5 Tips For Dealing With Adult ADHD

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For many of us, thinking about attention-deficit hyperactivity disorder (ADHD) still brings to mind that one distracted kid who couldn’t sit still in elementary school. But as we’ve learned more about the disorder, we’ve come to understand that there are a bunch of different ways that it may actually show up in our behavior (in other words, it can go way beyond simple hyperactivity). And, because the way ADHD manifests in women may not fit our stereotypes, women often don’t get diagnosed until adulthood.

Plus, treatment is complicated: It generally consists of therapy designed to help build organizational strategies and treat any other mental health issues, and may or may not include medication, so there may be some trial and error in getting it right. That means that many adult patients — about 38% of whom are women — are still looking for a way to deal with the disorder that makes sense for them.

“Our approach is different because we highlighted that ADHD is not just about inattention — it’s about inattention and over-focusing,” says Greg Crosby, MA, LPC, one of the authors of the just-released book Transforming ADHD: Simple, Effective Attention & Action Skills to Help You Focus & Succeed.

Translation: People with ADHD don’t just find it challenging to concentrate on activities they’re not interested in but are important for them to get done (e.g. finishing homework), it’s also especially hard for them to stop focusing on activities they are interested in (e.g. playing a video game). So, a major part of the book’s strategy is helping readers find ways to pair activities they’re particularly fascinated by with activities that aren’t all that exciting.

“There’s no need for the boring, mundane, and effortful to be a horse pill you just have to swallow,” explains Tonya K. Lippert, PhD, the book’s other author. “For instance, if you like being around others, do the task with somebody else. If a change of environment — a cafe where you can sit outside — will increase the pleasantness of the task, change your environment.”

But on your path to actually getting shit done, we all know there are a million potential distractions in the way. Below are five tips — based on Crosby and Dr. Lippert’s work and book — to help you stay on track.
1. Get a planner — for start dates, not deadlines.
“That could be a calendar, an app on your phone, or on your computer,” says Crosby. But, he cautions, one often overlooked hurdle to getting a planner is actually setting a date to begin getting it done. So, don’t just “get a planner,” make a plan to buy one at 9:30am tomorrow. And Dr. Lippert explains that a planner can serve as both your “second brain” so you don’t forget things, but also as an environmental cue to check on what you need to get done (and when).

2. Carve out time to wind down before bed.
One of the major elements of the book is finding ways to get enough sleep, including exercising during the day, explains Crosby, because sleep deprivation makes it harder to pay attention and regulate your impulses. To improve your chances of getting good sleep, he says, “you need wind-down time — at least 45 minutes of transition so that when your head hits the pillow you don’t start worrying.” That nighttime ritual can be anything that works for you. Maybe it’s taking a warm bath or listening to relaxing music. Ideally, this doesn’t involve your phone or laptop.

3. Be mindful about your worrying.
That whole worrying thing may be especially common among women: “Overall, the research shows that what accompanies ADHD and its expression differ between women and men,” says Dr. Lippert. “Women are likely to present as less hyperactive but more anxious than men with ADHD.”

If you find yourself becoming anxious, Dr. Lippert advises a mindfulness-based approach: “Recognize and call it by its name — anxiety or fear — and try to allow room for it non-judgmentally, even being curious about it and where you feel it,” she says.

4. Try to “surf” your urges.
For some people with ADHD, it may be difficult to control impulses, such as interrupting a conversation to interject with a point you’re really excited about adding. But these urges come and go in waves. So you can learn to “surf” those urges rather than obeying them immediately, explains Crosby. Again, this requires you to flex your mindfulness muscles: Simply notice when the urge arises and how it affects you physically and mentally — making sure not to judge it as good or bad — without acting on it. Or, if you must act on it, try delaying it until there’s a natural break in the conversation. You’ll still be building up your surfing talents, and your friends will feel less annoyed.

5. Plan with others efficiently.
“Couples have a lot of inattention problems without having ADHD,” says Crosby, “and if you add kids and ADHD to the mix, it can be a total nightmare of who’s doing what when.” So whether you’re figuring out weekend plans with your partner or team assignments in a work meeting, writing down the details — who’s going to do what and when — and putting them up somewhere you’ll see ’em can be a lifesaver. And, if possible, have “visual meetings” at the office in which you use things like Post-It notes, whiteboards, or index cards to visually organize the group’s discussion. Your colleagues will thank you whether or not they have ADHD — after all, we could all use a little extra organization.

The Perverse Link Between ADHD and Addiction

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Credit: Marine Corps.

While the exact number of adults with ADHD is unknown, it is estimated that 4% of the U.S. adult population is affected by ADHD. While most people can function very well and become successful despite their condition, ADHD is also associated with life-long impairments in several facets of life, including educational and professional achievements, self-image and interpersonal relationships. But one of the darkest sides of ADHD is its propensity for addiction.

Why ADHD can lead to substance abuse

Addiction is a global problem that affects people from all walks of life, irrespective of gender, financial status, skin color, sexual orientation, religion, or spiritual practice. According to the American Society of Addiction Medicine (ASAM), addiction is “a primary, chronic disease of brain reward, motivation, memory, and related circuitry,” which leads to dysfunctional behavior in order to provoke relief in spite of the negative consequences a person may attract.

“Addiction is an inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death,” according to a characterization on the ASAM website.

It’s these changes in the brain that make addiction so dangerous, causing a person to lose control over his or her use of substances. This also leads to subsequent problems at work, in relationships, and with one’s sense of self-worth and esteem.

Some people are more vulnerable to addiction than others. One primary factor which specialists have identified are adverse childhood experiences, which create their own brain changes. Research has also identified neurological conditions that make people prone to addiction, ADHD being one of them.

Attention-deficit hyperactivity disorder (ADHD) is a syndrome characterized by persistent patterns of inattention and/or impulsivity and hyperactivity that is inappropriate for a given age or developmental stage. The exact causes of ADHD are still unknown but the evidence so far suggests that dopamine neurotransmission dysfunction is at least partially responsible for the disorder’s symptoms. This dopamine link may also explain why ADHD often co-occurs with substance use disorders.

Symptoms of ADHD across lifespan. Credit: ADHD Institute.

The risk of drug and substance abuse is significantly increased in adults with persisting ADHD symptoms who have not been receiving medication.According to one study, ADHD is associated with a twofold increase in the risk of psychoactive substance use disorder. In addition, it is estimated that more than 25% of substance-abusing adolescents meet diagnostic criteria for ADHD. A 2004 survey found that 60% of the adults with ADHD have been addicted to tobacco while 52% have used drugs recreationally.

“One of the strongest predictors of substance use disorders in adulthood is the early use of substances, and children and teens with ADHD have an increased likelihood of using substances at an early age,” Dr. Jeff Temple, a licensed psychologist and director of behavioral health and research in the department of obstetrics and gynaecology at the University of Texas Medical Branch, told Health Line.

Bearing all of this in mind, clinicians working with patients that suffer from both ADHD and substance abuse may need to use a different approach than they would normally. While the treatment literature for ADHD in patients with substance use disorder is not well developed, the emerging trend is that medications effective for adult ADHD may be effective for adults with ADHD and co-occurring substance use disorder. Exercising regularly and having behavioral health checkups during treatment are also important.

The key seems to be starting ADHD treatment as early as possible, before a person has the chance to develop a substance use disorder during his or her teens. Although there is no “cure” for ADHD, there are accepted treatments that specifically target its symptoms. However, it is essential that ADHD treatment begins when the patient is sober, so some drug or alcohol detox may be required before treatment.

“A conservative approach for treating co-occurring ADHD and SUD would be to begin treatment with a non-stimulant pharmacotherapy, but if an adequate response is not obtained, consider stimulant pharmacotherapy. The decision regarding the use of stimulant medications for a patient with ADHD and a co-occurring substance use disorder should be made on the basis of a broad clinical assessment and an individual risk-benefit analysis. For many patients, psychostimulants can be used safely and effectively; however, careful monitoring during treatment is essential to ensure prescribed stimulants are being used in a therapeutic manner, and in the case of worsening substance use or when faced with evidence of the diversion of prescribed medication, treatment should be discontinued,” according to researchers at the New York State Psychiatric Institute.