ADHD Spotlight

50% of ADHD Kids Who Smoke Cigarettes Will Go On to Substance Abuse

There’s lots of negative publicity about cigarettes. Even so, we underestimate their special danger to young men and women with ADHD. Smoking them increases the likelihood they’ll abuse other substances.

Teens and young adults with ADHD are already twice as likely as other age peers to abuse alcohol, marijuana, and other drugs. Smoking cigarettes makes this worse. Warning the young people about this over and over is necessary, even though we worry that we’re never getting through.

The message is : “You cannot do this like your friends.” Will they listen? Good question–but we have to keep on trying.

20% or so of ADHD patients are dependent on an addictive substance by age 25. That’s more than twice the rate of controls. So keep trying to get the message across.
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Timothy Wilens MD: pharmacology update sponsored by the American Academy of Child and Adolsecent Psychiatrists, March, 2010

Treating ADHD Lowers Crime

Increasing prescriptions for psychiatric illnesses leads to less crime. Suitably diagnosing and treating adults with ADHD will reduce violent crime by 30-38 crimes per 100,000 population.

In one Scottish prison, close to 14% of prisoners had ADHD. This group of 27 had committed many more violent crimes than had the prisoners who did not have ADHD. They were also much more verbally aggressive: twelve times more!

It’s not just men. In one Iowa prison 14.3% of the female prisoners and 23.1% of the male prisoners had ADHD.

Female inmates at a German prison had a 10% prevalence of ADHD persisting from childhood. They were younger at their first conviction
(19.2 years) compared to 27 years for the non-ADHD women prisoners.

Prison officials are slowly recognizing the need to treat ADHD prisoners. Treatment may help maintain calm among prisoners who are impulsive, and in close quarters.

The officials have a dilemma, though. How to deal with prisoners jailed for addictive drug abuse, while treating others with CNS stimulants? This will take some sorting out.
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References are in ADHD and Crime: Considering the Connections, by Joel L. Young, MD 4/19/2010. cme.medscape.com/viewarticle/719862?src=cmemp&uac+125971FK

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ADHD “Plus” : Anxiety

Many people think of ADHD as “just ADD.” The facts are different. Most people who have ADHD also have at least one other psychiatric disorder. Isn’t one disorder enough? Maybe if it should be that way, but it’s not. Having one disorder makes it likely that you will have another.

In patients who have ADHD I always try to look for anxiety and mood disorders and, hiding in the background, abuse of alcohol and other substances. (I dislike the use of the word “substances.” It sounds so neutral. So scientific. What would I substitute, though? “Stuff”? “Drugs”? Looks like I’m stuck with “substances” for now.)

Here are the facts as we know them. In one study* 47.1% of ADHD adults had an Anxiety Disorder, and Social Anxiety Disorder was the commonest disorder, at 29.3% .** So adults with ADHD often DO have other significant psychiatric disorders. The commonest psychiatric symptom that occurs in adults with ADHD is anxiety. That anxiety is worst in social settings. No surprises there. Being anxious because your brain doesn’t function well consistently makes perfect sense.

These studies push me to look for significant problems with anxiety in my patients, and to treat them when they occur. The reverse is also true. Persons who are severely anxious are likelier to have ADHD than other people. I can get so preoccupied with treating the anxiety that I forget to look for ADHD. *sigh* It’s a major challenge to a clinician like me: keeping my mind open to other possibilities, not hyper focussing on one problem.

Why should you care about these studies? If you’re an adult who has ADHD, don’t be surprised if you also have anxiety symptoms. Often, with effective treatment of your ADHD, your anxiety symptoms will subside. Not always, though. If you’re still uncomfortably anxious, let your clinician know. Good treatment for anxiety will make you feel MUCH better.

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*Kessler R et al: The prevalence and correlates of adult ADHD in the United States:results from the National Comorbidity Survey Replication. American Journal of Psychiatry 163: 716-723, 2006

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“Just a Sliver of Me!”

“I was just sitting there getting nothing done, feeling overwhelmed and discouraged,” said my patient, his eyes flashing, “and then I suddenly realized, ‘You have ADD!’ ”

He frowned, indignant : “It’s hard, because everyone jokes about it: ‘I’m so ADD!’ No one believes it’s for real. It is for real. You have been trying to tell me this for 2 years now. You see just a sliver of me. It’s more than taking medicine. That’s the easy part. I have to do the rest. I have to get myself organized and keep myself organized. This is serious. It’s really messing up my life.”

As I was listening, I was doing my best to maintain my professional demeanor, but inside I was yelling, “Yesssssssss!”

What suddenly makes a patient able to hear what I am telling him? More to the point, though, what makes it possible for a patient to listen to the wisdom inside herself? Damned if I know, but as a clinician I keep on trying. The clinical skill involved is what Sheldon Roth, MD, a colleague of mine, calls the “art of wooing nature.” Well, sometimes nature is reluctant to be wooed.

As my patient said, “You only see just a sliver of me.” I have to recognize that, to keep my limitations in mind. Seeing “just a sliver” reminds me that I have to do more with patients than just prescribe medication and then monitor them to be sure they are taking it correctly. That’s fine with me, actually, because I have no interest in just prescribing medicine for patients. In some settings writing prescriptions is all the doctor has time to do. Not for me, lucky that I am. I get to see them whole, not settle for what I see in the “sliver of me.”

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What About Coaching?

Generally I enjoy my work with adults who have ADHD. They are interesting, vital people and it’s a pleasure to help them. Sometimes we are lucky, and the patient’s life just “lights up.” Happy patient, happy doctor.

Sometimes, though, I feel that something is missing . I know about ADHD medications, their uses and side effects and benefits. I enjoy doing psychotherapy with patients who frequently have life issues as a result of having AHDH. There’s still a chunk of the patient’s life which I don’t reach.

One way to help in these circumstances is to suggest an ADHD coach. Such persons provide practical, often daily advice about how best to cope with ADHD. What’s a coach, though, and what does such a person DO?

I found some answers in a new book called, The Disorganized Mind: Coaching Your ADHD Brain to take Control of Your Time Tasks and Talents. (Long enough title?) Nancy Ratey is the author. She, incidentally, is the wife of Dr John Ratey. A child psychiatrist, Dr Ratey with his colleague Edward Hollowell, MD, put ADHD “on the map.”

In a breezy, upbeat style, Nancy Ratey gives inside information about coaching. She has a program for clients, called ANSWER, to address their major problems. One aspect of the book I liked was that she provided guidelines for self-coaching, too. She gave attention to the issues of being the spouse or employee of adults with ADHD. What she didn’t do is tell the reader how to find and evaluate presons who claim they are coaches for adults with ADHD.

For information about this topic for my Washington,DC, area patients, I often suggest www.ADDVance.com website of Kathleen Nadeau, PhD. She and her colleagues are good at linking patients up with coaches and other resources.

I’m still uncertain about the role that “coaching” can play with adults with ADHD. Any comments or experiences to share?

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Non-Medical Use of CNS Stimulants

Abuse of the central nervous system stimulants used to treat ADHD is causing more and more trouble. For example , there is a sharp rise in the calls to emergency physicians about the drugs. When teenagers use these medications in an uncontrolled way, bad things happen.

My patients tell me that when they were (or are) in college, they and their friends matter-of–factly lent each other such meds to improve test performance or to stay up all night to finish a paper. Like using steroids to enhance athletic performance. It isn’t the best students who do this, though, it’s the worst. An estimated 60% (60%!) of students with a prescription for an ADHD medication share or sell the medication to someone for non medical use ( my italics).

Trying my best to be nonjudgmental, I point out to patients that this is illegal as well as potentially dangerous. My patients grin back at me with that, “Oh come on, doc, get with it!” look.

This issue bothers me. I write a lot of CNS stimulant prescriptions for ADHD. There is surely some abuse of my system, even if I monitor patients’ use carefully. Any reactions ?

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ADHD
Spotlight

50% of ADHD Kids Who Smoke Cigarettes Will Go On to Substance Abuse

Treating ADHD Lowers Crime

ADHD “Plus” : Anxiety

“Just a Sliver of Me!”

What About Coaching?

Non-Medical Use of CNS Stimulants

ADHD Meds and Chromosome Damage

Treat ADHD — To Lose Weight??

Weed, Young Adults, and ADHD

Fresh, New Start

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