Addiction and ADHD go hand in hand; three things parents and providers need to know about treating teens with co-occurring diagnoses

Parenting a teenager can be a challenging journey on its own. Add ADHD (Attention-Deficit/Hyperactivity Disorder) and substance use disorder into the mix, and it can bring a parent into crisis mode very quickly. In this blog, we’ll explore the co-occurring disorders of ADHD and addiction among teens, with a focus on understanding how these conditions intersect and how they can be effectively addressed in treatment. 

Did you know that 30-50% of teenagers in substance use disorder (SUD) treatment also have ADHD? This staggering statistic highlights the complex relationship between these two conditions. When ADHD is in the picture, it can significantly impact a teen’s experience of addiction and the treatment process. Childhood ADHD is a risk factor for the development of SUD in adolescence, and the complications of diagnosis and treatment are often associated with poor treatment outcomes for teens struggling with these two diagnoses at once. 

The Impact of SUD Treatment on ADHD Symptoms

  1. Know which symptoms to target first by assessing the severity of ADHD symptoms: 

One fascinating aspect of this relationship is that teens often experience a significant drop in their ADHD symptoms while undergoing substance use disorder treatment. The reason for this shift is believed to be the result of Cognitive-Behavioral Therapy (CBT) interventions, which are commonly used in SUD treatment. In some cases, it might be tempting to postpone specific ADHD treatments, especially if the ADHD is considered mild to moderate. The rationale behind this approach is to observe how the teenager’s ADHD symptoms evolve after they’ve undergone CBT interventions as part of SUD treatment. This can help determine whether more targeted ADHD treatment is necessary. If the ADHD symptoms are more severe, we recommend treating the ADHD directly, as the substance use may be an attempt to self-medicate due to intolerable symptoms

  1. Empowering teens to own their symptoms: 

One key to successfully addressing co-occurring ADHD and addiction is to empower the teenager to own their symptoms. Encouraging them to recognize the presence of ADHD and its impact on their daily life can be a vital step in the treatment process. By taking ownership, teens become more actively engaged in their recovery journey and feel more confident that they can make a difference in how they feel. 

  1. Diolague with family: 

It’s not uncommon for there to be some level of disagreement between parents and teenagers. Especially with SUD, the family dynamics can be filled with distrust, patterns of lying and enabling, as well as denial. However, it can be surprising to discover that there’s often an agreement when both parties take the time to discuss and understand the symptoms of ADHD. Families may disagree about everything; however, acknowledging the ADHD symptoms can be the one thing that creates common ground. This shared understanding can be a foundation to build on top of within family therapy and for all family supports. 

For treatment, our current suggestions are the following: 

  1. Get an accurate evaluation of the severity of the symptoms of both disorders to decide the order of treatment. 
  2. Start with shorter, CBT-focused individual sessions for the teen.  
  3. Enroll the teen in contingency management to track the substance use effectively and ongoingly
  4. Begin peer mentorship for the teen with a peer who has overcome this combination of symptoms. 
  5. Begin family therapy focused on trust building and family connection
  6. Begin parent education and coaching on both of these disorders.

There is hope on the other side of ADHD and SUD! We encourage families to make sure they ask providers what their approach is specifically for these co-occurring disorders before starting treatment. Most programs are licensed ONLY to treat addiction OR mental health – not both. Finding a co-occurring program that can treat both disorders is very important when finding the right care for teens. With the right care, adolescents can make it through this into healthy adulthood.