ADHD, Addictions, And Alcoholics Anonymous (AA)

Alcoholics Anonymous ADHD

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 –
“Faster-straighter-GET there,”
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):

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.

“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.

…Or Methamphetamine

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.

…Or Nicotine

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).”

…Or Opioids

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.

 

 

 

Alcoholics Anonymous ADHD

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

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 issues?

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

—Gina Pera

69 thoughts on “ADHD, Addictions, And Alcoholics Anonymous (AA)”

  1. 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.

    1. Hi Vicki,

      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.
      Gina

  2. 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.

    1. 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.

  3. 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.

    1. Dear Cyndi,

      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.

      https://store.samhsa.gov/sites/default/files/d7/priv/sma15-4925.pdf

      good luck!
      g

    2. 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

    3. Hi Lou,

      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.

      g

    4. 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

  4. Hello Gina,
    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!

    1. Hi Mary,

      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.

      https://adhdrollercoaster.org/adhd-medications/authorized-generic-concerta-update-6-1-19/

      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.

      https://amzn.to/3xaceL4

      I hope this helps. Good luck!
      g

    2. Maria Pugliese MD

      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

    3. 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.

      g

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