Expert: Christine D. DeLoatch, MA CCC-SLP - 1/4/2008

Question
Christine, I just read a previous response you made in this forum--(I must say I'm drawn by your qualifications and vocation to ask you a question--my girlfriend has ADD and is studying to earn a teaching certificate (in the state of NH)(she has been substitute teaching for six years and like you is especially interested in children with disabilities). First , before I ask a question, I would like to pick a bone with you , That is I wonder how you can say(in a previous response on this site, and I quote, "There is no risk of addiction when the medication is taken by someone diagnosed with AD/HD and when the medication is taken orally as prescribed".Wow. This flies in the face of my personal experience (i.e. I am an alcoholic and for me alcohol is an addictive drug)(for other people alcohol is not addictive). Following this train of thought , you have undoubtedly heard of people who died from there first snort of cocaine (an extreme allergic reaction), still others who have an immediate addiction (just gotta have it to attain that elusive euphoric feeling) and then finally that group who can take-it-or-leave-it. I'm not sure I'm making sense to you Christine, but, the question I have for you (or someone who you may know (a colleague perhaps) is ;my girlfriend had been taking Adderall for 5 years or so. Then the doctor was concerned about possible damage to the heart (due to the high dosage she was taking for  a period of two years at maximum allowable dosage. He put her on Focalin (March 07) and she tried it for three weeks. Then returned to the doctor requesting something different.(It was the end of the spring semester and she felt lost and incapable of completing her classes. The Dr. did not go back on his concern for her heart at that time (she had asked to be put back on Adderall), but did however, change the medication to Straterra. This she took for about four months - through the summer. Then college started up again, and she began to fall behind in classes, and also she is self-conscious of her figure and weight--Sooo the occasional comment when in a stressful situation concerning classes, or weight, or the ability to stay-up-late, sounded eerily like a crutch (and due to the timing of these statements was very akin to my  own experience of "what I need is a drink". More at stimulus-response: the trigger and then the behavior of the conditioned belief that the a magic bullet exists that gives that euphoric "great feeling" she speaks of. "I am better able to put my thoughts down on paper. The way that I'm thinking. Better organized too". ["when I'm taking Adderall". Maybe I'm paraphrasing her, but the gist of the matter is, that she feels incompetent without the stimulant "Adderall". ----Many times we would get up in the morning and she'd be making the coffee and be in a not-so-la-la-land mood and decide to make the coffee triple strength. Or when I made the coffee, she would add instant to the equivalent of another two or three cups. In and of itself, nothing seems out of the ordinary, maybe a bit excessive with the caffeine but personal taste is golden. I often wondered however, about the "lost day" she would have due to the being "buzzed" on the "stimulant" [confused, stressed and easily distracted is how I'd describe her mental abilities after a "dose" of more than two cups at once. BUT I NEVER VOICED MY OBJECTION TO OVERDOING THE CAFFEINE-only commenting "moderation in all things" and "you know what you are doing" and "I'm good with one cup". --------------Hmmmmmmmmmmmm  Maybe that's it----I am good with just one cup---of coffee-BUT when it came to alcohol I found out the hard way that I could not have just one, (and the old saying o"one is to many and a thousand is not enough" certainly is true for me. Maybe, just maybe, a certain person (I am trying to be objective here)(not all people) with a stimulant problem, (once they are "introduced" to the euphoric feeling). Cristine, are you with me here? Is it possible that this substance is poison to this person, but not to others? (or the majority for that matter?) No matter how intelligent  the person is they just have no "control". !!!   Thanks for listening , and I hope that my girlfriend (I'd like to ask her to be my wife) can achieve her mark of making a difference in educating children as you have.
but had noticed a correlation or cause and effect between the getting a "buss" on the triple coffee and then spending the day at starbucks trying to study, but not accomplishing anything and feeling unproductive and not wanting to go out to dinner or to a movie (or canceling plans that we had made the week before to dinner. The lack of ability to communicate clearly with each other which we so cherish- love of the English language, puns, metaphors, science ,the outdoors- is so ERRATIC following this use (abuse?) of "stimulant" (caffeine) and now New Years eve was absolute hell; with the unexplainable behavior and inability to communicate well. The next day I said that I love you but I can not accept the lies of when you say you are going to be back and then you call an say I'm spending the night at my friends. The next day, my girlfriend came over and said "I've been taking Aderall for three months".  My immediate reaction was to tell her "you can leave"; I was so hurt and feeling foolish and used at being lied to(for three months)- I believe, and we have discussed this, and she says she agrees, that each others health concerns are to be shared openly and honestly--the denial of a drug issue was in my own past with the battle to come to the place of "been there , done that" "I am an alcoholic" and then the intervening years of getting the courage to ask for help (find a 12 step program).----------------------------------------------------------------------------- I digress. Her statement on New Years day took me by surprise. This explains a lot. This in light of the fact that we tried to explain the (her) need to go out to a bar [something she admitted last summer was a known side effect - to her - of taking Adderall], tried to explain the falling behind in her course work at college, tried to explain the lack of energy. So in the occasional reflective mode of trying to improve ourselves, and determine the cause of our occasional "spat"- In these discussions of why she felt stressed or needed a backrub or bla, bla, bla, she never once mentioned the fact that she had begun taking the stimulant medication "adderall" again.---------------------------Question: Isn't that denial? A classic symptom of addiction?---------------- In our discussions, no, our arguments of why she felt the need to lie to me and say that she would be home by ten or eleven at the latest. And then after the time she said she would be back home , she would call on the phone to say insulting to me. Then we'd get back together again and everything would be "mended". It would take at least three days because I refused to waste my breath talking to someone who had mixed alcohol with their med's, insulted me (which is something that I have not been aware of., when she is sober, But obviously I am feeling like a gullible fool right about now.------------------------------------------------------Causes were, work and play and family and friends (we go out to dinner and the movies pretty regularly, go for walks, and have wonderful conversations too, and of course the sweetest laugh in all the world which tells you that "I'm the luckiest man in the world" and "I am in love". =======Ah well, maybe it's the stress of the season. Maybe it's the stress of being two weeks late on her course work (term ended 12/17/07). Maybe we need "space" as she calls it. Maybe it's? I'm searching for answers on how to help, but my experience says you can NOT help someone until they (first realize they have a problem, and second they) ask for help. Further I'm not a Psychiatrist , or a drug counselor. I'm a friend who can listen and support her and tell her that everything she thinks says or does is right. We do have our occasional differences. At the end of the day we are grateful, and never let the sun go down on our differences. I realize that I have overstated the problem in an effort to be thorough. It has been cathartic too. I am a believer that everything turns out for the best. Keep the faith. Craig

Answer
My Dearest Craig,

Thank you so much for asking me your question. First of all I stand by my statement - .  "There is no risk of addiction when the medication is taken by someone diagnosed with AD/HD and when the medication is taken orally as prescribed." - with one caveat, that is when it is the correct diagnosis and medication.

Let me explain why. Research strongly indicates that individuals with a chemical deficit do not usually become addicted to the medication.  That is not to say there is no 'dependency.'  

Studies show that boys with ADHD who are treated with stimulant medication engage in less recreational drug usage.  Why? The rational is because the medication meets the need - and the boys do not seek to self-medicate through recreational drugs.

There are many components to answering your question.  I see how you might arrive at the explaination that your girlfriend may be 'addicted' to her medication - because she refuses to stop taking it in the face of health concerns.  That seems illogical.  I offer you the possibility that she may have become dependant on the medication but she may not be addicted.  Addiction is often a bio-chemical process as well as emotional.  If she is not going through withdrawl symptoms it is likely not a true addiction. (She may feel however that she cannot function without it - emotional dependency).

Most ADDers I know forget to take their medication and rarely do they go about the process of asking for increases in medication.  Taking medication is a pain in the rear and actually it usually reminds us that we are ab-normal and frankly it's not something we like to think about or deal with most often.  We can be a little immature about it at times.  

People with addictions often take more of the drug and can even become preoccupied about when they'll take the drug next and life begins to revolve around the addiction. In the book Overload: Attention Deficit Disorder and the Addictive Brain, it takes a look at why people often seek recreational drugs especially cocaine or alcohol in an effort to self-medicate.  The treatment prescribed is often stimulant medication to meet the brain's chemical need with the precise chemical that is lacking.  When the correct medication is taken - there is no euphoria - no desire to take more.  It just is okay.  

Cocain if often used to self-medicate, by people with ADD because it is a stimulant, but alcohol is often abused because you may feel restless (hyper) and are trying to quell that feeling of being driven like a motor, so you take a depressant.  

I would like to submit to you that your girlfriend may be attempting to self-medicate through drinking.  It is very possible that your girlfriend may need to take 2 medications - an anti-depressant and a stimulant or she may need a different medication.  

There is a class of medications called SSRIs- Selective Seratonin Re-uptake inhibitors. These medicaions help seratonin stay around in the brain to help the neurons process information more effeciently; but...

“it has been shown that there are numerous subtypes of receptor for any given neurotransmitter [for example…]

Several serotonin receptors have been cloned and are identified as 5HT1, 5HT2, 5HT3, 5HT4, 5HT5, 5HT6, and 5HT7. Within the 5HT1 group there are subtypes 5HT1A, 5HT1B, 5HT1D, 5HT1E, and 5HT1F. There are three 5HT2 subtypes, 5HT2A, 5HT2B, and 5HT2C as well as two 5HT5 subtypes, 5HT5a and 5HT5B.” (information taken from http://web.indstate.edu/thcme/mwking/nerves.html)


As you can see – that if one medication like Zoloft – connects with 4 receptors – another medication like Lexapro might connect with a different 4 and still another medication like Effexor might connect with still a different 4 – If the medication doesn’t connect with the areas your brain needs they you may not feel the full benefit of the medication and find yourself attempting self-medicate despite being on ‘a prescribed medication.’

I am not a scientist – but this research can be found in depth & detail in the book Overload: Attention Deficit Disorder and the Addictive Brain by David Miller and Kenneth Blum, Ph.D.   – Their information was reported in Scientific American at one point.  

I hope you are starting to see why I made  and make that statement.  I am aware that also what concerns you, is that your girlfriend lied to you.  You may feel that, that behavior is common among people with addiction.  This is true – but it is also common among those who have other dysfunctions.  

I would love it if you could talk with your girlfriend about your concerns.  You may need to encourage her continue to try other medications or a combination of medications.  The reason I mentioned the three medications above is because I have been on all of them.  I tried herbal supplements also.  Actually they all worked to a degree – but other stressors and my bio-chemistry changed in my life, which may have caused there to be a need for a different medication. (Since being diagnosed with AD/HD - I now have diabetes, a thyroid disorder and a vitamin deficiency.)

You could always try the stress management phrase I was taught in a class…

“ I know… but…so…”  It would go something like this.  “I know you feel the Adderal is the best medication for you, but I see that you are also using alcohol and caffeine to help also, so I was thinking that you may want to explore other medications that would prevent a heart condition and might meet all your needs so you didn’t feel the need to use caffeine and alcohol.”  You could throw in an “I really care about you, and I want you around so that we can plan for the future.”  You could see where you get with that.  

You may be surprised to know that many individuals with ADD, have a family history that includes alcoholism.  There is even a 12 step book for ADD.  I really feel you could be a wonderful helpmate for her.  

One last thing.  There is  also a book called ADD & Romance by Jonathan Scott Halverstadt, MS that is good for people in relationships.  You may want to look into it separately or together.  

Many Blessings to you.  I am sorry I took so long in responding.  I gave your question a lot of thought and research – because I wanted to be through.  

Christine