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Smoking, Drinking, Substance Abuse, and ADHD

Why ADHD teens and young adults end up in substance abuse?

There is a difference between primary and secondary conditions or disorders in medicine. For example, one can have diabetes and hypertension at the same time, but one is not the consequence of the other, so they are co-morbid.  But depression for example is a primary condition that can cause insomnia and suicidality as consequences or secondary conditions.
ADHD is a primary condition or disorder that can cause many secondary conditions or disorders or complications as post-morbidities.  therefore it would be wrong labeling if consider complications of ADHD as co-morbidities, i.e they all exist at the same time, without one causing or triggering the other. If we do not make such important differentiation, then we would not know which one to treat, that is why mostly we are stuck with all conditions clogged together and cannot treat them, specially substance abuse.
ADHD as a primary condition has many post-morbidities, if left untreated, e.g. substance abuse,depression, anxiety, impulsivity & Aggression, suicidality, conduct disorder, oppositional defiant disorder, anti-social personality, borderline personality, narcissistic personality, risk taking behaviours, procrastination,sleep disorders, accidents and injuries prone personalities, loss of self-esteem and confidence, social/interpersonal problems, gambling, games and Internet addiction.
As I have discussed in other groups, e.g. Impulsivity group and elsewhere, substance abuse and risk taking behaviours alike are the consequences of behavioural disinhibition in ADHD.  These kids do not use substances to help them concentrate or be attentive as substance do not do that.  but they use substances as they are disinibited and engage in any other similar risk taking or novelty seeking activities. At the same time they may use substance to calm their high energy and restlessness. Cocaine, nicotine and other stimulants that are used more frequently among ADHD subjects than the general population as self-medicating, increase the level of dopamine and norepinephrine in the brain, the same as stimulant medications in the treatment of ADHD do.  In fact Cocaine’s action on brain in some way is very close to the action of methylphenidate(Ritalin, concerta, etc.) that are used in the treatment of ADHD. 
The major difference between the methylphenidate and amphetamine containing medications used in the treatment of ADHD and stimulant substance such as cocaine is that the latter inhibits dopamine transporter (that transport dopamine to the synaptic cleft of neurons), but the stimulant medications act like substrate for dopamine transporter and slows the dopamine re-uptake so make it more available to the neurons.  Another difference between the stimulant medications and substance such as cocaine and crack is their higher percentage increase of dopamine and nor-epinehprine in a shorter period of time (seconds) , so make them very addictive substances with very short effect.   
Another feature of ADHD specially of hyperactive/impulsive subtype is their novelty and reward seeking that are met immediately with substances such cocaine, cracks and to lesser degree with smoking. Taking into account this novelty and reward seeking feature of ADHD has alternative to substance nowadays through seeking other addiction, e.g. internet and gambling that is becoming more problematic. All these addictive actions raise the brain dopamine and to lesser degree nor-epinephrine that stimulant medications do without causing addiction, but supplying the needed dopamine and nor-epinephrine to the brain in long term in a therapeutic and constructive manner.
I hope not to bore anyone with all these medical jargons, but have tried here to explain how teens and youngsters with untreated ADHD are drawn to substance and other addiction out of their control.  So to help them, we need to understand the mechanism that ended them there and to treat the primary condition or cause, not to blame, judge, punish or lecture them.  Perhaps there are more masked ADHD under many substance abuse and now internet and gambling and game addiction than what we know.


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