Taking a longer approach to life is called for here. We are all passing through life acquiring strengths and attributes that are cultivated by facing tests and challenges. This view tolerates no regret of the past. One’s life is seen in phases that provide opportunities for growth at each step. Most of the ADHD patients are more empathic with the life struggles of others precisely because they themselves have been through so  much!

In the words of Baha’u'llah reminding us with Divine Authority:

“Sorrow not if, in these days and on this earthly plane, things contrary to your wishes have been ordained and manifested by God, for days of blissful joy, of heavenly delight, are assuredly in store for you. Worlds, holy and spiritually glorious, will be unveiled to your eyes. You are destined by Him, in this world and hereafter, to partake of their benefits, to share in their joys, and to obtain a portion of their sustaining grace. To each and every one of them you will, no doubt, attain.”

Gleanings from the Writings of Baha’ullah, #153

As I began to share my assessment and clinical insight regarding the need for tolerance/dependence and possible addiction evaluation, he became angry, indignant and insulting.  He demanded to be refunded for the visit.  I noticed a surge of frustration, anger and disgust in myself. This man was insulting and devaluing the very foundation of  the medical diagnostic process. He was making it difficult for a legitimate ADHD-afflicted patient to seek treatment.

Once it became obvious to him that he was not getting his way, he angrily left the office slamming doors, shouting profanities, and frightening the other patients in the waiting area.  He called the office a few minutes later and was verbally abusive to the staff and me on the phone.  For some reason the face of  my tired, innocent medical student daughter flashed through my mind asking me earlier that morning, “Dad, what’s the most common tumor of the salivary glands?”  Enjoy learning the hard science of medicine now, my dear, as the day to day life of a doctor will bring you trying scenarios in dealing with extremes of human behavior!

Mindfulness and awareness are needed here. First, the cognitive distortion needs to be addressed. The usual tendency is to discount the positive and hyper-focus on what went wrong. Next, distancing oneself  from the thought chatter and observing one’s reactions in a mindful state is crucial. If the emotions still do not want to loosen their grip, self-soothing strategies such as relaxation, humor, and psychotherapy can come to the rescue. Don’t give in to the rumination, it tends to want to take root and spoil the present moment. It has a tendency to stop the flow of life energy and create a root ready to grow at the next encounter.

The ADHD brain craves surges in dopamine (the reward and novelty neurotransmitter of the brain), causing many ADHDers to appear as if they have a higher sex drive than others.  They desire more sex.  My clinical observation is that this is an attempt to correct the underlying imbalance in order to gain calm and peace, albeit transiently.  Paradoxically, for many ADHDers an ideal sexual encounter is just a fantasy, and real life sexual relationships requiring commitment and patience are too laborious and boring.  Obsessing about sex fills this gap by providing a displacement/distraction and release with minimal effort.  YourBrainonPorn.com is excellent resource on neurobiology of pornography addiction and sexual physiology with many implications for the ADHD population.

If the sexual libido is persistently elevated, bipolar diagnosis needs to be considered (see Mood Disorder Questionnaire).  The ADHDer focus on sex is more an expression of relieving boredom and seeking novelty.  Preoccupation with an imagined problem and attempts to control it only serve to accentuate the behavior.  Understanding the underlying psycho-physiological processes and being patient with oneself enhances the sense of serenity and acceptance that many ADHDers lack.  Shame, guilt, and labeling a benign behavior as an ’addiction’ perpetuates the stigma and a characteristic self-deprecating attitude!

The unspoken clinical truth is that most doctors with a ”satisfied customer” mentality treat the symptoms without any reference to the core problems. Typical examples are overtreating undefined pain with opiates, ordering unnecessary medical tests, and nonjudicious use of stimulants. These problems in my opinion are not even responsive to traditional forms of psychotherapy.  Spirituality, self-care, personal growth, exercise, and nutrition are often lead to better results in transforming such entrenched dysfunctional styles of coping.

Applying labels such as bipolar, ADHD, and anxiety disorders frequently lead to overdependence on medications and therapists, and perpetuation of the suffering. Imagine the savings in health care costs as well as the improved health of our nation which will result when doctors begin to address these issues without the fear of bad reviews or institutional policies. Let’s all take more responsibility for our health, growth, and personal transformation.

Your family doctor gave you a prescription for Xanax and voila, you discovered a new best friend. It helped all your symptoms calm down; you began taking higher and higher doses. Your family doctor expressed some concerns, but to keep you satisfied and content refilled your prescriptions. You began to take Xanax just to relax before or after a meeting or to tolerate the kids nagging once you came home from the office.

You have developed a dependence on benzodiazepines. This is a very serious condition. Benzodiazepines, in low doses, have a role in short term therapy for certain conditions such as panic disorder, muscle relaxation and seizures. Tolerance and dependence need to be very closely monitored. For the majority of patients they could be life saving and beneficial in short term treatment, and have to be combined with psychotherapy and other more benign tools that do not cause dependence and tolerance.  Keep an open mind and willingness to observe a tapering regimen when you seek consultation with a specialist. You might need a few days of inpatient detoxification to begin addressing the issue. Insisting on having your prescription filled as before quickly classifies you as a drug seeking addict and poses many other challenges. Stopping the medicines suddenly on your own could cause seizures and death. Give it some time, with proper medical care and patience you will regain your balance.

I am often asked whether stimulants are an appropriate choice as part of a treatment program.  Although there are varied views on this topic by the experts in the field, my own clinical approach as an addictionologist is very clear. I advise avoiding any scheduled substances including stimulants and benzodiazepines in this population. I am also much more careful and demand a higher level of thoroughness to establish a diagnosis of Adult ADHD.  A brain injured by chemical dependence needs time and patience to recover.  Rehabilitation and observing sobriety remain the primary goals. There are many behavioral and non-medication interventions that prove quite helpful.  The spiritual joy of recovery, attention to better nutrition, exercise, and group support will promote new and healthy habits with profound implications in daily activities.  Don’t insist on chemical solutions; you have found the solution in your recovery program already!

Life began to unfold; you noticed little problems in the relationship annoying you. His procrastination, inability to complete tasks, impulsive decisions, and restlessness seemed less charming as the months and years went by. You were blessed with two adorable children. After much pain and self-blame, your oldest son needed a behavioral evaluation and was diagnosed with  ADHD. Now you feel exhausted  confused and overwhelmed in your own home. You realized your children are showing many of the characteristics your husband has. You are not as patient any more and feel  betrayed by life for cleaning up after every one.

You are married to ADHD! The qualities that attracted you in the beginning are some of the beneficial qualities of ADHD. It is time to have a serious family consultation.  Everyone needs to come to the table, be educated, assume responsibility, be more giving, and alter personal ways for the good of the family. This is how complex systems adapt and grow. There is too much at stake here. It takes courage, determination and humility to look deep within oneself. It is crucial for the kids to see consultation as a process in action. Do not despair but stand up for yourself. You both need to reignite the positive connotation of the ADHD and manage the negative ones. Proper medical consultation at this juncture is crucial to address the clinical aspects of the problem.

Remember that nice sunny afternoon walk in college all those years ago when the flow of life was light and joyful. That energy is still available to both of you; this is the time to call upon it!

How can we categorize autism, major depression, personality disorder, after effects of trauma, steroid-induced psychosis, and addictions under the generic umbrella of “mental illness”?  Might we not be better off to do away with the term altogether, and address issues with better definitions of such terms as mood, attention, anxiety, or addictive disorders.

What we really need to seriously address is our obsession with the depiction of violence  in our movies, video games, and literature. Study of violence and our cavalier attitude towards its depiction reaches far beyond what mental health is prepared to address. Instead, what we are doing is to further stigmatize those of us who are experiencing disease and discomfort of brain, mind, behavior or relationships.

Somehow the conversation during the session turned to the current hysteria around the Mayan calender and the end of the world prophesies. As she contemplated the ramifications of such a scenario, her affect seemed to rapidly improve!  “You know, Doctor, I just realized that none of my problems can last forever!  They will end at some point just as everything will end eventually.”  I began to worry whether she was conveying thoughts of suicide.  ”Oh no, Doctor, I will never take my own life; I do believe we go on living in our essence and I know suicide is mighty sin against our Creator.” She had realized and reconfirmed an ancient wisdom first conveyed by the prophet Buddha that everything in this world is impermanent and that idea in itself is liberating and paradoxically life-affirming. Maybe that’s why doomsday fantasies have always had an audience.