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Missed, misunderstood and misdiagnosed

Is undiagnosed ADHD and autism at the root of many addictions? asks Kathy Carter


Therapy Today, November 2023



Amy self-medicated with cocaine and alcohol for 26 years while holding down a high-pressure job before she had a self-described breakdown at age 42. After mental health treatment at a private clinic, and subsequent sobriety, she was surprised to find herself ‘very dysregulated’ when she returned to work. The roots of her addiction – undiagnosed ADHD and autism – had been completely missed in the clinic. ‘Cocaine and amphetamine-based drugs can actually help a person with ADHD calm down and focus. Once I got clean, my self-medication had effectively been taken away, enhancing my ADHD traits,’ says Amy.

‘The psychiatrist who eventually diagnosed me believed I had remained undiagnosed for so long because I had found cocaine at an early age; I was also self-medicating to stop feeling so out of place. I only wish more treatment and rehab centres factored in screening to help identify neurodivergent residents at intake.'


Despite increasing numbers of individuals identifying as neurodivergent, there is still a surprising lack of awareness of the links between addiction, autism and coexisting ADHD – with potentially deadly consequences. Neurodivergent author and trainer David Gray-Hammond calls addiction the ‘silent killer’ of the autistic and neurodivergent community. ‘People with ADHD may die because of their drinking,’ he said in a powerful blog, ‘Killing them softly’

Dr Mathias Luderer, a postdoctoral researcher at the University Hospital Frankfurt and Head of Addiction Services, agrees with Gray-Hammond’s stark premise of addiction catastrophically afflicting neurodivergent people. ‘In my patient group who have addiction and also ADHD, almost none of them received an ADHD diagnosis before they found themselves requiring help for their addiction. So if Gray-Hammond’s reference to “silent killer” means people with ADHD die because of their substance abuse without getting diagnosis and treatment, I agree,’ he says.


Statistics also show autistic people are still more likely to die by suicide than the general population. ‘Many neurodivergent clients who overdose and self-injure have unhealthy relationships with drugs and/or alcohol,’ says Alice McCarron, a neurodivergent clinical practice lead for an NHS self-injury service. ‘Potential causative factors for suicidality in autistic individuals include coexisting mental health problems, late diagnosis, adverse life events, masking one’s true self in order to fit in, and sensory processing differences,’ she says.

The number of undiagnosed neurodivergent individuals in addiction is still unknown, but we do know there were 275,896 adults in contact with drug and alcohol services between April 2020 and March 2021. Given it is estimated that around one per cent of the population is autistic, and that 6.5% of the population has ADHD,5 we could estimate that 2,700 autistic individuals and just under 18,000 people with ADHD may be represented in the population served by drug and alcohol services.

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