ADHD and Substance Abuse

In last months edition of the American Journal of Psychiatry, researchers from Massachusetts General Hospital reported the results of a 10 year prospective study designed to look at stimulant medications and their possible link to substance abuse disorders in adult males with ADHD. The study findings revealed no evidence that stimulant medications increase or decrease the risk for substance abuse disorders when used in children or young adults. Specifically, they looked at alcohol abuse, alcohol dependence, drug abuse, drug dependence, and nicotine dependence.

I have mixed feelings about these results. On the one hand I am glad to know that these medications don’t appear to put those of us who take it at any greater risk than we already are for substance abuse. On the other hand, dozens of studies over the years have concluded that people with ADHD are between 5 to 12 times more likely to become drug or alcohol dependant, and the use of stimulants (which is the most common current treatment for ADHD) does not improve the odds. In my own journey with ADHD, I have found that my medication makes me much less prone to abuse alcohol and I have been hoping that the same might hold true for other ADHDers in general.

My father and sister both have ADHD and are both alcoholics. I also did the math for my extended family (very large and very irish catholic) a little while ago and found that 1 in 4 of my cousins is a recovering alcoholic or has had at least one intervention. With over 20 cousins and half of them already having kids the numbers just don’t look very good. Studies also confirm that ADHD is approximately 75% heritable, which means that 75% of children with ADHD have at least one parent who has it. I think if I ever get married I will go adopt a bunch of those Chinese babies.

But I need to acknowledge that although ADHD seems to be largely uncontrollable, it can be effectively managed. I also need to acknowledge that environment plays a huge role in the development of alcoholism and I am living proof that education can change the outcome. Growing up I never went more than a few days without hearing an AA slogan or insight from my dad. I remember him telling me his story when I was in 3rd grade and thinking that I had heard it all before. Sometimes he even took me to meetings so that I could hear the stories, and as I got older I could begin to recognize the progression in friends who had a drinking problem.

The day I learned my mom had cancer was a Friday and after my football game I went to see her in the hospital. Then I went to a friend’s house, got black-out drunk, and spent the night on the bathroom floor. What’s ironic is that my dad, who had been sober for over 20 years, probably did the same thing. Fortunately, after that night I realized I couldn’t get away continuing to drink and can probably count on one hand the number of drinks I had in the remaining 3 years of high school. But it wasn’t easy. Even knowing all I did and watching my family fall apart because of alcohol, it was difficult to maintain a social life and always be the sober one.

I was scared of alcohol and what it might do to me, but at the same time hated to be different. I used to wish for a pill that would neutralize alcohol so that I could drink and be social but never get drunk or suffer the effects. I guess this is a plug to parents out there that despite the best efforts of teenagers, some pressures will always exist.

Before I started in Al-Anon I did my best to crush any thoughts that something wasn’t fair. Life’s not fair – I would think – so just deal with it. But, since coming into the program I have started to let myself say it. It’s not fair that those of us with ADHD have to work harder than normal folks to make the same gains in life. It’s also not fair that we need to be so much more careful about drinking – which is how a lot of people relax after doing extra work. It’s okay to say because it’s true. It’s okay to say because it helps me to accept the situation. After that I can choose what to do.

I got dealt my hand from a different deck of cards than most other people. Consequently, the rules of my game are a little different and I will most likely need to figure them out for myself. I have opportunities open to me that other don’t, which is good because I can’t just do what others do and expect it to work. I need to question. I need to explore. I need to learn. I’m never quite going to fit in, and that’s okay because I never wanted to in the first place.