Overview
Attention Deficit Hyperactivity Disorder (ADHD) is widely defined as a neurodevelopment disorder that impacts executive function and makes it difficult to sustain attention, regulate emotions, and manage impulsivity. In most cases, ADHD is genetic with a heritability rate of 80%, thought it has sometimes been observed to occur in adults who experience traumatic brain injuries (TBIs). Diagnosing ADHD can be difficult since many other disorders can be responsible for symptoms that include impulsivity and difficulty maintaining focus.
As of the DSM-V, ADHD comes in three primary presentations:
-
Predominantly Inattentive: overlooks details, makes careless mistakes, has difficulty focusing on a single task, losing focus when spoken to without competing distractions, fails to complete tasks or follow instructions as written, struggles with organization and deadlines, expresses reluctance to start tasks that might require long periods of focus, losing track of essential items for life or work, easily distracted by external stimuli or internal thoughts, forgets to complete daily activities for living
-
Hyperactivity-Impulsivity: fidgeting and squirming while sitting in place, trouble sitting still during occasions where remaining seated is expected, pervasive restlessness, appearing uncomfortable when not in motion, talking excessively, interrupting people to finish sentences or answer a question, struggling to wait in a queue, impulsively uses other people’s things without asking
-
Combined: criteria for Inattentive and Hyperactive-Impulsive are both met with neither having a clear predominance
ADHD and substance use disorders both are characterized in part by a shortage of neurotransmitters along reward pathways. Specifically, brains with ADHD struggle to produce and transport dopamine and norepinephrine, which address our ability to focus, retain motivation, and experience the sensation of a reward for completing a task. The prefrontal cortex then struggles with impulse control, future planning, and emotional regulation. Consequently, those with ADHD are at a higher risk of developing substance use disorders both because of an increased impulsivity to experiment with substances and to bridge the natural deficiency in dopamine. It’s common to find that those with both disorders had been using substances to self-medicate, whether it’s stimulants to provide an artificial boost to clear brain fog or depressants to mute the brain’s hyperactivity and anxiety. Some studies show that as many as 25% of people in substance use disorder treatment also have ADHD.
Commentary
Anecdotally, it’s extremely common for people to only find out in treatment that they had been dealing with ADHD, among other disorders, their whole lives. The failure to screen for these disorders in childhood and provide children with adequate treatment is obviously one of the most glaring flaws in our approach to addressing mental health. We save a lot of time, money, resources, heartache, and suffering when we address health concerns at the earliest possible moment instead of leaving someone to self-medicate in far costlier and more dangerous ways.