I have neurodivergent family members who strugged with substances in the past and paid a heavy price for this. I have also lost good friends to addiction. The loss that hit me the hardest was my friend Jon, who died in 2010 from a heroin overdose. Jon was left to die by the people he was with, after injecting heroin in a public toilet. Those who left him did so because of the fear of manslaughter charges, due to injecting drug users often injecting eachother. Jon had been diagnosed with ‘childhood’ ADHD and so suddenly when he turned 18 his ADHD disappeared and he was no longer neurodivergent. I JEST of course, as there is no such thing as childhood ADHD. This ridiculous view of ADHD in the past has robbed millions of ADHDers with their diagnosis and the right to access medication. SO many have had to get re assessed as adults in order to get their diagnosis and right to medication restored.
Due to stigma and sheer ignorance Jon’s parents didn’t want him to take Ritilin, believing Ritilin (a stimulant) would make him worse. Had he been on ADHD medication and received the right support around childhood and other trauma, he might well be alive today. The system failed Jon. I am still angry just thinking about how he was failed.
From 2000 to 2008 I worked as an NHS Senior Practitioner in a Surrey prison, managing a team of forensic drug workers. I loved my job and although I am not a recovering addict I felt a strong affinity with my clients - at the time I had no idea I was AuDHD and that my clients were all neurodivergent. Now I know and understand the natural connection and rapport I had with them. I remember so many of them very fondly and have a pile of letters sent by some clients after release. Some made it, sadly many didn’t.
Working in addiction is a rollercoaster and especially working within a prison - it made my ADHD very happy but in order to navigate the environment as a PDAer I roleplayed and who I was when working in that environment and the person I was at home and in church were two very differnt people. This did sometimes feel very confusing and meant I didn’t really know who I was. I also always clashed with management and would go out of my way to dress in ways that meant I was often mistaken by prison officers as being a prisoner, regularly asked what I was doing and why I wasn’t in my cell. I would just reveal my key chain and giggle inside. This was part of the roleplaying and involved wearing certain brands, a bandana and adidas trainers. This character is London Viv - who is a bit mysterious, has a shady past, is very assertive, a force to be reckoned with and a bit scary. This is the person that many people I worked with felt a connection with, which made me popular and trusted.
Addiction changes your brain and means the individual has acquired neurodivergence, but many are also ADHD, Dyslexic and autistic too. Many also have brain injury, another acquired neurodivergence, often linked to domestic violence, fights and accidents due to a chaotic lifestyle and the revolving door of offending, buying drugs, using drugs, getting arrested and ending up in prison.
There are some stark statistics when it comes to the numbers of neurodivergent people who experience addiction. There are many reasons lying behind why they end up with addiction problems, but firsty lets look at some of those stats:
36% of autistic people have co occurring substance misuse problems (Ressel at al 2020)
In one study, out of 500 autistic adults 54% were heavy episodic drinkers compared to 17% non autistic (Brosnan and Adams 2020)been
Being autistic doubles the risk of addiction (Embrace autism)
Being ADHD increases the risk of addiction fourfold (Embrace autism)
Being ADHD or AuDHD means your brain has more significant differences in regards to certain chemicals, not just Dopamine but also Noradrenaline which is important in the flight, flight response and also GABA, the hormone that helps with impulses and inhibition. If Dopamine is 'GO,GO.GO!', differences in available dopamine levels might lead to impulsivity and risk taking, then GABA is 'STOP!!!!!!'
There are a number of reasons behind high levels of substance misuse and addiction in neurodivergent people, here are some thoughts:
Trauma is a huge reason why people can end up with addictions. Addiction is mostly about killing/numbing ‘pain’; drink and drugs can temporarily numb traumatic memories, intrusive thoughts and challenging big emotions. Many ND people have experienced trauma throughout their lives, often due to stigma. Trauma is not just childhood events or one off events, ND people can experience all kinds of trauma: from professionals mistreating them, traumatic relationships relationships (co-oercive control, mate crime, abuse, domestic violence, exploitation etc) and even sensory trauma.
Managing physical pain as the result of illness, conditions or accidents for example is a trigger for many ND people who end up in addiction. ND folk are more likely to have co-occurring physical conditions such as Hypermobility, Ehlers Danos Syndrome, Fibromyalgia, Cerebral Palsy, etc. ADHDers are more likely to have accidents that can mean lifelong pain.
Many ND mask by using alcohol or drugs in order to feel more confident in social situations, fit in, belong and even to be able to keep working/parenting, etc
To alleviate sensory overload or deprivation, many ND folk might turn to substances that might be addictive.
During burnout, particularly those who are AuDHD, a neurodivergent person may turn to substances to cope. This can amplify anxiety significantly and increase paranoia. Hallucinations may also accompany this experience and an increase in meltdowns.
Self medicating - you can argue that all addiction is self medicating but there are those who for example are unidentified ADHD or have a diagnosis and haven’t managed to get or have refused ADHD medication. Without meds many ADHDers will self medicate with substances. The nature of the ADHD brain and nervous system means there are naturally occurring differences in the levels of dopamine, GABA and Noradrenaline. Many substances (especially certain Class A drugs and alcohol), release huge quantities of dopamine when taken.
With self medicating, this may be to stop intrusive thoughts, anxiety, tinnitus and many other things that trouble and disturb the individual.
Being monotropic plays a huge role in addiction in ND people; it is a cognitive style that means the individual focusses intensely on fewer things. There is no doubt that having a brain that can become so intensely deeply focussed, and fixed on things and find it hard to leave those attention tunnels, getting stuck, is a brain that can become addicted to many different things.
Interoceptive hyper sensitivity may mean cravings for substances are experienced more intensely, making them harder to cope with (Interoception is the sense of you internal signals - emotions, hunger, thirst, heartbeat, body temperature, etc)
Alexithymia (meaning ‘No words for emotions’) is a common experience in autistic people especially. It will mean it is much harder to appreciate, interpret, understand and describe emotions, including those of other people. Emotional and sensory dysregulation is more likely when you have interoception differences and experience alexithymia.
If we for those who are ADHD identified them earlier and offered medication, there would be many who were far less likely to end up in the revolving door of addiction, offending behaviours, (drug induced psychosis often) homelessness and prison. Its not a magic wand, but it would make a big difference. I know people who are no longer addicted to substances because of being identified and getting the right help. As a society we need to de-stigmatise differences such as being autistic, ADHD and AuDHD, especially by creating truly inclusive environments where there is an understanding that all brains belong.
When we have people in our lives who have become addicted to substances, it can be fightening and I do feel for parents terrified about a child that has fallen into addiction. Recovery from addiction is not something you can force onto someone, which is a hard pill to swallow. Recovery and the desire to go on that journey has to come from the individual. A PDAer in particular will pick up on any well meaning hidden expectations to change coming from others and this will likely lead to increased anxiety. Autonomy is important even when someone is dong something we don't want them to.
Here are some (hopefully) helpful suggestions for those supporting ND people in addiction:
Addiction changes the brain and the individual cannot just stop. In some cases just stopping is even dangerous (such as with alcohol addiction, Benzodiazepines and other substances that can be dangerous to suddenly withdraw from).
Addiction is not a choice that an individual makes and recovery is a journey that starts when the individual has had a shift in their own thinking, leading to a decision to change. Changing for the sake of others rarely leads to long term recovery although it may be part of their motivation.
You cannot make, force, pressurise or cajole someone into change, it doesn’t work. Change is a process and the motivation has to belong to and come from the individual themselves. As hard as that is, that is the reality. This can be hard and really frightening for family and friends watching the individual who may be spiralling into chaos.
Harm reduction saves lives! Many will take prescribed things like methodone for a heroin addiction, Subutex, Naltexone, etc. Abstinence is not for everyone and abstinence is for many something they very gradually work towards.
12 steps programmes are for many the difference between life and death but again it’s not for everyone. Many run a mile. SMART programmes (Self Management and Recovery Training) may suit those who don’t get on with the 12 steps https://smartrecovery.org.uk/smart-recovery-programme/
Learn all you can about neurodivergence, addiction and recovery from lived experience and also about the substances the individual is using. Knowledge is power and a little knowledge can be dangerous. Try DrugWise: https://www.drugwise.org.uk/ or FRANK: https://www.talktofrank.com/
Get support yourself, try Adfam https://adfam.org.uk/
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