A lot of parents are fearful of starting their child on medication. This fear is understandable – there’s a lot of stigma about mental health, and some people still consider living with untreated ADHD a ‘flex,’ as if white knuckling through life is somehow a badge of honor. Many parents don’t want to give their child a stimulant, because they equate stimulants with drug use. The truth about ADH and addiction, though, is much more nuanced than most people know.
What Is ADHD?
Many parents of children who have ADHD are fearful of starting stimulant medication because of perceived risk of future substance abuse. The research shows the exact opposite. Research has shown that delayed treatment and lack of treatment actually increase future substance dependency, and children who are adequately treated for their ADHD have less likelihood to use substances in adulthood. So, why is this and what’s the science behind it?
ADHD is more than just inability to sit still in class and losing homework. ADHD is fundamentally different neurotype. The brain of those with ADHD is different – the white and gray matter mature differently, and the dopamine pathways don’t work the same as they do in someone who doesn’t have ADHD. These changes lead to difficulty with reward-based learning, attention, impulsivity, and hyperactivity. ADHD brains don’t work the same way as a typical brain. Kids with ADHD can have problems with:
- Paying attention in class, even if they want to pay attention, or are trying to do so
- Remembering instructions
- Processing information
- Being easily distracted by noises, lights, or other things around them
- Time blindness
- Fidgeting and constant movements, even if those movements are small
- Exhaustion, especially after school
- Sleep schedules
- Object permanence
All of these challenges can add up to children feeling they aren’t good enough or thinking they are stupid. Many kids with ADHD struggle with low self-esteem. They see their classmates succeeding, and as much as they want to do well in school, they struggle. This isn’t because of intelligence – it’s because the reward pathways in ADHD brains don’t work the way they do in typical brains.
Learning: ADHD and Dopamine
First, let’s talk about dopamine. Dopamine is a neurotransmitter in the brain that is primarily responsible for learning, motivation, and the reward system in our brain. It’s commonly called the ‘feel good chemical,’ because it makes us feel accomplished and positive. In the ADHD brain, there is no reward in anticipation of doing something. In the typical brain, the brain recognizes that studying will lead to a good grade, so a little rush of dopamine is excreted in anticipation of studying. This motivates the person to study hard, and when they get a good grade, their behavior is reinforced. The brain thinks ‘yay! hard work pays off, I’ll keep doing that!’ In the ADHD brain, there is no anticipatory dopamine – so, there is no intrinsic motivation to study and do well. All of this happens without conscious involvement – no one is telling their brain to release dopamine so they can study, typically the brain just does it. In the ADHD brain, the dopamine pathways don’t work well, so all of motivation and learning is impacted.
ADHD and Self-Esteem
This constant struggle to complete work and tasks that other people seem to do effortlessly can lead to low self-esteem. Havin untreated ADHD is like living life on ‘hard’ mode. Everything is more difficult, from doing homework, to completing chores, to watching a movie without quitting part way through, to putting away laundry. It’s all difficult. People with ADHD, including children, can internalize these challenges and start to think there is something wrong with them, or that they’re a failure.
ADHD and Addiction
So, how does all this connect to addiction? People with low self-esteem are more at risk for substance use. People who are chasing dopamine are also more at risk for substance use. Since ADHD brains are lower in dopamine, people look for the feeling of accomplishment and positivity from outside sources, which can include illicit substances. In study after study, scientists have found that untreated ADHD was a predictor for substance use. One study found that half the people with alcohol use disorder they interviewed had untreated ADHD.
Stimulants help ADHD brains to calm down and focus. They are the gold standard treatment because they work! Pharmaceutical stimulants are designed to improve impulsivity, focus, and concentration in those with ADHD – they do not get people ‘high.’ Street drugs, including things like amphetamines, are designed to get people high. Even though they are all stimulants, the chemical compounds are different and work differently in the brain and body. Unfortunately, some people with untreated ADHD discover that street drugs can help improve their symptoms, but while their concentration may be improved, they are also experiencing altered level of consciousness, thinking, and feeling. Many people who start using illicit substances are primarily trying to self-medicate.
ADHD and Addiction: What to Do
End the stigma! Type 1 diabetic children take medications. Children with juvenile arthritis take medications. Typically, society doesn’t judge those children or their parents. When it comes to ADHD, however, there is plenty of negative judgement about treating the condition. When considering if medication is right for your child, don’t let the anti-ADHD medication crowd influence your decision. Do what’s best for your child. That may mean lifestyle changes, behavioral coaching, and yes – medications. Treating ADHD does not increase the risk of later in life substance use, in fact, adequately treating ADHD will decrease the risk of later in life substance use.
Want to learn more? Visit Onward Growth Psychiatry to learn about ADHD treatment options.
Links to studies:
“Childhood ADHD: Treated vs. Untreated — Treatments, Implications, & O” by Melissa Glenn