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The Overlapping Neurobiology of ADHD and Addiction

You can't treat one and not the other.

Decreased perfusion in the pre-frontal cortex

Addiction, like ADHD is marked by decreased dopamine neurotransmission in the circuits that govern cognition, executive function, motor control, impulsivity and reward.


In people with severe addictions: the voltage in their dopamine circuits is lower at baseline, and they fluctuate more, compared to people without addiction challenges.

In other words, people with severe addiction, feel worse when they don't use, basically all the time. Then when they use substances, they feel good, too good. Once you get used to that, it's hard to go back. 


Their dopamine voltage does not just rise and fall gently, it spikes and crashes. It is this instability in dopamine transmission that remains, even in recovery.


When your dopamine crashes, it feels really bad. You want to do something, anything, to equilibrate. We all do this. We do it all the time. The difference in people with dependency issues is that their coping tools are more limited.


Mother nature designed us to correlate natural dopamine-raising behaviors like sex, socializing and eating with survival. The bad news is that drugs and alcohol also raise dopamine, faster and higher than normal rewards, so your brain correlates drugs with survival. Tell a person with a heroin addiction that they should quit and they'll look at you like you just told them to jump off a bridge.


When you take dopamine away, suddenly from a person who is addicted it feels, literally, like they are dying.


If you've ever seen someone in full opiate detox, you'll know what I mean. That is why people with substance addictions who find recovery, often do so, by trading drugs or alcohol for another substance or addictive behavior like sex, smoking, gambling, shopping or eating. 

ADHD, like Addiction, manifests as impulsive behavior. People. with severe addictions may also have ADHD. In the residential facilities addiction facilities where I have worked, I have found that more than 70% of those inpatients also meet strict criteria for ADHD. If you look at people with methamphetamine addiction, that number goes up to 95%. That is astonishing.  

Therefore, if a person with addiction also has ADHD, not only will they suffer from their dependency, but they also show symptoms of poor concentration, disorganization, impulsivity and hyperactivity. Of note, these will persist even in recovery. It's not persistent post-withdrawal syndrome; it's co-morbid, untreated ADHD.

ADHD is real.

ADHD is the most common neuro-developmental disorder in children. It is more heritable than eye color. It's more common than anxiety and bipolar disorder combined. At least 50% of those kids grow up to be adults with ADHD.

Sure, it's not caused by genetics, and yes, it's made worse by childhood trauma, but it's not caused by trauma.


Yes, trauma results in epigenetic changes, but the genetic predisposition has to be there. Epigenetics may determine whether a tomato is red or green, but it won't change a tomato into a red-pepper.

People who have ADHD are twice as likely to drop out of school, become parents in their teens, have their electricity cut off, get fired, go bankrupt. They are three times more likely to fail in relationships, get divorced or get injured in car accidents.  


But the greatest injury of all, is the steady decline in self-esteem that accompanies repeated failure, despite their best effort. That's a catastrophe.


Low self esteem is the common denominator in homelessness and I've a assessed a lot of homeless and hopelessly addicted people. ADHD is a factor. I don't know the exact numbers, but it's a lot.

ADHD is not a religion that you have to "believe" in. A physician saying they don't believe in ADHD is like a cardiologist saying they don't believe in diabetes.


Decreased perfusion in the pre-frontal cortex. It's not just a neurological difference, it's a neurological disadvantage in every aspect of work, daily life and communication.

On the topic of substances... since I have started treating my ADHD, I have been able to deal with things that have been piling up for the last 5 years or more. It's been very liberating.


This medical intervention has also changed the way I approach music. I have clarity, because I'm not stoned or drunk, which has allowed me to play at a completely different level...the best shows of my life, actually. The experience is overwhelming. 


Artists, as you know, are prone to self sabotage. I am getting a lot of praise and I'm not used to it. So, last night I reached for the bottle again. It's a bad habit. But I have to say, it was largely unsatisfying.

I know it's a bit of a long answer, but I guess I'm prone to that.


ADHD and Compulsive Behavior


Addiction to substances like cocaine and heroin, are governed by the same neurobiology as compulsive gambling, gaming, shopping, sex, status and risk taking. Behind all these, is the quest for dopamine.

The feelings and emotions associated with dopamine became, through natural selection, the signal that a behavior was associated with survival. 


That's why people with the  most severe addictions would do anything, even kill themselves for dopamine.

Therefore you can't treat ADHD or Addiction or Compulsive behaviours until you stabilize their circuits, helping craving and withdrawal recede, and allowing them to better regulate their emotions and themselves.


That is why treating people to regulate themselves works. Whether it's meditation, contemplation, psychotherapy, hugs, group support or medication. Whatever it takes.

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ADHD and Co-ocuring Disorders

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