ADHD and addiction: When the diagnosis is overlooked

What the medication did to him bothered the teenager. When he took it, he no longer felt like himself, the young man says afterwards. He stopped taking it, but his ADHD symptoms remained: mood swings, sensory overload, inner restlessness, depressive thoughts. At some point he noticed that alcohol and cannabis made these symptoms disappear.

Daniel Elsässer from the Aschaffenburg Caritas addiction counseling department experiences cases like this more often. The addiction counselor estimates that at least ten to 15 percent of his clients have a diagnosed attention deficit hyperactivity disorder, or ADHD for short, or suffer from it without being recognized. In the total adult population it is around four percent.

ADHD is a neurological disorder that can have fatal consequences, such as addiction. Depending on what symptoms they have to deal with, people with ADHD use the effects of certain drugs to self-medicate.

The Frankfurt psychiatrist and addiction doctor Mathias Luderer also points out the overlap. “Although around one in four to five patients in addiction treatment has ADHD, the diagnosis is often overlooked,” he says.

The increased risk of addiction in ADHD is rarely discussed in treatment. The “Yearbook Addiction” also recommends screening for ADHD because of the high frequency of ADHD in people with substance-related disorders such as alcohol, tobacco and illegal drugs.

The double diagnosis complicates things. “The recovery process is usually not linear; acute symptoms cause relapses more often,” explains addiction consultant Elsässer. He accompanies those affected until they have an inpatient rehabilitation place. Afterwards he is there for you in aftercare.

The consultation looks for alternatives. Elsässer says relaxation techniques or exercise can help combat inner restlessness: “For some clients, strength training is good.”

Addiction doctor Luderer sees another problem: Many therapists are afraid to prescribe stimulants such as Ritalin for addictions. In rehabilitation clinics, important ADHD medications are discontinued due to ignorance and a lack of trust in new scientific findings. Luderer is therefore calling for more training and further education for doctors and psychotherapists.

He is therefore in favor of medication for ADHD treatment. This improves the chances of benefiting from the actual addiction therapy. “We have more concerns about psychotropic drugs than about cannabis and alcohol,” he wonders.

The latter are “socially accepted – these are both substances with clearly proven health risks, while ADHD medications have been proven to reduce the risk of mortality,” says the head of addiction medicine at the Frankfurt University Hospital. For him, careful diagnosis and support from experienced specialists are crucial for ADHD.