If you have ADHD and have been helped by Alcoholics Anonymous (AA) meetings, I am happy for you. This post is about something a little more complicated.
This post addresses the danger of ADHD going unrecognized as individuals pursue help for addictions through AA and AA-based substance-treatment centers. Here I offer:
- First-person examples
- Research tidbits
- An excerpt from an important new book
Almost 30 years ago, I attended my first meeting of Alcoholics Anonymous (AA). It wasn’t for me but for my roommate. She went only to snag a good seat for the meeting that came after: Overeaters Anonymous. I tagged along as moral support.
What struck me most about the AA meeting—and remains remarkable to this day—is the many people there that night who likely had ADHD. (The same is probably true for the OA meeting, too, but I’ll write another day about Eating Disorders Clinics and their lack of recognizing ADHD-related eating disorders .)
That insight came in retrospect, of course. Back then, I’d never heard of ADHD, not even in children. But there had to be some explanation, I remember thinking. Look at how most of these folks can’t seem to sit in their chairs; they’re constantly getting up to get coffee or go outside to smoke cigarettes. They just seemed so…fidgety.
At the meeting’s end, I chatted with the lady seated next to me. She knowingly explained: “They can’t sit with their feelings, so they keep distracting themselves.”
“Huh,” I thought. What did I know? Maybe that was true, for some. But for the others, well, that was the most fidgety collection of people I’d ever seen. (Note: This was before I’d attended my first CHADD conference lectures. Ha!)
ADHD & Addictions
Of course, now I get it. For the last 18 years, at least. People with ADHD are more vulnerable to addictive substances and activities of all types.
As Meg wrote in her poems in On Trying to Swim Blind: ADHD and Medication:
Still, something in me keeps pushing –
until I am breathless behind the wheel
thinking nothing but gin
could melt this cluster-f*%# tangle:
In the last decade, many scientific papers have studied various aspects of this vulnerability—and how to reduce it. Surprise! One way to protect children with ADHD from that poor outcome is by treating ADHD early. Isn’t that just the opposite of what many in the public think?
Early ADHD Treatment Can Prevent Addictions
Consider this one from 2017: “ADHD medication tied to lower risk for alcohol, drug abuse in teens and adults”
The use of medication to treat attention deficit hyperactivity disorder is linked to significantly lower risk for substance use problems in adolescents and adults with ADHD, according to a study led by researchers at Indiana University.
The risk of substance use problems during periods of medication use was 35 percent lower in men and 31 percent lower in women in the study. The results, based upon nearly 3 million people with ADHD in the United States, are reported in the American Journal of Psychiatry.
“This study contributes to growing evidence that ADHD medication is linked to lower risk for many types of harmful behavior, including substance abuse,” said Patrick D. Quinn, a postdoctoral researcher in the IU Bloomington College of Arts and Sciences’ Department of Psychological and Brain Sciences, who led the study. “The results also highlight the importance of careful diagnosis and compliance with treatment.”
ADHD Over-Represented in AA and Substance-Use Clinics?
Count on it: ADHD was over-represented in that meeting I attended with my friend.
No doubt ADHD scampers through thousands of other AA-centered rooms, including private substance-use clinics. Unfortunately, many of those clinics woefully over-rely on their interpretations of AA—and under-rely on addressing underlying psychiatric or neurocognitive challenges.
So yes, I get it now: the potential neurobiological underpinnings of addiction, that is. So why don’t many substance-abuse treatment centers get it? The vast majority of them still base their programs on the AA model, established almost a century ago.
No doubt: AA might have been the best (if not only) alternative for several decades. Absolutely, AA groups still help people, including people with ADHD and other conditions.
The provenance of free public groups is one thing. Yet, often-quite-costly substance-abuse treatment centers are quite another.
We know more about the brain and addiction. We understand more now. Most importantly, we have better core treatment for the many underlying psychiatric conditions that leave people more vulnerable to substance abuse.
So why are so many “treatment centers” unskilled in—and even hostile to recognizing—the connection between untreated psychiatric conditions and substance-use?
The Danger of Failing to Recognize Underlying ADHD
Too many readers have written to me sharing heartbreaking stories. They detail their own or their loved one ADHD going unrecognized at substance treatment centers. Instead, their substance-use issues were the sole target.
I can’t imagine how those folks must have felt. Trapped? Misunderstood? Cursed?
A reader makes an important point in a comment to this story (which I am adding now):
“Self-Medicating” With Alcohol…
Some people with ADHD start drinking simply to calm the ADHD-fueled “noise” in their heads.
Some have told me, “That first drink brings clarity, Gina. I can think. Then it fades, and I keep chasing it. And of course, everything goes downhill from there.”
What does it feel like to be told you’re “bad” and you’re “hurting your family” or you “won’t” stop drinking or abusing other substances when you’re just trying to calm the noise—and escape.
Listen, this is a complicated subject. It’s clear: Millions of individuals have found life-saving help in AA and its derivatives. The peer support alone can be profoundly healing.
Yet, for many grappling with underlying neurobiological challenges, AA alone simply does not take them to the finish line. It might even send them backward. Then their families scold them—and they scold themselves—for being “weak” and relapsing. For failing. For being selfish.
Joseph Biederman, a preeminent psychiatric researcher, and his team published this research in 1995: Psychoactive Substance Use Disorders in Adults with ADHD.
Conclusions: Although psychiatric comorbidity increased the risk for psychoactive substance use disorders in adults with ADHD, by itself ADHD was a significant risk factor for substance use disorders.
More information is needed to further delineate risk and protective factors mediating the development of substance use disorders in persons with ADHD.
This is the 21st Century! Let’s put our knowledge into practice and stop torturing people.
These patterns aren’t limited to alcohol abuse. For people with ADHD who become addicted, the choice of substance varies.
Methamphetamine is surely a temptation for many people with undiagnosed ADHD, especially in rural areas with no access to psychiatric care.
Consider this previous post: “I Was Addicted to Meth When I Was Diagnosed With ADHD”. Excerpt from the post, which came as an e-mail message to me:
I’m not sure if you remember me but I met you at the CHADD convention in DC in 2013.
I was the mess of a drug addict who walked in 45 minutes late, in tears, and I was desperate for help. You were one of the people who helped me that day, and I’m grateful for you taking the time to speak to me.
I was addicted to meth for 5 years until 2009, when I was diagnosed with ADHD and my psychiatrist put me on Vyvanse. I easily stayed sober for 4.5 years and built a successful career in real estate. At some point before I relapsed, the Vyvanse stopped working. I had no idea until it was too late.
My guess is it lost its effectiveness during the last half of 2012.
In last week’s post, I pointed to the historical role that nicotine has played for many in managing ADHD symptoms: ADHD & Nicotine: Historical Ads.
Consider this excerpt:
I found a bit of specific research on ADHD and nicotine.
For example, there was this from 1996: Nicotine effects on adults with attention-deficit/hyperactivity disorder.
“Several lines of evidence,” it began, “suggest that nicotine may be useful in treating the symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD).”
I can find no studies making a direct connection between ADHD and opioid addiction. But I have met more than a few people with ADHD who succumbed.
It typically starts with legitimate use of opioids. The “abuse” continues because, these adults tell me, they feel so much more focused and “clear” on the opioids.
This study’s findings contradict many prescribing physicians’ ideas about not treating for ADHD among those who are active opioid users. Published in the Journal of Dual Diagnosis, “Stimulant medication for ADHD in opioid maintenance treatment” drew this conclusion:
These findings show some promise with regard to the safety and utility of central stimulant medications for patients with ADHD who are receiving opioid maintenance treatment.
Journalist Taking Treatment Centers To Task
That is why I was so riveted to the radio a few minutes ago. Check out this fantastic NPR interview with award-winning journalist Gabrielle Glaser: “Critic Faults Alcoholics Anonymous for Lack of Evidence.”
An investigative writer on mental-health issues, Glaser is a remarkable spokesperson for this critically important issue. You can listen or read the interview. Some snippets:
On the dominance of AA and the 12-step approach in the treatment of substance abuse in the United States
There was a book that came out in 2013 called Inside Rehab by Anne Fletcher.
[Gina notes: Perhaps Fletcher’s most important finding is the alarming discrepancy between the treatments offered at many rehab centers and the treatments recommended by leading experts and supported by scientific research.]
Her book found that up to 80 percent of all rehabs rely on AA and 12-step treatments as the foundation for their centers. It really has crowded out other voices.
On the criticism she’s received that questioning AA is irresponsible, when so many people say 12-step programs are the only thing that enabled them to quit drinking:
I get those messages all the time. My response to that is that this treatment actually can be just as damaging and dangerous for the people for whom it’s failing. AA doesn’t refer anybody out. It doesn’t tell anybody that AA is not for them. It’s very unlike professional organizations, which refer people to second opinions.
AA tells people that if they don’t benefit, it’s basically their fault. This has produced, really, a lot of tragedies. I hear about them weekly. Someone sent me an email this morning about a younger brother who committed suicide last night with the [AA] Big Book and a glass of scotch next to his bed.
Glaser’s Book on Alcoholics Anonymous
Glaser also wrote a powerful piece in the April issue of The Atlantic magazine: The Irrationality of Alcoholics Anonymous.
Subtitle: “Its faith-based 12-step program dominates treatment in the United States. But researchers have debunked central tenets of AA doctrine and found dozens of other treatments more effective.”
Thinking of ADHD, in particular—not to mention its many co-existing conditions—this passage sent a chill down my spine:
He felt utterly defeated. And according to AA doctrine, the failure was his alone. When the 12 steps don’t work for someone like J.G., Alcoholics Anonymous says that person must be deeply flawed. The Big Book, AA’s bible, states:
Rarely have we seen a person fail who has thoroughly followed our path. Those who do not recover are people who cannot or will not completely give themselves to this simple program, usually men and women who are constitutionally incapable of being honest with themselves. There are such unfortunates. They are not at fault; they seem to have been born that way.
Glaser’s work is an important read.
Have you or your loved ones with ADHD struggled with substance use?
If treatment was sought at a substance-use treatment center, how did that turn out?
Has subsequent ADHD diagnosis and treatment helped?
I welcome your opinion and experience as it relates to this issue.
This piece originally posted on March 27, 2015
72 thoughts on “ADHD, Addictions, & Alcoholics Anonymous (AA)”
There is so much I want to say here but time and allotted space prevents me from doing so. I was sober for over 18 years. I was a binge drinker. I never drank during the day and never drank in the morning. I attended at least four aa meetings a week. Ten years into sobriety I was diagnosed with ADHD. I never lost a job and never had a DUI. However many late nights and the various patterns one associates with ADHD eroded my marriage and weakened my performance at work. I was the underachiever. Always missed deadlines. Always filed taxes late. When I learned how to reset the change oil light on my car without changing the oil was one of the best days of my life! I was not a good partner in marriage or work. I have a Masters in Organic Chem. I knew I had the capacity to perform at a higher level in work and in my marriage. The gap between where I wanted to be and where I was became a source of confusion and frustration to me personally and professionally. If I could pick one diagnosis, I’d pick ADHD over alcoholism every time.
Now that I am 64, I’ve had the benefit of CBT and five years of vyvanse. It took me three years to get the right amount of Vyvanse for me (40 mg). Alcohol quieted my mind when deadlines loomed at work. I run an office in a large metropolitan area and my professional life is wonderful. However the damage to my 34 years of marriage is irreparable. Too many missed birthday parties, showing up late or completely forgetting important family events, filing late taxes took its toll, and understandably so. People seem to empathize with the alcoholic in recovery. They root for you They say they are proud of you. To me, when I took the step of walking into the rooms of aa, I liken it to grabbing a life preserver when drowning. It’s self preservation. No one to my knowledge congratulates to drowning victim on how they grabbed the life preserver! They had to.
However, the pain caused by the many impacts of ADHD scars our life partners in ways that are deep and lasting. That’s when resentment sets in to our (my) partners and maybe there is “too much water under the bridge.”
There is so much more I’d like to share. And there is so much more detail that lies under the surface of what little I’ve shared on this post. These blog posts have helped me so much over the years. I’ve forgiven myself of so much and have worked so hard to undo the damage. However, I can only change myself, one day at a time, and have no ability to change others. I don’t think there’s a pill for that…..unfortunately
I am moved by your comment. Stories such as this fuel this mission. The unnecessary pain and struggle……times millions of people…..just unacceptable.
There is so much I want to say here, but time and allotted space prevents me from any detail. I have been sober for 18 years and AA was a tremendous positive influence in my life. About 7 years into sobriety I was diagnosed with ADHD. I’m 64. My sobriety enabled me to be open to ADHD. If I could pick one, I’d choose alcoholism over ADHD. Sobriety was easier. People and family empathize with the alcoholic; less so with an adult with ADHD.
In sobriety, the ADHD continued. Struggle with deadlines, low self esteem, inability to plan ahead, missing birthdays are just a few of the things that continued to erode my marriage and success at work. My children have ADHD. The sympathy that they received from my wife somehow never came my way. I get it. My wife was burned out and the impacts of ADHD-an
Hello i need a groupbof 12 steps for ADHD
Hola yo necesito un grupo de 12 pasos para TDAH . Yo soy una persona que tiene TDAH aunque ya sea ya adulta. El TDAH también sigue en los adultos. Y necesito grupos y reuniones para poder estar solo por hoy con ritunas y libre de distraerme . Necesito ayuda y saber si hay grupos ya.
Sorry but I don’t know of any 12-step groups for ADHD.
There are, however, all kinds of support/discussion groups online.
good luck finding what you need.
My husband was diagnosed with ADHD at the age of 25. He struggled growing up but despite his parents trying to get him diagnosed, he was not. He turned to substance abuse (alcohol and marijuana) in his teens and recently admitted to himself and everyone that he was an alcoholic. He’s 36 now and has been sober 9 months while getting his health in order. He’s in counseling for the addiction and sees a psychiatrist. He’s been trying different medications because he’s always been in IR Adderall (awful for addicts- lots of “highs”) He’s now on the ER Adderall for various reasons. And is angry all the time. Lethargic, unmotivated. My 6 year old also has ADHD with a school behavioral plan, psychiatrist and weekly counseling. Your articles speak the truth! His addiction tendencies are directly correlated with his ADHD. I am determined not to let my son go through the struggles that my husband has. Thanks for all of your advice and research.
I have been treating ADHD addicts and alcoholics for over 30 years. I agree with you about IR Adderall. The problem with it is after a person has been on it it is the only thing they feel is effective. In more recent years my drug of choice to prescribe is Vyvanse. It is a prodrug meaning it is inactive from the pharmacy and only becomes active once it is activated by an enzyme in your intestine. This means you cannot snort it or shoot it. It is longer acting than Adderall XR which is frequently under prescribed by psychiatrists who haven’t treated a lot of Adult ADHDers. I would treat the addict in rehab until the administration did not want stimulants on the premises and then I did it in out patient. Talk to his psychiatrist about how irritable he is. Your husband may not be able to give that feedback. He sounds as if he is not fully treated for his ADHD and as well may have moved from the “pink cloud” to the “dry drunk.” If he goes to AA and connects with other alcoholics both socially and in meetings, there is a greater chance he will make it. I don’t know your husband and some AA meetings may not welcome him but there is help available and no one can give better advice than another ADHD recovering alcoholic.
Thank you, Dr. Pugliese,
I always welcome another guest post from you — on that topic or others. 🙂
I have been drinking almost every day for over 20 years. I finally went to my GP in tears last year because I wanted to escape the cycle but couldn’t. He put me on Campral tablets, which have helped the cravings, but I still often weaken.
At almost 52 years old, I finally read what ADHD actually is (ie. not always the stereotype of the hyper kid), and realised with shock that was describing me (inattentive/impulsive). I have been formally diagnosed a month ago, and I immediately wondered if it was the driver of my alcohol addiction. So far I think it is, or might be, as some ADHD medication is improving the situation so far.
I have not wanted to attend AA meetings in the past, as I had read that they revolve around religion, and that is not for me.
Thank you for your article, as I have been wondering about the connection between ADHD and addiction, but haven’t found much actually written about it. The connection certainly makes sense to me, and I hope that the ADHD is what’s driving it, so that I can attempt to understand how to work around it.
I’m so grateful my work was helpful to you.
Absolutely, there is a huge connection between ADHD and addiction. Tons of research on it.
Specifically, significant research has shown that children who are treated for ADHD in childhood are less likely to go on to develop substance use problems.
You might helpful find this article from our U.S. government’s Substance Abuse and Mental Health Services Administration.
I, too, was afraid to go to AA for the religious side of it, but I quickly came to understand that it’s very much a Spiritual program, and when they reference God, it is a God of your own understanding, meaning something bigger than you (mine was the group itself for a long time). Some of their principles have been absolutely life saving for me, as an ADHD addict, I just take what I need and leave the rest. There is absolute comfort in hearing other people’s stories of recovery, however they did it, and knowing that no matter how bad your story is, someone in the room has likely done worse and survived. Wishing you the very best of success. I’m coming into my third year of recovery and whilst medication for ADHD helps me massively, I still attribute AA to my maintained sobriety. Xx
Thanks for your comment.
Yes, it seems to me that each group has its own “personality.” If one isn’t to one’s taste, try another.
But I thought that the term was “Higher Power,” — not God.
It absolute is “Higher Power”, but almost every group I’ve ever been to reference “a God of their own understanding”, some even use it as an acronym for “Good Orderly Design”.
I was walking out of a bottle shop in early sobriety after buying just cigarettes but as I was walking out of the doors, I felt SO guilty being there, I just kept hoping that no one from AA would see me and think I’d bust. They were my “higher power” and that’s how. Haha
Thanks, Lou. We find our Higher Power wherever we can!
I’ve enjoyed reading your research on ADHD.
I’m the mother of three children, two of which have been diagnosed with ADHD, my middle and youngest. My son is 18 and daughter is 9. Though both were diagnosed with ADHD, and they have similar struggles, they’re very different; oddly, the girl is way more hyper.
My daughter has been on Adderall from the start. She’s been doing amazing on it… I don’t give it to her unless she’s in school, so she isn’t on it on weekends or summers.
My son was medicated (Concerta) in elementary then he chose he didn’t want to take medicine and wanted to try to modify his behavior without medication. He will be graduating in June and going to college. He has been struggling horribly this last year with school.
This past month he asked me about going back on medicine so that he doesn’t struggle when he goes into college… his father is against it (he doesn’t believe in ADHD, believes it’s just lazy).
I told my son since he’s 18, legally, if he wants to go on medicine, it’s his decision, but he has my support.
I won’t lie, I worry about Adderall, even for my daughter. I agree with you that doctors generally prescribe randomly… so I guess I’m wondering if it’s better to go the route of a psychiatrist?? I’m still new in dealing with Adderall and I appreciate any information you’re willing to share!
Thanks for your question.
Just to clarify….when I warn about “doctors generally prescribing randomly” for ADHD, I include psychiatrists. Perhaps especially psychiatrists.
Regarding your daughter. Yes, it’s a common misperception, that girls with ADHD always have the “Inattentive” type. ADHD simply can present differently in girls, due to differences that gender can create in the brain. Many girls are “hyper” — but not always in the physical, running-around way. They might be hyper-talkative, hyper-nosy, etc..
If Adderall is working well for her, great.
It’s generally not recommended to take ADHD medication as a “school performance” drug. ADHD can affect every area of life, including social ability, reasoning, exercise, diet, etc.. So, it’s considered best to treat throughout the day (and, in some cases, 24-7….because ADHD doesn’t sleep…and it can create sleep disorders).
But there is nothing cookie cutter about ADHD.
If your son did well on Concerta (please be sure to see my post on generic/brand Concerta issues), maybe it’s best to stick with that.
College can derail many a young person with ADHD as it is. So many distractions. So many new experiences, positive and sometimes negative. (“Party drugs,” etc.)
As you read, Adderall is a common target of abuse. So he’d have to be careful who he told and, if he is living on campus, who has access to his room, etc..
I’m guessing the father has ADHD, too?
If it were my son, I would definitely help him to navigate this issue. It’s not easy for many adults with ADHD to get the brand/authorized-generic (as you can read in the comments to that Concerta post).
It might also be important to help him focus on organizational strategies, for managing time, goals, priorities, classes, projects, reading, etc.. Inability to do that has been the undoing of many potential college students with ADHD.
I encourage you to read my book’s chapters on medication.
I hope this helps. Good luck!
I would definitely encourage your son to go back on the Concerta at least for his freshman year in college.
It is so difficult to adjust at first with the new responsibilities that others take for granted. If he has a bad first year, he will drop out. At least that has happened to some of my ADHD patients whether on meds or not.
There are some good psychiatrists out there. Get an interview appointment. Then you can decide which one. If he goes away to college, sometimes Student Health can oblige. If he doesn’t have learning disabilities, he should still make contact with the university Learning Center in case he needs extended test time. College is so different from high school and the material expected much more abstract.
Gina guessed that your husband has the undiagnosed ADHD. I am going to be the devil’s advocate and guess that he is more OCD-ish with that laziness comment and that your side of the family has the ADHD. I have found in my psychiatric practice that the most common transmission is father to son but when a girl has it, it is either both parents’ side or the mother’s side. I do not mean to be disrespectful. My own mother had it. My kids both adopted have it dramatically.
My daughter is still on Concerta at age 31 (actually generic methyphenidate ER which is not the same but the only thing her insurance will pay for). My son is not on any ADHD meds except clonidine because on stimulants at age 5 on Concerta he drove our Suburban into a tree trying to get to Radio Shack before rather than after dinner. It made him too brilliant.
Good luck to you all. Maria Pugliese, MD
Thank you so much, Dr. Pugliese, for offering your expert perspective.
Age 5????? Oh my goodness…. Radio Shack…. My husband could appreciate this, I bet! 🙂
Yes, I know there are good psychiatrists. I hear 100s of stories every year — for 20 years — and so few of them are positive stories.
Hiya and thanks Gina ***
I am now 35 years into recovery *** or as I like to say ‘discovery”. I think when I first came in in 1985 – any talk of ADHD or similar, I would have poo-poohed straight out! I would have had NO idea what was being suggested? Around then, this was pre- internet etc. Information was pretty thin on the ground. Sadly lacking all around in fact…I think I found about AA for example by visiting a public library in London. It feels to me that the USA has a definite head start in this area of ADHD and the surrounding knowledge. I have about 15 or so hard copy books, plus another 10 in Kindle etc. As i bean to realise, what part of my potentially “fatal malady” was. After a long, long time in AA and other fellowships (NA, CA, etc). I know now that primarily one of my primary reasons to self medicate continuously. Was trying to re- focus or just FOCUS my brain. My mind and thinking were as Americans like to say extremely “scattered.” My drugs of choice were uppers and alcohol mainly. The go-faster drugs really.
A chance remark by someone in the AA Fellowship, led to this further voyage of discovery . She said I reminded her of the kids that she taught. They were ADHD and on the Autism Spectrum. At the time was drumming on a table and my thighs. A not unusual occurrence for me.
I discovered after initially putting her ideas down. That actually I totally identified as an Adult (and lifelong) ADHD-er. The doors were opened. Since then it is and will be, the cherry on the cake. Apart from the constantly present over-riding anxiety and fear that was a bedfellow of the condition of ADHD/alcoholism and drug addiction. That I had a name for the presenting and deep rooted issues….ADHD. That I now am able to try and reclaim some of the years, ‘the locusts had eaten….All that precious time that had been squandered – with a life threatening addiction to boot on top.
The solution became the problem. The medicine became the poison…
I thank God I am still here, as the numbers of addicts/alkies that make it are few and far between. People like Stanton Peele and others – maintain it is a 5 percent (or less) long-time recovery rate….Which is very, very very small. That is right across the board due to AA, NA, treatment centres, God, having a ” spiritual experience” etc etc…. Im glad I found AA when I did – It took me out of street drinking and drugs. But for years I knew something was “wrong”. —- I KNEW IT **** and it took a person in AA, with a God- given remark to turn things completely around….I stuck in there and now its further learning and discovery— thanks again— Jim
I appreciate your sharing your experience with AA, etc. 1985….good grief no…..who was thinking about ADHD then? lol
Thank goodness AA has been there during all the decades when there were no better answers — and many worse ones.
“The solution became the problem. The medicine became the poison.” ….Indeed.
You mention Stanton Peele. I am unfamiliar with him save for a extremely disparaging post he wrote on ADHD.
Then I see he’s written disparagingly of Gabor Mate’s cog in the Trauma Industrial Complex wheel. I agree with him on that!
Just this morning I was thinking about how often mental health professionals miss ADHD. I was reading an editorial in Current Psychiatry by Dr. Henry Nasrallah who was making the claim there is no such thing as treatment resistant depression.
He states that the depressions that don’t respond to conventional antidepressants usually have other causes. He writes at length about bipolar disorder, medical conditions, medications, and street drugs all causing syndromes that might resemble depression, but he never once mentions ADHD.
Yet I have seen dozens of patients over the years with emotional dysregulation and intense dysphoria from their ADHD, who had been misdiagnosed with depression, and who, despite years of medications or therapy, never had that “depression” go away. But when their ADHD was properly identified and treated, their mood improved as well.
Thanks for your comment. Absolutely! When I hear “treatment resistant depression,” I think “wrong diagnosis””
Some clinicians will resort to all kinds of treatments for these folks — ketamine, etc. — without even being willing to consider ADHD.
I think I wrote about one of John Ratey’s early studies. He screened a group of maybe 90 subjects with “treatment resistant depression” — and found quite a number had ADHD and, moreover, responded to treatment.
Thanks for being an early adopter!
I have been treating addicts and alcoholics for more than 45 years.
When I was Medical Director or the attitude at my detox/rehab was favorable, I treated ADHD in rehab. In the earliest days I used Cylert and in more recent times Vyvanse.
Then the tide shifted with the attitude being I couldn’t treat ADHD in rehab but could in out-patient. because I have two adult children who were diagnosed very early in life, I know what it is to live with ADHD. Treatment allows ADHDers a much greater chance to stay sober. Very few abused it.
My treatment center when I ran it was the only place ADHD could be treated. When people asked about using medication in AA or NA, I said that some meetings were closed-minded but certainly not all. Your medication is your insulin and you need it to survive and stay sober. Besides it is no one’s business but you and your doctor’s. I firmly believe in AA and NA but I also firmly believe that people with ADHD need life-sustaining medicine.
Thank you, Dr. Pugliese!
On behalf of the ADHD community, thank you for your years of light-years-ahead compassion and service.
I think the same applies for anger management groups.
I work as a novice therapist..and when asking anger management group directors what they do to assess for ADHD I have received little in the way of encouraging response.
A person with under managed ADHD symptoms of irritability, anger , misperceived rejection, low frustration tolerance, and emotional dysregulation can look like typical anger management issues–but it is not. Addressing those issues first so the person can help their brain be sufficiently stimulated to activate the brakes seems key to anger issues. Anger management training asks people to slow down and tap into those “brakes” part of the mind—which those with untreated ADHD may have trouble accessing.
To me it seems irresponsible to not properly assess for ADHD prior to addressing anger issues. I have learned this the hard way as a therapist in training.
The lightening speed reaction to perceived rejection, criticism, loss etc. and ensuing rage—compared to otherwise non-controlling happy content in the moment personality traits (when stimulated) distinguish ADHD from typical anger issues.
I am dismayed and shocked and how lacking ADHD training is in therapist training 🙁
Gina’s most recent book for clinicians really drives home the issue of ADHD hiding behind what looks like addictions (porn, video games ,other)…where someone without adhd may have addiction for another reason (to move away from difficult feelings ,for instance), the person with Adhd only does so to be stimulated–and when stimulated–is less drawn to those things.
WE must always do a full biopsychosocial assessment —and not presume things are all learned/social when there may be a biological piece easily addressed!
Well said, Cam!
i’m afraid the free-wheeling Internet (where anyone can make claims without evidence….and be believed by the vulnerable) and gamed social-media has allowed all kinds of charlatans to misdirect people from specific ADHD-related issues.
Trauma is the big one now. Including Gabor Mate claiming that ADHD is caused by trauma, that trauma causes addiction, etc..
Thanks for being a leader! We need you!
I totally agree with you. Although they may look the same at the time of the anger episode, the ADHDer is completely different in between. They are great fun to be with.
I cannot agree with you more. Gabor Mate’s book on ADHD is extremely concerning; clinicians must not view trauma as a panacea and there are clear differential diagnostic criteria distinguishing trauma from ADHD.
I went to a trauma training group where the trainer explained that trauma caused ADHD (!) and admitted she knew little about it.
Stimulants can make trauma worse where ADHD is not present, where stimulants can help those who have ADHD and trauma.
Skilled clinicians assess whether ADHD predated the trauma and recognize that many of those with ADHD did not experience significant trauma, among other key differences.
This type of misdiagnosis can cause real harm by delaying proper care; focusing on psychosocial healing approaches, which can flood someone with untreated ADHD.
This is why so many of those with ADHD have been mislabeled and received counter productive treatment (bipolar, BDP). Uninformed therapy can be dangerous.
Maté is writing beyond his expertise as an MD trained some time ago with expertise in a certain area, which is not ADHD 🙁 This misinformation is pervasive within the therapy world which overemphasizes environmental relational factors, at times ignoring biological ones.
In my clinical training, I made the mistake of missing ADHD and low iron and all sorts of biological correlates and causes of symptoms in clients! But working alongside doctors I learned by lesson and read everything I can on ADHD and always do a full biological assessment.
Gina you are a gift ! Keep up getting your message out.
Thanks enormously for your detailed explanation.
Sometimes the Internet just gets me down….. 🙂 Such capacity for expansion and education….and so much co-opted by charlatans and, let’s be honest, hucksters.
Given the nature of SEO (search engine optimization), the words that get attention get more attention. e.g. Trauma causes ADHD.
I don’t know where Mate got his degree or what type of degree he has. But it had to be a long time ago and, I suspect, in Eastern Europe. Very psychoanalytical.
He writes about the “blank slate” (tabula rasa). That children are born mentally perfect. It is their parents and other childhood experiences that cause problems.
It’s just unbelievable to me that he gets away with it. Not only gets away with it but his omnipresent Facebook ads show many comments from people who praise him highly.
Don’t get me started on “Rejection Sensitivity Dysphoria”. I just researched the SEO figures on that one. Promoted by one MD at a for-profit website. Copied by all the “health” websites.
Now everyone on the Internet believes that RSD is part of ADHD and is treated with guanfacine and MAOI!!! Stunning.
Thanks so much for your support and for being a serious clinician!
This resonates so much, currently dealing with all of these issues with my son.. “addiction” as well as the emotional dis-regulation. I also have ADHD (as well as low iron, b12, d3) and there are so few doctors that understand any of this. I wish there were more like you CAM… or that I could hire you! 🙂
Thank you for your reply, you give me hope! I did as you suggested and downloaded the list, after a few false starts, I managed to concentrate on it long enough to confidently say its easier to list the symptoms I do not display rather than those that I do. Less than a handful at best. I have come to much prefer written word over verbal conversation, seems I’m so much better at the former, I can take my time to read back and remember where I was going, I get so lost in speech, I actually feel sorry for anyone I’m talking to. I have reminders to feed my children! Then reminders for those reminders! My entire life is a tangled web of “coping strategies” and a constant state of overwhelm and panic is fairly normal to me.
I completely agree with what you said about the crossover from AA to support services, whilst I’ve never been admitted, looking back I did essentially do an “at home rehab”, well when they got to me anyway. The women I saw actually snored while I was speaking and woke up long enough to inform me that anything I tell her she has a mandatory obligation to report me if she feels my kids aren’t safe. We spoke for around 6 months, and I’m sure you won’t be the least bit surprised when I tell you I was her “star pupil”, I’m not sure a word I said to her after that warning was true, I told her exactly what she wanted to hear and we went our seperate ways, her totally confident that she’d done her job well. She couldn’t help me. I’m not sure she can help anyone. It’s not that my kids aren’t safe, they are, but to throw a threat out like that to a mum who already doubts herself and is trying to tell you their worst secrets? Makes me sad that these people are our “professionals” in an area that so badly affect so many lives.
I agree with you in that, yes some of the principles of AA would be great in rehab, but the reason AA works so well for those of us who “get it” is because of the people who deliver it. Without them, the lessons wouldn’t/couldn’t be learned.
When I first read your post I was slightly offended because AA has done so much for me, but upon further investigation (namely hyper focusing on what you’re actually saying), I completely agree with you and understand.
Thank you for educating me, I do love to learn, I just wish everything was this easy to understand. Haha.
Thank you, Lou, for understanding my intent. I am always looking out for my readers. Always. And that often involves being a “watchdog” on various treatments (especially when there are misdiagnoses!).
You aren’t the only one, though, who had that reaction. I completely understand — and thank you for keeping an open mind.
If I may be so bold, you sound very sharp to me. If ADHD symptoms with “word processing” and such cause you trouble, I really encourage you to look into medication treatment. Even for a trial period, if you are cautious.
As I always say, “it’s not like cutting off a leg.” 🙂
You can always stop. But you’ll never know how clear and organized your smart brain can be until you try. 🙂
I struggled to read all of the comments as is quite standard for me, and I’ve never been to a treatment centre, but I do struggle with alcoholism and (sporadically) attend AA. I did notice at a topic meeting yesterday that the list of suggested group topics read more like an adhd symptom checklist.
The problem I am having is being diagnosed! I’ve just managed to drop a Bipolar diagnosis, I’m still shaking my head at that one, only to be slapped with a BPD diagnosis from a 45 minute session and offered more medication! He even told me to “concentrate on the 5 symptoms I DO have, rather than the 5 I don’t!” I asked if those were also symptoms of adhd and he replied “oh you have ALL of the symptoms of adhd but I don’t believe you have it because you can Hyperfocus”! ♀️ (I did do my research and I officially have 1.5 symptoms of BPD, and I’m completely flabbergasted as to how a “professional” could come to that conclusion in such a short amount of time or from my answers!)
Honestly, my question is what are we supposed to do when we are surrounded by idiots?
If I didn’t have A.A. in my life, I simply wouldn’t have one. It’s the only place I feel even remotely “normal”. I’m not even sure I go there for addiction issues anymore, just support to calm down my non-stop internal monologue!
I think what I’m trying to say is that for some of us, AA is the closest we can get to some sort of treatment. If you have any advice I would really appreciate it. I’m at a loss as to what to do, I just know I’m not taking any more anti-psychotics or antidepressants because I’m pretty sure I’ve now tried them all. At least AA doesn’t try to medicate me. Haha.
I absolutely sympathize. I’ve heard the stories every day—for 10 years—about how prescribers and therapists are failing people with ADHD. Not only failing but harming.
Sometimes it really does feel that way to me, too — that I’m surrounded idiots. And hustlers. Oh, so many hustlers.
Good for you, for being able to rise above the noise and come to what sounds like your truth.
The best advice I have for you is to keep self-educating as much as possible — and get validation for your perceptions. The lower your tolerance for BS, the more quickly you’ll go through the professionals unqualified to help you.
I understand how valuable AA can be. I would never discourage someone from seeking support.
The main criticism here is substance-abuse centers charging a lot of money and failing to use evidence-based care….instead relying upon AA models as meted out by poorly trained staff. While the underlying disorders go untreated. No wonder the addiction recidivism rate is so high.
Definitely, the first-line treatment for ADHD is NOT anti-psychotics and antidepressants. It’s the stimulants.
You might want to download this inventory. It can help when evaluating women with ADHD. Developed by two veteran ADHD experts who themselves have ADHD (and happen to be women).
Perhaps you can remain with your group but just keep to yourself the ADHD information.
Ever since we had this conversation, I can’t get out of my head what you said about the connection between AA and ADHD. I’ve been listening closely at meetings and haven’t heard anything as yet that contradicts with what you said. I truly think you’re on to something. I’m now convinced that almost every person in those rooms are undiagnosed adhd. I constantly hear “I felt like this long before I picked up my first drink” (which is what I said before I learned about adhd, in that I believed I was born an alcoholic). Happy to chat more about it from an inside perspective if you’re interested. X
Thanks for keeping an open mind and checking it out “in the field.”
I would love to hear more from you on this. Care to write it here?
thank you and take care,
Capillary damage, my blood pressure went past Jesus on it’s way up.
No offence intended to anyone writing here. I could not even read all the comments because. AA. What can I say eh? Sometimes a well meaning bunch of regular christian hypocrites converting lost souls for their karmic gain. Oh, perhaps that’s another religion, but whatever, they’re all mostly the same working towards the same goal using fear, guilt and remorse as their vessel. A book is a book by any other name, and there are soooo many. But only ONE that’s true right? Damn it, blood pressure took off again, this time even passed L. Ron Hubbard on some vulcano on Jupiter.
If and when I surrender my misgivings to a higher power, I say it like Sting sings it: (then) it’s probably me. Myself in the future.
Wired wrote an insightful article on AA a few years back:
“It was in June 1935, amid the gloom of the Great Depression, that a failed stockbroker and reformed lush named Bill Wilson founded the organization after meeting God in a hospital room. He codified his method in the 12 steps, the rules at the heart of AA. Entirely lacking in medical training, Wilson created the steps by cribbing ideas from religion and philosophy, then massaging them into a pithy list with a structure inspired by the Bible.”
You crack me up.
But I hope you are only kidding about the blood pressure!
Fortunately, I have a history of low blood pressure. That’s how I’ve survived the last 20 years of being confronted with all kinds of ADHD-related nonsense, gimmickry, charlatanism, etc. without stroking out! 🙂
My blood pressure is normal now, though.
Maybe Wired goes a bit in the extreme. It does tend to do that, especially on “cultural” issues.
In my experience, all the Anonymous groups are only as useful as the people who organize and dominate in the meetings. Lots of variation.
The founding is more complex. Bill was a successful businessman whose career was destroyed by alcoholism. I don’t find it helpful that Wired calls him a “lush”; to me, that’s just more of the leftist psychiatry denial.
He founded AA with the help of a physician. Imagine what kind of resources were available to alcoholics back in 1939. Bill had been in one hospital for alcoholics, several times. But the doctor there had the believe that Alcoholism was an illness.
Bill struggled with the conception of God as a centerpiece of existing programs. A friend suggested that he could form his own conception of God.
To me, I find it pretty advanced for the era. The history is quite interesting: https://en.wikipedia.org/wiki/History_of_Alcoholics_Anonymous
The problem comes when it is mis-used, especially by pricey “substance-abuse treatment centers” who over-rely on it and under-rely on evidence-based treatment practices for addiction. Including to diagnose and treat underlying psychiatric conditions.
As a member of AA and one who has several mental health “labels” including ADHD, I want to thank you for an excellent article on the problematic side of treatment centres. In the meetings I attend, it is often said that many of the folks that go to treatment centres have simply paid way too much money for a Big Book. Sadly, many times this is true.
No doubt in my mind that the medications I take help me tremendously with my mental health Without them, I’d be a bouncing high to severely depressed person. But self-care, structure and a detailed schedule also help me a lot.
A couple of things greatly concern me with treatment centres. The first being that options other than AA are rarely presented. Although AA was the answer for me, it is not for everyone. I personally encourage anyone who has doubts about the AA program to give it a try for a couple of months. If the fit isn’t right, find something that is for them.
The second problem as I see it is that treatment centres are well known for taking people through the 5th step and then discharging them. They are left on their own for the most part and the support network they had in the close atmosphere of a treatment centre is gone. Obviously treatment centres do not bother to follow the steps as written. After the 5th step and an hour’s reflection on it to make sure we’ve left nothing out, we are to immediately go into steps 6 and 7. Without doing that, I’d have been left to face the mess that I was without hope that this part of me could change. To me, that is cruelty to the people who pay for their so-called help. Personally I’d have probably felt there was no solution and run back to my bottles.
As I mentioned, treatment centres obviously do not follow the Big Book. On page 133, it states:
“But this does not mean that we disregard human health measures. God has abundantly supplied this world with fine doctors, psychologists, and practitioners
of various kinds. Do not hesitate to take your health problems to such persons. Most of them give freely of themselves, that their fellows may enjoy sound minds and bodies. Try to remember that though God has wrought miracles among us, we should never belittle a good doctor or psychiatrist. Their services are often indispensable in treating a newcomer and in following his case afterward.”
Written in 1939, I find this as relevant today as when the Big Book was written, perhaps even more so. The symptoms of ADHD, bipolar and several other mental health problems can and do overlap in many ways. For me, until I got off the alcohol and began to work the steps, the extent of my mental illness wasn’t clear. I was altering myself with alcohol, self-medicating which gave a false picture. I was fortunate that the structure of the program of AA was what I needed to help get me to a place that I could help my doctors help me. That did take about 6 months though.
As for the answer(s), I do not have a clue. All I can say is the system is broken in most treatment centres and things need to change for the good of the people who entrust these centres to help them recover.
Thank you again for a well balanced article addressing a giant problem (as I see it) in today’s alcoholism/addiction recovery. I’m so glad I found this article today, even though you wrote it a few years ago. You helped me to clarify a number of things in my thinking on these issues.
I am so grateful to have “gotten it right” from your experienced perspective.
Thank you for your careful reading and, moreover, for fleshing out the details in your so very helpful comment.
I know this article is 3 years old. I have been dealing with the most fucked up mess in my fucked up life.
I was born in 1963 they didnt know about ADHD . I was adopted and my poor folks I put them thru hell. I was just the kid that was a fuck up. But I was smart my IQ latest results is 165. So they couldnt figure me out. I was a shity student but bright they had a disconect. I pretended I couldnt read until my das caught me reading the History of the Roman Empire. He tricked me into giving up the goods. He asked me if I was reading ” I said no i was looking at the art ” he had however seen me running my finger down the middle of the page ( my self taught method of speed reading , I was impatient to learn everything and reading slowed me down there where to many other subjects so I realized that a lot of words do not need to be read i individually words like , the ,and ,there , ect. And your mind filled them in automatically.
And it was faster to read from top to bottom and not side to side. I could therefore read 50 to
100 pages an hour. By 10 I was reading mt mothers course wirk on abnormal psychology. So sorry for the tangent my dad asked me about what the pictures and art where about. I blasted off and he read the page I was on deducing correctly that I just discribed the gist of the chapter he read. At first he looked pissed off but slowly a smile formed and a laughed calling me a little shit.
The reason I lied about not being about to read was simple I had been thrown into LDS class and frankly the curriculum was for retards. Just a nomlecture I had freinds i have this amazing abilty to adapt to the intellegence or lack of and realize that all people have dignity. So in order to avoid the bullshit of participating in that crap i figured im not playing thier game tge start of a life long rebellion to public education. In every class I went i could have taught it. I went to the library and sought out the most scholorly book i could find on the subject I was interezted in. Math and english I had no use for …so I often failed tnose tests. I got by by getting A + on testd but doing zero coursr work and never even brought homework home. I just took the trst without studying . Math and English tests i just ditched those classes. .
I was vulnrable. Plus im an empath so i was a target. For bullying molestation and just plain hatred from most adults.
i also have PTSD and hearing that im no good lazy selfish a sociopath ….they didnt know i probably knew more about sociopaths than they did. All things i knewnot to be true about mysrlf. I said fuck it they want a psycho and a bad kid Ill give them one. It was a bullying incedent that triggered this new me. The me of no fear ….not being intemidated by anyone or anything. Abd i went against my own personality i became completly selfish . So this kid Helmet was pushing me around for the hundreth time. Hes smaller than me. … I was 6 foot by the time i was in the 7 th grade. And wirey. I waz strong as hell from all the jobs i did around the nieghborhood and for my dad. But i didnt look it. I just snapped …I saw red and his face became everyone thst ever hurt me or let me down. If my brother hadnt hapoened along i would have killed him as i was on top of him slammi g his head on the ground. I had read the marine manual on hand to habd fighting and some of those deadly technique s came back. After tgat incident my brither was afraid of me…not for his safty i loved him bit for any kid thst picked on him. Because Helmut was smaller thsn me the nieghborhood kids felt that gl make it it even i kneded to fight Helmet and another kid at the same time. The ither kid was a local delinquent older and bigger than me. I knew he had to go first.He came up behind me and tried a chock hold i cocked back my right arm snd caught him in the eye with my elbow.
I then procedded to beat the tar out of Helmet again. To this day he still plots of wzys to get even. This behaviour continued and I became a srrisl killer in training….neaning that the behaviour patterns where similar. I never thought about killing people for fun. I only wanted to hurt bullies and molesters . An anti hero. I set fires tortured animals vandalised stole shit did drugs and drank.
Until at 15 I met the creator of the universe and tgat put me back onto the empath personality I reallt was. However That ability to tap into my inner pyscho when needed has helped out on occasion. I never had friends so at l5 I had developed coping methods that allowed me to get along with kids that liked the brutal honesty and loyalty i offered. And intellegent kids were alwaysxa staple regardless if they where book smart or not intellegent people seek the same. However i had friends rmthat ran the gamit from high functioning autistic kids to egg heads. Stoners jocks surfers i didnt care if you were my friend social status didnt matter.
I will continue this only if i realise someone is resding it.
I just looked up and was like wow
If someone is interested in talking to a dude that about ready tonthrow in the towel.
I read every comment. And I respond when it seems appropriate.
You aren’t asking a question, so I won’t try to devise an answer.
I’m sorry that no one knew, from a young age, the nature of your challenges.
It’s why I do the work that I do, because that should not happen. Ever.
Gina what a great piece. Thank you. I was in AA for years before I was diagnosed with bipolar II. It had been there all along, but I was repeatedly told by sponsors to “pray about it” or “work the steps harder” or “get out of myself by doing more service work.” Needless to say, medication, not faith healing, saved me. I also wanted to echo your sentiments regarding the fact that AA never refers anyone out of AA. AA does not in any way vet it’s members. In fact, members will tell you that “no one ends up in AA by mistake.” That’s what’s so weird about the woman’s comment above re: “real alcoholics.” If AA is only meant for “real alcoholics,” then why do you all try to convince everyone that they are there for a reason, a drinking problem. You just can’t have it both ways. I never belonged in AA, yet I stayed for 13 years – brainwashed. Also, to the person who commented above claiming that Carl Jung explained the spiritual and physiological aspects of the disease, that just is plainly false. AA is faith healing and has never delves into the “physiological aspects of the disease.” The founders labeled it a disease to reduce the social stigma around it – and, anyone who has read the big book know that the book describes the “disease” as an “allergy of the brain and mind” and a “spiritual sickness.” This is very much not synonymous with a physiological, scientific explanation of substance use disorder. At any rate, thanks for your voice of reason and for writing and publishing this. – Julie
Thanks so much for the validation. I knew I risked stepping on toes, and for some people, AA is one of the few available resources.
But for all the reasons you mentioned, it is important to also screen for treatable psychiatric conditions.
Hey! You really do steal my thoughts away! It’s interesting to see the responses of people who, instead of understanding what you wrote, are just offended that you dared suggest AA isn’t 100% perfect.
I grew up with un-diagnosed ADHD because my symptoms where not the stereotypical symptoms and the condition was not as well understood as it is today. At age 13, instead of getting that diagnoses, I was forced into a 12 step program (self-medicating behavior that would continue for a huge chuck of my life).
To the extent that such programs work, they do so because peer-support is very helpful for almost any kind of human problem that doesn’t have a medical basis. And that’s your point — when one has a mental health issue (a medical issue), their drug use issues are secondary in most cases.
The two biggest problems with 12 steps programs is 1) it’s a one-size-fits-all solution. In medical science, we’ve learned that mental health issues are almost never solved with fully predictable treatment plans. That is, specialized treatment for the individual seems to be required. 12 step programs don’t really have much flexibility in that area. And 2) it’s structured very much like a religious order. That’s why any questioning of it is met with irrational resistance. It’s like going into a church and questioning the existence of God.
But science and understanding require questioning. I shared my anecdote above, but only to make this point: people who don’t get what you’re saying don’t understand the difference between statistics and anecdote. They tend to think their personal experience must be the same as everyone else’s, or at least every one else who isn’t a “broken and unfixable” person. Statistics tell us the reality: 12 step programs can work sometimes, but the success rate doesn’t support the idea that it’s the best choice or that it should be the only choice.
Would you like to write my blog posts? 🙂
Because we’re on the same wavelength and all, and you’re a clear and cogent writer….just saying… 🙂
Seriously, thank you for understanding and validating the point I was trying to convey.
Yes, a few readers have written critical comments to that effect, contending that I am saying AA is worthless, etc.
For some people with ADHD, reading comprehension is difficult and all-nothing thinking is the reflexive go-to. Then there’s impulsivity, self-medicating from anger, and so forth.
I don’t take it personally, and I appreciate all comments that add to the discourse.
P.S. Jason, I’m really sorry that happened to you. Horrific.
On one hand, we can “send a man to the moon” and on the other, when it comes to neuroscience, anyway, we are largely troglodytes.
AA and treatment centers are two separate programs. Treatment centers base themselves on the 12 step program but is not complete, especially in the enforcement of rules and paying of counselors. AA is based on spiritual and physiological principles like Carl Jung’s ‘ inner religious experience’ for a psychic change. I’m an Adult ADHD sufferer. This is an outside issue, uncovered when alcohol was removed, and to be addressed by therapy and medication. Anyone who states AA is an end all is incorrect but AA is for my alcoholism and my ‘alcoholic’ thinking. It is a good start and once things clear, you can see what outside issues are left, if any, to be dealt with appropriately.
Thanks for your comment and an important clarification.
I added it to the post.
I still think it’s true that many AA groups have “alternate explanations” for the behaviors leftover after the alcohol is stopped. But the post is primarily regarding the substance-abuse treatment centers.
I have been sober for just shy of 7 years.
I regularly attend AA meetings and have a sponsor. I recently was diagnosed with ADHD at age 52. I had always thought ADHD was a possibility and that I likely had it for a number of years. I knew a little about it. Just enough to say oh I do that or that sounds like me. I find AA a way to calm myself. The 12 steps do not work for everyone but many people could benefit from the spiritual nature and the design for better living. We all have baggage and the steps help those of us see our part and be able to forgive ourselves and make amends to those we have hurt. Then move on to step 10,11,12 which are to structure a standard way of living by giving of yourself and reflecting on things you do wrong in daily living and make amends to them immediately
AA was teaching people some of the foundations of mindfulness practices. This has been going on since the 1930’s. Another thing about AA is it creates fellowship this helps in recovery in a number of ways. 1) it give the alcoholic a network of support.
2) it creates strong bonds among groups and friendships arise.
3) fellowship and service helps others recover. Service is where you do a job within AA or you carry the message to a still suffering alcoholic.
These are a few things which are important.
What if there were groups of ADHD individuals who could share experience strength and hope with each other.
I could see this helping ADHD individuals learn and grow by hearing what others have done. By creating friendships and learning new ideas
Certainly your blog is one piece of that which connects is to new information.
I very much appreciate the website and information.
I by no means believe AA is the be all end all and other options my have better success. AA is not to be at fault of treatment centers using it as a basis. That is there choice. AA has actually been over run by court mandated attendance by courts for years. Not just for dui but about everything. This has put a strain on AA and has often made meetings less effective because people are not there to become sober but because they need a slip signed. This is not AA’s fault by any means. AA takes people in regardless and trust to help. AA is an amazing grass roots self funded and self supported group of people working to become and stay sober and help others along the way. By no means is it perfect and it is not for everyone.
My next thing is I have had little problem staying sober once I came to AA my issue has been change my behaviors. We’ll come to understand I have struggled to understand that my ADHD is a significant if not greater part of my inability to change my behaviors. I am just realizing that I must do things differently than the standard drunk because I will get on a new path and a squirrel will appear and I will run that way because it’s a cute fuzzy squirrel. It is a very strong reason that change does not stick. I get so easily distracted that o forget what part of my behavior I was trying to change. For me I must work extra hard at organizing my plan for daily living it is how things go smoothly and it is the way I am able to make it part of my regular life.
Thanks very much for your thoughtful comment. I agree with all that you write.
AA can be invaluable for all sorts of people. As you say, and as I try to emphasize in the post, the trouble is with these treatment centers failing to perform evaluations to identify underlying conditions that can make a person vulnerable to substance abuse (as ADHD surely can).
That’s a very interesting point, about court-mandated attendance putting a strain on AA. Absolutely I can see that.
As for this part of your comment: What if there were groups of ADHD individuals who could share experience strength and hope with each other.
I could see this helping ADHD individuals learn and grow by hearing what others have done. By creating friendships and learning new ideas
Absolutely. That’s why I have led an Adult ADHD group here in Silicon Valley for more than a decade. It is a powerful thing. Finding other people (finally) who can relate, sharing strategies with others, not having to “hide” behaviors or “cover for fear of being judged, etc. I’m convinced that this group is an immense part of the treatment/healing process for most of the people who attend—and keep attending.
If you’re ever in Palo Alto, you’re welcome to join us. It’s free and open to the public.
Hi my name is Andrew
I have recently been diagnosed with ADHD as an adult.
I’ve suffered with addiction and alcohol related isssues throughout my life.
I have been a member of Alcoholics Anonymous for the last 7 years.
I’ve begun to notice and gain an awareness that the so called symptoms of Alcoholism as stated in the Big Book are alarmingly the same as the symptoms of ADHD.
Given the structure of the AA program is somewhat helpful in my daily life it has started to make me wonder why I would spend the rest of my life attending meetings if the possibility I am not actually an alcoholic and the cause o all my symptoms is just good old ADHD. I’m at a bit of a crossroads here and would appreciate some feedback.
Sorry for delay. I’ve been very sick that contagion going around. Still sick, so I’ll keep it short.
I definitely would encourage you to pursue an evaluation for ADHD. First, read up more, though. Read throughout my blog and elsewhere. Make a note of what resonates for you. It will be important to the evaluation process.
I thoroughly concur…who would want to structure an entire life around attending AA meetings if the source of your challenge lies elsewhere, and is treatable??
You owe it to yourself. Please keep me posted on your progress.
Gina with all due respect your representation of Alcoholic’s Anonymous is inaccurate. You seem to be under the impression that AA discourages the use of outside resources. This simply is not the case. Here are a few quotes from AA’s main text…
“Our liquor was but a symptom. So we had to get down to causes and conditions.” p.64….ADHD is surely a big factor in causes and conditions, no?
“We recognize that alcoholics are not immune
to other diseases. Some of us have had to cope
with depressions that can be suicidal; schizo-
phrenia that sometimes requires hospitaliza-
tion; bipolar disorder, and other mental and
biological illnesses. Also among us are diabetics,
epileptics, members with heart trouble, cancer,
allergies, hypertension, and many other serious
Because of the difficulties that many alcohol-
ics have with drugs, some members have taken
the position that no one in A.A. should take any
medication. While this position has undoubtedly
prevented relapses for some, it has meant disas-
ter for others” p.11 pamphlet
I don’t doubt for a second that your experience regarding prejudice in AA is true. Unfortunately there is no application process to become an active member. For this reason our message often gets scued. This is why it’s important to go through the book with somebody with experience instead of on your own. God bless…
“We missed the reality and the beauty of the forest because we were diverted by the ugliness of some of its trees” p.50
I appreciate your taking the time to share your thoughts. Thank you!
As I noted in the post, this is a difficult type to write clearly about. Such complexity.
The main issue, though, isn’t to criticize AA, which has undeniably helped millions of people.
The main issue is to point to the poor practices at substance-abuse treatment centers that overly rely on the AA model, without bringing other medical expertise to bear.
They are often a last resort for people with substance-abuse problems, people who don’t know that they are dealing with a neurobiology that makes them more vulnerable to addiction. These clinics don’t offer psychiatric expertise and screening for these conditions. At best, they might give people with ADHD medication for “depression” or “anxiety” — which only intensifies ADHD symptoms.
I’ve heard the stories.
That is where the objection comes, not to AA itself, but to these “clinics” that actually exploit the good reputation of AA to offer inferior but costly (in more ways than one) “treatment.”
I hope that clarifies.
As the scientific community advances our knowledge of how the brain works including how addiction or ADHD shows up in the brain, there may very well come a time when AA simply becomes one option among many.
But I have to tell this: While Bill Wilson and his friend Dr. Bob were many years ago creating AA –which has undeniably saved countless live around the world for decades–Lois, his wife created a place for the spouses of the alcoholics to share their experience, strength and hope and so Al-Anon was born. This a group for people affected by other people’s drinking.
Although I’m the one in my partnership with ADHD, I ended up in Al-Anon and it had an unexpected benefit. Not only did I learn how to keep my peace and serenity despite my partner’s behaviour, even with 40+ years of undiagnosed ADHD, I also found a place where I could learn to love and accept myself.
The 12 steps gave me the principles that would enable me to stand up for myself–with respect for myself and the other–in the face of anger, criticism and derision regarding how I kept house, my productivity and forgetfulness. Al-Anon certainly saved my marriage and quite possibly my life.
A few years later, after reading “Driven to Distraction”, I’d get an ADHD diagnosis, but it would be a some time before I truly tackled my ADHD. Until then I had the sound, applicable to everyone, principles of that 12 Step program to live by.
Recently I bumped into a former ADHD coaching client. He was cheerful and happy to report that he was attending a 12 step meeting for chronic indebtedness. He also said that he looked forward to, at some point, attending my 12 Step based ADHD Support Group.
12 Steps and AA may not be a perfect fit all the time, and like any treatment, including the most modern therapies used for ADHD–are not always administered as well as they should be.
Please don’t write off this very helpful program.
Thank you for detailing your story and your positive experience with AA and Al-Anon.
I would never disparage a program that is available freely to millions of people, especially one that offers community and, as you mention, helps people in finding their voice and in listening as well.
The problem is that AA is overly relied upon in actual substance-abuse treatment programs, to the exclusion of addressing underlying psychiatric conditions, including ADHD. That is definitely short-changing people and resulting in high recidivism rates. Treatment centers need to step up their game and step into the 21st Century.
After 1o years of marriage I think I can say that even AA can become an addiction. Over the years, I have seen how my husband gets more and more involved in all type of AA related activities…..daily 90 minute meetings, conferences, cds, endless phonecalls to his sponsor, books (AA literature is all he ever reads), etc… it never ever ends…there’s always something.
I sometimes wonder if this is how cult members behave.
He has been resisting taking medication for his ADHD after he gave it a quick try and didn’t like it.
He thinks AA is all he really needs for his problems and that I simply don’t understand. The irony is that even though he attends his daily meeting and does everything the AA literature says…he is still suffering.
I hope he someday realizes how much better he would feel if he tried medication and received adequate treatment for his ADHD.
I also hope that the AA community does something about all their undiagnosed ADHD members. Many would benefit from it.
Thank you for sharing your experience. I completely agree with you, because I have seen that scenario play out many a time.
It’s almost like the person is using AA as the last defense against facing reality.
I credit AA for being there when there were no better answers — treatment, support, or therapy. The system of it does a great job of keeping awareness “front and center”, with the sponsorships, meetings throughout the week, etc. But at some point, that system can also be a trap, keeping the person in denial. Especially when the sponsor or group spouts anti-medication sentiment (as many do, but that’s not in the “Big Book”).
I hope your husband comes around soon.
Gina, you mentioned in the reply to the person who’s husband was into porn, that it appears it is time for meds. I know there are stimulant and non-stimulant meds – which ones appear to be the ‘safest’ in slowing down the impulse to act or speak – creating the pause that is needed? By safest, I mean the ones wt less intrusive side affects. I’ve tried suppliments. L-tyrosine has some benefits but my mind is still like a popcorn bag with each kernel wanting to be expressed. What would be ‘entry level’ meds that one could talk to the doctor about?
Put a lid on that popcorn popper! 😉
Good question. It really depends on what’s going on in the neurochemistry department.
Some people with ADHD will do well on a stimulant alone, at least for a while. But some will ultimately need a pairing that addresses both ADHD and anxiety/depression.
Have you read my book? If so, check the chapters on medication, where I spell out a “start low and titrate slow” approach. (One that many MDs don’t know to follow; hence, too many people get side effects and give up.)
There are equal odds to the two classes of stimulant (AMP and MPH) working well for you. The best is to try one of each to get a fair trial.
For people with ADHD who have a bit of the heebie-jeebies about trying a stimulant (because once you swallow it, you’re stuck with it!), I suggest checking out the patch, called Daytrana. http://www.daytrana.com/
You place it on your hip and have to wait a while for it to enter your system. The advantage, though, is that you can just take it off if you don’t like the effect. It takes about 30 minutes to an hour to clear.
But you can also try a low dose of the other stimulants — Ritalin, Focalin, and Adderall (my last choice, because it has a more problematic side effect profile for some people).
At the lowest dose, it about has the effect of a strong cup of coffee.
Of course, medication to slow the impulse is one thing. There is also the issue of breaking bad habits, and sometimes even addictions to consider.
But a good place to start sorting it all out is with the Rx.
Re: side effects, I saw some good advice in a recent book (or books) I read: make sure you request the name brand first until you’re familiar with how the medication works for you.
The default for most physicians, pharmacists, insurance companies, etc. is to offer a generic “equivalent” whenever it’s available. However, those generics aren’t all created equal. It’s more expensive, but it’s the only way to get an accurate baseline for what works for you and at what dosage. I didn’t do this when I started meds, but I wish I had.
Also, Gina, that quote at the end is just heartbreaking. How many “simple systems” have ADHD folks failed to “completely give themselves to?” I find that kind of talk unhelpful at best in any situation 🙁
Yes, I ALWAYS recommend starting with the name brand first. You can always switch to generic. But if you start with it, you won’t know if it’s the medication that doesn’t agree with you or the generic.
And yes, “simple” indeed.
I wonder how adult ADHD plays out in porn “addiction”. (Yes, the quotes are there on purpose. After 13 years of reading and research, I cannot agree with the 12-step community that it is a true addiction). How does ADHD leave someone “vulnerable” to impulse-control disorders, or vice versa? And how on earth is it ever successfully treated, assuming it can be? Over a decade of meetings and therapy, and my porn-“addicted” ADHDer continues to lie and act out, and to behave like an entitled, emotionally abusive jerk in general, even when he’s not acting out. (Yes, I’m working on being able to get out of the relationship, but I wonder if ADHD is a cause or a symptom, or if it makes the impulse-control behavior more entrenched and impossible to change).
You make a great point. The researchers I’ve read in the area of hypersexuality object to calling it “addiction,” too. Nonetheless, they recognize that there can be pathology in the obsessive overuse of porn, masturbation, etc.
ADHD can create a vulnerability to addictions due to the deficits in dopamine transmission (the “reward” neurochemical); that’s a very simple way to put it. The ADHD-challenged brain, being understimulated, is chornically seeking stimulation, and often over-doing it. Poor self-regulation is part of the central challenge of ADHD.
To answer your question, ADHD is an impulse-control disorder. And, that can manifest in many areas in life.
You mention that your partner has done 12-step meetings and therapy, but no mention of medication. That seems far past due, if 10 years of the meetings/therapy hasn’t made a difference. Or perhaps he’s just a jerk. 🙁
Take care of yourself.
Hi Gina, What a relevant subject.
How much longer will the medical profession believe alcoholism, depression, ADHD, add, bipolar and all the labeled symptoms considered diseases and known as “mental illness,” and not as an energy-deprived or chemically imbalanced brain causing emotive and motive problems with transmission and transformation of energy.
With lack of emotion\motion the mind and body is known as depressed and with too much it is known to be manic or psychotic. When the doctor prescribes a controlled substance to a mentally ill patient it is considered medical treatment and for now it is still legal, but if an undiagnosed or untreated person should self-medicate oneself with an uncontrolled substance, that is considered addiction and that is illegal.
Why is it that the fortunate conscientious patient gets treated while the unfortunate and ignorant criminal is fined, jailed and untreated. Am I right or maybe that is not the matter. Edward
I don’t know if you’re right, Edward, but I certainly agree with you.
This issue is one that particularly penalizes the poor, who don’t have access to psychiatric care and sometimes do the best they can with illicit substances or even abusing legal ones. Taking what little money they have and perhaps pushing them into crime.
It’s the 21st Century. I hope we all join it soon!
I am interested to know how you feel qualified to talk about this subject if you are not an alcoholic with ADHD. Here is my experience and I hope to give you some understanding around the subject as I feel your motives are positive.
First of all around half of the room you walked into do NOT have ADHD. It’s so much more than being fidgety and drinking too much coffee. There is a correlation. People with ADHD are more prone to substance abuse, statistically 4 times more likely but a good percentage of those will never make it into a meeting.
I did! Now I know alot of alcoholics and addicts and while we’re mostly dual diagnosis, not everyone has ADHD in fact as a woman I have yet to find another who displays such extreme symptoms as me. So what do I do?
Firstly when I came into the rooms, I did not have a diagnosis because my alcoholism and addiction masked everything. If it hadn’t been for AA and working the 12 steps to the best of my ability I would never have got a diagnosis because all alcoholics and addicts are unmanageable in their nature. It wasn’t until I was 6 months sober until mental health services could work with me. We could rule out substances and look at why I can’t concentrate unless it’s something I’m passionate about, losing things I need constantly, feeling overwhelmed by absolutely everything, I can’t follow lists. I can’t stick everything in a purse because I’ll lose that. Friends feel I don’t listen and 70% of the time that is true. But what I needed to understand was that while there is a correlation I am not an alcoholic or an addict because of my mental illness. Many people with mental illness do not drink like I did. I had trauma in my past but I did not drink because of that, I drank because I was alcoholic!!
There is another quote from ‘As Bill Sees It’ that states AA is not a cure all ‘It would be a product of false pride to claim that AA is a cure all, even for alcoholism’. We work the programme alongside seeking professional help if necessary. That is my experience and I could not have done that without getting sober and personally for me I could not have got sober without working the steps. I know I am not alone in this. AA is a fantastic tool for aiding mental illness. There really is no negative.
You know the quote you referenced says the opposite of what you are implying. It states ‘They are NOT at fault’. And they’re not, often mental illness is so overwhelming they can not get this stuff and that is very sad but it happens.
But you know as an alcoholic and an addict that was of the hopeless variety I try and carry a message to the still suffering. My life has changed dramatically. I am nearly a year sober, I am the most mentally sound I have ever been. I’ve been able to get a diagnosis for ADHD and I have a sponsor who has guided me through the steps and I now sponsor others. This stuff quickly and dramatically changed my life. It made me useful, I don’t have to hide behind a diagnosis and use it as an excuse to drink and drug. I can use my experience to benefit others!
You know a lot of people come into meetings withdrawing from substances, shaking and fidgeting. It doesn’t mean they have ADHD, often they are typical addicts and I can say that as one.
Hope this helps!
Thanks for sharing your experience.
I would encourage you to please re-read my piece. It doesn’t say that you maintain that it does.
I do not disparage the AA model itself, only the tendency of substance-abuse treatment centers to base too much of their “program” on it while ignoring underlying psychiatric issues.
I do not claim that everyone at the AA meeting I attended had ADHD. This is what I wrote:
You can bet ADHD was over-represented in that room—and no doubt thousands of other rooms, including private clinics, where AA is still the model used to address substance-use problems and underlying neurocognitive or psychiatric issues are ignored.
I stand by this statement, especially since this was the mid-1980s, when almost no one was talking about Adult ADHD or even milder forms of bipolar disorder.
I also respect the work of Gabrielle Glaser, and this post is largely based on her work and others. I cite one of her responses to an interview question:
There was a book that came out in 2013 called Inside Rehab by Anne Fletcher. That book found that up to 80 percent of all rehabs rely on AA and 12-step treatments as the foundation for their centers. It really has crowded out other voices.
If you are not concerned about people with underlying ADHD/bipolar disorder being treated (often at great cost) at centers that do not have qualified psychiatric staff and that have high recidivism rates, that’s your business. If you want to disagree with everything in my post, again, your business. But when you misrepresent the content of my post with your criticisms, that’s my business. 😉
You don’t seem to realise that there are ” real alcoholics ” and those people that misuse alcohol because of life events and trauma. I am of the first type and no amount of therapy, counselling and physciatric help did for me what AA has done . It’s been life changing and helps me to deal with life on life’s terms. Unless you’re a real alcoholic you would not know or understand . Many people with diagnosis of mental illness find that the steps and program allow them to run their lives and their illness with a lot more manageability than when they were in active alcoholism. They are able to differentiate between the alcoholism and their mental illness. There are some brilliant books out there on this subject . Carl Jung also agreed that it needed more than we he could offer to help an alcoholic to recover .
Where in my post gives you evidence that I “don’t realize there are ‘real alcoholics’ and those people that misuse alcohol because of life events and trauma”?
Perhaps you’d like to re-read, because I did not limit the world of alcoholism to people with ADHD or any other group.
My blog is about ADHD. That is my focus.
This post has a very specific point — that substance-abuse treatment centers that overly rely on AA are missing other important treatment factors for many clients.
Thanks for writing.