With kind permission from Wendy Richardson MA, MFCC, CAS, ADHD and Addiction and Author of the best selling book of the same title.
ADD AND THE FAMILY
Living in families, and raising children can be difficult under the best of circumstances. Many of us had a hard time living in the families that we grew up in. It may be difficult today, living together in the families that we have created. We may feel guilty for not giving our children or partner what we feel they deserve. We may feel painfully aware of how we are not taking care of our own needs. This is especially true if a member, or several members of our family have Attention Deficit Disorder.
As our knowledge of Attention Deficit Disorder grows, we are learning that ADD is not simply a disorder of childhood. ADD is life long condition. Children with ADD grow up to be adults with ADD. People with ADD do not live and grow in a vacuum. They have relationships, children, and create families with people who may or may not have ADD. Therefore, it is essential to help not only the person directly affected by ADD, but the entire family. Attention Deficit Disorder, similar to addictions affects every member in the family. Families do not cause ADD, and yet families need help to live and thrive in spite of the impact of ADD.
We now know that ADD runs in families. It has been estimated that there is a 30% chance that a child with ADD has at least one parent who has ADD. It has also been estimate that there is a 30% chance that that same child will have a sibling with ADD. I frequently work with families where one or both parents have ADD, and one or two of their children also have the condition. Living in a family with ADD can be like living in a five ring circus. There is always someone or something that demands attention.
As parents we want the best for our children, and are often willing to sacrifice our needs for theirs. But what is the impact on the family if one of the parents has untreated Attention Deficit Disorder? Too many times, I hear caring parents say, "Please help my son or daughter. I've dealt with this all my life and can continue to." The problem with this is that it can be incredibly difficult to provide consistent parenting for any child, let alone a child with ADD, if you as the parent have untreated ADD. There is a reason why the airlines request that adults put their oxygen mask on first, so that they are then able to help the children.
Families with ADD have higher incidents of physical, and verbal abuse. Substances such as alcohol, food and drugs are often used to self-medicate the pain and frustration of family ADD. Some parents of children with ADD suffer from Post-traumatic Stress Disorder (PTSD). PTSD is a condition that occurs when people are subjected to extreme, ongoing stress that is beyond the realm of normal experience. PTSD symptoms include depression, anxiety, sleep disturbances, hyper-vigilance, and re-experiencing of the trauma.
For the for mention reasons, it is imperative that ADD is viewed in the context of the family, or persons environment. Relationship therapy that is specific to addressing the impact of ADD is essential. Family therapy which includes parents and siblings with and without ADD is critical. So often the non-ADD siblings are left out, or feel that they have to somehow make up for the difficulties that their ADD sibling(s) are causing. Educating and treating all members of the family system promotes family wellness.
We have learned from the evolution of the chemical dependency field over that past two decades that treating alcoholics and addicts outside of the context of their relationships is less than helpful. We have also learned that family members of the chemically dependent person also need treatment, so that they too can recover. The same is true with Attention Deficit Disorder. Let us continue to be quick learners as our knowledge of ADD expands. ADD is not caused by poor parenting, or dysfunctional families, and yet the entire family deserves treatment. No one in the family is immune from the impact of Attention Deficit Disorder.
Wendy Richardson M.A., LMFCC specializes in the treatment of ADD and co-related substance abuse. She provides education and therapy for couples and families where ADD is present. She is a writer who speaks nationally ,and provides workshops and trainings on Attention Deficit Disorder.
THE LINK BETWEEN ADD/HD AND EATING DISORDERS
SELF-MEDICATING WITH FOOD
As human beings we find creative ways to decrease our emotional, physical, and spiritual pain. Some people use alcohol and other drugs to ease the pain and frustration of their ADD symptoms. Others use compulsive behaviors such as gambling, spending, or sexual addictions. Eating in ways that are not good for us, but temporarily make us feel better is also a form of self-medicating. Self-medicating is when we use substances and behaviors to change how we feel. The problem with self-medicating is that it initially works, but soon leads to a host of new problems.
Eating can temporarily calm ADD physical and mental restlessness. Eating can be grounding for some people with ADD, helping them focus better while reading, studying, watching television or movies. If your brain is not quick to contain your impulses, you may eat without thinking. Some compulsive overeaters are shocked to realize they have finished a carton of ice cream or a king-size tub of theater popcorn. They were not consciously aware of how much they were eating. Eating puts them into a pleasant trance like state that is a respite from their often active and chaotic ADD brain.
Although we don't think of food as a drug, it can be used as one. We have to eat, but eating too much or too little of certain types of food has consequences. Since there is no way to totally abstain from food, eating disorders are extremely hard to recover from. You may have to abstain from certain foods, perhaps those containing sugar, because they trigger a compulsion for more, yet everywhere you look you see and smell these foods.
WHY FOOD?
Food is legal. It is a culturally acceptable way to comfort ourselves. For some people with ADD food is the first substance that helped them feel calm. Children with ADD will often seek out foods rich with sugar and refined carbohydrates such as candy, cookies, cakes, and pasta. People who compulsively over eat, binge, or binge and purge also eat these types of foods.
It is no accident that binge food is usually high in sugars and carbohydrates, especially when you take into consideration how the ADD brain is slow to absorb glucose. One of the Zametkin PET scan studies, results indicated that "Global cerebral glucose metabolism was 8.1 percent lower in the adults with hyperactivity than in the normal controls..."1 Other research has also confirmed slower glucose metabolism in ADD adults with and without hyperactivity. This suggests that the binge eater is using these foods to change his or her neurochemistry.
SUGAR CRAVING AND HYPERACTIVITY
Researchers have searched for the connection between sugar and hyperactivity. Some studies have reported that sugar causes hyperactivity in children. When these studies have been duplicated, however, the results were not always consistent. The idea that sugar causes hyperactivity is relatively new in our culture, and has not been passed on from previous generations. This is why grandparents are often miffed when they are told not to give their grandchild any sugar. They haven't had the experience of sugar causing hyperactivity.
What if we have been looking at the question backward? What if ADD hyperactivity actually causes people to crave sweets? If the ADD brain is slower to absorb glucose, it would make sense the body would find a way to increase the supply of glucose to the brain as quickly as possible.
I have worked with many ADD adults who are addicted to sugar, especially chocolate which also contains caffeine. They find that eating sugar helps them stay alert, calm, and focused. Prior to ADD treatment many report drinking 6-12 sugar sodas, several cups of coffee with sugar, and constantly nibbling on candy and sweets throughout the day. It is impossible to sort out what is pure sugar craving when it is mixed with the stimulating effects of caffeine on the ADD brain.
THE SEROTONIN CONNECTION
Serotonin is a neurotransmitter that has been associated with symptoms of depression. Serotonin helps regulate sleep, sexual energy, mood, impulses and appetite. Low levels of serotonin can cause us to feel irritable, anxious, and depressed. One way to temporarily increase our serotonin level is to eat foods that are high in sugar and carbohydrates. Our attempts to change our neurochemistry are short lived, however, and we have to eat more and more to maintain feeling of well being.
Medications such as Prozac, Paxil and Zoloft work to regulate serotonin. These medications are frequently helpful when used in combination with ADD and eating disorder treatment. Proper levels of serotonin can also help improve impulse control giving the person time to think before they eat.
COMPULSIVE OVER EATING
Most of us overeat at times. We may eat for sheer enjoyment even if we're not hungry, or we may eat more than we intend at a dinner party or celebration. But for some, overeating becomes a compulsion they cannot stop. Compulsive overeaters lose control of their ability to stop eating. They use food to alter their feelings rather than satisfy hunger. Compulsive overeaters tend to crave foods high in carbohydrates, sugars, and salt.
BINGE EATING
Binge eating differs from compulsive overeating in that the binge eater enjoys the rush and stimulation of planning the binge. Buying the food and finding the time and place to binge in secret creates a level of risk and excitement that the ADD brain craves. Large amounts of foods high in carbohydrates and sugars are rapidly consumed in a short period of time. The binge itself may only last fifteen to twenty minutes. Proper levels of serotonin and dopamine aid in impulse control problems that contribute to binge eating and Bulimia.
BULIMIA
Bulimia is binge eating accompanied by purging. The bulimic experiences the rush of planning the binge, which can be very stimulating for the person with ADD. In addition, the bulimic may be stimulated by the satiation binging provides; then, he or she adds an additional dimension to the process: the relief of purging. Many bulimics report entering an altered state of consciousness, experiencing feelings of calmness and euphoria after they vomit. This cleansing provides relief which is short lived, and so the bulimic is soon binging again.
ANOREXIA
Our culture is obsessed with thinness. "Food is OK, but, don't gain weight." No wonder so many adolescent boys and girls, as well as women and men, become imprisoned in binge and purge cycles, chronic dieting, and anorexia nervosa.
Anorexia can be deadly. Anorectics have lost their ability to eat in a healthy way. Self-starvation is characterized by loss of control. They are obsessed with thoughts of food, body image, and diet. Anorectics can also use laxatives, diuretics, enemas, and compulsive exercise to maintain their distorted image of thinness.
As we learn more about ADD, we discover that people manifest ADD traits differently. Obsessing on food, exercise, and thinness gives the anorectic a way to focus their chaotic ADD brains. They become over focused on thoughts and behaviors that related to food.
Frequently these people will only become aware of their high level of activity, distractibility, and impulsiveness after they have been in recovery for anorexia. Self starvation curtails hyperactivity.
Distractibility and spaceyness are characteristics of both anorexia and bulimia, whether or not they're accompanied by ADD. In each case the inability to concentrate or focus results because the brain is not being properly nourished. For people with ADD, however, there is a history of attention difficulties that predates the eating disorder. Their concentration, impulse problems, and activity level may not improve when their eating disorder is treated. As a matter of fact, their ADD traits can get worse once they are no longer self-medicating with food, or organizing their lives around food and exercise. If you are someone who has struggled with eating disorders, and suspect you may have ADD, it is important to get an evaluation. Both your eating disorders and your ADD must be treated.
COMPREHENSIVE TREATMENT
It is essential that both ADD and eating disorders are treated. Too many people are struggling with their eating disorders because they have undiagnosed or untreated ADD. When ADD is properly treated the individual is better able to focus and follow through with treatment for their eating disorders. They also have greater control of their impulses, and less of a need to self-medicate their ADD symptoms.
Stimulant medications such as Dexedrine, Ritalin, Desoxyn, and Adderall that work with the neurotransmitter dopamine can be helpful in treating ADD restlessness, impulsiveness, attentional problems, and problems with obsessive thoughts. Medications such as Paxil, Prozac, and Zoloft are useful because they increase serotonin levels, thus helping with impulse control, obsessive thoughts, and decrease agitation.
The key to successful treatment lies in a comprehensive treatment program that address the medical, emotional, social, and physical aspects of both ADD and eating disorders. Recovering from eating disorders takes time, hard work and commitment. Recovering from eating disorders when you have ADD is even tougher. I encourage you to be patient. Put away the whip of contempt, and have compassion for yourself. You've been through a lot. Over the years I have seen many people who were once hopeless and despondent because they could not recover from their eating disorders chart solid courses of recovery once their ADD was treated.
1. Zametkin, Nordahl, Gross, King, Semple, Rumsey, Hamburger, and Cohen, "Cerebral Glucose Metabolism in Adults with Hyperactivity of Childhood Onset," {The New England Journal of Medicine}, 30 (1990).
Wendy Richardson, MA., LMFT, the author of The Link Between ADD And Addiction: Getting The Help You Deserve, is a licensed marriage, family, child therapist and Certified Addiction Specialist in private practice. She is also a consultant, trainer, and speaks at national and international ADD, chemical dependency, and learning disability conferences.
The Link Between ADHD & Addiction
It is common for people with ADHD to turn to addictive substances such as alcohol, marijuana, heroin, prescription tranquilizers, pain medication, nicotine, caffeine, sugar, cocaine and street amphetamines in attempts to soothe their restless brains and bodies. Using substances to improve our abilities, help us feel better, or decrease and numb our feelings is called self-medicating.
Putting Out Fires With Gasoline
The problem is that self-medicating works at first. It provides the person with ADHD relief from their restless bodies and brains. For some, drugs such as nicotine, caffeine, cocaine, diet pills and "speed" enable them to focus, think clearly, and follow through with ideas and tasks. Others chose to soothe their ADHD symptoms with alcohol and marijuana.
People who abuse substances, or have a history of substance abuse are not "bad" people. They are people who desperately attempt to self-medicate their feelings, and ADHD symptoms. Self-medicating can feel comforting. The problem is, that self-medicating brings on a host of addiction related problem which over time make people's lives much more difficult. What starts out as a "solution", can cause problems including addiction, impulsive crimes, domestic violence, increased high risk behaviors, lost jobs, relationships, families, and death. Too many people with untreated ADHD, learning, and perceptual disabilities are incarcerated, or dying from co-occurring addiction.
Self-medicating ADD with alcohol and other drugs is like putting out fires with gasoline. You have pain and problems that are burning out of control, and what you use to put out the fires is gasoline. Your life may explode as you attempt to douse the flames of ADD.
A 1996 article in American Scientists states that "In the United States alone there are 18 million alcoholics, 28 million children of alcoholics, 6 million cocaine addicts, 14.9 million who abuse other substances, 25 million addicted to nicotine."1
Who Will Become Addicted?
Everyone is vulnerable to abusing any mind altering substance to diminish the gut wrenching feelings that accompany ADHD. There are a variety of reasons why one person becomes addicted and another does not. No single cause for addictions exists; rather, a combination of factors is usually involved. Genetic predisposition, neurochemistry, family history, trauma, life stress, and other physical and emotional problems contribute. Part of what determines who becomes addicted and who does not is the combination and timing of these factors. People may have genetic predispositions for alcoholism, but if they choose not to drink they will not become alcoholic. The same is true for drug addictions. If an individual never smokes pot, snorts cocaine, shoots or smokes heroin, he or she will never become a pot, coke, or heroin addict.
The bottom line is that people with ADHD as a whole are more likely to medicate themselves with substances than those who do not have ADHD. Dr.s Hallowell and Ratey estimate that 8 to 15 million Americans suffer from ADD, other researchers estimated that as many as 30-50% of them use drugs and alcohol to self-medicate their ADHD symptoms.2 This does not include those who use food, and compulsive behaviors to self-medicate their ADD brains and the many painful feelings associated with ADHD. When we see ADD it is important to look for substance abuse and addictions. And when we see substance abuse and addictions, it is equally important to look for ADHD.
Prevention and Early Intervention
"Just Say No!" may sound simple, but if it was that simple we would not have millions of children, adolescents, and adults using drugs every day. For some their biological and emotional attraction to drugs is so powerful, that they cannot conceptualize the risks of self-medication. This is especially true for the person with ADHD who may have an affinity for risky, stimulating experiences. This also applies to the person with ADHD who is physically and emotionally suffering from untreated ADHD restlessness, impulsiveness, low energy, shame, attention and organization problems, and a wide range of social pain.3 It is very difficult to say no to drugs when you have difficulties controlling your impulses, concentrating, and are tormented by a restless brain or body.
The sooner we treat children, adolescents, and adults with ADHD the more likely we are to help them to minimize or eliminate self-medicating. Many well meaning parents, therapists and medical doctors are fearful that powerful ADHD medications will lead to addiction. Not all people with ADHD need to take medication. For those who do, however, prescribed medication that is closely monitored can actually prevent and minimize the need to self-medicate. When medication helps people to concentrate, control their impulses, and regulate their energy level, they are less likely to self-medicate.
Untreated ADHD and Addiction Relapse
Untreated ADHD contributes to addictive relapse, and at best can be a huge factor in recovering people feeling miserable, depressed, unfulfilled, and suicidal. Many individuals in recovery have spent countless hours in therapy working through childhood issues, getting to know their inner child, and analyzing why they abuse substances and engage in addictive behaviors. Much of this soul searching, insight, and release of feelings is absolutely necessary to maintain recovery. But what if after years of group and individual therapy, and continued involvement in addiction programs your client still impulsively quit jobs and relationships, can't follow through with their goals, and has a fast chaotic, or slow energy level. What if, along with addiction your client also has ADHD?
Treating Both ADHD and Addictions
It is not enough to treat addictions and not treat ADHD, nor is it enough to treat ADHD and not treat co-occurring addiction. Both need to be diagnosed, and treated for the individual to have a chance at ongoing recovery. Now is the time to share information so that addiction specialists, and those treating ADHD can work together. It is critical that chemical dependency practitioners understand that ADHD is based in one's biology and responds well to a comprehensive treatment program that sometimes includes medications. It is also important for practitioners to support the recovering persons involvement in Twelve Step programs and help them to work with their fear about taking medication.
A COMPREHENSIVE TREATMENT PROGRAM CONSISTS OF:
A professional evaluation for ADHD and co-occurring addiction.
Continued involvement in addiction recovery groups or Twelve Step programs.
Education on how ADHD impacts each individual's life, and the lives of those who love them.
Building social, organization, communication, and work or school skills.
ADHD coaching and support groups.
Closely monitored medication when medication is indicated.
Supporting individuals decisions to take medication or not ( in time they may realize on their own that medication is an essential part of their recovery).
Stages of Recovery
It is important to treat people with ADHD and addiction according to their stage of recovery. Recovery is a process that can be divided into four stages, pre-recovery, early recovery, middle recovery, and long term recovery.
PRE-RECOVERY: Is the period before a person enters treatment for their addictions. It can be difficult to sort out ADHD symptoms from addictive behavior and intoxication. The focus at this point is to get the person into treatment for their chemical and/or behavioral addiction. This is NOT the time to treat ADHD with psycho stimulant medication.
EARLY RECOVERY: During this period it is also difficult, but not impossible to sort out ADHD from the symptoms of abstinence which include, distractibility, restlessness, mood swings, confusions, and impulsivity. Much of what looks like ADHD can disappear with time in recovery. The key is in the life long history of ADHD symptoms dating back to childhood. In most cases early recovery is NOT the time to use psycho stimulant medication, unless the individual's ADHD is impacting his or her ability to attain sobriety.
MIDDLE RECOVERY: By now addicts, and alcoholics, are settling into recovery. This is usually the time when they seek therapy for problems that did not disappear with recovery. It is much easier to diagnose ADHD at this stage; and medication can be very effective when indicated.
LONG TERM RECOVERY: This is an excellent time to treat ADHD with medications when warranted. By now most people in recovery have lives that have expanded beyond intense focus on staying clean and sober. Their recovery is an important part of their life, and they also have the flexibility to deal with other problems such as ADHD.
Medication and Addiction
Psychostimulant medication when properly prescribed and monitored is effective for approximately 75-80% of people with ADHD. These medications include Ritalin, Dexedrine, Adderall, and Desoxyn. It is important to note that when these medications are used to treat ADHD the dosage is much less that what addicts use to get high. When people are properly medicated they should not feel high or "speedy, instead they will report increases in their abilities to concentrate, control their impulses, and moderate their activity level. The route of delivery is also quite different. Medication to treat ADHD is taken orally, where street amphetamines are frequently injected and smoked.
Non stimulant medications such as Wellbutrin, Prozac, Nortriptyline, Effexor and Zoloft can also be effective in relieving ADHD symptoms for some people. These medications are frequently used in combination with a small dose of a psychostimulant.
Recovering alcoholics and addicts are not flocking to doctors to get psychostimulant medication to treat their ADHD. The problem is that many are hesitant for good reasons to use medication, especially psycho stimulants. It has been my experience that once a recovering person becomes willing to try medication the chance of abuse is very rare. Again the key is a comprehensive treatment program that involves close monitoring of medication, behavioral interventions, ADHD coaching and support groups, and continued participation in addiction recovery programs.
There is Hope
For the last few years I have witnessed the transformation of lives that were once ravaged by untreated ADHD and addiction. I have worked with people who had relapsed in and out of treatment programs for ten to twenty years attain ongoing and fulfilling sobriety once their ADHD was treated. I have Witnessed people with ADHD achieve recovery once their addictions were treated.
"Each day I understand more about how pervasive ADHD is in my life. My clients, friends, family and colleagues are my teachers. I wouldn't wish ADHD and addictions on anyone, but if these are the genetic cards that you have been dealt, your life can still be fascinating and fulfilling."3
WENDY RICHARDSON, MA, L.M.F.C.C., CAS
Wendy Richardson, MA, LMFCC, author of The Link Between ADD & Addiction, Getting The Help You Deserve, Pi-on Press (1997) is a certified addiction specialist who began working in addiction treatment in 1974. Ms. Richardson is nationally recognized as an expert on ADHD and co-occurring addictions, eating disorders, and criminal behavior. She trains therapists, educators, addiction specialists, attorneys, judges, and correctional personnel in America, Canada and abroad. She has been in private practice in Soquel, CA, since 1986.
NOTES
1Bum, Cull, Braver man, and Comings, 'Reward Deficiency Syndrome,' American Scientist, March-April (1996), p. 143
2Maureen Martin Dale, "A Double-Edged Sword," Student Assistant Journal (November-December 1995): 1
3Wendy Richardson, MA, LMFCC, The Link Between ADD & Addiction: Getting The Help You Deserve (Colorado Springs, Colorado: Pi-on Press, 1997)
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