How ADHD Wires the Brain for Addiction
There are several ways in which the brains of those with ADHD differ from neurotypical brains, and some of these differences place people with this disorder at higher risk for addiction. One structural difference lies in the thalamus, an area of the brain that helps with impulse control or “response inhibition”. In neurotypical brains, there is a gatekeeper in this region which helps to support decision making through a careful evaluation of past experiences, current circumstances, and potential future consequences. In the brains of people with ADHD, this gatekeeper is impaired, meaning that they have trouble learning from past mistakes, adjusting their behavior to match their current setting, or considering what might go wrong if they make a certain choice. Sometimes this leads to choices that are relatively harmless- like making an impulse buy, saying something too bluntly or staying out too late on a work night but other times, these choices can cause more significant problems for people.
Some of the more significant problems that impulsivity can lead to are drug and alcohol use. In a number of studies, researchers have found a significant link between impulsivity and substance use, and evidence that impulsive people are at a much higher risk of becoming addicted to drugs or alcohol. Part of the reason is thought to be related to regions of the brain responsible for executive functioning, including the thalamus. Executive functions are high-level thinking, problem-solving, and decision-making skills that continue to develop into a person’s early twenties. In people with ADHD, executive functioning is thought to be impaired, specifically when it comes to regulating emotions and avoiding behaviors that would lead to consequences later on, including substance use. These factors combined help to provide neurological explanations about why people with ADHD are at higher risk for addiction.
Any number of factors can place people at higher risk for alcohol or drug addiction including genetics, a family history, experiencing trauma in childhood, and also experiencing any mental health issue, including ADHD. Much like being predisposed to any other health condition, risk factors require people to more closely monitor themselves, watching for warning signs. People at higher risk for addiction need to be more vigilant about their use of drugs and alcohol, and even non-chemical vices like sex, pornography, or gambling. Noticing increased or more frequent use, cravings, or an inability to set and maintain boundaries around their use are all signs that may indicate problem use. Seeking treatment at this early phase can help reduce the likelihood of developing a serious addiction, while also offering support to individuals in treating their ADHD at the same time.
While the standard treatment for children with ADHD involves a combination of therapy and medication, treating ADHD in adults is more challenging. The medication most commonly used for ADHD treatment are prescribed amphetamines, powerful stimulant medications that are high risk because of their potential for abuse and addiction. While there are some instances where prescription medication is the best course of treatment for adults with ADHD, there are some instances where the risks may outweigh the potential benefits, particularly if the person has struggled in the past with a co-occurring addiction. People who want support in managing their ADHD should talk with their doctors about the best treatment option for them, making sure to provide detailed information about any existing mental health or substance use issues.
By Hailey Shafir, LPCS, LCAS, CCS