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a program of recovery from addiction, and reduce the negative effects of ADHD on learning, social interaction, and self-esteem.2 Develop the coping skills necessary to improve ADHD and eliminate addiction.
3 Understand the relationship between ADHD symptoms and addiction.
4 Sustain attention and concentration for consistently longer periods of time and increase the frequency of on-task behaviors.
5 Demonstrate marked improvement in impulse control.
6 Regularly take medication as prescribed to decrease impulsivity, hyperactivity, and distractibility.
7 Parents and/or teachers successfully utilize a reward system, contingency contract, or token economy to reinforce positive behaviors and deter negative behaviors.
8 Develop positive social skills to help maintain lasting peer friendships.
| SHORT-TERM OBJECTIVES | THERAPEUTIC INTERVENTIONS |
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Establish rapport with the client toward building a strong therapeutic alliance; convey caring, support, warmth, and empathy; provide nonjudgmental support and develop a level of trust with the client toward him/her/their feeling safe to discuss his/her/their ADHD vulnerabilities and their impact on his/her/their life. |
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Strengthen powerful relationship factors within the therapy process and foster the therapy alliance through paying special attention to these empirically supported factors: work collaboratively with the client in the treatment process; reach agreement on the goals and expectations of therapy; demonstrate consistent empathy toward the client's feelings and struggles; verbalize positive regard toward and affirmation of the client; and collect and deliver client feedback as to the client's perception of his/her/their progress in therapy (see Psychotherapy Relationships That Work: Vol. 1 by Norcross & Lambert and Psychotherapy Relationships That Work: Vol. 2 by Norcross & Wampold). |
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| Client and parents describe the nature of the ADHD including specific behaviors, triggers, and consequences. (3, 4) | Thoroughly assess the various stimuli (e.g. situations, people, thoughts) that have triggered the client's ADHD behavior; the thoughts, feelings, and actions that have characterized his/her/their responses; and the consequences of the behavior (e.g. reinforcements, punishments), toward identifying target behaviors, antecedents, consequences, and the appropriate placement of interventions (e.g. school-based, home-based, peer-based). |
| Rule out alternative conditions/causes of inattention, hyperactivity, and impulsivity (e.g. other behavioral, physical, emotional problems, or normal developmental behavior). | |
| Complete psychological testing or objective questionnaires for assessing ADHD and substance abuse and/or to rule out emotional factors or learning disabilities as the basis for maladaptive behavior. (5) | Administer to the client psychological instruments designed to objectively assess ADHD (e.g. the ADHD Rating Scale-IV; Substance Abuse Subtle Screening Inventory-3; the Disruptive Behavior Rating Scale); give the client feedback regarding the results of the assessment; readminister as needed to assess response to treatment. |
| Identify and monitor the symptoms of ADHD and their impact on daily living. (6) | Teach the client how to monitor ADHD symptoms, rate their severity on a scale (e.g. 0–10), and (if indicated) record their consequences; implement daily self-monitoring. |
| Provide behavioral, emotional, and attitudinal information toward an assessment of specifiers relevant to a DSM diagnosis, the efficacy of treatment, and the nature of the therapy relationship. (7, 8, 9, 10) | Assess the client's level of insight (syntonic versus dystonic) toward the presenting problems (e.g. demonstrates good insight into the problematic nature of the described behavior, agrees with others' concern, and is motivated to work on change; demonstrates ambivalence regarding the problem described and is reluctant to address the issue as a concern; or demonstrates resistance regarding acknowledgment of the problem described, is not concerned, and has no motivation to change). |
| Assess the client for evidence of research-based correlated disorders (e.g. oppositional defiant behavior with ADHD, depression secondary to an anxiety disorder) including vulnerability to suicide, if appropriate (e.g. increased suicide risk when comorbid depression is evident). | |
| Assess for any issues of age, gender, or culture that could help explain the client's currently defined problem behavior and factors that could offer a better understanding of the client's behavior. | |
| Assess for the severity of the level of impairment to the client's functioning to determine appropriate level of care (e.g. the behavior noted creates mild, moderate, severe, or very severe impairment in social, relational, vocational, or occupational endeavors); continuously assess this severity of impairment as well as the efficacy of treatment (e.g. the client no longer demonstrates severe impairment but the presenting problem now is causing mild or moderate impairment). | |
| Verbalize the powerlessness and unmanageability that resulted from treating ADHD symptoms with addiction. (11) | Using a 12-step recovery program's Step One exercise, help the client to accept his/her/their powerlessness and unmanageability over ADHD symptoms and addiction (or assign the client to complete the Step 1 exercise from The Alcoholism and Drug Abuse Client Workbook by Perkinson). |
| Verbalize the relationship between ADHD and addiction. (12) | Using a biopsychosocial approach, teach the client about the relationship between ADHD symptoms and the vulnerability to substance use (see Substance Use in Adolescents with ADHD by Kennedy et al.). |
| Implement a program of recovery structured to bring ADHD and addiction under control. (13) | Help the client to develop a program of recovery that includes the elements necessary to bring ADHD and addiction under control (e.g. medication, behavior modification, environmental controls, aftercare meetings, further therapy); (or supplement with “Developing a Recovery Program” in the Addiction Treatment Homework Planner by Lenz, Finley, & Jongsma). |
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