ADHD and Addiction: Two Sides of the Same Coin
Seventeen years sober, and still stuck
I was 17 years sober when I was finally diagnosed with ADHD. Though I’d managed to stay sober and had done a lot of work in my recovery, I was still stuck in many ways. I was prone to rumination and anxiety, which led to many a sleepless night. When it came to follow-through, I tended to overthink and underperform. I procrastinated on too many things, and my efforts and focus were disorganized, all of which meant I wasn’t able to live up to my own ambitions for myself…I was surviving rather than thriving! This way of being had a negative impact on my education, my career, my physical health, my finances, my relationships, my emotional life and my mental health.
I didn’t know it at the time, but it’s now clear to me that I was trying to manage my ADHD traits with my addiction recovery work. All the effort I poured into my recovery (therapy, meetings, the steps and so on) absolutely kept me from sliding back into drinking… but I was still self-medicating with food, caffeine and constant busy-ness to get through the energy and emotional slumps, to numb out and to quiet the noise in my head. None of it was enough to manage my ADHD, so I was still avoiding all those areas of my life where I’d tried too many times to change and never progressed.
My ADHD diagnosis, and finally treating it, was the missing piece of the puzzle for me: the other side of the coin I hadn’t known about.
Connecting the dots between ADHD and addiction
When I opened my coaching practice back in 2009, I was immediately struck by how similar many of my clients’ behaviours were to my own. They had many of the same coping mechanisms: self-soothing and self-medicating with substances or behaviours to quiet the mind, boost their energy or relieve boredom, just as I had for all those years.
Over time I started to realise that this wasn’t just a ‘me thing’. It was showing up so frequently and so consistently that it cemented for me that ADHD and addiction were two sides of the same coin. So I went looking for more information to help me support my clients and one of the only books I could find at that time that went beyond the research was The Link Between A.D.D. and Addiction by Wendy Richardson. I was so struck by what she was saying, and even more struck by how few people were talking in any depth about the link between addiction and ADHD, that I actually reached out and ended up swapping a few emails with her! 🙂
She was lovely, and encouraged me to trust my instincts and to keep shining a light on this aspect of ADHD with my clients when it was called for. Realising how common and how needed this work was is what eventually led me to retrain as an addiction recovery coach and CRAFT facilitator.
When recovery work neglects ADHD: the weak spot in our armour
What I see in clients who work on their recovery but not their ADHD.
These are people who are very committed to their addiction recovery. They’ve successfully changed many aspects of their lives toward that goal. They’ve changed their daily routines and habits, sometimes even their jobs, friendships and much of their social lives. They’ve come through the physical withdrawal and the mental obsession with the substance or behaviour they used. They’ve educated themselves about addiction, often immersed themselves in the recovery community, and found the support they need: coaching, sometimes recovery groups etc. They read all the ‘quit lit’ books and listen to the podcasts. In other words, they do all the right things, and as far as their addiction goes, all this work pays off and they’re seeing the positive results.
But under the surface of all this progress, their neurology is still constantly pulling at them to use something (anything!). Lower dopamine and norepinephrine leave an underlying craving that never quite goes away.
It may be quieter now that they’ve stopped using, but it’s still there. There’s a saying in recovery circles that speaks to this underlying vulnerability:
“While you’re in the meeting working hard at your recovery, your addiction is outside in the parking lot, doing press-ups.”
No matter how well they’re doing with their addiction recovery, if they have undiagnosed or under-managed ADHD, there will come a day when their neurology makes them vulnerable: the constant craving, the restlessness, the emotional lability, the overthinking, the stress and poor sleep, the forgetfulness, the poor impulse control, the overwhelm and procrastination. Left unmanaged, all of this can have a huge impact on our daily lives and our ability to show up for our loved ones, for ourselves and for our careers.
Then, like me, they’ll either avoid or give up on their ambitions and settle for just getting by. Or worse, these under-treated traits and their impact will lead them back to addiction.
There are many complex reasons for a relapse or a slip, and I don’t want to oversimplify this in any way. But research backs up what I see. A 2023 study found that adults in treatment for alcohol use who had ADHD traits were at higher risk of relapse, even after completing inpatient treatment for their drinking, and a 2015 follow-up found that people whose ADHD was treated had fewer relapses than those whose ADHD went untreated. So when we don’t deal with undiagnosed or under-managed ADHD, it becomes a real vulnerability: the neurological weak spot in our armour. And when we do deal with it, that weak spot becomes part of our armour.
When ADHD support overlooks addictive habits
I also see the other side: people who do everything they can to support their ADHD but don’t look at the addiction side of the coin. The same low-dopamine pull is there for them too, and they’re so used to self-medicating it that it’s become their normal.
They may have a coach, and may even be taking medication, but their habits, often formed long ago (in early childhood, like mine), have stayed the course.
Things may not be as bad as they were before diagnosis and treatment, but they’re still using substances or behaviours to self-soothe, often to the point where it affects their health, their sleep, their mood, or even their relationships, finances or career.
What changes when we treat both
After my own diagnosis, coaching, psychoeducation, diet and lifestyle changes and, eventually, medication, I was finally able to break a lifetime habit of underperforming.
I went back to school, opened my own business, took better care of my health and followed through on the goals I set myself. I was able to organize my life, my time, my days, my environment and my emotions, which finally gave me room to grow. I set up healthy habits and stuck to them. This was the recovery I’d wished for! The one I could never reach when I focused only on emotions, mental states, meetings and so on.
If this sounds like you
If you’re in recovery with ADHD, you’ll be working harder than everyone else just to stay in place. You can absolutely stay sober… but your energy for all the other parts of your life you’d love to grow (creativity, physical health, social life, career, education and so on) will too often be held back by limited resources.
And if you’re managing your ADHD but still reaching for something to get through the day (the evening wine, the snacks, the scrolling, the extra coffee), that’s the other side of the coin asking to be looked at.
If either of these sounds like you, please know that you’re not failing at recovery or ADHD management. You simply didn’t know what you didn’t know. Treating both sides of the coin is what finally allowed me to move from surviving to thriving, and I see it do the same for my clients.
If you’re wondering whether you might be self-medicating your ADHD, my free checklist, 5 Signs You’re Self-Medicating, is a gentle way in to discover how and it only takes about 5 minutes: https://checklist.dianeoreilly.com/5-signs
