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ADHD, Substance Abuse, and Impulsivity

A  recent study from the journal Nature Neuroscience suggests that teens who struggle with substance abuse and those with ADHD have somewhat different cerebral profiles, specifically in terms of impulsivity, a feature of both conditions. Both groups exhibit impulsivity, but that trait appears to derive from different areas of the brain. Among the teens who had tried alcohol, cigarettes or other drugs, like marijuana, brain scans showed different patterns of brain activity in the right inferior frontal gyrus and in the orbital frontal cortex compared to teens who had not touched these substances before. These differences showed up in self-control tests during which activity in their brains was monitored. Prior research has found that the right inferior frontal gyrus is involved in the ability to control, or inhibit, impulses. People with head injuries that damage that area of the brain have problems with inhibition. The orbital frontal cortex has been known for years to be involved in drug use.

What’s interesting is that the ADHD teens who were administered this self-control test also showed difficulties with controlling impulses, but their patterns of brain activation were quite distinct. The teens with ADHD exhibited differences in the bilateral frontal lobe and the basal ganglia, both of which are known to play a significant role in ADHD symptomology. So the same end behavior, impulsivity, appears to be linked to different parts of the brain.

The reason this study is important is that ADHD people have a significantly increased risk for substance abuse. The data from this research effort strongly suggest that atypical functioning of certain cerebral networks, those involved in impulse control, underlies addiction.  But impulsivity in addiction, as opposed to ADHD, appears to be a different animal. The study did not examine ADHD people who also were substance abusers. What will be interesting to see is if ADHD people with substance issues look more cerebrally similar to the ADHD group or to the substance abuse group.

Overall, this study shows us that the brain is an incredibly complex organ that we are just beginning to understand. Also, we see that impulse control does not always indicate the presence of ADHD. While it is easy to judge others who show what appears to be a lack of “willpower,” this study points to the underlying biology that is involved, and thus invites us to consider addiction as a bona fide disease.

With ADHD and addiction, many people who are not afflicted presume that a lack of willpower is to blame. “I know when to stop,” they will righteously declare. “They just need to learn their limits.” This scientific information gives us reason to pause and reflect, and perhaps reevaluate how we view both ADHD and addiction, and to consider having more compassion for people who deal with these challenging conditions. So many people presume expertise when dealing with mental health conditions. If you really want to understand mental health, go to school on the brain. I recommend the following books to help you in that endeavor:
1.  Howard, P. (2007). The Owner’s Manual for the Brain. Austin, TX: Bard Press.
2.  Nigg, J. (2006). What Causes ADHD?: Understanding What Goes Wrong and Why. New York: Guilford Press.
3.  Stoehr, James D. 2006. The Neurobiology of Addiction. 1st ed. Philadelphia: Chelsea House.

24 Responses to “ADHD, Substance Abuse, and Impulsivity”

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  2. Sheena Haselton says:

    This may not be the best place to ask this, but, I’d like to find Drug Addiction Treatment Center and I can’t find where to find one… do you have any info on this addiction treatment center? It’s located in Los Angeles, near my apartment I can’t find comments or reviews on them — Los Angeles Drug Rehab, 601 S Figueroa St #4050, Los Angeles, CA 90017 – (213) 634-4424

  3. Dennis says:

    Hi, My wife and I recently read the newspaper article in the Milwaukee Journal Sentinel with much interest and nodding of our heads as we have a 21 1/2 year old son who was diagnosed with ADHD and we said this was our Matthew. Briefly,everything that was stated was true of our son. Matthew had much difficulty in school and would have gotten B’s had he just done his homework because he is that bright (which I know is typical as well). He did graduate high school and is trying a Jr. college to be a Auto Tech. However he has taken courses 2 times in order to get through the basics before he could get into the program and has I think finally finished the prelims. He has had a couple jobs at the starting level and is working now at a dealership but wants to go to another one because he wants to work on those kind of cars. And now says he doesn’t want to continue school? We were in counseling while he was a high schooler but he most times would shut down when pressed for things. I should tell you he is adopted and has an older Korean (adopted) brother who is now out of the home. He has many issues: dirty room, sleeps all the time and doesn’t get up even with an alarm/music blaring and then leaves 20 minutes before work starts and its a 20 minute drive. He has now started smoking cigarrettes. Once he turned 18 he said he wasn’t going to take any more meds. He doesn’t because he doesnt like the way they made him feel. There’s alot more but wanted to see if you had any further reading material and suggestions for us. (The above email address is home please respond to it). Thanks and we enjoy your blog as well. Yes he is impulsive has quite the temper, doesn’t plan anything ahead nor sees the future…

  4. kristie perry says:

    I noticed that I am not alone ! Someone else out there is feeling how i feel!!

    • Kevin says:

      Kristie, you are not alone. Thank you for posting, and let me know if I can steer you in the right direction to get more support.

  5. David A. says:

    The flip side of the “it’s a brain thing” conclusion, for me, is that I feel I have no control. It feels like a life sentence: if this is just how my brain is, what hope do I have of getting better?

    So I find the brain science fascinating and depressing at the same time. We know so little right now that drug treatments are like doing trial and error with a sledgehammer. The doctors don’t even know what the mechanism of action is for a lot of the drugs they prescribe. Most of the drugs I’ve been on were originally anti-seizure medications; they weren’t even developed to treat my disorder.

    All I can really do is hold out hope that something new becomes available before my best years are behind me: deep brain stimulation, for example, or some other more precise method. Because if you’re on of the many people for whom the drugs don’t work, you’re kind of S.O.L.

    • Kevin says:

      David, I think there will be some great advancements in the next decade. Understanding is growing by leaps and bounds. Also, pharmaceutical companies have an interest in developing new drugs for many of these types of conditions because people will likely need to take them for a long time. I hold on to cautious optimism. Thank you for your honest sharing. You have added greatly to the level of this discussion.

  6. Great piece, Kevin. The overlap between ADHD and addiction in the teens I work with amazing. I would say the 50% of the teens I treat in my cyber groups who have ADHD also have substance abuse problem. Thanks for the blog! Really informative!

  7. Woh I love your articles, bookmarked!

  8. Brett says:

    Kevin,

    Thanks for helping to inform people of the physical reasoning behind impulsivity. I think as everyone learns more about this, they can move on from the traditional “why can’t they just stop” rationale to “how can we help,” which I’m sure will be more beneficial.

    • Kevin says:

      Brett, thanks for your remarks. I am surprised that, with all the information available, the “why can’t they just” mentality still pervades. I am glad you posted and hope you come back again!

      • David A. says:

        I think the “why can’t they just…” mentality prevails because of latent, deeply-held views about human nature and free will.

        Basically, if John admits that so-and-so’s actions are largely due to brain biology and not some ephemeral “will”, that means that some of HIS actions are down to simple brain biology too, and that can be an ego blow to some people. They want to feel that they got where they are by sheer force of will, not by lucking out genetically.

        But this is a big can of worms to open up; just wanted to throw the idea out there.

        • Kevin says:

          David, I talk about this issue extensively in my book on ADHD. “I have problems remembering things,” people tell themselves, “but I figure it out and get the job done. Why are we letting people make excuses with this ADHD nonsense?” It never ceases to amaze me.

  9. M.R. Stein says:

    Kevin,

    I can attest to the ADHD/ addiction/ impulsivity connections! We always knew the ADHD/impulsivity partnership, and worried about the possibility of addiction. Well, we’ve lived thru this ‘holy trinity’ with our son.

    What’s been also so interesting, is that the symptoms and behavior that separated our son’s performance (in school and out) from his classmates became ever more apparent as he grew from grade school, to middle, to high school. The disparity became even larger when former classmates began experiencing success in college and after. He couldn’t ignore their achievements in comparison to his lack of.

    So, take his LOW self esteem, and change that to NO self esteem… stir in increasing depression. Stack that next to the addiction gene on Chromosome 11 …… and well, it’s not a pretty spiral.

    Results of Spect scans performed recently were indeed like ‘reading his mind’…. the medical confirmation was certainly there! The ADHD brain functions differently… and should close the argument on whether ADHD is simply a “convenient excuse for kids who WON’T conform”. These behaviors are not a conscious choice, as some would prefer to believe.

    As parents, we were as diligent as we could be, seeking out professional help for both our son and family all along the way. Information such as this was not available for us. Would it have changed the outcome? Perhaps not, but, as the old adage goes… “forewarned is forearmed”.

    Coincidentally, today our son celebrates 6 months clean of substance abuse. This is a credit to terrific inpatient ‘rehab’ facility, months of continued (structured) living and learning… and.. most importantly… HIS decisions & determination.

    Kevin, Please, keep sharing and spreading this information! Continue to make yourself heard… You present a lifeline to any and everyone afflicted by these disorders.

    • Kevin says:

      Margie, it is certainly wonderful to read what you’ve written, and the wisdom gleaned from experience. My compliments and best wishes to your son and his hard work! It is so nice to hear from you!

  10. Miriam says:

    Nice!

  11. Stev D. says:

    I agree with the first commentator. I feel like in the short few months I have been visting this blog that I have been getting a real education. Thank you. One of my boys is already a teenager, so I have been watching for signs of substance abuse, as you have recommended. I will say though that he is a cyber junkie. Your book is helping me confront that problem too. When is your ADHD book coming out? I thought it was supposed to be here already. ANd I also am interested in the video blog you promised. Is that still happening????????

    • Kevin says:

      Stev, just like you, I get an education in writing and maintaining this blog. I don’t just write off the top of my head. I read and research too. People like you help keep me going. :-)

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