Use of Cocaine in an Adult Man to ‘Treat’ Undiagnosed ADHD

"In these stories, the identities and locations have been changed to ensure client confidentiality.”

A 34-year old married man, who was a mid-level manager at a large retail company, was evaluated because of his drug use.  His addictive behavior had seriously impaired his functioning at work, his relationship with his family and his marriage.  As those situations deteriorated further he was encouraged to seek treatment by his family.

On evaluation, the client described himself as having mood swings.  He reported that when he used cocaine he would feel calmer and could think better, and was far more productive.  He also reported a history of numerous psychiatric interventions for hyperactive behavior as a child, which also included trouble paying attention, procrastination over homework assignments, and easy distractibility.

Due to the client’s unusual response to cocaine – the paradoxical response making him calmer and more focused, and the history of hyperactive behavior and trouble sustaining attention and focus, he was diagnosed with ADHD.  The client was begun on Wellbutrin and did extremely well.

He began individual and family therapy to first resolve the crisis he had caused through his cocaine abuse, and then to examine his self-defeating behaviors at home and at work.  Also explored was how his wife had enabled his substance abuse problems by refusing to firmly insist he seek treatment earlier in their marriage. He attended Narcotics Anonymous meetings on a regular basis, to help him maintain abstinence from the cocaine.