t is generally excepted that ADHD has a high risk to abuse and possibly addiction. First, a quick definition of addiction; followed by what ADHD traits might be the culprits for causing abuse and addiction. I then looked at different types of abuse addiction, i.e. substances, drugs, Internet, sex and pornography, followed by treatment and tips of overcoming. In closing, I refer to the importance of your "being".
Researchers agree that there is a high correlation between ADHD and an addiction, whether it is substance abuse (alcohol, nicotine, drugs) or other forms of abuse i.e. internet addiction, work, or sex addiction (Ohlmeier et.al. 2008; Barkley, JA; Bickel et.al, 2007; Biderman et.al 1997). Baler & Volko (2006) defines addiction as "a process that manifests itself in the uncontrollable, compulsive drug seeking and use, and that persists even in spite of negative health and social consequences". Because addiction affects the biological/neural composition of the brain, it has a significant negative effect on executive functions, more precisely, the ability of self-control and decision-making. Conversely, dysfunction of executive functions proves to have a bigger tendency to an addiction (Bickel et.al. 2007). This seems like a "double whammy" for adults with ADHD.
It seems that the ADHD trait which is mostly associated with an addiction is impulsivity (Bickel et.al. 2007) and the attention deficit (Yen et.al. 2009; Cao et.al. 2007 and Yoo et.al. 2004). Following Barkley's (2008) extensive description of ADHD and the executive function disorder, it seems as if an addiction all relates back to the lack of appropriate impulse control (Cao et.al. 2007). Another interesting research by Ohlmeier et.a. (2008) found that, apart from looking at the traits that "causes" ADHD to become addicted, we might also found answers in physiological reasons for addiction. They found that some of the addiction substances "stimulate the release of neurotransmitters—especially of dopamine—thus reducing the core symptoms of ADHD" (Ohlmeier et.al. 2008 ).
When we think about addiction and the abuse of substances, the majority will probably think about alcohol, drugs like cocaine and others and marijuana. These substances are obviously very dangerous and have immense negative effects in all spheres of life. But we should expand our views on what can be abused, or what can be an addiction. Although some might not be so detrimental to all spheres of life, the definition of addiction is not only about the severity of the consequences. Addiction is a persistent compulsive, uncontrollable urge to use something despite the consequences there-off. With this broader view, researchers have also noted work addiction, food addiction, chocolate addiction, Internet addiction, nicotine, amphetamines, "street drugs" and sex addiction to go with the other known substance addictions.
Excessive Internet usage
On Internet usage, some researchers have looked at unhealthy Internet usage as a form of addiction (Cao et.al. 2007; Yoo et.al. 2004 & Yellowlees & Marks 2007). They also concurred with other research on ADHD that impulsive control disorders (which are typically an ADHD trait) are at risk for amongst other, Internet addiction. Furthermore, aversion for delayed reward and preference for immediate reward has been reported to be an endophenotype of ADHD . "The Internet activity, like gaming, which provides intermediate responses and rewards, may satisfy adolescents with ADHD more than other adolescents. Moreover, adolescents with ADHD have abnormal brain activity associated with impairment of inhibitions in performance. The shortage of self-control may cause adolescents with higher ADHD symptoms difficulty in controlling Internet use after being engaged in Internet activity. As a result, under the design of the Internet, the endless activity usually consumes a great deal of time and deprives them of creative activities, thus making them progress to addiction" (Yen et.al. 2007:96). Young (1998) has developed a 10-point scale to diagnose possible Internet abuse, which was confirmed by many researchers (like Cou, 2001; Kraut et.al 1998; Whang, Lee & Chang, 2003 & others):
- preoccupation with the Internet,
- a need for increased time spent on-line to achieve the same amount of satisfaction,
- repeated efforts to curtail Internet use,
- depression, or mood liability when Internet use is limited,
- staying on-line longer than anticipated,
- putting a job or relationship in jeopardy to use Internet,
- lying to others about how much time is spent on-line,
- and using the Internet as a means of regulating mood
- Compulsive use of the Internet
There are different diagnostic criteria for determining sexual addiction, but the PATHOS questionnaire provides the easiest way of "screening" possible sexual addiction (Carnes & Carnes, 2010). The PATHOS acronym and criteria is:
- Preoccupation: do you often find yourself preoccupied with sexual thoughts?
- Ashamed: do you hide some of your sexual behaviour from others?
- Treatment: have you ever sought help for sexual behaviour you did not like?
- Hurt others: has anyone been hurt emotionally because of your sexual behaviour?
- Out of control: Do you feel controlled by your sexual desire?
- Sad: do you feel depressed or sad after having sex?
Researchers have looked at sexual addiction and ADHD (Blankenship & Laaser, 2004; Yen et.al. 2007). Blankenship & Laaser quoted the following (2004:8)
"It is common for people with ADHD to turn to addictive substances such as alcohol, marijuana, heroin, prescription tranquilizers, pain medication, nicotine, caffeine, sugar, cocaine and street amphetamines in attempts to soothe their restless brains and bodies. Using substances to improve our abilities, help us feel better, or decrease and numb our feelings is called selfmedicating.” (Richardson, 1997; Whalen, Jamner, Henker, Delfino, & Lozano, 2002; Lambert & Hartsough, 1998).
Blankenship & Laaser (2004) and Yen et.al. (2007) conclude that there is indeed a connection between ADHD and sexual addiction, probably because of ADHD traits like a tendency for high-risk, stimulus seeking, inability to tolerate boredom and impulse control (2004:9). But Blankenship & Laaser makes a (uncomfortable) connection between ADHD sexual addiction and trauma, pointing to the possible sexual, emotional, spiritual and/or physical abuse ADHD might have experienced through their life. Poor self-esteem, frustration with failures, social isolation, negative thoughts are all typical ADHD experiences and may compound the risk to sexual (or any other) addiction because some sort of abuse are often used as a form of emotional treatment. The point they are making is: these needs to be treated as well in treating ADHD and addictions.
Pornography is mostly discussed under sexual addiction (Twohig & Crossby, 2010; Carnes & Carnes, 2010; Mich & Hollander, 2006 etc.) and are described as sexual impulsivity and compulsivity; words that are closely associated with ADHD. Twohig & Crossby make an important point, namely that addiction causes the activation of dopamine (2010:12). Now, if ADHD is a disorder of a lack of the dopamine neurotransmitter, it follows why researchers have found such a close link between ADHD and addiction. Its not an excuse, but it does help understanding that its a neuro-biological disorder and treatment must be inclusive.
Why should we take note of these research? Well, as Bickel et.a. (2007) found, if we know how and what ADHD's tendency to addiction work, we can implement different treatment programs. It might just be that the traditional treatment programs will not render the same success as in non-ADHD addiction cases due to the different reasons and/or origins of ADHD addiction. For example, know that ADHD addiction is primarily impulsivity, lack of self-regulation and attention, we could develop treatments "that will (1) decrease activation of impulsive brain regions and (2) increase activity in executive brain regions" (Bickel et.al. 2007).
A few markers for self-help treatment
Please note that these tips do not replace professional help! Please consult professional help.
- Accept that you have a problem. Acceptance is always the first step to recovery.
- Know the facts about ADHD and your abuse/addiction. The Internet put knowledge literally at our fingertips. Know what it is you're dealing with.
- Decide to make a change; and remember it WILL not be easy.
- Write down WHY you want to change; what benefits might it have; medical, health, relationships, financial, time management etc. Reconfirm your values, morals and belief system.
- Remove all that reminds you of your addiction, or which makes it easy for you to fall into that particular abuse. For example, if you do have an Internet / Pornography addiction, implement a password and parental control for yourself; change your screen so that all family members can see what you are busy with etc. Even is you will break the parental control, at least its providing one additional step - that moment of re-consider. Burglar bars doesn't keep out burglars, it just make it that one step more time-consuming. Lock a cabinet and put the key in a safe - three steps to get to it.
- Externalise the consequences. One of ADHD's problems are the delayed consequences and time-blindness (Barkley, 2010). Get a spouse or friend to whom you can account on a weekly basis. It might be painful, but will assist. Although it is one of ADHD deficits, forward and backward looking, but try to recall the pain or bad feelings of past mistakes; even write it down to re-visit it regularly.
- Make a list of your the trigger factors / feelings. Stress, procrastination, anxiety, a feeling of overwhelmed; try to recognise them and find a way to deal with it. Know your weak spots.
- Start a hobby, sport or exercise. Get involved in a community project.
- If you fall or relapsed - its not the end of the world or your journey to freedom. Stand up. Failure is not falling, its not trying. Remember your identity in Christ.
- Build in personal incentives and a reward system.
- Don't foster "perfection". We sometimes chase perfection and when it doesn't happen, we quit without realising that the improvement was already a considerable improvement.
In closing we need to take cognisance of the fact that adults with ADHD have a huge risk factor for addiction due to the neuro-biological traits, causing impulse control, impulsivity, time-blindness (loosing time on priorities due to addiction) and overall executive function impairment. Knowing and accepting this fact, is already step one of treatment. Knowing this, also confirms what all the researchers have alluded to (Blankenship & Laaser, 2004): ADHD medication is still the most important treatment plan for ADHD for the mere fact that it assist the neuro-biological impairments which are part of the reason why ADHD falls into abuse and/or addiction. And thirdly, it is of utmost importance for adults with ADHD (and councillors, families etc.) to constantly remind ourselves of the fact that ADHD and the tendency to abuse and addiction is a biological issue and not necessarily bad parenting or bad character. As Yen et.al. (2007:96) has put it, the "pre-existing neuro-psychological characteristics of ADHD could be used to explain the association" of ADHD and an addiction.
Because of this important fact, part of my advice to myself and others, is to recognise your identity in Christ! Our identity in Christ helps us steer the difficult waters of ADHD and the high risk to abuse and addiction. Valuable belief statements to be reminded of in tough times are:
- you are created in the image of God. You're being is not an accident, not a result of non-God-like intervention
- God has joy in you being you, despite of your ADHD
- God accepted us through Christ not of what we do, but for our "being".
- God's love for us is unexplainable. Despite what we have done or might be doing.
- God saved us through Christ; all sins are forgiven, past and future.
- God gave us what we needed to live a fulfilled life - the Holy Spirit (2 Pet 1:3). Which means that we can overcome struggles; not always necessarily easy, but possible. As Paul wrote in Ephesians 1, the same power which raised Christ from the dead (just imagine that power), was given to us in the Holy Spirit.
But just this will not help alone; trauma treatment, medication and other possible CBT programs might still be important for you to follow, but from experience I can say: focussing on my identity in Christ re-confirmed my being, purpose and gave me courage to "keep on, take charge, stand up".
Whatever an ADHD adult do excessively, always measure yourself against some of these criteria of addictions. Secondly, consciously withdraw from time to time from that excessive substance as a check to measure your dependency to assure yourself you are still control (or not).
We know impulse control is one of the most harmful impairments of ADHD, we need to and can work on consciously improving our self-control. It is not one of the fruits of the Spirit by accident.
May God, through the power of the Holy Spirit assist you to guard against any addiction.
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- Image credit: "Road to Recovery".