Other common disordersADHD, chronic insomnia and eating disorders: why are they linked to addiction?

1Why have we grouped these disorders into one family?

Medically, ADHD belongs to the neurodevelopmental disorders, while insomnia is classified among the sleep-wake disorders. But in addiction treatment clinics the two meet often, which is why we gave them their own family in the mental health guide.

The common thread is that each of these disorders causes an exhausting daily struggle, and the person looks for any quick way to ease it: a young person who is distracted and impulsive may find temporary calm in hashish or temporary focus in stimulants, and someone with insomnia may find quick sleep in alcohol or sedatives. In both cases the story begins with an attempt at “self-medication” and sometimes ends in a dependence that doubles the original problem.

This group also includes eating disorders, such as anorexia nervosa, bulimia nervosa and binge-eating disorder. These are serious disorders that affect body and mind together and may overlap with substance use, but they are treatable, and the earlier treatment starts the better.

The relationship runs in both directions: the disorder can lead to substance use, and substance use and withdrawal make insomnia and inattention worse, so the cycle goes round. Breaking this cycle is the essence of what we call dual diagnosis.

2ADHD in this family

The US National Institutes of Health define it as a neurodevelopmental disorder marked by three features: inattention, such as difficulty concentrating and organizing; hyperactivity, such as fidgeting and talking a lot; and impulsivity, such as interrupting and difficulty waiting. Symptoms begin in childhood and usually continue into adolescence and adulthood.

Many adults were never diagnosed as children, so they spent years being called lazy, careless or “badly brought up,” while they actually had a real, treatable disorder. You will find the details in the guide to ADHD.

Full details are in the ADHD guide.

3Chronic insomnia in this family

Everyone has difficult nights, especially under stress, and this is “acute insomnia,” which usually goes away when its cause does. Chronic insomnia, however, is defined by the US National Heart, Lung, and Blood Institute as difficulty sleeping that occurs three or more nights a week, lasts more than three months, and is not fully explained by another illness.

Chronic insomnia is more than “not sleeping enough”; it affects memory, concentration and mood, and is linked to a higher risk of high blood pressure, heart disease and diabetes. You will find the details in the guide to chronic insomnia.

Full details are in the chronic insomnia guide.

4Types of other common disorders

Each disorder in this family has a full guide and its own pages. Here is a brief card for each:

5What is the difference between ADHD and chronic insomnia?

The two disorders sometimes overlap: many people with ADHD complain of sleep problems, and chronic lack of sleep alone can cause distraction and irritability that resemble ADHD symptoms. That is why the doctor always asks about sleep before judging attention.

6How does each lead to addiction?

The US National Institute on Drug Abuse notes that many studies have documented a higher risk of substance use disorders in young people with ADHD who are untreated. Impulsivity, thrill-seeking and difficulty tolerating boredom make the first experience easier, and repeated school failure weakens self-confidence and adds stress.

Some young people misuse Ritalin or other stimulants without a prescription to concentrate or stay up late, or turn to hashish to “calm down.” With insomnia, the usual route is alcohol before bed, or sedatives such as Xanax and Rivotril, or pregabalin without medical follow-up.

1. The start
   A real problem

   Insomnia or distraction that wears the person out and affects their day.

2. The quick fix
   A substance or medication without follow-up

   Temporary relief that makes the brain associate relief with the substance.

3. Tolerability
   The effect fades

   The person needs more to get the same result.

4. The rebound
   Symptoms return worse

   Trying to stop causes worse insomnia, anxiety and distraction, so the person goes back to the substance.

That is why we have given each disorder a page on its relationship with addiction: ADHD and addiction and chronic insomnia and addiction.

7Are ADHD medications and sleeping pills “drugs”?

This question worries many families. Some ADHD medications, such as methylphenidates, are controlled drugs dispensed by prescription, as are many sleeping pills and sedatives. Using them under the supervision of a doctor who follows the case is completely different from taking them without a prescription, in larger amounts than prescribed, or for non-therapeutic purposes.

8What are the shared risks if the two disorders are left untreated?

• Decline in school and work, and difficulty holding a steady job.
• A higher risk of accidents, especially road accidents from impulsivity or drowsiness.
• Depression and anxiety, both of which increase with lack of sleep and repeated frustration.
• Repeated family and marital conflicts and misunderstanding from those around.
• Misuse of alcohol, substances and sleeping pills, then dependence on them.
• Low self-confidence and a constant feeling of falling short.

Early treatment greatly reduces these risks. You will find details of the complications on the pages for the harms of ADHD and the harms of chronic insomnia.

9Can they be treated without relying on addictive substances?

Yes. For chronic insomnia, the American College of Physicians recommends cognitive behavioral therapy for insomnia as the first step for adults. It is a structured program that resets sleep habits and the anxious thoughts tied to sleep, with medication coming afterward when needed and for periods the doctor determines. For ADHD, treatment combines behavioral interventions, parent training and school support, and stimulant or non-stimulant medication chosen by the doctor according to the case and the history of substance use.

At Eradah we pay particular attention to people who have one of these disorders together with substance use, and we make one integrated plan that treats the addiction and the underlying disorder together. Details are in ADHD treatment and chronic insomnia treatment.

10How can the family help their son or partner?

Families often treat ADHD as “naughtiness” or “carelessness,” and insomnia as “being spoiled” or “staying up by choice,” so they resort to blame and punishment. The result is usually more tension, and the person looking for a secret solution away from the family, which may be a substance or a medication taken from a friend.

1. Treat the symptoms as a health problem that deserves assessment, not as a flaw in character.
2. Help build a steady routine for sleep, waking, studying or work, with fewer screens at night.
3. Keep an eye on medications in the home, and do not share your medication with anyone, however harmless it seems.
4. Praise effort and small progress; repeated frustration is a main fuel for substance use.
5. If you notice substance use or dependence on a sleeping pill, ask for an assessment that treats both together instead of focusing on only one.

11When should you seek help from a psychiatrist?

• If trouble sleeping lasts for many weeks and begins to affect your work or mood.
• If you can no longer sleep without alcohol, a sedative or a sleeping pill taken without medical follow-up.
• If teachers or family notice persistent distraction and impulsivity in the child at home and at school alike.
• If you are an adult who has struggled since childhood with disorganization, forgetfulness, impulsivity and repeated unfinished starts.
• If any substance use appears, or use of other people’s medications to concentrate or sleep.

This list is for awareness and is not a diagnosis; an accurate diagnosis needs a specialist assessment.