Addiction, Part 3
Which ADHD medication is best for someone who has already battled substance abuse? For many doctors, the first choice is a nonstimulant. These drugs may not be as effective as stimulants for treating certain symptoms, but they may be safer for individuals who have already exhibited a tendency toward addiction. Other doctors choose to prescribe a stimulant, perhaps initiating treatment with an extended-release formulation, like Concerta or the Daytrana skin patch; these slow-acting meds are less likely to be abused than immediate-release meds.
For most people, stopping alcohol or drug use isn’t nearly as hard as staying sober. Maintaining effective ADHD treatment is key. “People who have ADHD are prone to impulsiveness and are less able to tolerate frustration,” says Richardson.
“I was able to get clean a number of times before I was diagnosed and treated, but I always relapsed,” says Jennifer. Recently, while visiting old friends with whom she used to abuse drugs, she felt tempted again. But this time, she could fight it off. “If I hadn’t been on ADHD meds, I probably would have relapsed right then.”
If a 12-step or another self-help program works, stay with it. If you feel you need more help to remain free of drugs and alcohol, ask your doctor about cognitive behavioral therapy. It has proven effective both to treat ADHD and to prevent substance abuse relapse. “Treatment shouldn’t be a one-shot thing,” says Dr. Dodson. “You really have to keep after ADHD” to maintain protection.
Experts also recommend adopting a sobriety-promoting lifestyle. For starters, this means doing what it takes to avoid becoming too hungry, too angry, too lonely, or too tired. The basic elements of this strategy, known by the acronym H.A.L.T., are as follows:
- Avoid hunger: Eat three full meals a day, along with three healthy snacks. Limit sugar and caffeine intake.
- Avoid anger: Learn to manage your emotions. Don’t bury your resentments. Talk about them. Consult a psychotherapist, if necessary.
- Avoid loneliness: Reach out to supportive people to create a new social network to take the place of drug- and alcohol-using friends.
- Avoid becoming overly tired: Get enough sleep, and bring any sleep problems to your doctor’s attention. “Among my patients, at least 90 percent of relapses happen between 11 p.m. and 7 a.m.,” says Dr. Dodson.
Experts emphasize that relapse isn’t an event so much as a process that unfolds over weeks or months. It’s essential to watch for worrisome signs — for example, feeling unusually restless or irritable, having trouble sleeping, or having an impulse to get in touch with an old drinking buddy. In such cases, it can be helpful to write about these feelings in a journal.
It’s also essential to have a well-established plan for dealing with temptations as they arise; such a plan might involve phoning a coach or a supportive friend, or perhaps attending a meeting. In some cases, an intense workout is all it takes to defuse a potentially explosive urge to start using again.
Perhaps the most powerful tool for preventing relapse is to enlist the support of friends and family members—to watch you and perhaps even to alert your doctor if you exhibit signs of trouble. “A lot of people with ADHD have zero ability for self-appraisal,” says Dr. Dodson. “It’s good to have lots of extra eyes on the ground.”
This article comes from the February/March 2007 issue of ADDitude.