You Mean I'm Not Lazy, Stupid or Crazy?!: The Classic Self-Help Book for Adults With Attention Deficit Disorder (49 page)

13.
I am very sensitive to any kind of medicine … I am afraid of having a negative experience
.

If you have fears, respect them. It does no good to try to frog-march yourself toward something that really scares you. Beliefs are very powerful. The placebo effect can actually work in a negative way—your fears can produce unpleasant effects. Be aware, however, that some adults with ADD have had the
experience that they are not so sensitive once they have calmed themselves down through meditation, coaching and other strategies. Dave’s story in the meditation chapter is a good example of this.

14.
I don’t want to be dependent on a drug
.

Do you mean you don’t want to realize that your functioning/dys-functioning has a biological basis? This one can be a tough hurdle. Acknowledging that we
can’t do everything all by ourselves through sheer force of will can be a bitter pill to swallow. Ask anyone who has worked the Twelve Steps and they will tell you
that the surrender part is the most challenging. Not the surrender itself, but allowing oneself to get out of the way so a Higher Power can take over. Have you ever considered that your Higher Power might just be offering to take the
burden off your shoulders in the form of a medicine? Most of us have trouble accepting help in any form. We have been programmed to believe that we must be independent at all costs. This belief does not serve us.

15.
Will I have to take medicine for the rest of my life?

Maybe, maybe not. Of course, the choice to take medicine is always yours. It is not a “have to” but a decision based on what serves you at a given time. In general, ADDults seem to need less medication over time—we have taken an informal poll of a number of professionals who have treated adults with ADD for a decade or more. There is
no research available that would give us clues as to why this would be so, but we have a few theories:

• When you are medicated you work more effectively—this includes psychological work as well as the work of putting supportive systems in place. When you are anxious or disturbed, the ADD symptoms get worse. The medication often allows us to get our lives running more smoothly, thus there is less need for a higher dose.
  
• Does taking medication over time actually foster positive changes in the brain?
  KK:
  “For example, I have not taken stimulants for the past ten years. Ten years ago I noticed that my baseline brain functioning had changed. I no longer experienced the same level of mental fog that had plagued me all my life … this was off medication. I discussed this surprising development with a neuroscientist friend. He said that there was evidence that some antidepressants might actually reset the brain. He didn’t know of any similar findings on stimulants but stated that it was not out of the realm of possibility.
  

“Over the years, I have noticed that my ADD symptoms appear in specific situations—my baseline functioning is pretty good, but when I am dealing with psychological
issues or certain performance challenges the symptoms come back. The more I face those challenges and deal with them the less the symptoms interfere. However, please don’t take this information as a recommendation to say no to medication. I was on stimulants for five years, and I don’t think I could have gotten where I am today without that jump-start.”

Don’t forget that we carry a lot of baggage
as a result of living our lives with an unidentified neurological difference. We have skill deficits and life messes to clean up, as well as emotional fallout that needs to be processed. These challenges add to our mental processing load. When we get farther along on the path of recovery, the need for medication is likely to change.

In the realm of possibility … what would happen if every ADD
child was totally accepted for who they were from the very be
ginning? What if our schools and other institutions didn’t make us wrong, but worked with our differences? What if we never had to be institutionalized at all? It used to be thought that ADD was a disorder of childhood, that we matured out of it at some point. The growing number of diagnosed adults blows that theory out of the water.
But what if we never heard the message that we were defective? Without the overlay of guilt and shame and fear, might we have outgrown our ADD?

16.
I heard that some people get psychotic from taking stimulant medication. Is this true?

If you also have bipolar disorder, taking stimulant medicine for your ADD may trigger a manic episode. It is important to let your doctor know if you or any close
family members have a bipolar history. He or she may prescribe a mood stabilizer (such as Lamictal or Depakote), and then add medication to treat your ADD.

17.
I took Ritalin before and it didn’t help me (or I had a bad experience with it)
.

All stimulant medications are not the same. You may have uncomfortable side effects on Ritalin, for example, but do very well on Dexedrine or Adderall. Or
the situation can be reversed. Side effects are not the only issue. Many people find that there is a dramatic difference in effectiveness between different stimulants. Doug Pentz, Ph.D, is codirector of The Affinity Center, a Cincinnati clinic specializing in ADD and related disorders. His advice is to keep trying. In his experience, 95 percent of the adults treated at The Affinity Center eventually
find a medication or combination of medications that work for them.

18.
Will I get addicted?

There is no evidence that taking stimulants in therapeutic doses leads to dependence or abuse. In fact, there is evidence that successful treatment of ADD with stimulants lowers the chances of substance abuse. Think about it: Impulsivity is one
of the hallmark symptoms of ADD. If your stimulant medication
gives you the ability to stop and think, you will be less likely to make choices that don’t serve you. In the book
When Too Much Is Not Enough
, author Wendy Richardson says that “some professionals believe that ADHD medication has a high potential for abuse. If this were true, why do so many with ADHD forget to take it? Those with ADHD who are addicted to sugar, alcohol, or street drugs sure don’t
forget to use them.”

19.
I am an alcoholic/addict in recovery … doesn’t that mean I can’t take these drugs?

No. It means that you need to be more cautious than the average ADDer. We recommend that you read Wendy Richardson’s books for more detailed information, but we will include a few highlights here. The stage of recovery is very important. The following information is from
When Too Much Is Not Enough
by Wendy Richardson, who adapted recovery stages from the work of Terence T. Gorski and Merlene Miller (
Counseling for Relapse Prevention
[Independence, Mo.: Herald House-Independence, 1982]).

Pretreatment:
This is the stage before alcoholics or addicts enter treatment. When the addiction is out of control, it is not the time to treat ADD with medication.

Stabilization:
This is
a time of physical and emotional detox. Treatment for ADD is also not recommended during this stage.

Early Recovery:
This is not the ideal time to begin medical treatment for ADD. The commitment to recovery is not as solid as it needs to be. There are people, however, who are affected by ADD to such an extent that they can’t focus enough to participate in recovery programs. In those cases, it
may be necessary to treat the ADD with medication. Of course, it is important that these individuals be highly motivated and monitored closely. They need to be involved in an active recovery program.

Middle Recovery:
This is the stage of creating a life based on recovery. It is now time to begin the process of evaluating and treating ADD. It can help you stay sober and increase the quality of
your life.

Ongoing Recovery:
This may be a stage when untreated ADDers are challenged by feelings of frustration, anger, shame and confusion. They have been working hard at recovery—doing all the right things—but don’t seem to be getting anywhere. The problems with jobs, relationships and concentration are still there. Treatment with medication can support further recovery and prevent relapse.

What Do I Do Next?

I want to try medicine.

Do some comparison doctor shopping. Ask other adults with ADD who live in your area for referrals. If you don’t know any, go to the CHADD Web site (www.chadd.org) and click on Support. There is a locator function that will provide information on CHADD chapters in your state. Go to a meeting and ask other ADDults for suggestions on physicians who are
experienced with ADD. Another option is to go to addconsults.com. For a fee, you can hire someone to do the legwork and find ADD-savvy professionals in your area.

Get an Official Diagnosis

Avoid bursting into your doctor’s office with guns blazing, demanding an immediate prescription for the ADD you have self-diagnosed. We are only partly joking … this has actually happened more than once. Well,
not the guns part, but the attitude. It’s important to form a partnership with your prescribing physician, and it certainly doesn’t help to create an atmosphere of attack and defense on the very first encounter.

Remember, You Are the Customer

It is important to work with your doctor, so what should you do if your doctor is not a good fit for you? For example, if you are a person with years of
sobriety, who has come to realize that treating your ADD is now a priority, it doesn’t help to have a physician who believes that stimulants should never be used by recovering individuals. Look for a doctor who has some experience treating people with ADD and addictions. If your doctor always seems in a rush and doesn’t seem to listen to you or have time for your concerns, let him know that this
is not working for you. If your attempts to communicate aren’t getting through, go shopping again.

Finding a Doctor

The Doctor Test

Most of the advice given on how to evaluate a physician’s experience with ADD is pretty general. You are told to ask a prospective doctor questions like:

How many ADD patients do you have?

Have you had specialized training in ADD?

What’s your philosophy about treating ADD?

These are not bad questions, and we encourage you to ask them. However, they are
not specific enough. Read this chapter and ask the following additional questions when you are interviewing a prospective physician:

Can you explain rebound to me?

Can you tell me about extended release versus regular stimulant medication?

Can you tell me a little about how a stimulant can settle my brain down?

Please tell me about the difference between Strattera and Ritalin.

No One Local?

You may not be able to find an ADD expert right in your backyard.
If this is the case, you have a few options. You can travel. Many ADDults end up pursuing the long-distance option. A number of specialty practices are willing to set up a concentrated ADD evaluation and medication trial package for out-of-towners. Unless you are willing to travel every three months or so after the initial evaluation,
you will also need to find a local doctor who is
willing to work with you and the long-distance folks. In fact, most of the centers who do this insist that you have a local doctor to monitor your progress more closely. If travel is not an attractive option, seek out someone who has at least some experience treating ADD. When you are doctor shopping, look for someone who can admit that they don’t
know it all, and who is open to input from others with more expertise. It is possible to arrange for your doctor to have a phone consultation with an expert of your choice. You, of course, would be responsible for the payment, but this option is less expensive than travel.