Breaking the link between ADHD and addiction

Dr Melanie White

Adult sufferers of ADHD are two to three times more likely to experience substance abuse or dependence, but a research project which will map the genetic markers of the condition will help sever ties with addiction and could lead to customised treatments.

Dr Melanie White from QUT's Institute of Health and Biomedical Innovation (IHBI) said testing for specific genes associated with actions of the reward centre of the brain involving dopamine - a neurotransmitter which plays a major role in reward-motivated behaviour - would give a better understanding of how the brain works in those with ADHD (Attention Deficit Hyperactivity Disorder).

"I'm looking at genetic markers of symptoms of ADHD in adulthood as well as whether people have used a range of different types of substances, and the interaction between these genetic markers and aspects of the environment," Dr White said.

"Given ADHD medication is typically a stimulant, I'll be investigating whether it improves their symptoms in the short term and the role of this medication in future substance use or symptoms."

Dr White, who was awarded a Churchill Fellowship to progress her research, said most children diagnosed with the neurodevelopmental disorder carried it into adulthood.

While symptoms, which include restlessness in work and relationships and impulsivity, can be adapted to fit in with the demands of life, the link between ADHD and substance abuse is impossible to ignore.

"One theory is that people are using substances to redress the chemical imbalance in their brain, or that the reward centre and dopamine activity is wired differently in those with ADHD versus the rest of the population," Dr White said.

"However, the theory I'll be investigating is whether early stimulant medication use when the brain is still developing, results in the brain responding differently when exposed to substance use later in life.

"There are diagnostic differences in terms of whether your symptoms are predominantly inattentive or hyperactive-impulsive, but I have no doubt there are several different genes that might lead to susceptibility to substance abuse on top of the risk for these ADHD symptoms."

Dr White carried out research at the Federal University of Rio Grande do Sul in Brazil, which has studied the largest group of adults with ADHD in the world.

However, she is looking for expressions of interest from Australian adults with ADHD for future studies.

"Hopefully in the future, this type of information will enable us to make customised plans based on people's specific genetic profile amongst other characteristics, often called 'personalised medicine'," she said.

"We hope to be able to effectively say 'this medication would be more effective for you because of your genetic makeup', or conversely 'we don't believe this medication would be a good idea because it may increase some risks for you down the track'."

Painkiller Addiction Increasingly Common In Newborns

When you picture a person going through painkiller withdrawals, a baby crying in his crib is usually not the first image that comes to mind. But the number of babies born with withdrawal symptoms has skyrocketed since 2000, according to a new study.

In 2000, approximately 4,300 babies were born with neonatal abstinence syndrome, a condition that occurs in some babies that were exposed to opiates such as heroin, Vicodin and oxycodone in the womb, according to the study. In 2009, the number jumped 300 percent to 13,000.

"That's about one baby per hour," Dr. Stephen Patrick, lead author of the study and postdoctoral researcher at the University of Michigan, told CNN. "We were surprised by it. That's a startling increase."

Opiates used by an expectant mother during pregnancy pass through the placenta and into the baby. The babies' bodies become dependent on the drugs but no longer have access to them once they are born, triggering withdrawal. Between 55 percent and 94 percent of babies exposed to the drugs before birth show signs of withdrawal once they are born, according to the American Academy of Pediatrics.

Signs of withdrawal unique to infants include a distinct, high-pitched cry and an aversion to light and sound. They may also show symptoms similar to adult withdrawal patients, such as insomnia, diarrhea and vomiting.

Doctors use methadone, a drug used by addicts looking to kick the habit, to wean the babies off of the drugs slowly. Making them go cold-turkey could lead to seizures and possibly death, according to the study.

Getting the babies over their addiction could take weeks or even months and often requires long-term hospitalization. The cost of treating drug-addicted babies increased from $190 million in 2000 to $720 million in 2009, according to the study, published in the Journal of the American Medical Association on Monday.

The increase in opiate-addicted babies is a product of growing numbers of adults who abuse painkillers.. More than two-thirds of patients prescribed painkillers abuse them by taking them too often or by taking them in conjunction with other painkillers not prescribed to them, according to research published by Quest Diagnostics.

In addition, two million people in 2010 admitted to abusing prescription painkillers for the first time -- almost 5,500 per day, according to the Centers for Disease Control and Prevention.

Tennessee had the highest rate of painkiller abuse between 2007 and 2008, according to the National Survey on Drug Use and Health. It also has one of the highest rates of opiate-addicted newborns. At East Tennessee Children's Hospital, almost 50 percent of the babies in the neonatal intensive care unit are experiencing withdrawals.

"In Knox County, we're drowning," Susan Kovac, attorney for the Department of Children's Services in Tennessee, told CNN. "We've seen the number of children in foster care increase by almost 50 percent over the last few years, and that's just the tip of the iceberg because we're trying to keep the children out of foster care. We've got lots and lots of relatives who are raising drug-exposed infants."

Florida also experienced a surge in the number of addicted babies, which increased from 354 in 2006 to 1,374 in 2010, according to the study.

The researchers call for individual states and the Federal government to take action to reduce the amount of painkillers prescribed and say educating the public about the dangers of using the drugs while pregnant may also help. Cutting the number of prescriptions of opiates could drastically reduce the number of babies born with NAS, according to the study.

"Newborns with NAS experience longer, often medically complex and costly initial hospitalizations," the researchers wrote in the study. "The increasing incidence of NAS and its related health care expenditures call for increased public health measures to reduce [in utero] exposure to opiates across the United States."

Childhood Addictions: Unacceptable, Abusive and Avoidance Behaviours

A new US survey has found that more and more American teens are participating in abusive and addictive behaviours i.e. smoking pot, abusing pain killers and using illicitly-obtained stimulants prescribed to treat Attention Deficit Disorder (ADD).
15.9 percent of tenth graders reported using marijuana in the last month. The percentage of eighth graders who considered using ecstasy once or twice a dangerous activity decreased from 42.5 percent in 2004 to 26 percent in 2009.

Abusive Activities
It isn’t just drugs our kids are addicted to. Kids are now playing a very dangerous and abusive game called “the choking game”. This “game” is an abusive activity that involves them choking one another or using improvised nooses to cut off the essential oxygen supply to the brain, just long enough to feel “high” and not long enough to black out, hopefully.

Self Harm
Teens are also using sugary drinks and food as a drug. This comfort eating is causing obesity rates to soar. These are simply avoidance and coping strategies that children are using to avoid facing what's happening in their lives and in the world today. It's like saying that anything will do to get them away from reality.

Obesity in children has the effect of excluding a child from normal competitive activities, not just sports but social activities involving interactivity and relationships between the sexes. This is a more 'comfortable' place for the child to inhabit and once established, it is very difficult to leave.

Positive re-enforcement

Obesity in children can be induced by parents trying to deminstrate their love in an inappropriate way and because the food is provided by a loving, comforting person, the child associates the food with love and comfort. It is this positive re-enforcement that is difficult to overcome.

Technology abuse
Marijuana, pain medication, stimulants, the choking game or fast food are not necessarily the biggest “drugs” to which kids are addicted. They are using their iPods, DSIs, YouTube, reality TV and the modern cult of 'celebrity' as escapism.

They are doing this to shut down their minds, avoid dealing with their feelings and emotions. They have come to substitute these unpredictable and complex emotions with the simpler on/off “high” of being lead by technology and have become voyeurs to other people's distress and emotions, displayed to them on a screen, and categorised as 'entertainment.'

At What Cost?
The price that humanity will pay for raising a generation of substance, technology and artificially stimulated emotion addicts, is probably incalculable. We can certainly expect that teenagers using pot, painkillers, choking each other for kicks, etc will be unable to resolve their emotional and psychological issues, in this way.

Consequently, they face an increased rate not only of repetative substance dependence, underpinned by depression and anxiety and associated physiological disorders, e.g. hypertension, cardiac disease, malignancy, etc.

Puberty and Sex
Unresolved emotional conflicts during puberty lead to greater risk taking in sexual exploration and intercourse becomes the 'perceived' answer. After all that's what the glossy magazines, films, pop stars and popular personalities advocate.

If our young people turn to sex to resolve issues, we can expect higher rates of sexually transmitted diseases, over the next ten years. We have to anticipate more violence from both sexes, because our young people are evolving into adults with little or no real experience or guidance as to how they manage their emotions, including anger, envy and jealousy.

Avoidance of Disruptive Interruptions
There is also a higher likelihood of repeatedly turning to street drugs, to try to contain or avoid the uncomfortable feelings and emotions that arise everyday and in normal human interaction.

Their psyche is broadcasting emotional shockwaves that their immature brains do not understand and cannot, or do not want to, deal with. Therefore it grasps at a familiar avoidance tactic. The drug induced solution turns off or turns down, the level of consciousness and therefore the need to deal with this disruptive 'interruption.'

Life-threatening events

If the distraction becomes a life-threatening event, as in the 'choking' game, then the brain is forced to re-calculate it's priorities. The internal alarm systems trigger and the more dominant and instinctive reactions that are pre-programmed to sustain the life of any human, take over. They stabalises and normalises the body's physiological functions.

The release of adrenalin and nor-adrenalin during these traumatic events create a 'high' feeling, as well as dispelling and discarding any 'non'essential' thoughts, emotions and activities. The troubled thought have been extinguished but only for a limited space of time and is has been done at a huge cost to the body.

There are better ways to resolve troubled thoughts. Ways that are more effective and not only less damaging but also more beneficial and soothing to the psyche.

Muffled Senses
All of this activity can be reduced to the simple adage that you need to get 'high' to enjoy life and to fully participate in life's great adventure. We need to be intoxicated in some, less cognitive and have a more distorted or muffled sense of our present reality. This comes from the 'brand' and 'lifestyle' marketing that our children are faced with all day every day. They have grown up with it, you, as parents have not.

Don't Panic!
I believe there is still hope for our children and that hope is in the parents' hands. Your role, as a parent or guardian, is to show them the pleasure and joy that can exist in being with other people, interacting in a playful non-threatening way, listening to the experiences of their elders or people from other countries.

Show them the benefit of cooperation and collaborative play, the value of each link in the chain of events that leads to a succesful outcome and the resolution of troubling issues. The pessimistic view is too painful to endorse and with effort, it can be changed from this point on. As their parents or guardians, take the lead and break their addiction in a positive, loving and supportive way.

You are invited to share your experiences, successes and concerns with me here. Please post a comment.