I’ve recently noticed a trend in my office: middle-aged people have been seeking me out because their drinking has become problematic. Their partners have expressed concern and they’re left wondering in bewilderment how it ever got to this point. They’re intelligent, motivated, successful, caring men and women leading generally satisfying lives as partners, parents, and professionals. They may have even seen a therapist or two already in the past in an effort to uncover possible issues from early life difficulties, seemingly to little effect. They wonder how our work together could possibly be any different.
What I’ve noticed is that many of these clients tend to share some commonalities:
- They bore easily; they’re often restless and on the move
- They’re energetic and talkative, often dominating the conversation and changing topics, perhaps interrupting frequently
- They’re forgetful and/or struggle with time management and attending appointments
- They’re generally quite interesting as they can share a flurry of ideas concurrently*
- They’re quite intelligent* and high-functioning,* but may have had a history of being disruptive in grade school (and may have developed a complex about frequently being reprimanded*)
- Perhaps they’ve wondered if they might have some attention deficits, but nothing’s ever come of this consideration or early childhood assessment*
- They may be quite sensitive*
These characteristics are commonly seen in individuals with Attention Deficit/Hyperactivity Disorder (in addition to other diagnostic criteria). ADHD is frequently identified in young boys who exhibit behavioural disruptions in grade school, but less so in girls who tend to present somewhat differently (likely in part due to differential influences in socialization).
Perhaps parents from previous generations feared medicating their children and/or the stigma that might have accompanied seeking formal psychological assessment and diagnosis. In other cases, high-functioning intelligent children may have kept up with their academics, without much commitment to formal study practices, and thus flew under the radar. For various reasons, some people make it all the way into middle-aged adulthood without ever having their ADHD identified (or symptoms thereof, as it’s possible to experience symptoms on the spectrum without qualifying for a formal diagnosis).
Oftentimes such individuals resort to self-medicating symptoms they didn’t realize they were dealing with by using alcohol and other drugs to help with increased focus, productivity, and to escape the flurry of thoughts they’re so inundated by in order to unwind before bed. When thinking about ADHD, we seldom fully appreciate how exhausting it can be to have to constantly moderate attention away from countless distractions, personal “notes to self,” and new ideas, all within seconds just in time to return to the conversation at hand and appear attentive to the person in front of you! Seeing ADHD in this light helps me understand the high correlation with concurrent addiction.
Many factors contribute to the susceptibility and development of addiction; among them, genetic, psychological, sociological, and existential influences. It is also well known that most cases of addiction tend to correlate with some form of psychological trauma. To this end, addiction is often about self-medicating symptoms of distress. In therapy, while it’s essential to approach addiction from a trauma-sensitive lens, it’s also important to consider possible unidentified mental health concerns –likely also tied to trauma, which may independently perpetuate the cycle of addiction if left unaddressed.
Another important thing to realize is that addictive tendencies are degenerative in nature. Long-term substance abuse can create cumulative health impairments. Addictive tendencies can be progressive as they become ingrained behaviourally and neurologically (i.e. physically reinforced in the brain). As we age, we tend to lose water weight, so substances like alcohol can have greater influence than expected. It’s also easy to lose sight of the fact that substance abuse habits started in youth can subtly escalate over time, as greater tolerance and dependence develops –all of which can contribute to middle-age problem drinking.
If you’re wondering whether your substance use could be an issue, consider:
- Is it interfering with your relationships and other commitments?
- Do you continue to ‘use’ despite significant adverse consequences?
- Is the use compulsive?
- Do you experience craving and preoccupation?
- Is it difficult or impossible to control the amount or frequency of use?
- Have others expressed concern?
Therapy can be helpful in identifying and learning to manage symptoms of addiction and ADHD. Sometimes simply acknowledging such concerns can be a first step that brings considerable relief. If you think you could be affected by similar challenges, reach out to a regulated healthcare professional to see how you could be supported and what options are available.