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ADHD, Addiction and Mental Health
Dr. Dawn-Elise Snipes

This is part 1 or 2 part series. See next part's notes for CEUs

Objectives
~ Explore the connections and symptom overlaps between ADHD, addiction and mental illnesses
~ Explore the impact of these symptoms on the individual.

Intro
~ ADHD is one of the most common psychiatric disorders, with a worldwide prevalence of 5.2 % among children and adolescents, persisting into adulthood in 60–70 % of cases either as a residual or as a full clinical disorder
~ Medications used to treat ADHD such as methylphenidate, amphetamine, and atomoxetine indicate a dopamine/norepinephrine dysfunction as the neurochemical basis of ADHD and a potential target for anxiety and depression
~ The presence of probable ADHD and the severity of ADHD symptoms are related with the severity of insomnia, even after controlling the depression, anxiety

Attention Deficit/Hyperactivity
~ Difficulty getting organized
~ Chronic procrastination or trouble getting started
~ Many projects going simultaneously
~ Trouble with follow-through
~ A tendency to say whatever comes to mind without considering timing or appropriateness
~ A frequent search for high stimulation
~ An intolerance of boredom
~ Easy distractibility; trouble focusing attention, tendency to tune out or drift away in the middle of a page or conversation
~ Trouble following “proper” procedures
~ Impatient; low tolerance of frustration (Emotional Dysregulation)
~ Impulsive, either verbally or in action (e.g., impulsive spending of money)
~ A sense of insecurity
~ Mood swings, especially when disengaged from a person or a project
~ Physical or cognitive restlessness
~ Chronic problems with self-esteem
~ Inaccurate self-observation
~ Involvement in goal directed activities
Adult ADHD and Comorbidities
~ ADHD and mood disorders have similar
~ neurobiological differences in the prefrontal cortex, which is responsible for attention, behaviour selection, and emotion.
~ abnormalities in dopamine (DA) and norepinephrine (NE) signaling
~ The National Comorbidity Survey reported that adults with ADHD are 3x more likely to develop major depressive disorder (MDD), 6x more likely to develop persistent depressive disorder.
~ Rates of ADHD in people with bipolar disorder are between 9.5% and 21.2%, and rates of bipolar disorder in people with ADHD are 5.1% and 47.1%
~ Characteristics of the manic or elevated phase of bipolar disorder that overlap with ADHD include restlessness, talkativeness, distractibility, and fidgeting
Adult ADHD and Comorbidities
~ Prevalence rates of depression in individuals with ADHD are 18.6% to 53.3%. And comorbid ADHD in individuals with depression at rates of 9% to 16%
~ Factors that were significantly predictive of undetected ADHD included the number of SSRIs previously tried that failed to attenuate symptoms. (Serotonergic agents alone would not be expected to improve ADHD symptoms, which typically respond to noradrenalin-dopamine reuptake inhibitors)
~ Rates of anxiety disorders in individuals with ADHD approach 50%
~ Anxiety disorders and ADHD have similar neurobiological deficits in the prefrontal cortex related to “cool” processing and deficits in top-down regulation.
Adult ADHD and Comorbidities
~ Addiction is approximately twice as common in individuals with ADHD
~ The association between ADHD and SUD is bidirectional since individuals with ADHD more frequently report the use of substances in order to manage their mood or as sleep aids
~ Individuals with ADHD also experience neuropsychological difficulties associated with
~ Inhibition
~ Memory
~ Executive functioning / organization
~ Decision making
~ Emotional dysregulation / self regulation
~ Time management
ADHD and Trauma
Impact of Adult ADHD and Comorbidities
~ Adult ADHD has been associated with
~ Poorer driving and a higher incidence of traffic citations and motor vehicle accidents.
~ Negative consequences for individuals’ self-esteem
~ Difficulty in interpersonal relationships
~ Underemployment: Adults with ADHD were 42% less likely to be employed full-time as were adults without ADHD
~ Early and optimal treatment of ADHD could potentially prevent the later development of psychiatric comorbidities
Adult ADHD Key Questions
~ 3 key questions that clinicians can ask to screen for undiagnosed ADHD in complicated patients:
~ Have you had consistent problems with attention and distractibility most of your life?
~ Have your current complaints (i.e. difficulty in relationships, emotional dysregulation) been present over the last 10 or 20 years?
~ What were you like in the classroom as a child?
Summary
~ ADHD and many disorders have similar symptoms and common neurological and neurochemical causes including dysfunction in the frontal cortex and the dopamine and norepinephrine symptoms.
~ Treatment strategies should
~ Address behavioral manifestations to improve self esteem, work/school functioning and interpersonal skills
~ Explore the root causes of the symptoms to ensure adequate differential diagnosis / comorbid diagnosis of mental health issues including trauma, depression and bipolar disorder.
~ Part 2 of this presentation will cover cognitive, behavioral and environmental interventions