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Statistics show that people with ADHD are more likely to experience job termination, car accidents and license suspensions, interpersonal problems, and divorce. 1 It is fair to say that ADHD impacts every aspect of life, including potential treatment for substance use disorder and addiction. However, could weed for ADHD provide new treatments for symptoms of this disorder?
What is ADHD?
Attention-deficit hyperactivity disorder (ADHD) is perhaps the most well-known mental disorder, affecting roughly 9.4% of children and 4-5% of adults in the United States each year. 2
ADHD is a neurodevelopmental disorder involving symptoms including difficulty staying focused, hyperactivity, and impulsivity. ADHD typically presents itself between the ages of three to seven, although some find their symptoms lessen in adulthood. ADHD is not a learning disability, although many children with ADHD also show signs of a separate learning disability.
While the exact cause of ADHD remains a mystery, we have learned it involves decreased production of the neurochemical dopamine.
Dopamine facilitates communication within your body and regulates movement, additionally impacting mood, sleep, digestion, appetite, memory, attention, and learning. Dopamine interacts with the prefrontal cortex, which is responsible for executive functions including impulse-control, regulating attention, planning, and higher cognition. 3
Brains with ADHD seem to underproduce dopamine, leading to poor executive functioning and tell-tale ADHD signs of low impulse control, hyperactivity, and inattention.
While previously categorized independently, the Diagnostics and Statistical Manual of Mental Disorders (DSM-V) now classifies ADD and ADHD as the same. ADD used to refer to inattentive-type, while ADHD referred to impulsive-hyperactive presentation. ADHD serves as the recognized medical term for neurodevelopmental disorder.
When it comes to ADHD, our minds might jump to images of impulsive grade school kids running wildly on the playground or fidgeting and unable to concentrate in class. However, ADHD is more than having too much energy or being easily distracted.
It is vital to note that diagnostic criteria were developed from ADHD in children, typically boys. As such, adults with ADHD and women may experience different symptoms.
To be diagnosed with ADHD, you must demonstrate persistent and age-inappropriate hyperactivity, impulsivity, or inattention. Symptoms are divided into categories reflecting the two areas attention-deficit hyperactivity disorder impacts.
For a physician to diagnose you with ADHD, the following requirements must be met: 4
- Experienced six or more symptoms for at least six months, if between two and sixteen years old
- Experienced five or more symptoms for at least six months, if over seventeen years old
- Symptoms (inattention or hyperactivity/impulsivity) were present before twelve years of age.
- Symptoms interfere with functioning in two or more environments
- Symptoms significantly impact the quality of life (school, social, work)
- Symptoms cannot be explained by another mental condition
- Symptoms are considered inappropriate for a given age
Types of ADHD
There are three types of ADHD. Each type reflects different ADHD signs with diagnosis based on the criteria listed above.
- Inattentive ADHD refers to people who mainly experience symptoms relating to inattention and lack of focus.
- Hyperactive-Impulsive ADHD refers to people who experience more symptoms related to lack of impulse control and increased energy.
- Combination ADHD refers to people with a relatively even split between inattentive symptoms and impulsive-hyperactive symptoms.
Each type of ADHD includes distinct symptoms that act as diagnostic criteria for different ADHD types.
- Easily distracted
- Cannot concentrate for long periods
- Forgetful of daily tasks
- Find it challenging to organize tasks and activities
- Often lose essential items (wallet, keys, phone, etc.)
- Do not always appear to be listening when spoken to
- Makes careless mistakes or doesn’t pay close attention to details
- Does not listen to or follow-through on instructions or activities
- Dislikes or resists work that requires sustained focus and mental effort
- Has trouble waiting their turn
- May speak excessively
- Interrupts others before they finish speaking
- Intrudes on the activities of others (pushes into games or conversations)
- Finds it hard to stop fidgeting, tapping hands or feet, and squirming in seat
- Unable to quietly engage in activities
- Feels like they’re “always on the go” or driven by an “internal motor”
- Gets up or moves when expected to remain seated
- Runs or climbs when not appropriate (may be limited to feeling restless for adults)
What Can an ADHD Test Do for You?
There is no single test that indicates whether you have ADHD. However, reading about common symptoms experienced by adults with ADHD, checking off the diagnosis criteria in the DSM-V and talking with your doctor is a good starting place. 4
Because symptoms of ADHD can look different from diagnostic criteria and overlap with other conditions, adult ADHD is hard to diagnose. Be patient and stick with your doctor – they will help you work through the symptoms causing you distress, so you can live your life freely.
Treatment relies mainly on ADHD medication, although a combination of medication and therapy can provide further benefits. The most prescribed ADHD medications involve two types of psychostimulants: methylphenidate and amphetamine analogs.
Amphetamine is a central nervous system (CNS) stimulant often prescribed for ADHD and narcolepsy. Its mechanism of action works by blocking dopamine reuptake and increasing dopamine production. One of the most well-known ADHD medications in this category is Adderall. Adderall is a mix of amphetamine and dextroamphetamine that helps regulate dopamine levels.
Popularly prescribed and commercially available amphetamine analogs include dextroamphetamine, methamphetamine, and mixed amphetamine salts (MAS).
Amphetamine and Adderall side effects can include:
- Heart palpitations
- Increased blood pressure
- Raised heart rate
- Increased sweating
- Nausea and/or vomiting
- Extreme mood swings
Rare but serious side effects can include hypertension, seizures, psychosis, and myocardial infarction.
Although structurally similar to amphetamine, methylphenidate is another psychostimulant widely prescribed for ADHD and narcolepsy. Methylphenidate works by blocking dopamine and norepinephrine reuptake.
Methylphenidate side effects can include:
Rare but serious side effects can include:
- Myocardial infarction
Other ADHD Medications
Other non-stimulant ADHD medications include Tricyclic antidepressants, Monoamine Oxidase Inhibitors (MAOIs), Selective Serotonin Reuptake Inhibitors (SSRIs), atypical antipsychotics, bupropion, atomoxetine, clonidine, venlafaxine, and modafinil.
Treating ADHD with Dual Diagnosis of Substance Use Disorder
Many people entering recovery find themselves wondering, “Do I need to treat both my ADHD and SUD? Can I just treat my addiction and worry about my ADHD later?” The short answer is yes – ADHD directly impacts recovery adherence and success, so treating ADHD simultaneously with SUDs is imperative.
For individuals with ADHD and SUD, physicians often hesitate to prescribe the typical ADHD stimulants that could reinforce addictions. Statistics show people with ADHD develop SUDs earlier than people without ADHD and have a more difficult time stopping long-term use. 5
Detox for Dual Diagnosis SUD and ADHD
When someone with ADHD is detoxing, physicians must consider which medications will interact more effectively with the patient’s brain chemistry. Ensuring patients don’t experience a dopamine crash during withdrawal improves recovery adherence.
An essential element of therapy for people with ADHD is psychoeducation. Learning about other people’s experiences, symptoms, and how the ADHD brain works can make symptoms less scary and more approachable. Other widely used therapies for ADHD include cognitive-behavioral therapy (CBT), structured skills training, coaching, and behavior modification therapy.
Cognitive-behavioral therapy encourages patients to become aware of their thought patterns, helping them develop emotional coping skills and behaviors that create healthier habits.
Structured skills training is a modified version of CBT that’s proven especially effective. Coaching helps patients develop strategies to tackle procrastination, organization, and time-management issues. Therapists mainly use behavior modification with children to help reinforce positive behaviors and shed negative habits.
Most treatment for ADHD relies on stimulants. For people with SUD, though, the worry is that stimulants can counteract therapy and other drugs used to control cravings and withdrawal. Luckily, clinical trials of methylphenidate and dextroamphetamine for the dual treatment of ADHD and cocaine dependence show stimulants for SUD and ADHD are relatively safe when monitored. 6
Non-stimulant medications may be preferred when stimulants are not an option, although research suggests they’re less effective ADHD medications. It is always essential for physicians to weigh the possibility of misuse against the expense of not treating ADHD symptoms.
New delivery systems like the crush-resistant shell used by Concerta or the methylphenidate skin patch approved by the FDA may provide more abuse-resistant approaches to treating patients with co-occurring SUD and ADHD.
Brain mapping is a tool that uses an electroencephalogram (EEG) to measure neuron communications in the brain. Brain mapping can help identify overactive or underactive parts of the brain and determine potential triggers.
The impact of drug use looks different than ADHD. Brain mapping can help you determine whether you have ADHD or are experiencing ADHD symptoms caused by other sources.
What is Marijuana?
Also known as cannabis, weed, pot, mary jane, grass, ganja, herb, chronic, hash, dope, and bud – marijuana is the most commonly used illicit drug on the market. Marijuana can be classified as a hallucinogen, stimulant, or depressant – it all depends on how it interacts.
People who use marijuana recreationally often do so for the calm, euphoria, and relaxation they experience. Medical marijuana has been used to treat seizures, chronic pain, nausea, glaucoma, appetite loss, and many other disorders, although more research is needed to support its effectiveness.
Common signs of marijuana use include: 7
- Feelings of anxiety or paranoia
- Low attention span
- Poor memory
- Difficulty learning
- Mood changes
- Increased heart rate
- Increased coughing, phlegm production, or bronchitis
Rare but serious signs of chronic marijuana use include:
- Increased risk of depression and thoughts of suicides in adolescents
- Heightened risk for temporary psychosis (not knowing what’s real)
- Increased risk of developing a long-lasting mental condition, like schizophrenia
Statistics on Marijuana Use
The CDC reports over 22.2 million users each month. As more states begin legalizing recreational and medical marijuana, the statistics on monthly marijuana use are likely to increase. Of those users, statistics show one in ten will develop an addiction. That rate increases to one in six when marijuana use begins before the age of eighteen.
It’s important to note the risk of developing a cannabis addiction is 1.5 times higher for people who received ADHD diagnoses as children, making marijuana for ADHD a questionable approach. 8
Can Marijuana Treat ADHD?
Because it is classified as a Schedule I narcotic, studies on the effectiveness of marijuana for ADHD are limited. Most information comes from qualitative analysis of self-medicating and exploring how marijuana’s side effects could impact ADHD. While the studies examining the relationship between weed and ADHD are thin, many people have come out in support of the “natural remedy for ADHD.”
Many who advocate marijuana for ADHD comment on the drug’s ability to regulate some of the more challenging aspects of ADHD, but with fewer side effects than stimulants. 2016 analysis of online forums found them jam-packed with people sharing how marijuana helped curb ADHD signs with minimal adverse effects. 9
Conversations and qualitative analysis of the effects of cannabis suggest it may be more helpful in limiting ADHD signs for hyperactive-impulsive presentation than inattentive presentation.
CBD and ADHD
CBD (cannabidiol) is a component of cannabis without the psychoactive ingredients that deliver the high typically associated with weed.
No ongoing large-scale clinical trials are examining the relationship between CBD and ADHD. However, CBD promotes antipsychotic and anti-anxiety qualities, making it an intriguing option for ADHD treatment. Further research will help us understand more clearly how CBD and ADHD work together.
Limitations and Marijuana Dependence
People with ADHD are at heightened risk for developing a substance use disorder in their lives, including marijuana addiction. Because individuals with ADHD are predisposed to develop SUDs, people who self-medicate with marijuana for ADHD should do so cautiously.
Additionally, both short-term and long-term marijuana use can lead to side effects including dependence, so it’s important to weigh how medical marijuana may impact you.
Weed and ADHD Medication
If you are already taking ADHD medication, it’s beneficial to consider how your weed and ADHD medications could interact. For instance, when Adderall and medical marijuana are combined, they can cause your heart rate to spike.
On the other hand, medical marijuana seems to cancel out some of the negative side effects of Adderall, combatting appetite suppression with hunger and agitation with calm and euphoria. However, when left unchecked, using marijuana for ADHD in combination with Adderall can make it easier to develop an Adderall addiction by removing the adverse effects of Adderall use.