by Comprehensive Staff

04/06/2018 10:50 pm

Treating People with ADHD and Substance Use Disorders

If the title of this blog brought some discomfort, there’s a good chance you are a therapist, medical provider, or a client. Why does this phrasing evoke discomfort in some? And can we develop a discussion and understanding that will better serve us all? In speaking with some colleagues in behavioral healthcare and substance use disorder treatment, I asked, "What do you feel when you hear a client being treated for a substance use disorder (SUD) say they want medication for their Attention Deficit/Hyperactivity Disorders (ADHD)?" The initial feelings ranged from unease to skepticism to suspision. These feelings may influence a provider's thoughts and questions while conducting a clinical interview with a client.

Fortunately, part of our training includes learning to catch our own biases and feelings - but this does not make us invulnerable. And these reactions are not without substance. These are some of the typical responses I have heard about ADHD medications: medications used to treat ADHD are a hot item in for sale at schools, universities, parties, and for general substance abuse. People may misuse these prescription pills to assist in staying awake, waking up, taking the edge off other substances, to get high, or to supplement their income. 

A Center for Disease Control (CDC) study in Oklahoma as recent as 2012 showed up to 71.7% of children between 5-13 years being prescribed ADHD medications did not meet criteria for ADHD (60.5% in South Carolina). But here is another sobering number: according to a large meta-analysis, the prevalence of ADHD amongst those with substance use disorders is approximately 25% (compared to the 4% national average). The difficulty of differential diagnosis in the case of ADHD/SUD is not something to be downplayed. 

Let's make sure to talk about the clients' experience. I spoke to some of our clients experience, and here are some things they reported: "Whenever I ask for medication for my ADHD, I'm made to feel like I'm drug-seeking or a criminal." "I knew the doctor was going to say now before I even got done explaining myself." "I feel like no one cares or knows how hard it is to function with ADHD." These are truly unpleasant, uneasy, and sometimes desperate thoughts and feelings. 

So what is it that we can do as healthcare providers? Each provider I spoke to about this topic started out skeptically, but their feelings evolved within moments, shifting toward curiousity and compassion. It seemed that clinical reasoning and treatment came to the forefront.

With curiosity and holistic compassion we can pivot to better care, even in simple ways. As a study and a mindset it can move us to think about how our body language could reinforce a client’s tentativeness or negative feelings. It can encourage us to learn better ways to identify what ADHD looks like for those with a substance use disorder. Having this pivoted orientation can bring mutual engagement in educating our clients on holistic care. We want to provide integrated and informed care across fields that address emotions, behaviors, and neurobiology, and this is a way to start. 

-By William Waters, Psy.D., LP, LMHC, Division Director, Pasco