Addiction, Me and ADHD

Note: I am not a doctor. My aim is for this article to be an informal but informative springboard to start your own research. I have tried to mostly refer to my own experiences but balanced with expert sources (listed at the bottom). 

Addiction is a major issue for ADHDers. Studies have shown that we have an increased risk for addiction to substances (e.g., nicotine) and behaviours (e.g., sex and video games) [1] [2].

I categorize my own experiences with addiction as either self-medicating (stuff that stopped me from feeling bad) or pleasure-seeking (stuff that made me feel better). 

Self-medication involves using “non-prescription” methods to help us manage our symptoms. It is very common with ADHDers, especially when we are undiagnosed. Substances with stimulants can help us focus, so we naturally tend towards smoking and consuming caffeinated beverages from a young age. 

While studying for my university exams (before my diagnosis), I used to drink multiple cans of energy drinks and cups of very sweet tea, while also vaping the highest legal concentration of nicotine. I still remember getting headaches from (what I assume was) acute nicotine poisoning

However, the most problematic self-medication substance for me was alcohol. It was very appealing as it would alleviate my anxiety (which is very common in ADHDers), stop my racing thoughts and help me fall asleep. I am very thankful that alcohol upsets my stomach, or I might have had a severe problem today.

Pleasure seeking activity is using/doing things that make us feel good. I really struggled with an addiction to video games and pornography during my teens and early twenties. Simply put, they made me feel good and I would want to do it more and more, especially when I was bored (which was all the time).

I still strictly manage my consumption of these activities as I know that I can easily fall back into addiction (like I have many times before). 

Cycle of addiction

Addictions can be especially troublesome for ADHDers. An addiction cycle for ADHDers tends to go as follows (with the example of smoking) [3]:

1. ADHDers are likelier to start smoking at a younger age for reasons previously mentioned

2. Due to difficulties with self-control, ADHDers start chain smoking and become increasingly addicted to nicotine

3. ADHDers have a harder time quitting due to difficulties with impulsivity and self-inhibition

4. Due to issues with our dopamine system, ADHDers experience worse withdrawal symptoms and relapse much easier

I want to heavily stress that relapsing is not a sign of weakness or failure. Managing addiction is difficult for everyone but can be especially difficult for us ADHDers. With support and treatment, addiction can be managed, and the possibility of relapse reduced.

Treatment

Truthfully, what helped me the most with my addiction issues was my prescribed ADHD medication. The stimulants completely removed the need for me to self-medicate and helped curb my excessive pleasure-seeking activities.

There are fears that ADHD meds act as a ‘gateway drug’ but these fears are unfounded. It is quite the opposite; studies have found that meds can SIGNIFICANTLY reduce the likeliness of future addiction in youths [1]. For people who have already battled with substance abuse, there is also the option for non-stimulant ADHD medication (such as Strattera). Traditional addiction treatment options such as therapy are also a viable option.

Addiction is a very common issue for ADHDers. I would hazard a guess that most (if not all ADHDers) struggle with some degree of addiction at some point in their lives. However, it has to be stressed that addiction can become quite a serious problem. 

If you are struggling with addiction, I would heavily advice consulting your doctor for options to treat your addiction issues alongside your ADHD, as one can make the other even harder to manage, and as such might need be treated simultaneously [4].

[1] ADDitude. 2020. The Truth About ADHD And Addiction. [online] Available at: <https://www.additudemag.com/the-truth-about-adhd-and-addiction>. 

[2] Davis, C., Cohen, A., Davids, M. and Rabindranath, A., 2015. Attention-Deficit/Hyperactivity Disorder in Relation to Addictive Behaviors: A Moderated-Mediation Analysis of Personality-Risk Factors and Sex. Frontiers in Psychiatry, 6.

[3] McClernon, F. and Kollins, S., 2008. ADHD and Smoking. Annals of the New York Academy of Sciences, 1141(1), pp.131-147.

[4] WebMD. 2020. ADHD And Substance Abuse. [online] Available at: <https://www.webmd.com/add-adhd/adhd-and-substance-abuse-is-there-a-link >.

Accountability (aka, should I apologize if I didn’t mean to hurt?)

Accountability,

i.e., holding yourself responsible for the things you have said or done.

We ADHDers often say or do things without realizing that we might be hurting others. 

We also might hurt or inconvenience people when we don’t do things; our bad memories cause us to forget to call the dentist or pay the bill as we promised we would.

So, if we did these things, or didn’t do these things, and it wasn’t intentional, but people were hurt, should we be held accountable by others and ourselves?

When I was younger, I used to think, no. If I didn’t MEAN to do it and I couldn’t help it, why would you blame me? Why should I apologize? It wasn’t my FAULT after all. 

It wasn’t my fault.

But here’s the thing —  when we accidentally hurt someone,  that person is still hurt. When we forget to do something, the consequences could still affect other people. It doesn’t matter if we “meant it.”

We have to learn to take responsibility for our actions, regardless of our intentions. 

ADHD and other mental disorders can make us a bit self-centred. This is understandable as we have to spend so much mental energy looking inwards and managing/ restraining our thoughts and emotions. However, when we are understandably focused on ourselves, we have difficulty seeing and understanding that our actions can hurt others.

One reason people tend to have difficulty holding themselves accountable is guilt. As we fuck up a lot, the feelings of guilt can trigger a lot of other negative emotions that we might not be able to handle. We start to feel like we’re “bad,” because even when we have good intentions or no intentions at all, we still manage to hurt people.

When I hold myself accountable for something I didn’t mean to do, I apologize. I explain that I didn’t mean it and that I will try harder next time. 

And then I look inward and remind myself that I am not a bad person. My intentions were not bad. I remind myself that to err is to be human and we are all capable of hurting others unintentionally. I remind myself that I took responsibility for my mistake and its consequences.

Actions have consequences, and avoiding responsibility is an action.  The result of not holding ourselves accountable can be worse than the initial deed itself.  That is something I had to learn the hard way.

Until just a year ago, I was a compulsive liar. 

I never realized it consciously. I think it started as a defence mechanism before I was diagnosed—a maladaptive coping mechanism. As I  had difficulty completing tasks over and over again, I would lie to make my excuses seem believable to others.

Why didn’t I do my report? Oh, I was visiting my friends in the hospital.

Oh, I forgot to call the doctor because… my phone plan ran out.

The truth was that my executive dysfunction prevented me from getting things done, but I didn’t even know what executive dysfunction was yet, so it just looked like I was being lazy, even to me. Because I didn’t know why I was having trouble, I wasn’t able to explain myself to people — so I lied.

This continued ‘til I hurt my sister with my lies. We had always been close, but my lie made her feel like she just couldn’t trust me. She stopped talking to me for months.

Actions have consequences. I didn’t mean to hurt her… I couldn’t help it… But she was still hurt.

I  still struggle with compulsive lying but I am trying my hardest to hold myself accountable. When I find myself telling a lie, I immediately come clean. This isn’t easy. No, it’s quite difficult. People will lose some trust in you, but from my experience, it’s a trust that can be built back. On the other hand, if you are caught in a lie, you could lose all their trust forever. 

Holding yourself accountable is good for your ADHD. Dr Barkley argues that accountability increases motivation, which we ADHDers often lack, and reinforces the consequences of our actions, which we can have difficulty grasping.  Therefore, ADHDers need not less, but more accountability.  Learning to accept responsibility for our mistakes allows us to better ourselves and to better ourselves and work with our ADHD rather than against it.

I imagine accountability as an external motivator. Our internal motivation doesn’t work properly, but we can use accountability to replace it. Instead of telling the truth because it’s the right thing to do (which is an internal motivation), I tell the truth because I don’t want to hurt the people I love (which is an external motivation). To avoid another situation, like with my sister, I am more motivated to hold myself accountable.

My sister forgave me after I sat her down and properly apologized to her. I don’t know if I am fully forgiven,  but I’m trying my hardest to get there.

How I beat back RSD

RSD, or Rejection Sensitive Dysphoria is the name given to the strong sensitivity to perceived rejection and criticism in people with ADHD. It is not a part of the DSM, though, none of the emotional dysregulation caused by ADHD is. It affects most, if not all ADHDers, and certainly for me, was/ is the worst aspect of my ADHD till I got it somewhat under control.

A year ago, during my undergrad dissertation presentation, I forgot what a specific mathematician was famous for, so I panicked and called him ‘a smart dude’ to an audience of university lecturers. And I also forgot my supervisor’s name. Cue the waves after wave of awkward RSD!

So this is how I beat it back:

1) Keep reminding yourself that it probably didn’t go/ happen as badly as you think. You have RSD and you know your brain exaggerates. So you know that there is a very very high chance that it didn’t go as bad as your brain is making you think it did.

2) Reframe the event. Your RSD makes you think of the event in a certain negative way. So forcibly reframe it. Look at it from other perspectives.

A common one for me used to be when people didn’t reply to my messages immediately, I would get hit with feelings of rejection. Reframed, I try to think of all the other reason they hadn’t replied. Maybe they were busy. Maybe they are feeling down. It could be hundreds of other reasons, unrelated to you.

3) Think all the things you did right. Sounds simple but thinking about the positives can help you calm down. 

Black and white thinking can make you think everything went badly if you made a few mistakes. However, that is rarely the case so trying to think about the positive helps quite a bit.

4) Talk to the other. RSD is about perceiving rejection or criticism. Many times, there mightn’t even have been a rejection, rather we just wrongly assumed there was.

So talk to the other party. Their actual thoughts will help clear your RSD most effectively.

Back then, after the presentation, I reminded myself that some of the others giving presentations did much worse than me and that I did manage to get all of my points across. And when I talked to my supervisor afterwards, they told me I did quite well. 

Just an hour later, I was feeling much better. 

And I believe I ended up getting a B for the presentation. It hadn’t gone as badly as RSD had made me feel. It NEVER is. 

Learning with ADHD

ADHD can and does cause memory issues. It can affect short term memory (eg, remembering phone numbers for a bit), working memory (ie, manipulating information, like doing sums in your head) and finally, recall (bring back up the information stored). 

Of the three, issues with recall feel like the worst (to me) as it means that we have difficulty bringing back stuff we should already know. It’s frustrating cause we know the information deep down, we just struggle with recalling it when we want to.

This friend I have known for years now? Forgot their name again.

My house number? Forgot it again.

The name of the restaurant I have been to multiple times? Nope.

One of ADHDers’ most common catchphrases (“umm, what was just saying?”) is because of this recall problem. We get distracted mid sentence and can’t recall what we were saying.

ADHD in general, from concentration to these memory problems, can make learning very challenging. And it certainly did for me until I found a strategy that worked (for me).

Imagine you lost something in your house. The common advice given would be to retrace your steps. This involves going down paths you took, chained one after the other to finally reach what you were looking for. The strategy is that even if you don’t remember the final destination, you can retrace your steps to recall it. 

My strategy involves exactly that, with the metaphorical house being our minds.

A fact or a piece of information is easily lost. To make it easier to find, you have to connect it to other pieces of information. I see it in my head as a massive spider web where all interconnected information is connected. So even if I forget one piece of information on that web, I can navigate down other paths to help me find it.

So a real example is when I needed to learn about electricity generation (I am a renewable energy engineer). I couldn’t just learn about generators and have it stick in my head.

So what I did instead was start from the basics… from how electrons work. Then how wires work. Then how AC and DC electricity works.. And so on. So now, even if I forget a detail about a generator, I can essentially start from scratch to re-remember it. 

Yes, it does take much longer to learn but the information is stored and recalled more solidly.

This is the method I use to study and learn that has taken me from failing everything to getting As and Bs. I start from the very basics and build my knowledge up like a web, making sure to take time to understand in the process.

Of course, I won’t claim this will work for everyone, nor that this is the one true method. But it worked very well for me, and I hope that even if it didn’t help directly, it can give you some helpful information.

ADHD self check checklist

ADHD can make it difficult to figure out how we are feeling physically, mentally and emotionally. Commonly it is due to difficulty with self awareness caused by our executive dysfunction.

This is a checklist I go through mentally to try and figure out why I might be feeling off.

[click to see checklist as a flowchart]

  • I feel off.
  • Am I sitting funny/ have I been sitting in this position for a period of time?
  • Am I mentally drained?
    • Have I been working on this task for a long time?
  • Have I eaten/ drank anything recently?
    • Have I been eating properly? Am I craving something specific?
  • Have I gotten enough sleep recently?
    • If not, am I being kept up by any specific thoughts/ worry?
  • Have I socialized recently?
    • Have I forgotten to hang out with my friends?
    • Have I spent time with my family?
  • Is how I’m feeling positive or negative?
  • If negative, have I experienced anything recently that I haven’t processed?
    • Have I fought/ argued/ had disagreements with people close to me?
    • Is there anything coming up that I am worried about?
    • Have I been making a lot of small mistakes recently?
      • Have I felt that I lot of things have been happening to me that I can’t control?
  • If positive, have I let myself enjoy the feeling?
  • If don’t know, has anything happened recently out of the usual?
    • Have there been any changes in my life, big or small?
      • Have I been unable to follow my normal schedule due to any reason?
    • Have I done my usual relaxing activities/ hobbies?
      • Have I exercised recently?

Reasons for difficulty starting tasks

ADHDers have difficulty with starting tasks (initiation). While a significant part of it is our executive dysfunction, other conditions and issues also factor into it. Its why you might have difficulty doing work even when medicated.

I’ve recognized and listed my main initiation difficulties below, an explanation of where I feel it stems from and my solution for it.

  • I’m intimidated/ overwhelmed by BIG WORKLOAD and dunno where to start

    Executive dysfunction problem. The brain doesn’t know how to break up the work into workable chunks (planning).

    My Solution:

    The aim is to ease the intimidation by giving yourself a small and easy task to start with. ADHDers struggle with STARTING, so once the process has started, it should get easier. Think of it like task ice breakers.

    I plan larger projects by taking some time at the very start to divide the work into ‘ONE THINGs’. These are tasks I can do without needing to think about anything else as our brains are much better at handling just one topic at a time.

    Planning requires switching between topics so the goal is to get the overall thinking out of the way. That way we don’t have to keep mentally juggling everything and getting intimidated/ overwhelmed.


  • Two or more different things to do and I dunno which one to do first

    Executive dysfunction problem. The brain isn’t good with choices and priority.

    My Solution:

    Thinking about which task to do wastes a lot of time and the decision paralysis causes us to end up doing nothing.

    Unless there is a time constraint, the best solution is just picking one and running with it. Its a brute-forcing method but I haven’t found a better method that works.


  • Work is too small, too boring to start

    Executive dysfunction problem. Difficulty with uninteresting work.

    My Solution:

    Nothing is truly boring. Relate the work to your interests. Find new interesting ways of doing things. Go above and beyond and learn more about the topic than necessary. Overcomplicate to make it interesting, if possible or gamify it.

    I once had to edit the names of a few hundred files. I was expected to do it manually but instead, I learnt to code an auto name editor to do the work for me. Actually ended up doing the work faster.


  • I’ve failed while doing this before, I’m anxious starting it again

    Learned helplessness/ anxiety/ perfectionism/ RSD.

    My Solution:

    This one is tricky. Personally, I needed to come to terms with failing and realize that every failure is a learning experience. 

    Remember that failing a task doesn’t mean YOU yourself are a failure.

    You have genuine mental health difficulties so judging yourself to others’ standards simply doesn’t make sense. There is NOTHING shameful about struggling due to genuine mental health problems.


  • I can only do it when everything is PERFECT

    Anxiety/ perfectionism.

    My Solution:

    Its happened to me too many times. I waste time and when I finally get down to it, it’s 6 pm so I put it off cause I might as well start the next day with more time. Come the next day, I waste time again, and put it off again, and over and over.

    Our anxiety about not being able to focus easily makes us want to start with plenty of time. Not to mention, fear of failing makes us want to ensure everything is PERFECT so we are less likely to fail.

    If you start the work at 6 pm, do it till 7 or 8. Doing some is better than none. The perfect time to have done anything is yesterday, but the second-best time is right now.
  • I CAN’T START

    Executive dysfunction problem. The brain struggles with ‘activation’.

    My Solution:

    Activation difficulty is one of the worst issues in my opinion. We might be fully motivated, have our anxieties and perfectionism under control, but we struggle getting ourselves to do ANYTHING.

    Things like feeling super hungry but just being unable to go make something to eat. Or wanting to pee, but just not being to get yourself to go to the bathroom for hours. It still happens with me nowadays.

    The main difficulty tends to be starting so my strategy is to get myself to do/ succeed any small task to get the ball rolling. Small victories to build momentum and sustain some mental inertia.

    Recently I felt quite out of it mentally and struggled to do anything. However, I have a habit of brushing my teeth in the mornings which I forced myself to do. After I got up and brushed my teeth, I felt the ball rolling and was able to cook and then write and then work properly.

on happiness as an ADHDer

I was unhappy for a long time. For most of my childhood and teens, and even early twenties, I was unhappy. Well ‘unhappy’ is an understatement.. I was very depressed. 

Nowadays I am less unhappy. I have my depression completely under wraps and my anxiety mostly under wraps. I have made good headway with my ADHD symptoms. Yet I still find myself not content. I still find myself unhappy.

I have been thinking about what it means to be happy. I wanted to make sure I hadn’t fallen into the classical trap of thinking that I will stop being unhappy and be happy when I’ve finally achieved that one goal/ get that one thing I wanted. 

Hell, can you even AIM to be happy?

All you can try to do, is to do things that you think will make you happy but that falls into the above trap. There is no guarantee it will work and for most people, the goal just ends up shifting, leading to endless pursuit of trying one thing after another.

Smarter people than I have claimed that happiness is more about the journey than the destination. That instead of pursuing happiness, you should just do your own thing, and you will find happiness. There seems to be some truth to that.

It hit me recently that happiness for an ADHDer, for me, is even simpler than all that. I am unhappy when I am bored. I am happy when I am doing things I love. ADHD is incredibly annoying but it really can simplify things.

Hyperfocuses and hyperfixations are hollow and fleeting.

Doing novel things for novelty is tiring; everything get old after a while, so you have to keep finding new things to do forever and ever.

What’s left is to pursue what truly interests you.

It can be a creative output, as creativity is infinite as it comes from within. For some its music and for others its writing.  Or an athletic pursuit, like Michael Phelps, who attributes his swimming prowess to his ADHD.

Something you can keep honing.

That really seems to be the way. Successful ADHDers have all mentioned that to get a grasp on your ADHD, you need to fully pursue your interests and this seems to align with everything.

I’d thought that simply continuing with blogging would allow me to be happy but I really hadn’t fully grasped that it also requires constantly challenging myself. I need to do more and keep pushing myself. It’s the growth and challenge that makes us happy.

So that seems to be my current conclusion: pursue what you truly love and keep honing it and you will find happiness along the way. It’s all we can do after all.

(I think that’s what most people say the ‘secret’ to happiness is anyway. I guess its just ‘less complicated’ for us because of our ADHD, ironically, as we feel bad when we don’t do things that interests us, so we have no choice but to do it)

ADHD food: chili

Cooking is hard when you have ADHD. Eating is somehow harder.

When I moved out of my parents’ for uni, I immediately lost 15 kilos (33 pounds) cause I stopped eating properly. I knew how to cook, or so I thought, but I didn’t like the taste of my cooking. My family is South Asian, and the food isn’t the easiest thing to make right. So I never cooked and I never ate.

The perfect food for ADHDers has to be simple to make. The more steps there are, the more of a hassle it is. It has to have a few steps, you have to be able to make it in bulk and you shouldn’t have to keep watch. And ofcourse, it has to be delicious.

Chili fulfills all those categories and more. You can eat it in a wrap, with rice and with pasta.

The ingredients are simple:

  • A large onion
  • garlic (a few cloves)
  • celery
  • mince of choice
  • canned tomatoes (1 can)
  • kidney beans (1 can)
  • red chili powder and paprika (depending on how hot you want)
  • green chilli chutney (optional)
  • stock of choice
  • tomato puree (let’s say, two spoons)
  • salt to taste
  • some kind of cooking oil (a few spoons)

There are three main steps:

1) Chop onions, garlic and celery

image

2) Brown the mince in a pot with some oil on highest heat (optional, just to give it some texture)

image

3) Cook it all together. You can literally just toss the rest of the ingredients in starting with the spices. Make sure you add enough water/ stock to cover everything.

Cover with lid and let cook for 30 mins on high medium-high heat (I set a timer on my phone).

Then take off lid and cook for another 25ish minutes or until the desired consistency on medium-low heat. If something tastes off, you probably haven’t added enough salt.

I throw in a spoon of green chilli chutney for some extra heat.

image

If you’re nervous cause its your first time making it, you can keep watch and check it every 10 mins (its what I did).

As you can see from my instructions and pictures, I’m not a professional nor am I trying to make a professional level dish. Its just something that’s easy to make, filling and versatile. If you want a change of pace, you can add different vegetables as you want. I am partial to mushrooms.

ADHD Study Advice

Studying is difficult. Studying when you have ADHD is significantly more difficult.

Despite the ADHD, I didn’t struggle too badly in high school. However in college, the complete lack of structure meant all hell broke loose (in my mind), resulting in me failing exam after exam, year after year.

After struggling for a few years and then getting diagnosed, I tried to find some study tips aimed towards people with ADHD. I read many of the articles online but they were essentially just basic study tips, ie, take good notes, take regular breaks, etc. However, that isn’t very useful when you can’t even bring yourself to open a book to study.

So through trial and error, I found my own study method. It’s not perfect, and I am definitely not the first person to have though it up for sure, but it worked for me.

When you have ADHD, it’s quite hard to get yourself to start studying. Hell, this first step is most often the most difficult. You just can’t bring yourself to do it, even with the looming threat of failing. 

However, we have a special talent; an ability to focus obsessively on things that we are interested in. You might have experienced it already when pursuing something you love. I mean the thing you are OBSESSED about. 

You can use that for studying! The tip is to relate your study back to your obsession. It sounds simple but it can be effective.

Say you are interested in music and you study physics. Relate them together. Understand physics in relation to your passion for music. Understand waves using how the strings work in guitars. Understand how electricity works using how electric instruments function. You can even make up a song to memorize things you need to remember in the tune of your favorite song. 

We have a hard time remembering or learning things for the sake of itself, because it’s boring. But once it’s related to what we love, what we are obsessed about, it becomes easier. When we are interested in something it stops being difficult so what you are essentially trying to do is to spark an interest in the subject.

I had failed a Statistics module multiple times. Then I related it to my curiosity, my desire to understand scientific papers and suddenly, it was no longer all Greek to me. It MADE sense and it became easier. I wasn’t studying for the test.. I was studying to further my passion.

Everything can be related to something else. Use the power of your obsession and you will find that even the thing that you struggle with the most will become much easier. 

I can’t guarantee this method will work for everyone but it helped me quite a lot. Despite the repeated failure, I did manage to graduate and not only that, I actually managed to increase my GPA by 50% in my final year.

Update: Using this method, I was able to achieve As and Bs in Masters.