The ADHD Brain!

A good friend of mine, let’s call him Josh, frequently jokes. “How many ADHD kids does it take to change a lightbulb?” 
“How many?” I ask.
“Let’s go ride bikes!” he chortles with a wry smile on his face.  
We’ve had this interchange at least a dozen times over the years.  Perhaps a testimony to the light-hearted nature of our friendship, his small repertoire of good jokes, or …oh what was I writing about…?  Oh, yes, his potentially undiagnosed attention deficit hyperactivity disorder, ADHD.  

Josh is also overcoming addictions to pornography and alcohol; with difficulty.  That is not a joke.  Approximately 1 out of 4 of my clients with addiction are like him.  

ADHD or ADD (Attention Deficit without the Hyperactivity), here forth referred to in this article as ADHD, is a disorder we likely know of but may not understand.  Josh deserves both compassion and the best chance at living a life free from the debilitating consequences and shame of addiction.  Someone in your life deserves the same.  

Let’s look at ADHD.  
What is ADHD?  What does ADHD have to do with addictive or compulsive behavior?  What can we do about ADHD?    

So, let’s say that Josh has ADHD.  That means that he is likely distractible, has difficulty paying attention, has challenges with remembering things and following through; he may have a hard time sitting still due to a need to be in motion; he may also may often act without thinking and be drawn to “BSOs” as I call them – Bright Shiny Objects.  

How did he get this way?  His brain, a physical organ, is different.  Allow me a metaphor to illustrate a point.  Some people have small bladders, another physical organ, anyone part of the IBB “Itty Bitty Bladder” club?  Though it may be difficult to travel with such folks – can we really give them a hard time for how God decided to form their bladder?  No, just don’t give them a Big Gulp before a road trip!  In the same manner, ADHD is a brain disorder and like those with IBB, those with ADHD are created differently.

What is the link between ADHD and Addiction?  At a brain level; the ADHD brain and the addicted brain have several similarities.  One, the dopamine reward system is not functioning as it does for the majority of people.  It has what we can refer to as depressed dopamine activity.  Accordingly, the ADHD brain and the addict brain can tend to feel moderately crappy.  I know, “too much clinical jargon Dr. Hosley!”  Sorry, I’ll try to keep things simple.  Moderately crappy means feeling a little off, slightly depressed, bored.  Because of this, both brains are actively looking to feel better.  And thirdly, both the ADHD brain and the addict brain are prone to impulsivity – the ADHD brain for something new and the addict brain for another hit of their preferred substance or behavior.  This neuropathway, the neuropathway between feeling crappy and feeling good, is a superhighway for both brains.  Feeling better is a constant need and methods of achieving this are consistently accessed.  

The correlations between ADHD brain and addict brain are important to Josh’s healing journey.  Assessment and appropriate treatment may be critical to achieving health.  
We are learning more about ADHD.  Most importantly what we are learning is that treating ADHD is a good idea.  That may sound like a simple suggestion but treating ADHD, like other mental health conditions, is often a challenge due to stigma and ignorance – people judge incorrectly and either lack or have bad information.  Myth’s and judgment abound.  Here are just a few.  ​

• Meetings, accountability and this or that worked for others to get sober.  You just need to try harder.
  • FALSE: That is like telling your friend with a small bladder that they should be able to hold as much urine as the average adult.  This defies logic.  Pull your car over and let them use the restroom!  Similarly, an ADHD brain is operating differently, and we need to be accommodating.  
• Using stimulants to treat ADHD can lead to increased addiction potential later in life.
  • FALSE: It is true that ADHD children and adults are more prone to addiction.  And, people treated for ADHD may still have an addictive struggle in their life.  However, treating ADHD with stimulant medication reduces the likelihood of substance abuse and thus addiction.   
• People with addictions to stimulants, e.g. cocaine, nicotine, caffeine, or stimulating activities, e.g. pornography use, need to get sober without use of a stimulant.
  • FALSE: Prescribed use of stimulant medication is consistent with positive treatment outcomes.

If Josh had a torn-up knee, we would recommend he see an orthopedist and get treatment.  If he had a small bladder, we would be sure to pull over the car on a road trip.  If he has ADHD, we need to be sensitive to his need for treatment.  We need to be aware of ADHD, access good information and explore treatment options.  Adequate treatment could be what is needed to finally overcome addiction. 

Case in point: I have a client who recently started taking ADHD medication.  He wept in my office as he related his ability to resist acting out behaviors that had previously seemed absolutely overwhelming and debilitating to him.  He is experiencing a breakthrough on his journey.  He has hope.  

The best place to start if you think you or someone you know has ADHD is with accurate diagnosis.  Tools to screen for ADHD abound.  Be mindful, a screener does not equate to an accurate diagnosis.  A trip to add.org or totallyadd.com may get you started towards accurate diagnosis by giving you access to information and resources.  However, ADHD is difficult to diagnose accurately; see a professional.  Add.org makes the following statement about assessment: 

A full assessment and potential diagnosis of ADHD is not accomplished using an online test or during a quick doctor’s appointment. A thorough evaluation usually takes more than one visit and must be done by a professional who is trained in ADHD. Other conditions can sometimes resemble ADHD, so it is important to work with a professional who is able to rule out these other conditions and make the appropriate diagnosis.  Many psychologists, psychiatrists, therapists and some general practice physicians are trained to diagnose adult ADHD.
A thorough assessment requires a complete physical and psychiatric medical history as well as screening to rule out any possible physical disorders. All assessments should include an extensive interview with you and often with your significant other (other people are often more aware of your behaviors and struggles than you are), and the application of various symptom-rating scales. For accuracy, it is common to use more than one scale to confirm results. https://add.org/adhd-test/
Treatment often means stimulant medication – like Ritalin or Adderall.  There are also other options.  I worked for many years alongside Dr. Timothy Hyatt, a naturopath who created a product for his wife after she experienced severe Adrenal Fatigue after many years on ADHD stimulant medication.  He calls is EQ, or equilibrate, and it is one of several natural options to support the ADHD brain.  It is available online at biogenicnutrition.com.  So, am I recommending everyone with ADHD be treated with medication? 

No.  I’m not.  That is too simplistic.  

Josh is a concert level Cellist.  He put himself through school on scholarship and plays that difficult instrument with more passion than any I’ve seen.  One evening; shortly after the passing of my mother 6 years ago, we were at a local McMennamins restaurant.  He said, “You know, Ryan, I would like to play you a song in honor of your mother.”  He went to his car, brought in his Cello, and in the midst of the restaurant played a song that had the entire restaurant enraptured and left me in tears.  

Writing this article spurred me to call Josh.  I spoke to him and learned more about his journey.  I learned that as a child he had in fact been diagnosed with ADHD.  He had been on meds – and off them.  He struggled with depression, even suicidal thinking.  He has not had an easy journey.  But he is also amazing.  Loyal, courageous, inspiring and faithful like few men I know.  I put it to him, “Josh, could you have played the Cello that way while on meds?”  He said, “No way.”  

Interesting.  

I was listening to a Dr. John C. Maxwell talk recently on leadership.  His point was that leaders need to keep things simple for people they are leading while not being simplistic.  The difference, he defined, was that simplistic answers often sound good but fail to embrace the hard work of complex thought.  Situations often have many variables and complex thinking embraces these variables coming up with thoughtful answers that lead people well.  Simple thinking, he said, has considered the complexities of a situation and can present a profound truth in a clear way that will empower people.  

Addiction recovery is complex.  We have unwanted behaviors creating pain in our lives and the lives of others.  We have our stories that have often been difficult but that are known by God and part of our testimony – our unique word or imprint that we leave on the planet that will reverberate for generations in the lives of those who know us and that we touch.  We also have our God given uniqueness that we have to believe are inspired and without mistake.  

The song Josh played was a miracle to me.  To miss a miracle for the sake of sobriety would be a shame.  To lose the miraculous to the grip of an addictive process is equally saddening.  

God, I so often wish it was easier.  Yes, that was my voice inside my head, but I had to share.  

My word to you – and I hope it is simple: Addiction recovery is complex.  ADHD is an important variable. Treating ADHD can empower people dramatically and contribute to victory in an area of struggle.  And some treatment may have side effects.  Start with a good assessment.  Be considerate.  Be prayerful.  Be informed.  God be with you – and God be with Josh.  May your miracle persist.  

Authors Note: This article is intended to be a conversation and was not written with academic rigor.  I give credit to Dr. Todd Love – a colleague and expert in ADHD and addiction who was generous with notes he has used in presentations and who has an awesome website.  He was particularly helpful in identifying the correlations between ADHD and addiction as well as myths about treatment. https://www.doctoddlove.com  Other sources used were add.org and totallyadd.com 

Ryan Hosley, PsyD, CSAT