A struggling couple asks what ADHD has to do with one man's quick rages. His partner writes 'He can be a lovely person but it doesn't take much to make him snap , in particular with me.' Alcohol makes it worse. Melissa explores what could be going on, how it's related to ADHD, and how to respond.
"Emotional Lability" - which means responding to stimulus much more strongly and much more quickly than others do - is a core characteristic of ADHD for many adults. So this ADHD partner's emotionality is part of his ADHD and needs to be treated as such. He may be able to 'hide' it from others because his relationships are less meaningful with them. and so the triggers others create are less strong. But the issue remains and needs to be addressed for this couple to have a chance of feeling happy - and stable - together.
The woman who asked this question noted that her partner has a history of alcohol and drug usage, and that just two drinks can send him in to a fit of abusive, and sometimes incoherent, behavior. It's good to understand the role that alcohol can play here, because it is a trigger in itself. Part of his emotionality has to do with 'poor brakes' that come with ADHD - i.e. less ability to inhibit one's responses. Alcohol is known to lessen inhibitions - so what little control he does have he loses as soon as he starts to drink. Though it may be difficult, the best course of action would be to stop drinking or limit himself to one beer only. (Perhaps he can drink a non-alcoholic beer, or find a substitute drink he likes better?) The solution for this problem isn't about 'willing himself' more self-control - it's a physiological 'fact' about how his brain works.
In addition, many people with ADHD have addiction issues. Research suggests that between 21 and 53% of people with ADHD will have alcohol abuse issues at some point during their lives (the range is because different studies give different numbers depending upon how they were conducted.) The addiction issues for both alcohol and drugs are probably linked to three things - poor inhibition (as above) and also a tendency to do what feel good in the moment vs. what is good for themselves in the long-run. The third is that some, including Dr. John Ratey, think of ADHD as a sort of 'reward deficiency syndrome,' meaning that the chemical makeup of the brain in the reward centers are such that those with ADHD do more 'reward seeking' behavior than others. This means that when the alcohol or drugs feel good they just ignore the future consequences of the behavior (potential job loss, relationship problems and the like.) Also, some drugs, such as marijuana, play a role of calming the ADHD mind, which has its own 'feel good in the moment' attraction. This strong focus on the present moment, vs. future consequences is tied up with the executive functions of the ADHD brain - an area that many with ADHD have weaknesses in.
As for what to do about this. Here are some ways to address the issues:
- provide rewards in the moment (that feel good) for not drinking. If you are with him, you could play a role in this. Note, however, that he has to want to take this direction for this kind of support to work.
- medicinal treatment to increase inhibition. This might include anti-depressants used off label or other medications that give him some time to think before he acts (i.e gets into a rage). His doctor can provide specific recommendations.
- mindfulness training for inhibition - specifically set up for the purpose of being able to be more mindful of those moments before he loses control and moves into a rage - if he can identify those moments, then he should be able to set up a 'stop' routine. An example of that would be a verbal cue with you, where you or he identifies that things are going in a poor direction, and you have a set response (such as stopping the conversation right then or going to a different room to calm down.) Mindfulness could also help him identify stories he might be telling himself (such as 'she never gives me a break!') that are not true and that he could, when he hears them inside his head, 'fight' against.
- better treatment and management in general for ADHD. See the free treatment e-book on my home page for a good overview of what that entails.
- counseling or therapy to better understand his triggers. With ADHD I find that they are often tied up in the dynamics of the relationship. For example, he feels that you are 'parenting' him and resents your telling him what to do. (Conversely, you resent his not doing more...this is called 'parent/child dynamics.') For much more information about this, read my books - The ADHD Effect on Marriage and The Couple's Guide to Thriving with ADHD. In addition, I give a comprehensive couples seminar by phone that could help you both understand the dynamics between you. It's a great course that has helped many couples, and during which I answer all of the questions you ask me.
Because of the emotional lability and inhibition issues associated with ADHD, 'quick triggers' are quite common. To have a successful, healthy relationship, the party with the ADHD must make the effort necessary to get them better under control.