse control, anger management, organization and time management and social-skills training.
It is essential to include the family in the treatment plan. Families need to understand the characteristics of AD/HD and to learn effective ways to interact with the individual. Blaming, reacting to anger with more anger, and allowing the individual to get away with inappropriate behaviors are all ineffective ways to deal with the problem.
The evidence is clear that there is a distinct correlation between AD/HD and addictions. Treatment professionals can help in all phases of referral, identification and treatment. Helping the individual with AD/HD avoid and/or overcome problems with addiction involves accurate identification and comprehensive treatment for the individual and his/her family.
References
Pat Fuller is a certified teacher and state
certified counselor. She has worked in public education since 1991.
Fuller has been employed by Proctor Hospital for one year as a
classroom certified teacher in the chemical dependency and the
aftercare units for adolescents'. She is a case manager counselor as
well.