ADHD and Substance Use

Welcome to Thriving with ADHD dear ADHD community. This month we talk about substance use and ADHD. Animo Sano’s PA Maddison Henley is our guest again and she will share more about this important topic. 
In this episode we'll cover the following topics:

1. Why do ADHD and substance use disorders often occur together? Are there specific risk factors that make this more likely?
2. How do various substances, such as alcohol, nicotine, and illicit drugs, impact the symptoms and treatment of ADHD?
3. What steps can be taken to prevent individuals with ADHD from developing substance use disorders?
4. What are the most effective treatment approaches for someone dealing with both ADHD and substance use disorders? Are there particular therapies or interventions that you find most successful?
5. What resources, support systems, or community services do you recommend for individuals and families dealing with ADHD and substance use disorders?

Tune in!

Thank you for listening to Thriving with ADHD. This show is produced by Animo Sano Psychiatry. For more information about our clinic, please visit animosanopsychiatry.com.

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Transcript

   📍     Welcome to Thriving With adhd, a podcast we'll share every day practical tips to thrive in life as an adult with adhd.  This podcast is brought to you by Animo Sano Psychiatry, a behavioral health practice with a specialist ADHD clinic based in North Carolina. And this is your host Nada Pupovac.

Welcome to Thriving with ADHD, dear ADHD community. This month, we talk about substance use and ADHD. Ani Mosano's PA, Madison Henley, is our guest again, and she will share more information about this important topic. As usual, before we jump into conversation with Madison, here's a bit more about her.

Madison is a dedicated physician assistant with a passion for mental health care. A proud former student of Mercer University, where she obtained her bachelor's degree  and completed physician assistant duties. She has worked in outpatient behavioral health care since 2021.

 Her commitment to providing compassionate and comprehensive care is evident in her approach, ensuring that her patients feel heard, understood, and supported. As a result of her commitment to our patients and keen interest in mental health education, Madison  has been promoted to Associate Director of Clinical Operations and Clinical Education at Animusano Psychiatry.

There is no doubt, medicine will be a perfect person to answer our questions about substance use and ADHD.  Welcome back to Thriving with ADHD. Long time no see, and I'm really glad that you're back. And this time we have, I think, very important topic, substance use and ADHD. Um, unfortunately there are people, uh, who have the condition and use the , substances. So I think it's important to talk about it.

So I'm really glad that we have you to discuss this.  Yeah. Thanks for having me. I agree. I think it's, uh, uh, an important topic for us to go over today.  Absolutely. So  explain to us, please, why do ADHD and substance use disorders often occur together? Are there any  specific risk factors that make this more likely to happen? 

Yeah. Um, that's a great question.  Um, ADHD and substance use disorders are very commonly co occurring, um, and there's kind of a lot of different factors and, and other, um,  things that can play a role in, and why that is the case, uh, one of which is, um, Just some of the shared genetic factors that the two disorders can share.

Um, and so there's a lot of studies that, uh, actually indicate that there is a little bit of a genetic overlap between ADHD and substance use disorders, uh, genes that are mainly associated with dopamine regulation, uh, that plays a role in both ADHD, um, substance use disorder, like addiction, uh, things like that.

Um. So that's one, uh, kind of reason that they, they might coexist. Um, another reason is just the impulsivity that goes along with ADHD. So we know that impulsivity is very commonly associated with ADHD. Um, and so a lot of times individuals have, um,  Like behaviors that are, uh, like seeking sensations or, or, um, like risky behaviors, dopamine releasing behaviors.

And so, um, just having that kind of likelihood of, um, chasing after those dopamine rushes and things like that can lead to experimenting with substances, especially, or kind of more commonly, those with ADHD, like starting at a younger age than maybe others might would.  Another reason is just simply the fact that Uh, some people with ADHD might use substances as a form of health medications.

So, uh, like trying to find ways to alleviate their symptoms. If maybe they haven't gotten diagnosed or unaware of the diagnosis, or maybe they are, but they didn't want to start prescription medications.  Like looking at other options that might also, uh, alleviate some of their symptoms, um, like illicit substances or even, uh, things like nicotine that can, um, sometimes like serve as, as a stimulant and, um, like enhance concentration, uh, calm people down in the moment, things like that, um, that kind of take care of.

Uh, some of the symptoms that are going along with their ADHD. Um, another factor, as always, there's always an environmental influence. And so, um, like exposures to stress, uh, like family histories of substance use, uh, Those are all risk factors, peers or family members, friends, uh, using illicit substances.

Um, but there is kind of evidence to suggest that those who receive ADHD treatment at a younger age are less likely to,  uh, like develop substance use disorders than those who start treatment later. Um, same thing with treating like anxiety and depression that, that are also comorbid with  ADHD, um, could kind of lower the risk.

There of, of having the two together. And how do various substances such as alcohol, nicotine, uh, illicit drugs that you mentioned impact symptoms and treatment of ADHD? I suspect it's not so great, so.  Yeah, um, yeah, so obviously they're, they all have a  negative effect in some way, shape, or form, uh, different substances can have different effects, um, alcohol, uh, so  we, we typically don't, uh, promote alcohol use, uh, especially in people that are receiving treatment.

ADHD treatment, um, number one, because alcohol itself can actually make ADHD symptoms worse. So, um, alcohol is going to impair a lot of that executive functioning, um, can also increase impulsivity as well. And so that combination, uh, can lead to poor decision making, uh, risky behaviors, um, which obviously is, is not a good thing.

Uh, and then also, Alcohol can, um, interact with actually the medications that we prescribe for ADHD. So, um,  can have kind of an effect both ways where, um, the, it affects the efficacy of the medication, but also can increase like the side effects, uh, alcohol can increase the side effects of the medication as well.

Um, so not a good combination to have, even if people are on ADHD medication. Um, individuals with, uh, ADHD that. Use a lot of alcohol may also have like a harder time, uh, maintaining their, their symptoms and daily functioning just because of the worsening effects that alcohol can have on those symptoms.

Um, in terms of, of nicotine. So, uh, I, I feel like a good number of my patients do still use, uh, nicotine products. I would say more so vaping now than, than cigarette use, but, um, a lot of people describe like, Nicotine as, as being a way that they can actually like focus and, uh, calm down a little bit and while that might be like the temporary case for nicotine, it is like a really addictive substance and has a lot of negative health effects that don't outweigh the minor benefits that they might be getting from that.

Um, and so nicotine dependence can definitely complicate kind of, uh, ADHD treatment and that see of medications and everything as well. Um,  otherwise, like illicit drugs. Um, so marijuana, obviously one that we see pretty commonly. Uh,  Marijuana is one that also, kind of similarly to alcohol, can impair cognitive functioning or executive functioning, um, especially motivation too, and so those are things that people with ADHD are already struggling with, and so, um, in most cases, using a substance like marijuana is gonna, um, Make the symptoms worse.

Uh, there's also some different articles and research out there that, um,  Marijuana and like other similar products, uh, can actually decrease the efficacy of a lot of the stimulant medications that we use for ADHD. Um, I think the one that has the most evidence is methylphenidate, um, but yeah, so that's interesting as well, um, especially if you have patients that don't feel like their medications are working and they are using, uh, at least any sort of PHC. 

Um,  other, other illicit substances, so stimulants like cocaine and methamphetamine, obviously those are illicit substances and are not prescribed, but, If people are taking substances like that in combination with a prescription stimulant. Um, that can be a really dangerous combination with, uh, like, cardiac risks, dangerous cardiac side effects, um, like even potential for, like, heart attack, death.

And so it is really important to, like, disclose if there are illicit substances being used, or kind of evaluate for that in our patients, just because the side effects can be really serious of combining the two together. Um, And, and having a proper treatment plan, uh, like if, if there are substances on board and, um, yeah, I think that sometimes patients are kind of worried or scared to tell us or disclose any substances that they might be using.

But, um, it is a really important, um, part of, of, uh, like finding the right treatment plan and, um, there's, there's plans regardless. So,  yeah. So are there. Steps that can be taken to prevent individuals with ADHD from developing substance use disorders.  You mentioned the genetics, so I suppose with those patients, it could be a bit harder, but I'm I suppose there must be a solution to prevent these things from happening. 

Yeah, so I mean, even with, even when there's a genetic factor, obviously, it doesn't mean 100 percent that they're going to have a substance use disorder, have an overlapping  disorder. Not everyone with ADHD  has a substance use disorder either.  One, like, really important thing to just try to do the best, uh, possible, like, steps for, for trying to prevent would be, um, early diagnosis and treatment.

So, uh, timely and effective treatment of ADHD can significantly reduce the risk of substance use. Um, the different medications that we use and behavioral techniques and therapy, uh, can help manage symptoms and improve functioning. Uh, so those who are managing their ADHD appropriately, like with medication, with therapy, with lifestyle changes, actually have lower rates of substance use disorders.

Um, compared to those, uh, that are not managing their symptoms appropriately.  And, and, uh, we kind of talked about it, but, um,  the, the evidence is there for starting, um, medication and, and treatment earlier on to, to try to help, uh, with not going down the substance use path, um, and so that's really important, um, as well as, as being on medication can actually lower that risk in itself, uh, compared to not being on, on medication.

Because you're. Getting a better handle on some of that cognitive functioning, lowering that impulsivity and dopamine seeking behaviors there.  Um, obviously, uh, another aspect is education and awareness. So, um, like just educating those who are diagnosed with ADHD about the risk that's there of substance use then, and the higher rates of substance use, um, kind of as a comorbid, uh, condition so that people, you know, Are seeing the importance of adhering to a treatment plan and also just knowing that that's,  um,  possible so that if they are put in like a bad social situation or something like that, they know that they kind of have that risk there. 

Um, yeah, again, like environment always plays a role, but we can't. Control everyone's environment, but, um, also looking at things like coping skills and resilience training. So teaching those who, uh,  do have these diagnoses to have like different coping mechanisms that can help them manage stress and, and, um, reduce relying on substances as like a form of, uh, like self medication or treatment during those times of high stress. 

So having different tools in their tool bag to kind of cope with stress and anxiety during those times and not having to rely on illicit substances or even alcohol or nicotine. And then also having good family or and or peer support is really important. So Even if maybe home life isn't ideal, like having a good support system and other places, um, having an accountability person in their life, uh, positive role models, things like that can really help as well.

That's amazing. Can we talk more about effective ways and approaches to, for some dealing with both ADHD and substance use disorders? So, uh, what particular therapies and interventions, uh, do you find the most successful in this case?  Yeah, so I'm, I'm going to give a broad overview here because I, I realized that it would be easy to get down, uh, a bunch of different rabbit holes with this question, but, um, so, so treating a HD and substance use, uh, obviously it's going to be like a really  just going to be, it can be different for every person.

Um, I mean, first off, we would be evaluating. Um. If there is a patient that has ADHD and also has a substance use disorder, um, like what type of substance they're using, um, how much they're using, how often, what their motivation is like to stop using, um, kind of depending on the answers to those questions, uh, would depend on, like, typically what our next steps would be, whether it's something that is able to be managed outpatient versus, uh, maybe needing something a little bit more intense, like, A detox program or, um, like a partial hospitalization program, different things like that to help with, uh, managing, um, substance use and sobriety as well.

Um, And so then, obviously, uh, when the two are co occurring, um, or especially if somebody comes to you, like, with both diagnoses already, uh, obviously confirming the ADHD diagnosis is important too, because there can be a lot of overlapping symptoms and making sure that, um, the inattention or executive dysfunction wasn't just because of whatever substance they were on before and, and so forth.

So. Just kind of confirming diagnoses there and making sure that, um, they still meet the criteria and everything, even without being on any substances is, uh, also really important. But, um, as far as treatment goes, I mean, there's, there's two different classes of treatment for ADHD. We have our stimulants, uh, which are controlled substances, and then we have non stimulant options.

Um, so that's where things get, uh, a little bit tricky sometimes with substance use disorders. Um, when we're prescribing controlled substances, uh, obviously they have the risk or abuse potential there, which is why they are controlled substances. And so if there is either a history or active substance use, that is something that we would want to use, uh, like extremely cautiously and monitor for any, um, uh, Signs of misuse or diversion, but, um, they there are certain cases where those still can be like an effective and appropriate option, but it kind of depends on each.

Um, individual situation. Um, in other cases, there's also the non stimulants that we can use as alternatives to where they don't have the same risk potential for misuse as some of the stimulants do. Um, so sometimes those can be a better option in some of those cases. Um, but again, uh, whichever option we're using, trying to get to, uh, a place where we are better managing ADHD symptoms to hopefully lower the risk of substance use or lower that, um, need for that dopamine rush.

So there. There's certainly a lot of different, like, avenues that that can go, um, and, and deciding which needs to be treated first and, and so forth, uh, depending on the substance and, and how often and how much and all of those different questions, but, um, there's also, like, different accountability programs that I find.

It'd be really helpful for my patients. So just having somebody or a group setting, um, a common example is like Alcoholics Anonymous or Narcotics Anonymous, um, but, but similar ones to that as well. But just providing that like peer to peer support and structure for, you know, Um, maintaining, uh, like absence from substance use, uh, and then also like looking at higher levels of care if we needed to.

So if a patient meets the requirements or needs for, uh, like a more intensive outpatient program or something like that. Um, that, that sometimes can be a part of our,  uh, treatment approach as well. Um, so kind of, uh, a broad answer of depending on, on the situation, but, um, most of the time we, as long as there is a confirmed case of ADHD, we're still going to be treating the ADHD, but, um, kind of depends on, um, the case for like which medication in particular we might use. 

I appreciate that. This wasn't a.  Maybe the easiest question to answer, but hopefully it started a conversation for someone out there listening and, uh,  or anyone who knows someone with both conditions and, uh, maybe it's an interesting conversation. It gives us some ideas to just get started from some point and, uh, get, you know,  improvement, uh, uh, from, uh, this point on.

So, um, we can maybe talk now more about resources and support systems. community services that you can recommend, um,  is exactly for this case for, uh, for help for individuals and family, families dealing with both ADHD and substance use disorders.  Yeah. So, I mean, going back medication management, always an important aspect, uh, cause we do have that evidence that, Um, like seeking out medication management is going to be really important, uh, for managing both, um, both conditions, especially together.

Um, Resources, uh, so like doing, um, different detox programs is always, um, like a resource I give to my patients depending on the severity of their substance use, um, if needed. And there's some that are, uh, like more local, there's others that, that have like more widespread, um,  Uh, like audience or, um, you, um, therapy, I strongly encourage, uh, individual therapy as well as, um, like trying to find a group therapy that kind of meets their needs.

And  it's a younger patient, um, maybe considering like family therapy with their parents as well, just to kind of help with the dynamics at home, um, and having like a open and supportive environment there.  I have a good handful of patients that have done coaching, uh, specifically ADHD coaching, but I did some, some brief, uh, research on, on there actually being a lot of, uh, like coaching opportunities for, um, substance use too, and, and more so kind of serving as like an accountability group, um, and things like that.

So I think that would be, uh, highly recommended as well. And again, just. Being educated and there's a ton of different like organizations like Uh, Chad or children and adults with ADHD that offer a lot of like good information and support groups and resources on their websites. Um, most communities have like the community mental health services as well that can help with kind of pointing people locally in the right direction for those different types of resources.

Um, a lot of school programs now have like educational centers or programs to kind of help, uh, especially if People have young children that are being diagnosed with ADHD, um, like are recognized in the risk of substance use there and knowing kind of the early, like, signs, symptoms, things like that. Um,  and there's a ton of, uh, online resources as well that can have, uh, valuable information.

SAMHSA is a good one, the Substance Abuse and Mental Health Services Administration, um, but there's, there's a ton of others out there, too, that. And provide, uh, really useful information, uh, online. That's, that's amazing.  And to wrap up,  as always, , if there is one thing that  you would like our listeners to take away from this episode, what that would be? 

Yeah. Um, I guess, uh, a key, one of the key takeaways would be, um, recognizing the importance of early intervention, um, and treatment. Right. Um, as well as kind of the fact that, um. Even if, if you weren't somebody that got early treatment or intervention and, um, maybe you do have both diagnoses of ADHD and, uh, a substance use disorder of, of some kind that, um, there are ways to address both and it's not something that you have to, um, like worry about there not being an ADHD option just because you, you have a substance use disorder.

Um, for kind of, uh, the different options there. So there, there are options for everyone. Um, and there's different ways to, um, have, like, an informed approach, uh, to your medication options and therapy options and everything. And so, yeah, I, I think that's, uh, a good takeaway as far as there. Being a treatment option for everybody, no matter kind of what the current situation looks like. 

Thank you so much. Thanks for providing us hope. That's the most important. Thanks for telling us that there is a solution, no matter how bleak the situation might seem.  At some point,  so yeah, I think this is a very important message, uh, from, from this episode. So thank you so much for that. Um, thanks again for, uh, coming to the show, uh, we always love to have you here and, uh, we'll see you in the future with some different, exciting topic.   📍 Thank you for listening to Thriving with adhd. This show is produced by Animo Sano Psychiatry. Please follow, rate or share our podcast on Spotify, Apple Podcast, or any other streaming app of your choice. Music is by Daddy's Music music from Pixabay. For more information about Animo Sano Psychiatry, please visit animosanopsychiatry.com