Assessing Substance Abuse and Misuse in
ADHD Youth
by
Richard L. Rubin, MD
While the higher risk for Substance Use
Disorders (SUD) is well recognized in ADHD
people, we now know from careful studies that
this is not caused by the ADHD medicines.
Rather, untreated ADHD teenagers have three
times the risk as those taking medicine, and
treated people have about the same occurrence
as non-ADHD teens. However, assessment of SUD
presence is still needed. Alcohol abuse can
be explored with the CAGE questions:
Have you ever 1) Felt the need to
Cut down on drinking? 2) Been
Annoyed by others' criticism of your
drinking? 3) Felt Guilty about
drinking? And 4) Needed an Eye-opener
drink first thing in the morning?
Multiple
substance use is assessed by the
CRAFFT questions: 1) Have you ever
ridden in a Car when the driver was
using drugs? 2) Do you ever use drugs to
Relax, feel better about yourself, or
fit in? 3) Do you ever use drugs while you
are Alone? 4) Do you ever
Forget things you did while using
drugs? 5) Do your Family or
Friends ever say you should cut down
your use? 6) Have you ever gotten into
Trouble while using drugs?
Besides the harm from SUD, doctors are
recognizing that the usual ADHD medicines may
not be effective when substance abuse is
active. Similarly, the medicines do not
diminish active substance abuse that is
presumed motivated by ADHD self-medicating.
The SUD needs to be controlled as a priority
before ADHD progress is possible.
In addition to various types of
substance abuse, ADHD teens and young adults
are prone to multiple substance misuse
possibilities. Illicit pill supplies are
obtained in schools and social hang outs, and
many drugs are freely available on the
Internet. Substance misuse also happens with
popular energy drinks, performance enhancers,
and body building supplements. Nicotine comes
in snuff and gums. A popular European oral
tobacco product is SNUS, using a salt mixture
for faster absorption. ADHD self-medicating
adds to the usual pleasure attractions and
dependence risks of these substances. Besides
giving satisfaction, these may mimic or
exacerbate ADHD symptoms, deceiving parents
and doctors. This can distort initial
evaluation accuracy and explain behavior
setbacks. A third form of self-medicating
risk is excessive use of over-the-counter
medicines for ADHD behavior complications.
Driven, intense exercise leads to analgesic
and anti-inflammatory pill overuse that is
harmful to liver and kidney function. ADHD
associated sleep disorders foster sedative
pill use. Evaluations should address these
covert problems before decisions about
subsequent treatment.
References
(1) Mayfield D, McLeod G, Hall P. The CAGE
Questionnaire: Validation of a New Alcoholism
Instrument. American Jnl Psychiatry,
131;1121-1123, 1974.
(2) Knight J., Shrier L, et al. A New Brief
Screen for Adolescent Substance Abuse. Arch
Pediatr Adolesc Med, 153, June 1999.
Our thanks to Dr. Rubin for his
contribution of timely articles for
myADHD.com News over the past two years.
