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).
Identify the current, specific ADHD behaviors that cause the most difficulty. (14, 15, 16)
Assist the client in identifying the current, specific ADHD behaviors that cause him/her/them the most difficulty functioning as part of identifying treatment targets (i.e. a functional analysis).
Review the results of psychological testing and/or psychiatric evaluation again with the client, assisting in identifying or in affirming his/her/their choice of the most problematic behavior(s) to address.
Ask the client to have extended family members and close collaterals complete a ranking of the behaviors they see as interfering the most with his/her/their daily functioning (e.g. mood swings, temper outbursts, easily stressed, short attention span, never completes projects).
List the negative consequences of the ADHD problematic behavior. (17)
Assign the client to make a list of negative consequences of ADHD that he/she/they have experienced or that could result from a continuation of the problematic behavior; process the list (or supplement with “Impulsive Behavior Journal” in the Adult Psychotherapy Homework Planner by Jongsma & Bruce).
Verbalize the powerlessness and unmanageability that resulted from treating ADHD symptoms with addiction. (18)
Using a 12-step recovery program's Step 1 exercise, help the client to accept his/her/their powerlessness and unmanageability over ADHD symptoms and addiction (or supplement with the Step 1 exercise from The Alcoholism and Drug Abuse Client Workbook by Perkinson).
Verbalize the relationship between ADHD and addiction. (19)
Using a biopsychosocial approach, teach the client about the relationship between ADHD symptoms and the vulnerability to substance use.
Implement a program of recovery structured to bring ADHD and addiction under control. (20)
Help the client develop a program of recovery that includes the elements necessary to bring ADHD and addiction under control (e.g. medication, cognitive behavioral therapy, environmental controls, aftercare meetings, further therapy; or supplement with “Mastering Your Adult ADHD” exercise in Mastery of Your Adult ADHD – Client Workbook by Safren, et al.).
List five ways a higher power can be used to assist in recovery from ADHD and addiction. (21)
Teach the client about the Alcoholics Anonymous concept of a higher power and how this power can assist him/her/them in recovery.
Participate in a medication evaluation and take medication as prescribed, if prescribed. (22, 23)
Refer for a medication evaluation; if ambivalent, use motivational interviewing techniques to help the client explore pros and cons toward agreement to adhere to the prescription, if prescribed (or supplement with “Why I Dislike Taking My Medication” in the Adult Psychotherapy Homework Planner by Jongsma & Bruce).
Monitor the client's psychotropic medication adherence, side effects, and effectiveness (or supplement with “Evaluating Medication Effects” in the Adolescent Psychotherapy Homework Planner by Jongsma, Peterson, McInnis, & Bruce); confer as indicated with the prescriber.
Increase knowledge about ADHD symptoms and their treatment. (24, 25, 26)
Educate the client about the signs and symptoms of ADHD and how they disrupt functioning through the influence of distractibility, poor planning and organization, maladaptive thinking, frustration, impulsivity, and possible procrastination (or supplement with “Symptoms and Fixes for ADD [now ADHD]” in the Adult Psychotherapy Homework Planner by Jongsma & Bruce).
Discuss a rationale for treatment that accordingly targets improvement in organizational and planning skills, management of distractibility, cognitive restructuring, and overcoming procrastination (see Mastery of Your Adult ADHD: Therapist Guide by Safren, et al.).
Teach the client how to monitor ADHD symptoms and assign monitoring tasks selectively for use in therapy.
Read self-help books about ADHD to improve understanding of the condition and its features. (27, 28)
Assign the client readings consistent with the treatment model to increase his/her/their knowledge of ADHD and its treatment (e.g. Mastery of Your Adult ADHD: Client Workbook by Safren et al., The Attention Deficit Disorder in Adults Workbook by Weiss).
Assign the client self-help readings that help facilitate his/her/their understanding of ADHD (e.g. Driven to Distraction by Hallowell & Ratey; ADHD: Attention-Deficit Hyperactivity Disorder in Children, Adolescents, and Adults by Wender; Putting on the Brakes by Quinn & Stern; You Mean I'm Not Lazy, Stupid or Crazy!? by Kelly & Ramundo); process the material read to reinforce relevant therapeutic concepts.
Invite a significant other to join in the therapy to provide support throughout therapy. (29)
