Substance abuse is a common affliction that causes severe morbidity, death, and financial strain on victims’ families, the victims themselves, and the healthcare system. Persons with mental illnesses are disproportionately represented in substance use disorders. Co-occurring disorders such as Attention-Deficit/Hyperactivity Disorder (ADHD) and alcohol use have become rampant among populations globally. As a result, to tame the current co-occurring disorders challenge, the American Psychiatric Association has established a standard version called the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition, often called DSM-5, with a standard structure that contains the names, symptoms, and diagnostic features of each recognized mental disorders that also includes addictions. Therefore, DSM-5 has exhibited high-end effectiveness in the diagnosis and treatment of co-occurring disorders.
DSM-5 Criteria for Co-Occurring Disorders Diagnosis ADHD and Alcohol Use Disorder
To be diagnosed with ADHD using the DSM-5 criteria, an individual needs to meet the following criteria as stipulated in the American Psychiatric Association. First, the person must show a persistent pattern of inattention or hyperactivity with the characteristics of impulsivity that cause interference with functioning and development. Secondly, the aspect of inattention is incorporated in the diagnostic process of ADHD. Symptoms that show inattention include an individual failing to give close attention to details or intentionally making careless mistakes in classwork or during other activities, the person normally fidgets with or taps hands or feet or squirms in the seat, the individual often leaves seat in scenarios when remaining seated is what is expected, the victim runs about climbs in scenarios where it is illegal or inappropriate, and the person excessively talks (Banna & Saad, 2019). Therefore, from the aforementioned criteria, among other diverse strange behaviors, psychiatrists incorporate DSM-5 in the diagnosis of ADHD.
Correspondingly, alcoholism does not have an official diagnosis. In regards to the American Psychiatric Association’s fifth publication of the Diagnostic and Statistical Manual of Mental Disorders (DSM–5), the disorder formerly known as alcoholism is now formally referred to as severe alcohol use disorder. There are a set of eleven conditions according to DSM-5 that exhibits the co-occurring of alcohol disorder (Kranzler & Soyka, 2018). The eleven symptoms listed in DSM-5 include the scenario where alcohol is normally taken in huge volumes or over a longer time than intended, there is recurrent desire or unsuccessful efforts to stop drinking, much time is spent on deals that enables one to access alcohol drinks every time, cravings for alcohol, consistent use of alcohol that makes one unable to perform their obligations such as work at school or home or where employed, persistent use of alcohol despite having interpersonal issues, persistent use of alcohol in dangerous places, continued use of alcohol despite having recurrent physical or psychological challenges, intolerance, and having a recurrent withdrawal mood that is manifested by either in characteristic withdrawal syndrome for alcohol or use of a substance such as a benzodiazepine to help the victim relieve or avoid withdrawal symptoms (Kranzler & Soyka, 2018). If a person exhibits two or more symptoms from a set of eleven criteria, they are therefore diagnosed with an alcohol consumption disorder, which can be mild, moderate, or severe, according to the DSM-5.
Incidence of the ADHD Disorder, both Independent of and Co-Occurring with the Alcohol Abusing Population
Several incidences exhibit the onset of ADHD where the excessive intake of alcohol as drug and substance abuse is a contributing factor. Co-occurring disorders adversely affect the obscuring of one another, making it hard to achieve appropriate diagnoses in the patient population (Treatment Improvement Protocol 42, 2020). For instance, the co-occurring incidences of anxiety, depression, and ADHD are often mimicked among patients with drug and substance abuse.
Notably, acute intoxication experienced from instantaneous alcohol can cause manic- and hypomanic characteristics, and victims with withdrawal symptoms who exhibit agitation and mood-based challenges can also be diagnosed with ADHD or alcohol disorder, therefore, causing difficulty for healthcare providers to make an appropriate diagnosis (Iqbal et al., 2019). The independent incidences in alcohol disorder and ADHD is that it is easy to substantiate addiction in alcoholism since it is caused by excessive drinking of alcohol, unlike ADHD whereby there is no evidence of contributing factors as it is caused by internal or external factors such as unfortunate events in life, peer pressure, and lifestyle. Therefore, while trying to achieve an appropriate diagnosis, it is imperative for healthcare providers to keenly analyze underlying signs and symptoms.
Theories on Causes of ADHD and Alcohol Disorder
There are diverse theories on the causes of ADHD. Psychodynamic theories associate the cause with lack of appropriate parenting, stressful family scenarios such as loss of loved ones, genetics (where symptoms tend to run in families, lead exposure, drug, and substance abuse, medications taken during pregnancy, among other factors (Iqbal et al., 2019). On the other hand, alcohol disorder is linked to theories such as peer pressure, depression, stressful life situations, addiction, etc. Therefore, from the aforementioned causes, it is candid to note that ADHD and alcohol disorder can be described as co-occurring disorders due to the similarity of causes and symptoms.
Significantly, the behavioral theories are the most appropriate in explaining the ADHD and alcohol syndrome co-occurring disorders. The behavioral theories involved include the executive dysfunction theory, delay aversion, state regulation, and dynamic development theories (Champ et al., 2021). The executive dysfunction theory is based on the cognitive process such as planning, sequencing, holding attention, and reasoning. On the other hand, the delay aversion theory by Sonuga-Berke describes inattentiveness and hyperactivity in scenarios where the delay is inevitable (Champ et al., 2021). The dynamic development theory by Sagvolden and colleagues explains ADHD manifestations from the neurotransmitter throughout to the societal levels. Therefore, since ADHD and alcohol disorders exhibit similar symptoms, the aforementioned theories can help explain the conditions.
Experiences of Individuals with ADHD and Alcohol Disorder Co-Occurring Syndromes
Individuals with ADHD have impaired attention, whereby they cannot pay attention to tasks they undertake at a specific time. Besides, these individuals are restless, and as a result, they do excessive movements as they cannot settle in one place for a long time. Also, they break down easily due to lose or wing moods that are characterized by anger and resentment. Notably, people with alcohol disorder exhibit addiction whereby they are constantly drinking even when they are supposed to attend to other errands, they make poor judgment due to impaired psychological capability, and most of them are always untidy.
Evidence-Based Treatment for ADHD and Alcohol Disorder
The appropriate evidence-based treatment for ADHD is to offer behavioral interventions. Behavioral interventions guide healthcare providers or counselors to monitor behaviors and offer appropriate rewards for the desired positive behaviors to increase positive behavior in the future (Banna & Saad, 2019). Planned or taking back the reward might also be applied to reduce negative behaviors. However, before administering the behavioral therapy, victims must first undergo guidance and counseling to help them acquire a positive attitude towards their behaviors. Behavioral therapy can also be applied to alcohol disorders to foster positive behavioral change.
Particular Considerations for Counsellors Working With ADHD and Alcohol Disorder Clients during Screening/Assessment and Treatment Phases
Counselors are highly tasked to make a keen assessment of patients suffering from ADHD and alcohol disorder to ensure the onset of the treatment exercise to the end bears positive results. Factors that a counselor should consider when assessing or screening ADHD and alcohol addiction clients include investigating the daily activities that the client undertakes, the career of the individual, family history regarding the disorder, the problem that brought the client for evaluation, and the temperance and resilience of the client (Iqbal et al., 2019). On the other hand, before undertaking treatment for the victim, the counselor should investigate the past medical history of the client and the extent of the damage caused by the disorder. Therefore, this will help the counselor determine whether the pharmacological or non-pharmacological treatment approaches can be used as interventions for the patient.
The prognosis for Diagnosis of ADHD and Alcohol Disorder
The prognosis for the diagnosis and treatment of ADHD and alcohol disorder is evidence-based. As noted in the evidence-based treatment, the appropriate therapy is to apply the behavioral interventions where behavior change is observed. It is easy to realize behavioral change for ADHD and alcohol disorder patients by countering the co-occurring behaviors. Besides, monitoring behavior is imperative in making appropriate decisions on further intervention strategies. Therefore, the prognosis for ADHD and alcohol syndrome co-occurring disorders is evidence-based.
From the foregoing discussion, it is evident that ADHD and alcohol disorders exhibit almost similar characteristics in terms of symptoms and treatment strategies. The co-occurring disorders show aspects of anxiety, acute depression, restlessness, among other features that make it difficult for healthcare experts to make an appropriate diagnosis. This can lead to wrong treatment interventions. However, it is prudent to note that ADHD and alcohol disorder have significantly similar intervention strategies. Therefore, diagnosis and treatment of these co-occurring disorders do not pose dangers when the wrong diagnosis is applied, and it is imperative to apply non-pharmacological interventions.
Banna, A. E. S.E., & Saad, M. A. E. (2019). Attention-deficit/hyperactivity disorder: Insights from DSM-5. International Journal of Psycho-Educational Sciences, 8(Special Issue), 25-29. https://files.eric.ed.gov/fulltext/ED602306.pdf
Champ, R. E., Adamou, M., & Tolchard, B. (2021). The impact of psychological theory on the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in adults: A scoping review. PLoS ONE, 16(12), 1-32. https://doi.org/10.1371/journal.pone.0261247
Iqbal, M. N., Levin, C. J., & Levin, F. R. (2019). Treatment for substance use disorder with co-occurring mental illness. Focus (American Psychiatric Publishing), 17(2), 88–97. https://doi.org/10.1176/appi.focus.20180042
Kranzler, H. R., & Soyka, M. (2018). Diagnosis and pharmacotherapy of alcohol use disorder: A review. JAMA, 320(8), 815-824. https://dx.doi.org/10.1001%2Fjama.2018.11406
Treatment Improvement Protocol 42. (2020). Substance use disorder treatment for people with co-occurring disorders. Case Western Reserve University. https://case.edu/socialwork/centerforebp/resources/tip-42-substance-abuse-treatment-persons-co-occurring-disorders#:~:text=TIP%2042%20identifies%20key%20elements,their%20clients%20who%20need%20both.