ADHD and Comorbid Substance Use Disorder

[DS3]

I found this article to be very interesting and informative. I'll point out some parts as they pertain to me. (Mind you, I am a smoker and have been since 1999. Tried to quit a few times, but never really succeeded. Perhaps now that I have my medications I should try again.)

Link: http://www.psychiatrictimes.com/adhd/adhd-and-comorbid-substance-use-disorder

Assuming that doing well in elementary or high school rules out ADHD is one common pitfall. A vigilant parent can compensate so well for a child’s ADHD that the disorder does not manifest clinically until college, when the unstructured environment, lack of parental prompting, and the critical need for time management brings the dysfunction to the fore.

This describes me to a point. I always did well in school and stayed with a solid B in most classes. Mainly because I found learning fun. Art even more so.

Another pitfall is the assumption that the lack of hyperactivity precludes ADHD. This is how many young women with ADHD are missed. ADHD is just as likely in a child that quietly doodles and stares off into space as it is in the disruptive child who will not sit still and climbs on the furniture.

This would be where my love of art comes into play. I always seemed to be doodling. I actually did not get my diagnosis until this year (age 29) because they missed it. As I explain it to most people, I imploded instead of exploded. I still am an introvert. Although I would say that I have some very complexional ideas and thoughts at times.

Assuming that the lack of typical ADHD symptoms rules out the diagnosis is also a common pitfall. Patients can be focused and attentive while doing things they like or when under pressure, but yet be totally disorganized, scattered, chronically late, impatient, and always on the go.

If it's something I like, I'll get through it in a snap. But if it's not, I'm great at procrastination and it will take me forever to get through it.

• Poor selective attention: difficulty in focusing, listening, reading; difficulty in sticking to task, thoughts always wandering, losing and forgetting things; underfunction of the dorsal anterior cingulate cortex– lower striatum-thalamus loop.​

Some days seem to be better then others. I find if I don't make a list and stick to it, I will get side tracked.

• Poor sustained attention: difficulty in organizing, planning, problem solving, managing time; lack of foresight to potential consequences; lack of hindsight; inability to learn from mistakes; difficulty in choosing between com-peting priorities; underfunction of the dorso-lateral-prefrontal cortex–upper striatum-thalamus loop.​

I actually manage time well, and am quite organized. Probably because I have some Obsessive Compulsive Disorder (OCD). I do have difficulties when it comes to decision making and often ask for some outside advice to help me with the major decisions.

• Poor motor control: fidgeting, being physically restless, difficulty in sitting for prolonged meals, meetings, movies; underfunction of the prefrontal motor cortex–lateral striatum-thalamus loop.​

I'm fidgety. Always have to be doing something, or have something in my hands going on.

• Poor impulse control: acting before thinking, talking before thinking, interrupting, intruding, being impatient; underfunction of the orbitofrontal cortex–lower striatum-thalamus loop.​

At times I do act before thinking. I like to believe it is my sensitivity to others, then again, it usually ends up biting me in the bottom. And I am very impatient -especially if I am in a hurry.


While the article seems to explain more the symptoms of ADHD and less on the substance abuse, I know that many people with ADHD self medicate through alcohol, cigarettes, coffee, et cetera. I think that's how I managed so well until everything seemed to come crashing down around me. (Favorite food still is chocolate covered coffee beans. Ate them like there was no tomorrow in high school, and then I picked up smoking.)