Doing from Being: ADHD and addiction recovery
Summary:
The article explores the connection between ADHD and addiction. It highlights how supportive therapy relationships, including neurodivergent-friendly approaches like dance movement therapy, can aid recovery by fostering connection and creativity.
What is the link between ADHD and addiction?
Many people in recovery from addiction have a diagnosis of ADHD and studies have established consistent correlations between the two. Why? The biomedical explanation for this is usually lack of dopamine. Others relevant factors may be genetics, intergenerational or antenatal experiences, childhood/complex trauma and chronic shame. The British psychoanalyst and clinical psychologist Peter Fonagy has stated that the defining feature of trauma is isolation. While addiction is often said to be a “dis-ease of isolation”, many people with ADHD also experience painful loneliness resulting in part from internalised rejection and exclusion from the outside world.
Perhaps we will never know the exact interplay between the two. We are however learning more about what makes “good” therapy for those with ADHD,.
First up is: the importance of an unconditionally supportive therapeutic relationship.
Approaches for ADHD/addiction often combine addiction recovery, pharmacotherapy and psychotherapy. For addiction recovery, the 12 steps remain popular. They provide peer-led support, safe forms of secure attachment, practical tools for living and the restoration of hope and meaning. For the American Franciscan priest and writer Richard Rohr, the 12 steps are nothing less than “America’s greatest contribution to spirituality” with relevance for both nations and individuals.
The British All-Party Parliamentary Group on 12 Step Recovery recently called for more social prescribing of 12 step groups and a 2020 Cochrane Review found ‘high certainty evidence’ that AA (and clinically-related Twelve-Step Facilitation) may support continued sobriety, as compared with other treatments, such as cognitive behavioural therapy.
There are however less helpful - or even actively harmful - approaches to therapy for those with ADHD or ADHD/addiction. Harmful approaches might:
not hold space for the multi-dimensional aspects of the phenomenon eg severe and life-limiting disability, creativity and innovation
be very deficit-focused
focus on ‘curing’ something that is, essentially, a way of being, reinforcing inner dialogues of failure and negative and destructive self-talk
be inaccessible
I have not yet found studies exploring the accessibility of addiction recovery modalities for those with ADHD. David Gray-Hammond is an autistic consultant who has described the challenges of AA for autistic people. He cited spiritual, sensory, social and executive functioning aspects. Particular blocks for ADHD-ers might include the enormous challenges of meditation, an important element of the 12 steps, as a means to access a source of understanding or spirit when one considers the effect of living in a body that is either hyper-aroused and frozen. Other challenges are undertaking inventories where there are issues around executive functioning.
As dance therapists, what (if anything) can we helpfully do to serve those with ADHD and addiction? Does dance therapy have a role to play in supporting either regular therapy or addiction recovery?
I think perhaps yes.
For a start, we would do well, in general, to adopt neurodivergent therapeutic frames in our practice. Robert Chapman and Monique Botha (2022) argue that neurodivergence-informed therapy must include three essential elements.
First, the reconceptualisation of dysfunction as relational rather than individual.
Second, the importance of neurodivergence acceptance and pride, and disability community and culture to emancipate neurodivergent people from neuronormativity.
Third, the need for therapists to cultivate a relational epistemic humility regarding different experiences of neurodivergence and disablement.
Other important elements might be:
working with a therapeutic frame of compassion (Gilbert, Mate)
acknowledging the body as both a potential site of pain, trauma and discomfort and a source of bodily authority, wisdom and even spirituality
ethically using our own lived experience, with humility and care, to support our clients, and ourselves
holding space for emergent meaning and not-knowing
openness to both complexity (of experience) and the simplicity
supporting practical (simple) ways of working with the brain and the body, such as by supporting the sequencing of movements, as embodied ways to support structure
supporting creative work with embodied image, art-making and metaphor for all the above
supporting connection to self and others
acknowledging and supporting adversity-activated resilience, and
advocating for our clients outside the room, fiercely and tenderly
A last word.
Again, from Richard Rohr:
“in many spiritual traditions of the world, the body is viewed with fear and suspicion, considered to be the seat of desire and a best a dumb beast that must be trained and brought into submission to the personal will. But what is missed here - and is of crucial importance - is that the moving centre also carries unique perceptual gifts, the most important of which is the capacity to understand the language of faith encoded in sacred gesture.”
What do you think?
What does your body wish to move to tell you about your experience of this?
References:
Chapman, R., Botha, M. (2022). Neurodivergence-informed therapy. Preprint https://www.researchgate.net/publication/362159043_Title_Neurodivergence-Informed_Therapy
Gray-Hammond, David. (2020). The limits of the traditional twelve step program for autistic folk. https://emergentdivergence.com/2020/11/23/limits-of-the-traditional-twelve-step-program-for-autistic-folk/
Kelly JF, Humphreys K, Ferri M. Alcoholics Anonymous and other 12‐step programs for alcohol use disorder. Cochrane Database of Systematic Reviews 2020, Issue 3. Art. No.: CD012880. DOI: 10.1002/14651858.CD012880.pub2. Accessed 18 October 2022.
Rohr, Richard. (2011). Breathing under water: spirituality and the 12 steps.
Wilens, T. Impact of ADHD and its treatment on substance abuse in adults. J Clin Psychiatry 2004;65[suppl 3]:38–45).
