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copperbadge · 2 years

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Hi! I suspect this question may sound sarcastic or asshole-ish, but I promise it's sincere. And I realize that you're not a doctor, so feel free to ignore or tell me to DMOR, but you seem to have looked into this pretty extensively, so I thought you might have some thoughts. If you take ADHD meds and they work (that is, you don't feel any different but you can actually Do Things, which maybe gives you really positive feelings, which is not how you usually feel about yourself), how do you know that it's actually ADHD and not that normally you're just lazy, but now you took meth and you're hyper and euphoric or whatever it is that it does to non-ADHD people? Asking for a friend.

I...hm, layers to this one. First, thank you for offering a tone note because on the one hand, without it I definitely would have felt a bit hostile, but on the other hand it's very difficult to ask a question like this without sounding like you're trying to get a rise, when you really are just trying to get information. I'd struggle with that too. So thank you! I believe you are in earnest :)

I'm going to try to dig through this by levels rather than go through the question chronologically, that might cause the least amount of confusion and crosstalk. This is going to get long and quite rough and I’m going to address a lot of tender subjects including drug use, addiction, and self-esteem issues, so please read with care for yourselves.

(I’ve tried to add in bolded topic headers so if you have ADHD and get bored of reading about one thing you can skip to the next!)

So to start with -- and this isn’t particularly satisfying as an answer, but well...I know I have ADHD because I’ve been evaluated for it, twice now, and the doctors said I did.

I fit a lot of the classic symptoms on the usual checklists, and while I’m smart enough to game those checklists, I tried to answer as honestly as I could. I wasn’t especially interested in getting Adderall for its intoxicant properties, since I’ve got plenty of access to other, arguably much easier to obtain intoxicants. I also, because I know myself to be someone who enjoys gaming tests for the game’s sake, made sure that at least one of the evaluations had cognitive tests that were harder to fuck with, like tangrams and memory tests and such. On the very top level, I know I’m medicating my ADHD because the tests say I have ADHD.

But say we don’t trust the tests, or say I’m not as honest as I claim. On the next level down, but still quite near the surface, let's talk about "how do you know you're medicated and not high?"

I've been in several kinds of altered state -- concussed, runner's high, stoned on weed or opiates, drunk -- and very occasionally I’ve been around people on coke or meth, though I’ve never done those myself. It's usually not difficult to tell that you are not functional on a normal level. It's difficult to describe how to someone who hasn’t experienced it, but for me being in an altered state like that is very evident. The first time I got a runner's high I was absolutely terrified because I knew something was wrong with me cognitively, but not why it had happened. When I woke up concussed, I knew immediately that something was wrong, but it was all I could do to get dressed and go across the street to a clinic, I was so fucked up. If you’re in an altered state and suddenly need to do something complicated, you're aware you would very much like not to be in that state anymore.

I've described Adderall as being like the most functional high you've ever had, but there are differences. If I've had, say, a weed edible, I feel calmer and happier and I'm also aware I'm stupid. I'm impaired and I can tell that. If I've taken an Adderall, I feel calmer and happier but not nearly to the same level, and there's no impairment to my intellect. Part of the calm is that if I think of something I need to do, I can immediately get up and do it, competently -- or I can decide not to. I control my impulses and actions. With street meth -- which I should note is much, much more potent than a low-dose Adderall -- compulsive behavior and lack of control are much more evident. Even if you are getting a lot done while on meth, you’re not necessarily in control of what, or how many times you have to do it to get it right. I'm told this is also often how people who don't have ADHD react to Adderall -- they’re not efficient as much as they are manic, particularly at stronger doses, which is why a) a good test of “do I have ADHD” is “How do I react to Adderall” and b) they start you on a super low dose.

When my psychiatrist and I meet to discuss how the medication is going, he asks me stuff like, do you feel you're in control of yourself? Are you having hallucinations? Do you find yourself craving a dose even when you know it would be detrimental? Do you feel your performance at work has improved, remained the same, or fallen? Do you find yourself able to focus but not able to control what you focus on?

On Adderall I do feel like I'm in control of myself, I do better work, and while I'm still learning to aim that focus, I am capable of doing so. I don't take it after 1pm because I know that'll fuck up my sleep schedule, and truthfully I don't want to. The one time I’ve taken Adderall after 3pm was because I was going to an art museum and I wanted to see how that would alter my experience, being able to focus more fully on the art and the person I was going with. And while I did have a great time, I wouldn’t make a habit of either taking the drug late in the day or taking it purely so I could have An Experience while on it. It’s fine, it’s fun, but it’s not so much fun I’m willing to mess with my sleep over it.

I also have zero desire to drink (for the best, given alcohol and stimulants are a no-no) and a much decreased desire to get high. I don't need to self-medicate because I am actually medicated. I wasn't doing a shitload of self-medication before, but I was undoubtedly doing some, and more during the pandemic, and I can see how it would have become unhealthy had I continued. Do I still occasionally take an edible in the evening to unwind? Yes. Do I do it at the level I was doing it earlier this year? Fuck no. And I take half the amount I used to when I do, making sure I’m doing it well after any Adderall has worn off.

The question of "medicated or high" can still be a little difficult. What I said above is also what a lot of addicts say. They believe they are in control, they are better when they're on their intoxicant of choice, etc etc. "I can stop anytime I want" is like, the number one way to quietly tell someone that you, in fact, can't. Addiction's simplest definition is "loss of control over behavior" and addicts will do a lot to convince you that they haven't lost control over their behavior. (For more on this, Caustic Soda has a great episode about addiction in which Dr. Rob discusses how addiction and physical dependence differ.) All I can really say in response to this is that Adderall improves my quality of life in ways external to my emotional state -- yes, it helps emotionally, but that’s small potatoes compared to say, weed or opioids (opioids -- now there’s a drug I could get into trouble over) and weed’s way easier to get these days than Adderall. Weed does not, however, help me cook healthful meals and clean the bathroom. Adderall does.

So let's talk about the deepest part of this -- "How do you know you're not just lazy?"

Increasingly we are coming to an understanding of human behavior that informs us that laziness doesn't exist. What we think of as laziness can be caused by a number of factors: failure of executive function, fear of failure, exhaustion, avoidance of the unpleasant. Humans want to experience pleasure, it's a fairly strong primal drive, and we do not experience pleasure purely through inaction. If you should be doing something but aren't, that's not pleasurable, it’s stressful and boring. Lots of people will tell you “I fucking love to sleep, sleep is the best thing” and I’m sure they truly feel that way, but it’s not because they’re lazy, it’s because they have a sleep debt they’re banking against or paying back. There’s a lot of debate about laziness right now, but even as I refer to myself as one of the laziest people on the planet, I know laziness doesn’t exist in the way we conceive of it. When I call myself lazy, I’m using it as shorthand to say “I will find the most low-energy way to achieve something.” Because I am tired, because I have ADHD. (And also because I’m not twenty anymore.)

With exquisite timing, @thebibliosphere has very recently written an essay on this situation called “But You’re So Successful Without It”. Joy can’t take any of the medications available for ADHD, and the essay talks about what it feels like to have ADHD and to burn out because of it, which is where I was about to hit earlier this year. There is no way to call Joy lazy and absolutely no way to hear what she has to say and think that she would choose to go through what she has if she had an alternative. Nobody with any compassion would force her to.

And here’s how I know I am not actually lazy: like Joy, I want to be doing the thing. If I need to do dishes and laundry so I’m not eating with my hands and wearing smelly clothing, but I’m not doing them, that’s not laziness. I know that my life is less pleasurable, indeed very unpleasant, if I don’t do those things. If I’m still incapable of doing them, it’s not because I Don’t Wanna. It’s because I am too tired, because I don’t feel like I can deal with unpleasant sensations on top of forcing myself to do something, or because my executive function isn’t functioning. If you aren’t doing something you should be doing, there’s usually a reason beyond “I’m just lazy” and it’s helpful, in breaking out of the mindset of “I’m a lazy (and therefore bad) person”, to ask yourself why.

If there’s a reason you’re not doing it, even if that reason is simply “I’m so tired”, then you’re not lazy. You’re tired. If it’s because it’s unpleasant, then you’re not lazy, you’re avoiding pain. If you want to and just simply can’t, you’re dealing with a loss of executive function.

Sometimes there are nonmedical workarounds. I wear gloves to do the dishes, I bought a cordless stick vac so my back wouldn’t hurt because I was constantly holding the vacuum cord in one hand, I blast podcasts when I’m doing something boring so my mind is elsewhere. I used to run at 3am because at any other time I was too fucking tired and I hate being out in public around strangers.

But, well, the best workaround for wonky executive function for me is Adderall. It’s not for everyone, it’s not an option for some, but for me it is one more tool -- admittedly a pretty spectacular one -- to manage a difficult life.

All that said, the idea of being a Bad Person for Not Doing A Thing is a knot that it takes a long time to unpick. It is very freeing, and certainly less stressful, to both acknowledge that some things are beyond us, and receive help that brings them back into the realm of our ability to do. But it’s a process, and nobody can hustle anyone down that path faster than they are capable of going. So, all I can do is offer my personal experience.

Even if this shit does kill me eventually, I’d rather have thirty more years where I am the person I’ve been in the last two months, than have fifty more years where I am the person I was in 2021. And even if I eventually have to go off it, what I’ve learned will help me not to hurt myself for something beyond my control.

#sam has adhd #adderall #drug use #addiction #self-esteem

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