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fails to give close attention to detail or makes mistakes.

      3 Often fidgets with or taps hands and feet, or squirms in seat.

      4 Often has difficulty sustaining attention in tasks or activities.

      5 Often does not seem to listen when spoken to directly.

      6 Often feels restless.

      7 Often does not follow through on instructions and fails to finish duties.

      8 Often unable to engage in leisure activities quietly.

      9 Often has difficulty organizing tasks and activities.

      10 Is often “on the go,” acting as if “driven by a motor.”

      11 Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort.

      12 Often talks excessively.

      13 Often loses things necessary for tasks or activities.

      14 Often interrupts, doesn't wait for his/her/their turn, or blurts out answers before a question has been completed.

      15 Is easily distracted by extraneous stimuli.

      16 Is often forgetful in daily activities.

      17 ADHD increases vulnerability to addiction.

       

       

       

       

       

       

LONG-TERM GOALS

      1 Maintain 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 Reduce impulsive actions while increasing concentration and focus on activities.

      5 Minimize ADHD behavioral interference in daily life.

      6 Accept ADHD as a chronic issue and need for continuing medication treatment.

      7 Sustain attention and concentration for consistently longer periods.

       

       

       

       

       

       

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SHORT-TERM OBJECTIVES	THERAPEUTIC INTERVENTIONS
Work cooperatively with the therapist toward agreed-upon therapeutic goals while being as open and honest as comfort and trust allow. (1, 2)	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 express his/her/their ADHD vulnerabilities and their impact on his/her/their life and addiction.
	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).
Describe past and present experiences with ADHD, including its effects on functioning. (3)	Conduct a thorough psychosocial assessment including past and present symptoms of ADHD and their effects on addiction, as well as educational, occupational, and social functioning.
Complete psychological testing or objective questionnaires for assessing ADHD and substance abuse. (4)	Conduct or arrange for psychological testing (e.g. Conners Adult ADHD Rating Scales, Substance Abuse Subtle Screening Inventory-4) to further assess ADHD, other possible psychopathology (e.g. anxiety, depression), and relevant rule-outs (e.g. learning disability/antisocial features); provide feedback of testing results; readminister as needed to assess response to treatment.
Implement remedial procedures for any learning disabilities that add to frustration. (5)	Refer the client to an educational specialist to design remedial procedures for any learning disabilities that may be present in addition to ADHD.
Cooperate with and complete a medical evaluation. (6)	Arrange for a medical evaluation to rule out nonpsychiatric medical and substance-induced etiologies (e.g. hypo/hyperthyroidism, stimulant use, thyroid replacement meds).
Comply with all recommendations based on the medical and/or psychological evaluations. (7, 8)	Process the results of the medical evaluation and/or psychological testing with the client and answer any questions that may arise.
	Conduct a conjoint session with significant others and the client to present the results of the psychological and medical evaluations; answer any questions they may have and solicit their support in dealing with the client's condition.
Disclose any history of substance use that may contribute to and complicate the treatment of ADHD. (9)	Arrange for a substance abuse evaluation and refer the client for treatment if the evaluation recommends it (see the Substance Use chapter in this Planner).
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. (10 11, 12, 13)	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).