ADHD

[Par4thecourse]

I'd just like to add that a proper diagnosis and proper treatment of ADHD can be life changing and a truly life saving event for the individual born with this disorder. I've read about folks, talked to others and experienced personally how much help we receive through pharmaceuticals to address attentional issues. I get emotional trying to describe just what I mean. If you had known me when I was a child, lost, alone and damned as a small boy with this monster on my back, and the changes RX's have made in my life, you might not recognize me.

To my Harvard grad father, my Radcliffe summa cum laude mother, my admiral in the navy and surgeon grandfather, I was, for the first 20 years of my life "a goddamned son-of-a-bitch kid" who refused to study.

I yearned to learn. I longed to study. I wanted to be a doctor.

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[DD214_DOC]

I'd just like to add that a proper diagnosis and proper treatment of ADHD can be life changing and a truly life saving event for the individual born with this disorder. I've read about folks, talked to others and experienced personally how much help we receive through pharmaceuticals to address attentional issues. I get emotional trying to describe just what I mean. If you had known me when I was a child, lost, alone and damned as a small boy with this monster on my back, and the changes RX's have made in my life, you might not recognize me.

To my Harvard grad father, my Radcliffe summa cum laude mother, my admiral in the navy and surgeon grandfather, I was, for the first 20 years of my life "a goddamned son-of-a-bitch kid" who refused to study.

I yearned to learn. I longed to study. I wanted to be a doctor.

Same here. I still did pretty well despite not actually getting treatment until adulthood, but looking back I lament how much more I wanted to and could have accomplished. I'll also burst your bubble by telling you that, as you get older, stimulants don't work as well. At least, that's been my experience and also anecdotal evidence shared to me by treating physicians.

 

[Par4thecourse]

Thanks for your input. I'm familiar with some of the aspects of stimulants not working as well as time marches on. But, I feel like shouting, "I've been to the mountain top." In a very real sense, it makes little difference now. All that time it turns out, I wasn't a god damned son of a bitch kid, a lazy, ungrateful, good-for-nothing, spoiled bum. I never purposely or maliciously set out to defy my folk's good intentions. I never wanted to waste their money they spent on good schools and summer school and tutors. I was never who they thought I was and I can't find words to describe what that meant and still means to me. I had hated my guts. But, it wasn't my fault I couldn't learn.

Their message sank in and I came to believe whole-heartily that I was as bad as they described. I had to be no good. I couldn't explain to myself why I wouldn't do school work.

With my first dose of Ritalin, everything changed. I was listening to a brief 5 minute news summary on the radio and I heard every word of it. I never knew what that was like. And suddenly and completely unexpected, in an instant, I was paying attention! without straining or sweating. It was like a miracle. It was like a miracle.

 

[smalltownpsych]

Thanks for your input. I'm familiar with some of the aspects of stimulants not working as well as time marches on. But, I feel like shouting, "I've been to the mountain top." In a very real sense, it makes little difference now. All that time it turns out, I wasn't a god damned son of a bitch kid, a lazy, ungrateful, good-for-nothing, spoiled bum. I never purposely or maliciously set out to defy my folk's good intentions. I never wanted to waste their money they spent on good schools and summer school and tutors. I was never who they thought I was and I can't find words to describe what that meant and still means to me. I had hated my guts. But, it wasn't my fault I couldn't learn.

Their message sank in and I came to believe whole-heartily that I was as bad as they described. I had to be no good. I couldn't explain to myself why I wouldn't do school work.

With my first dose of Ritalin, everything changed. I was listening to a brief 5 minute news summary on the radio and I heard every word of it. I never knew what that was like. And suddenly and completely unexpected, in an instant, I was paying attention! without straining or sweating. It was like a miracle. It was like a miracle.

I am glad that the medication works so well for you and I have seen it work well for many patients. Unfortunately, my experience has been that they seem to be the minority of my patients. For any psychotropic medication, it seems there are always a few patients who benefit tremendously, but many more who are in the "it might be helping a little" category.

Your post also points out the confounds of environmental factors and the resultant internalized messages. For you, the medication had sufficient benefit to override or mitigate those factors, but when the effects of medication are minimal then they are stuck with the other factors plus one more.

 

[Shikima]

http://droree.blogspot.com/2016/04/adhd-public-health-fad-that-wont-fade.html

 

[Par4thecourse]

It is a strange phenomenon. I have never read an account about ADHD and the tremendous differences medication makes, period. Literally, every time I hear or read or watch something on t.v. about this topic, it is presented with a negative twist. The disorder doesn't really exist, or it's controversial, or the meds are dangerous, or a diet absent certain chemicals makes all the difference for the hyperactive kid.

"While the medications used to treat ADHD can be dangerous and addicting, if they are used properly they can be totally safe and hugely helpful. When they are used properly, and when they work, which is in 80 percent of people who have ADHD who try them, they are like eyeglasses for the mind: they produce mental focus. And, when monitored properly, they cause no side effects, other than appetite suppression without unwanted weight loss. Used properly, these medications are very safe and highly effective. First used to treat what we now call ADHD in 1937 (most people have no idea these medications have been around that long), stimulant medication can turn a child’s or adult’s life completely around. While medication should never be the only treatment (education, lifestyle modification, exercise, and coaching or tutoring should also be included), it can be an extremely helpful component of the treatment regimen." Ned Hallowell M.D. Driven To Distraction

I don't know what the exact rates of successful treatment are, but I do have a lot of confidence in Hallowell. I don't know how much medication helps the "average" person who has ADHD. Again, I trust Hallowell. But, I do know there are plenty of undiagnosed kids and adults and some of them may be spared lives of crushing failure, public humiliation and a profound and seemingly inexplicable pain in their hearts that just will not go away. (They who have suffered with this disorder will understand instantly.)

ADHD touches everything I am and I often find it to be a pretty cool blessing. We, ADHDers, seem to have some special qualities, it turns out, that I wouldn't trade. Energy, enthusiasm, empathy, the ability to spot a hurting person just like that. Big heartedness. Intuitiveness.

 

[Par4thecourse]

Very good points. I think the inattentive child does get in trouble a lot too, though, but you are right if the school and home environment has a more hyperactive/impulsive person getting all the attention, the inattentive child will get left out.

The thing I wanted to highlight instead of getting in trouble often is the part of not knowing why. This doesn't necessarily mean discipline, but just finding yourself yelled at or not meeting an expectation down the road, and not even realizing it until someone is giving you grief about it.

You are right. The sense of bewilderment kicks in, too, and self-deprecating thoughts and hatred. When I didn't even know what I had been doing when I got kicked out of class I was devastated. (Sometimes I knew as soon as I disobeyed a teacher, too, yet still dumbfounded that I could have been given instructions to be quiet and still instantaneously disregarded what I was told and kept talking anyway. I didn't mean to or deliberately, consciously defy her. It happened so quickly it baffled and hurt me. I wanted to be a good kid. I was viewed as rotten and despicable and that made my stomach ache. I hurt all over with no where to go.)

 

[Par4thecourse]

Thanks for your input. I'm familiar with some of the aspects of stimulants not working as well as time marches on. But, I feel like shouting, "I've been to the mountain top." In a very real sense, it makes little difference now. All that time it turns out, I wasn't a god damned son of a bitch kid, a lazy, ungrateful, good-for-nothing, spoiled bum. I never purposely or maliciously set out to defy my folk's good intentions. I never wanted to waste their money they spent on good schools and summer school and tutors. I was never who they thought I was and I can't find words to describe what that meant and still means to me. I had hated my guts. But, it wasn't my fault I couldn't learn.

Their message sank in and I came to believe whole-heartily that I was as bad as they described. I had to be no good. I couldn't explain to myself why I wouldn't do school work.

With my first dose of Ritalin, everything changed. I was listening to a brief 5 minute news summary on the radio and I heard every word of it. I never knew what that was like. And suddenly and completely unexpected, in an instant, I was paying attention! without straining or sweating. It was like a miracle. It was like a miracle.

Has anyone taken an RX and experienced a miracle?

 

[Shikima]

Has anyone taken an RX and experienced a miracle?

 

[Par4thecourse]

"Jesus Christ Superstar 1973 21HQ The Crucifixion Stereo {HQ} Repost"

I kept looking at this scene in a dream one night. I thought I was awake because I heard this woman crying, shrieking actually. And it got louder and louder. I opened my eyes and saw his mom kneeling about 20 yards away from him. She was writhing in agony.

I noticed he was hanging there with blood all over the place. A fine drizzle or mist tainted red obscured her a bit. I looked at him again, intently, looking for his reaction. Looking closer, straining to see his face through the crimson colored fog, I noticed his eyes were open and I could see her reflection in them. And it dawned on me that he was enduring her suffering. Part of his agony was watching his mom suffer.

And I heard her cry out. She was kind of hoarse and in a raging fury, "Why are you hurting my baby? Why? What did he do? What? Jesus, come down. Please!" Sobbing, "My baby boy. Please come down. Take him down! He never hurt anyone! Why are you doing this? Jesus, don't die. Please don't die. My precious baby."

 

[Shikima]

If anything, I think that the data at least tell us that giving a stimulant to a kid with ADHD probably doesn't increase their risk of substance abuse, as is often a concern when prescribing a schedule II controlled substance. Of course, that is predicated on the assumption that the kid actually has ADHD.

Just saw this yesterday - 18 yr old not doing well in college, had to drop out. Adderall XR 30mg daily and would abuse it to pull all nighters. Because of the high stimulating effects, started to buy xanax and klonopin for the downers effect. Smokes weed quite frequently. Can't regulate his mood and sleep schedule. Intelligent but I sent him packing to substance treatment and sent a letter shaming him.

 

[WingedOx]

Because of the high stimulating effects, started to buy xanax and klonopin for the downers effect.

well yeah, that's how you achieve perfect equilibrium.

At least it's the patient self-medicating so you can just cut him off. Trying to manage patients who have been put on similar regimens in small incremental steps over the years by prescribes is a whole different beast.

 

[WingedOx]

well yeah, that's how you achieve perfect equilibrium.

At least it's the patient self-medicating so you can just cut him off. Trying to manage patients who have been put on similar regimens in small incremental steps over the years by prescribes is a whole different beast.

so hey, funny story: About 15 min after I post this, I get a patient who's been coming to me from a private cash psychiatrist who actually used the word "equilibrium" to describe his regimen of 60 mg methylphenidate + 3 mg xanax + 5 mg diazepam per day (+ 10/325 hydrocodone/tylenol from PCP).

 

[Shikima]

so hey, funny story: About 15 min after I post this, I get a patient who's been coming to me from a private cash psychiatrist who actually used the word "equilibrium" to describe his regimen of 60 mg methylphenidate + 3 mg xanax + 5 mg diazepam per day (+ 10/325 hydrocodone/tylenol from PCP).

Nancy Reagan was right - "Just say no".

I shoo that customer base away.

 

[WingedOx]

Nancy Reagan was right - "Just say no".

I shoo that customer base away.

The funny thing is that the Valium is actually a new addition since the last time I saw him.

He landed in my lap because his psychiatrist wanted him to come to the VA for neuropsych testing for his short term memory issues. I'm not entirely sure what I should be doing with him, but I've made it clear that I refuse to co-prescribe, and if I'm going to do any med management for him, he needs to close his case with his private shrink. Basically I'm at a point where all I can do is document that I counseled him that he needs to have his medication regimen altered and wash my hands of it.

 

[Shikima]

The funny thing is that the Valium is actually a new addition since the last time I saw him.

He landed in my lap because his psychiatrist wanted him to come to the VA for neuropsych testing for his short term memory issues. I'm not entirely sure what I should be doing with him, but I've made it clear that I refuse to co-prescribe, and if I'm going to do any med management for him, he needs to close his case with his private shrink. Basically I'm at a point where all I can do is document that I counseled him that he needs to have his medication regimen altered and wash my hands of it.

And a referral to SUDS.

 

[WisNeuro]

He landed in my lap because his psychiatrist wanted him to come to the VA for neuropsych testing for his short term memory issues.

As a neuropsych, I hate these consults. Non-dementia aged people on a whole mess of stimulants, benzos, opiates, MJ, etc, and they're having short-term memory/attentional issues? You don't say. I wonder where that could be coming from? I wish some of my referral sources would just use common sense and Occam's razor before assuming that their 30 and 40 something patients had some extremely rare degenerative disorder rather than a med/SUD problem.

 

[PikminOC]

well yeah, that's how you achieve perfect equilibrium.

At least it's the patient self-medicating so you can just cut him off. Trying to manage patients who have been put on similar regimens in small incremental steps over the years by prescribes is a whole different beast.

In private practice I just don't accept these patients. Then it doesn't become my problem

 

[Par4thecourse]

You boys are in a unique position to offer hope to the drug addicted, the lost, the beat up men and women and kids who are stuck wandering out there in desperate need of a kind, top notch doctor. You are saving lives. The good you do is something most of us will never be able to accomplish.

 

[smalltownpsych]

You boys are in a unique position to offer hope to the drug addicted, the lost, the beat up men and women and kids who are stuck wandering out there in desperate need of a kind, top notch doctor. You are saving lives. The good you do is something most of us will never be able to accomplish.

Psychiatry is not necessarily a good place to go for help with substance dependence. I am sure you were being sarcastic, but I'm not sure why. What should a psychiatrist do with someone who desperately wants a benzo or stimulant to help them feel better and you are pretty sure it's not a good idea? I hope you realize that we watch them suffer every day and some of our flippancy is our our own coping and it does not necessarily equate to lack of compassion.

 

[birchswing]

Psychiatry is not necessarily a good place to go for help with substance dependence. I am sure you were being sarcastic, but I'm not sure why. What should a psychiatrist do with someone who desperately wants a benzo or stimulant to help them feel better and you are pretty sure it's not a good idea? I hope you realize that we watch them suffer every day and some of our flippancy is our our own coping and it does not necessarily equate to lack of compassion.

I read no sarcasm. I don't post most of the replies I write, but I had actually written one about the overestimation of a psychiatrist's abilities. Benzodiazepines are the most commonly prescribed drugs in my state by psychiatrists. So for me reading that post, I felt a twinge of irony. But look at the context. The poster said the psychiatrist gave him a miracle. I think it was sincere (though incorrect).

 

[smalltownpsych]

I read no sarcasm. I don't post most of the replies I write, but I had actually written one about the overestimation of a psychiatrist's abilities. Benzodiazepines are the most commonly prescribed drugs in my state by psychiatrists. So for me reading that post, I felt a twinge of irony. But look at the context. The poster said the psychiatrist gave him a miracle. I think it was sincere (though incorrect).

I could be wrong then and it is true that this poster has stated that the stimulant medication has helped them personally just as it has helped many of my patients. Even benzos, which can be more problematic, have their place in treatment. Unfortunately, the problem, of substance abuse confounds this all and some patients get painted with a broad brush. I am pretty good at separating the issues out and am very comfortable when dealing with patients with addiction, but many of my colleagues are not. I do think more emphasis on addiction and treatment needs to happen during training for both psychiatrists and psychologists. My dissertation was partially founded on that premise.

 

[birchswing]

I could be wrong then and it is true that this poster has stated that the stimulant medication has helped them personally just as it has helped many of my patients. Even benzos, which can be more problematic, have their place in treatment. Unfortunately, the problem, of substance abuse confounds this all and some patients get painted with a broad brush. I am pretty good at separating the issues out and am very comfortable when dealing with patients with addiction, but many of my colleagues are not. I do think more emphasis on addiction and treatment needs to happen during training for both psychiatrists and psychologists. My dissertation was partially founded on that premise.

I think that's a good goal, but I think it's an even better goal to stop some of the bleeding by changing the way doctors prescribe medicines. I've been told that it's PCPs who are doling out benzos, but now that I have found the ProPublic data on medicare prescribing, I can see that it is actually psychiatrists prescribing them most commonly. I visit askdocs on Reddit frequently and just came across this today:
https://www.reddit.com/r/AskDocs/comments/4kafzp/psych_best_anxietydepressionconcentration_meds_or/
A patient put on amphetamines and Xanax. It just doesn't stop. I hear all this "We didn't know then what we know now" but prescriptions for benzodiazepines have increased over the last decade. I was talking to my aunt today who sees a therapist. The therapist told her about a psychologist in the 1940s who went in as his normal self to an asylum and was diagnosed with everything under the sun. And I told her it's still happening. I don't know that it's possible to leave a psychiatrist's office without a diagnosis and a prescription. This forum would naturally tend to concentrate people who care the most about their profession. Someone who is just clocking in and out isn't going to come here to help fellow psychiatrists. So I don't say this to sound condescending toward members of this forum. I imagine members of this forum probably do see some patients in whom they find no diagnosis or medication necessary. Anyhow, my point was that helping people with substance abuse is a good goal, but stopping abusing people with substances is a bit more pressing. There's already help for people who are addicted to street drugs. Much less help for those with iatrogenic benzo dependence, for example.

 

[Par4thecourse]

Totally sincere. You guys are in a position to help these poor folks get their heads cleared up. Are you familiar with Dr. Silkworth of AA? He was a beloved physician of a number of alcoholics back in the 30s who were hopeless. He helped a bunch of them with his compassion, his honesty and his medical knowledge. That's all I was saying. You guys work with some people who desperately need your expertise and you are obviously trying to help them. Perhaps quite a few will reject all the benefits of your training and medical interventions and willingness to reach out to them, but some of them will be eternally grateful for everything you are trying to do for them.

Whose woods these are I think I know.
His house is in the village though;
He will not see me stopping here
To watch his woods fill up with snow.
My little horse must think it queer
To stop without a farmhouse near
Between the woods and frozen lake
The darkest evening of the year.
He gives his harness bells a shake
To ask if there is some mistake.
The only other sound’s the sweep
Of easy wind and downy flake.
The woods are lovely, dark and deep,
But I have promises to keep,
And miles to go before I sleep,
And miles to go before I sleep.


Couldn't help myself after seeing Birchswing's reference to Robert Frost

 

[birchswing]

Totally sincere. You guys are in a position to help these poor folks get their heads cleared up. Are you familiar with Dr. Silkworth of AA? He was a beloved physician of a number of alcoholics back in the 30s who were hopeless. He helped a bunch of them with his compassion, his honesty and his medical knowledge. That's all I was saying. You guys work with some people who desperately need your expertise and you are obviously trying to help them. Perhaps quite a few will reject all the benefits of your training and medical interventions and willingness to reach out to them, but some of them will be eternally grateful for everything you are trying to do for them.

Whose woods these are I think I know.
His house is in the village though;
He will not see me stopping here
To watch his woods fill up with snow.
My little horse must think it queer
To stop without a farmhouse near
Between the woods and frozen lake
The darkest evening of the year.
He gives his harness bells a shake
To ask if there is some mistake.
The only other sound’s the sweep
Of easy wind and downy flake.
The woods are lovely, dark and deep,
But I have promises to keep,
And miles to go before I sleep,
And miles to go before I sleep.


Couldn't help myself after seeing Birchswing's reference to Robert Frost

Beautiful. I love that poem. I am also happy for your optimism.

 

[smalltownpsych]

Totally sincere. You guys are in a position to help these poor folks get their heads cleared up. Are you familiar with Dr. Silkworth of AA? He was a beloved physician of a number of alcoholics back in the 30s who were hopeless. He helped a bunch of them with his compassion, his honesty and his medical knowledge. That's all I was saying. You guys work with some people who desperately need your expertise and you are obviously trying to help them. Perhaps quite a few will reject all the benefits of your training and medical interventions and willingness to reach out to them, but some of them will be eternally grateful for everything you are trying to do for them.

Whose woods these are I think I know.
His house is in the village though;
He will not see me stopping here
To watch his woods fill up with snow.
My little horse must think it queer
To stop without a farmhouse near
Between the woods and frozen lake
The darkest evening of the year.
He gives his harness bells a shake
To ask if there is some mistake.
The only other sound’s the sweep
Of easy wind and downy flake.
The woods are lovely, dark and deep,
But I have promises to keep,
And miles to go before I sleep,
And miles to go before I sleep.


Couldn't help myself after seeing Birchswing's reference to Robert Frost

Was he the one who wrote the dr.s opinion or was that Tiebout? I get them confused. Anyway, I am all about collaboration and cooperation between the medical community and the recovery community. So much that I should get a t-shirt made.

 

[vistaril]

the fact that the cash pay psychiatrist only had him on 3mg total Xanax daily dose is surprising. here you can get at least 4mg Xanax daily(sometimes 2 tid) plus the stimulant and you can use your insurance as well if you go to the largest group.

 

[Par4thecourse]

Was he the one who wrote the dr.s opinion or was that Tiebout? I get them confused. Anyway, I am all about collaboration and cooperation between the medical community and the recovery community. So much that I should get a t-shirt made.

Yes. It was Silkworth. He is held in high esteem by many in the recovering community. He was a rare physician at the time because he never quit on the addicted. He had a heart for those who he believed were sincerely trying to get well, but failed time after time. After Bill Wilson had his spiritual awakening and had remained clean for a stretch, he went to others who were suffering and preached religion to them without much success. He shared his frustration with Dr. Silkworth who listened patiently and without judgement. Then, he encouraged Bill to stop preaching and just let others know what had happened to him, if the topic came up.

The millions of people worldwide who have found sobriety in and through AA are the result of Wilson's heeding the doctor's advice.

 

[Par4thecourse]

I don't think there are any shortcuts here man. You still need a standard psychiatric evaluation examining symptoms, ruling out other medical or psychiatric causes for inattention, childhood hx, collateral info, ASRS screening tool, drug testing, referring out for neuropsych testing and TOVA, monitoring state pharmacy for abuse or diversion, etc... In the end it's a clinical diagnosis and you need to trust that the patient is not taking it as a performance enhancer or to get high.

"Diagnosis is made primarily by reviewing One's History; there is no foolproof “test” for ADHD (the preferred abbreviation for both disorders). In arriving at an accurate diagnosis it is important to look for other problems that may occur along with ADD, such as low self-esteem, depression, substance abuse or family turmoil. While the following lists may give you an idea if an evaluation for ADHD is appropriate, we strongly recommend getting diagnosed by a mental health professional if you suspect that you or your child may be ADHD.

• A sense of underachievement, of not meeting one’s goals (regardless of how much one has actually accomplished).
• Difficulty getting organized.
• Chronic procrastination or trouble getting started.
• Many projects going simultaneously; trouble with follow through.
• A tendency to say what comes to mind without necessarily considering the timing or appropriateness of the remark.
• A frequent search for high stimulation.
• An intolerance of boredom.
• Easy distractibility; trouble focusing attention, tendency to tune out or drift away in the middle of a page or conversation, often coupled with an inability to focus at times.
• Often creative, intuitive, highly intelligent
• Trouble in going through established channels and following “proper” procedure.
• Impatient; low tolerance of frustration.
• Impulsive, either verbally or in action, as an impulsive spending of money.
• Changing plans, enacting new schemes or career plans and the like; hot-tempered.
• A tendency to worry needlessly, endlessly; a tendency to scan the horizon looking for something to worry about, alternating with attention to or disregard for actual dangers.
• A sense of insecurity.
• Mood swings, especially when disengaged from a person or a project.
• Physical or cognitive restlessness.
• A tendency toward addictive behavior.
• Chronic problems with self-esteem.
• Inaccurate self-observation.
• Family history of AD/HD or manic depressive illness or depression or substance abuse or other disorders of impulse control or mood."

Who else? Dr. Ned Hallowell

 

[Par4thecourse]

yes this is wrong. the evidence is equivocal at best. patients with ADHD are more likely to have substance use problems, legal troubles, and die in accidents but there is no good evidence that treating ADHD makes any difference to these outcomes (data is mixed at best) though the ADHD moral entrepreneurs use the poorer outcomes to demand more access to treatment.

Having undiagnosed and untreated ADHD makes getting sober more difficult.

 

[smalltownpsych]

Having undiagnosed and untreated ADHD makes getting sober more difficult.

Research on that? What I have observed are patients who are focused on abusable medications trying to stay sober and not doing very well at all. It can also be very difficult for the other people in recovery to be around someone who is using adderall regardless of the reason. Why not just drink tons of coffee like the rest of them?

 

[Ceke2002]

Having undiagnosed and untreated ADHD makes getting sober more difficult.

Research on that? What I have observed are patients who are focused on abusable medications trying to stay sober and not doing very well at all. It can also be very difficult for the other people in recovery to be around someone who is using adderall regardless of the reason. Why not just drink tons of coffee like the rest of them?

Gotta agree with smalltownpsych on this, being (re) diagnosed with ADD and having it treated did exactly jack bugger all to help me when I was trying to get clean off various drugs of abuse and addiction. Not only was the medication prescribed for ADD not worth the cost/benefit analysis for me (it worked well, I just didn't like the side effects long term), it also made it harder for me not to then want to go out and use other substances. For me it was a case of 'take my prescribed dosage of dexamphetamine -- immediately start craving crystal meth -- cave in and score crystal meth -- immediately start craving heroin...lather, rinse, repeat'.

 

[Ceke2002]

I'll see your Eric Idle and raise you one Big Bill Broonzy

 

[Par4thecourse]

Treating both ADHD and addictions
It is not enough to treat addictions and not treat ADHD, nor is it enough to treat ADHD and not treat co-occurring addictions. Both need to be diagnosed and treated for the individual to have a chance at ongoing recovery. Now is the time to share information so that addiction specialists and those treating ADHD can work together. It is critical that chemical dependency practitioners understand that ADHD is based in our biology and responds well to a comprehensive treatment program that sometimes includes medications. It is also important for practitioners to support the recovering persons involvement in 12-step programs and help them to work with their fear about taking medication.

A comprehensive treatment program consists of:

a professional evaluation for ADHD and co-occuring addiction. Continued involvement in addiction recovery groups or 12-step programs

• education about how ADHD affects each individual’s life and the lives of those who love them
• building social, organizational, communication and work or school skills
• ADHD coaching and support groups
• close monitoring of medication when medication is indicated
• Support for an individual’s decision to take medication or not. In time they may realize on their own that medication is an essential part of their recovery.

Wendy Richardson, MA, LMFCC, CAS

Constant failure, low self-esteem, and depression reduce the chances for that individual to get sober. These are common experiences among the ADHD community. Allowing a person to use her talents fully through the proper diagnosis and treatment of ADHD, sets her free from the kinds of things which often lead to addictions.

 

[Ceke2002]

Treating both ADHD and addictions
It is not enough to treat addictions and not treat ADHD, nor is it enough to treat ADHD and not treat co-occurring addictions. Both need to be diagnosed and treated for the individual to have a chance at ongoing recovery. Now is the time to share information so that addiction specialists and those treating ADHD can work together. It is critical that chemical dependency practitioners understand that ADHD is based in our biology and responds well to a comprehensive treatment program that sometimes includes medications. It is also important for practitioners to support the recovering persons involvement in 12-step programs and help them to work with their fear about taking medication.

A comprehensive treatment program consists of:

a professional evaluation for ADHD and co-occuring addiction. Continued involvement in addiction recovery groups or 12-step programs

• education about how ADHD affects each individual’s life and the lives of those who love them
• building social, organizational, communication and work or school skills
• ADHD coaching and support groups
• close monitoring of medication when medication is indicated
• Support for an individual’s decision to take medication or not. In time they may realize on their own that medication is an essential part of their recovery.

Wendy Richardson, MA, LMFCC, CAS

Constant failure, low self-esteem, and depression reduce the chances for that individual to get sober. These are common experiences among the ADHD community. Allowing a person to use her talents fully through the proper diagnosis and treatment of ADHD, sets her free from the kinds of things which often lead to addictions.

You know I can't help noticing that every time someone, especially someone who also shares a diagnosis of ADHD/ADD, puts forward a dissenting opinion to your own that you seem to immediately jump to copy/pasting tracts of information to support your position without actually acknowledging that people with ADHD/ADD are individuals and what's true for one person is not necessarily true, or appropriate, for another. I'm really glad you experienced a bonafide miracle from your diagnosis and treatment, but I didn't, nor was my being diagnosed and treated helpful in anyway at all in regards to my getting clean off drugs -- and for you to indicate that somehow this means my own personal, and experiential position on the issue is somehow flawed, or wrong, is quite frankly a tad insulting.

I don't 'have' ADHD/ADD, I am an individual person with a diagnosis of ADHD/ADD - emphasis on the word 'individual'.

 

[Par4thecourse]

When asked for research on a topic, I oblige.

 

[Ceke2002]

When asked for research on a topic, I oblige.

And is what you quoted from a peer reviewed journal or publication? Because the only link I can find is an opinion piece on the website of a treatment centre. Here, this is more like what's expected when someone asks you to provide research. Just for future reference.

Prog Neuropsychopharmacol Biol Psychiatry. 2002 Apr;26(3):609-11.
Treatment of comorbid opiate addiction and attention-deficit hyperactivity disorder (residual type) with moclobemide: a case report.
Vaiva G1, De Lenclave MB, Bailly D.

http://www.ncbi.nlm.nih.gov/pubmed/11999916

edited to add: and proper research always takes into account that group which disproves the hypothesis as much as those that do.

 

[tvelocity514]

This is more of a child psych Q, but at what point do you say that the problem is that the child isn't getting enough structure and discipline/guidance at home vs prescribing a stimulant? To further complicate matters, even if you distinguish this, I feel like it's a whole other story to change the home life in order for the child to succeed (especially since we can't RX a better structured home).

 

[Shikima]

This is more of a child psych Q, but at what point do you say that the problem is that the child isn't getting enough structure and discipline/guidance at home vs prescribing a stimulant? To further complicate matters, even if you distinguish this, I feel like it's a whole other story to change the home life in order for the child to succeed (especially since we can't RX a better structured home).

New recommendations for younger children to learn from a behavioral model rather than starting off with stims.

 

[hamstergang]

This is more of a child psych Q, but at what point do you say that the problem is that the child isn't getting enough structure and discipline/guidance at home vs prescribing a stimulant? To further complicate matters, even if you distinguish this, I feel like it's a whole other story to change the home life in order for the child to succeed (especially since we can't RX a better structured home).

It's difficult. We know stimulants are very effective and can help a child succeed, so we don't want to withhold it. But we also know that fixing things at home and parent training is essential. If we prescribe a med on the initial evaluation, we give the parents permission to not change. But even if we don't give a medication, few parents make changes quickly.

So there's no great answer. Weigh the various factors in each individual case, or go strictly by the current guidelines.

 

[smalltownpsych]

When asked for research on a topic, I oblige.

And is what you quoted from a peer reviewed journal or publication? Because the only link I can find is an opinion piece on the website of a treatment centre. Here, this is more like what's expected when someone asks you to provide research. Just for future reference.

Prog Neuropsychopharmacol Biol Psychiatry. 2002 Apr;26(3):609-11.
Treatment of comorbid opiate addiction and attention-deficit hyperactivity disorder (residual type) with moclobemide: a case report.
Vaiva G1, De Lenclave MB, Bailly D.

http://www.ncbi.nlm.nih.gov/pubmed/11999916

edited to add: and proper research always takes into account that group which disproves the hypothesis as much as those that do.

Exactly what Ceke said. It would be fine to state that the treatment you received for ADHD has been helpful for you in maintaining sobriety. Just as Ceke stated that it hasn't. That is anecdotal evidence that should not be generalized to others because we really don't know if these are exceptions or the rule. I think that earlier statement from splik that the research is equivocal at best is probably fairly accurate and if I know splik there are plenty of studies that they could cite to back that up. I think that he or she might have already done that in another thread.

 

[Par4thecourse]

Comorbidity of Alcohol and Substance Dependence With Attention-Deficit/Hyperactivity Disorder (ADHD)
Martin D. Ohlmeier; Karsten Peters; Bert T. Te Wildt; Markus Zedler; Marc Ziegenbein; Birgitt Wiese; Hinderk M. Emrich; Udo Schneider

The present study results thus appear to be of particular importance in terms of preventive medicine. Several investigations have shown that the treatment of children suffering from ADHD with methylphenidate (MPH) reduces the risk of later substance abuse (Biederman et al., 1999; Huss 1999). In a long-term study over 5 years, considerably less use of addictive substances was observed in patients with ADHD who had received therapy with MPH than in untreated ADHD patients (Loney 1988). Adolescent ADHD patients who were treated with stimulants thus appear to have a lower risk of developing an addiction (alcohol, cocaine, and other drugs) and engage in less substance use (Biederman et al., 1999). On the other hand, various studies have demonstrated that the treatment of ADHD patients suffering from addictive illnesses with stimulants reduces their substance abuse and craving (Levin et al., 1998a, 1998b; Riggs et al., 1998). Under therapy with MPH, reduced cocaine craving and an improvement in ADHD symptoms was described in ADHD patients engaging in cocaine abuse (Levin et al., 1998b; Schubiner et al., 2002).

Attention Deficit Hyperactivity Disorder in Adults 2010
By Russell Barkley
pgs 26 -29

 

[Par4thecourse]

The Self Medication Hypothesis:
ADHD & Chronic Cocaine Abuse

A Literature Review
By Daniela Plume B.A / April, 1995

Medication can often make the difference between completing or not completing drug treatment programs. Ralph and Barr (1989) found 70%-80% of individuals with ADHD show an improved response to stimulant medication when compared to controls on placebo. These researchers maintain that therapeutic doses of stimulant medications for individuals with ADHD do not produce euphoria, but rather, enhance behavior. Zweben and Smith (1989) have noted that in some chemical dependence treatment settings and among some practitioners, all-or-none thinking about medications exist such as: "never use benzodiazepines with recovering alcoholics" or "never give psychoactive substances to psychoactive substance abusers". These kinds of thinking can impede the proper treatment of ADHD in cocaine addicts. Treatment of ADHD symptoms has been shown to improve self-control and decrease impulsivity, emotional lability, and anxiety; enabling the patient to become more actively involved in substance abuse rehabilitation therapies (Zweben & Smith, 1989; Khantzian, 1983, 1984). Cavanagh (1989) and Turnquist (1983) both assert that the symptoms of ADHD compromise the quality of sobriety and may also render such individuals at particularly high risk for relapse due to their "innate discomfort". An attitudinal shift towards a medical problem (as opposed to a moral one) may further aid in alleviating depression and improving self-esteem through the reduction of guilt and blame (Turnquist et al., 1993).

 

[FlowRate]

Has anyone taken an RX and experienced a miracle?

Yes. I'd argue there are a number of life-changing treatments available for several disorders.

A common example might be wearing glasses for the first time.

 

[Par4thecourse]

Yes. I'd argue there are a number of treatments available for several disorders which are life-changing.

A common example might be the first time one gets glasses.

Perfect example. It is often used as an illustration to help explain the profound differences medication makes for the ADHD sufferer. Wouldn't it be appropriate for our gang of misunderstood, minimized and traumatized members to be recognized publicly with such a profound disability say as legal blindness with its treatment as noncontroversial and efficacious as glasses for nearsightedness?

Instead, our bunch is subjected to endless criticism, debate, fierce often bitter arguments, uncertainty, innumerable theories and opinions, dismissal, denial, suspicion, wild accusations and away we go!

For indeed, putting on a pair of glasses that converts a person's 20/500 "vision" to 20/20 is exactly what it's like to have our meds kick in. It is incredible! It is unbelievable! But, we better not say so in public. Nope. Everything drug related is taboo. For most of our lives we were restrained and damned by inexplicable failures to achieve. Now, we can thrive and accomplish what we once considered impossible and in effect we're told to back off. Shhh! Don't you go bragging about what speed did to you.

 

[Therapist4Chnge]

It is a strange phenomenon. I have never read an account about ADHD and the tremendous differences medication makes, period.

I'd guess it makes for boring news, so I doubt a news outlet would offer space to hear about someone doing well.

 

[Therapist4Chnge]

so hey, funny story: About 15 min after I post this, I get a patient who's been coming to me from a private cash psychiatrist who actually used the word "equilibrium" to describe his regimen of 60 mg methylphenidate + 3 mg xanax + 5 mg diazepam per day (+ 10/325 hydrocodone/tylenol from PCP).

What...no Ambien?

 

[FlowRate]

Instead, our bunch is subjected to endless criticism, debate, fierce often bitter arguments, uncertainty, innumerable theories and opinions, dismissal, denial, suspicion, wild accusations and away we go!

Well there's the rub with most psychiatric syndromes, although I certainly recognize that it must be frustrating.

 

[Par4thecourse]

Autism is exalted, as it should be. It is a very real and profound condition garnering widespread compassionate interest and resolve to find its causes and solutions. Our beloved media and the public don't trash the very concept of autism.

ADHD? It's more or less a big joke, a big rather controversial joke. ADHD is not held as a disruptive, serious, crippling malady worthy of a respectful place in our public consciousness. And that is tragic. Not only do the afflicted encounter challenges from every direction daily just to survive with some measure of dignity due to the inability to pay attention consistently, but we are deluged with non-stop criticism that challenges the authenticity and the very nature of our plight in the first place.

We don't question, disregard or insult a person lying on the ground, bleeding with a compound fractured femur. That's why I want this brave, relentless and downtrodden band of bruised warriors to begin to rally, to organize and to demand respectful recognition.

 

[Par4thecourse]

I'd guess it makes for boring news, so I doubt a news outlet would offer space to hear about someone doing well.

Would it be boring if we found the means to treat autism successfully?