The first response to an ADHD diagnosis is often relief, excitement, even delight. Having answers, feeling that you might not actually be “lazy, crazy or stupid”, finding out that medication might give you the ability to restructure your life – all that is wonderful. This is especially true for people like me, who are born problem-solvers. We like answers and explanations and solutions.
It’s less clear after that. I’ve read that some experts liken it to a grief process (although I’m not sure where bargaining comes in).
What I did find was that, after the initial excitement and euphoria wore off, I was intensely frustrated and disappointed. The medication worked. It made a real difference. I couldn’t deny that, even as I found that it wore off too quickly (common problem for me) and I had to keep adjusting it. I loved being able to focus on what I wanted. I loved the feeling that, when I got sucked into a distraction cycle, I was able to realise it and pull myself out very quickly. This new awareness, this ability to hold onto thoughts and make use of them, instead of watching them pop like soap bubbles, instead of giving into despair after the fifth time you’ve walked into the same room with an intent that keeps disappearing- it was amazing.
And I couldn’t deny that this ability to regulate emotions was wonderful – not being anxious and terrified and overwhelmed by everything meant that I could actually function properly. This newfound ability to make decisions and act on them? That was great too. I can’t even begin to think about how many hours, days, weeks I’ve lost to executive dysfunction: the inability to translate impulse into action. To decide things.
But it wasn’t everything. It wasn’t a magic bullet. I say this a lot, and I think I say it because – in spite of everything I’d been told, and everything I’d read – I desperately wanted a magic bullet. I really, really just needed an easy answer. For once. Please. Please?
Wanting doesn’t make it so.
There are a number of reasons that just topping up your dopamine levels as needed isn’t a perfect solution to a dopamine processing problem like ADHD.
Firstly, it doesn’t really change the way you perceive time. Time is still, primarily, a form of now and not now.
Secondly, it doesn’t stop you getting distracted. You might get distracted a lot less, but you’re still going to have random thoughts pop up in your head, you’re still going to get pulled into ideas and imaginings. The difference is that now, you should be able to pull yourself out. It’ll also be a lot quieter in your head.
But finally – and we get to the subject of this post at last – it doesn’t change your habits. It doesn’t change your physical habits, and it doesn’t change your cognitive habits. The way you think, the way you plan, the way you function, by this point in your life, has all been profoundly influenced by your untreated ADHD. And humans are a creature of routine and habit, a fact which is doubly true for ADHD brains (even if we hate routine and want to bust out of it and chase novelty).
My whole life, as an ADHDer, I’ve been chasing dopamine. The background level of dopamine in ADHD brains is too low, and we don’t get the same level of contentment or happiness that other people (all else being equal in their lives) mostly get to enjoy. This is one of the reason why ADHD brains sometimes have a tendency towards addictive behaviours, which unfortunately includes addictive substances: alcohol, nicotine, weed, cocaine, they’re all on the list of things that might give you a bit of a hit.
(Sidebar: ADHDers being treated for addiction respond very well to stimulant medication – the problem is that specialists can be hesitant to prescribe stimulant medication to someone with a history of substance abuse, which must be intensely frustrating)
I’m fortunate that my primary addiction is to caffeine (a form of stimulant self-medication, although caffeine is definitely not as effective and has more side effects), and perhaps to reading as an escape. I tend more towards obsessive behaviours; I’ll obsessively read romance novels, or play a particular computer game, and then my obsession will stop or shift. Suddenly, I’m not enjoying those things (this is especially true for computer games). The novelty has worn off, and I go and chase a new obsession.
And yes, computer games and romance novels can deliver a dopamine kick for me.
Now, I’m not particularly interested in ditching games or romance novels, so I’m mostly only explaining this as a way to illustrate the process. We need the dopamine to be happy, to be functional, but our need for dopamine and the way we chase after it can also make us profoundly dysfunctional.
The fact is, the coping mechanisms that we develop to deal with ADHD – to be able to build a life around the distraction, disorganisation, loss of time, and emotional floods – are effective. They’re there to help us get by in the short-term, to stimulate the dopamine kick we need, to calm us down in times of stress, or to avoid the emotional pain our symptoms can cause.
Long-term, though? Those coping mechanisms can be a real problem. They can be actively harmful. They can be incredibly inefficient. And they can lead to this intense frustration I describe above.
Because there’s nothing like sitting at your desk wondering why you haven’t started working on your project when you know you have enough dopamine to do it.
What’s the deal?
Consider your medication
I’ll start with the disclaimer that, firstly, I suspect I’ve been under-medicated for a while. I’m working on that at the moment, and that’s something that you’ll need to consider. The appropriate dose of medication is not even remotely predictable according to body weight, body composition, sex, or severity of symptoms.
It can be affected by hormonal state. Progesterone peaks correlate with increased severity of symptoms so… sucks to have ovaries, I guess. On the upside, oestrogen correlates with reduced symptoms. If only there weren’t twice as many progesterone peaks as oestrogen peaks in a typical cycle, right?
It can be affected by fatigue. Not enough sleep? Poor sleep? Your medication will struggle, and the symptoms of ADHD will get worse, which is fun to deal with when you add in the usual consequences of being fucking tired. It’s also a fundamentally shithouse reality, since ADHD is also associated with sleep problems.
Maybe most importantly, it can be affected by stress. Stress exacerbates symptoms like mad, and I can speak from experience here. A medication regime that is finely tuned to maintain levels under normal circumstances will be overwhelmed by stress (in fact, stress affects everything, including the symptoms of hypermobility syndrome, visceral hyperalgesia, and Crohn’s disease, so I get a bit shirty about it).
If you have an understanding psych specialist who trusts you, discuss the possibility of being allowed to make minor adjustments to your intake according to your need. Some won’t budge (because hurrah, schedule 8 drugs) and some will want you to sit tight for a while (it is a good idea to try to stabilise your dosage habits first), but others will give you the cautious nod. That doesn’t mean you should bump it up every time you have a shitty day, but when the world starts throwing some genuine shit in your direction, it might be time to take a little extra.
Coping Mechanisms that Aren’t
Now we get into some of the really tricky stuff, because changing habits is hard. Habits are habits for a reason: they’re repetitive, routine behaviours that side-step around the need for executive dysfunction. You don’t have to decide to do them: you simply do them. Your brain wires the habits together into a routine, and you’re away.
It’s going to be different for everyone, because everyone has different coping mechanisms. It’s up to you to try to figure out which habits are really limiting you, and how you want to approach them – although it’s not a terrible idea to ask for help. You can ask your specialist, or approach people in online forums, or even find an ADHD coach (they exist).
With that in mind, I have to talk about my own practical and cognitive habits. This is really complicated and requires a lot of detail, so I’m going to focus on my current bugbear.
Procrastination of writing
I’m meant to be preparing a report on some of my recent work. I’m trying to start plotting out my Nanowrimo project. I’m finishing up another story, and I’m also wanting to do a solid edit/re-write of another story (which means I’ll be able to finalise some character and timeline details that affect the other stories).
This means I’m super good at sitting at my desk, chatting, and checking social media. I’m really good at saying “Well, I’ll take a break and have a coffee and come back to it, but for real this time, honest.”
Why? How is procrastination a coping mechanism, rather than a complete disaster?
In this case, I’m mostly procrastinating things that I enjoy – things that I want to do. ADHD makes it much harder to focus on things I don’t want to do, but it can also make it harder to decide to focus on any cognitively complex pursuit, whether you enjoy it or not.
In my case, there are multiple things at work.
Firstly, there’s a fear of failure. Years and years of ADHD have taught me what often happens when I try. I know that I’ll get distracted, and my attention will wander, even as I start to work. I know that the first line is the hardest, that there’s a risk of staring at the screen and having no idea what to do. I know that I’ll get brain fog, that consequence of fatigue (and, in my case, low blood pressure), and I won’t be able to think clearly, or solve problems, or lay out the components of a problem, because I won’t be able to concentrate.
Which will make me feel very stupid, and that hurts.
I know that maybe two hours will pass, and I will have accomplished nothing worthy of note, and I’ll get that sinking misery in my stomach that means I’m wasting time, letting myself down, and creeping ever close to some sort of deadline without anything to show for it.
It’s a godawful feeling. It’s frustrating.
So I put it off. I put off the sense of failure, the disappointment, the low self-esteem. I put off trying because I know that it hurts. I don’t want to get lost in brain fog. I don’t want to get distracted and confused. It’s easier if I just don’t start.
That’s a purely cognitive habit, and it’s a common one for ADHDers.
The other reason I procrastinate deals more directly with dopamine chasing. The pressure of a deadline often makes us come alive with inspiration. Our body starts pumping out various neurotransmitters, and at that last minute, that night before deadline, the kick arrives.
And we need that kick to get the job done. So we leave it until late – stressful late, not-sleeping late – because then we’ll get that thumping high that shoves is into our productive, creative zone, and off we go.
In undergrad, I sometimes used to try to start writing essays early. I would sit down, textbooks and references at the ready, and I’d make myself a new Word document, and I’d prepare to be organised. That’s right. I was going to work slow and steady. I was going to write a paragraph, perhaps one per day. Yup.
Couldn’t do it.
I simply could not make myself do it. And I tried. I really, really tried. As ever, executive dysfunction is almost impossible to explain to people who don’t have it. “Why don’t you just do it?” they ask in confusion.
“I just… don’t,” you reply, equally confused, and angry with yourself.
Looking back, I now know that I didn’t have that kick that I needed. My brain didn’t have what it needed to get the job done. I had the intelligence, the writing ability, the information, and the time. But I didn’t have the focus, and I couldn’t get the focus without that kick.
Studying was easier, at least in the sciences, because I quickly established a routine for how it would work, and it didn’t demand the complexity of a creative process like writing an essay. I couldn’t construct a system for creative work. I didn’t know where it came from. It just happened.
But it only happened at the last minute.
What does this mean now that I’m on medication? Well, it means that I don’t need to procrastinate to get my kick. It means that I don’t have a chemical need for the pressure cooker.
The problem is, I still have those habits and routines and fears. Some part of me is used to getting distracted, so I instinctively gravitate towards the easy things: I’ll check my email, I’ll catch up on Facebook, and so on and so forth. Medication means I can choose what to focus on. I just have to learn to make that choice.
That sounds weird, but it’s true. I am so unused to being able to decide that I forget I can. I forget it’s an option. I forget that I can just open up my story or report and just decide to work on it.
My habit is to procrastinate, to avoid, to curl up and flinch and hide from the pain of failure. It’s a habit because it was a chemical need. Now that the chemical need is removed, I have to recognise the habit, and change it.
There are so many other habits I have to unlearn, some of them more obvious than others, and maybe I’ll go through some of them later in detail.
One other habit I’ll mention in passing relates to emotional dysregulation: since (thanks to medication) I no longer have to talk myself down from my gigantic outsized emotions, I also don’t have to just suppress my reactions to things. I can actually start to let myself feel without worrying that those feelings will take over. That’s a very hard thing to learn. I’m so used to trying to shove my own feelings aside, because they’re overwhelming and huge and I can’t manage them; and they do damage.
But if they’re suddenly in bounds? If they’re emotions I can look at and think about and let myself feel? That changes things.
That changes a lot.
The adjustment continues
Ultimately, having medication means I’m able to make plans and execute them in a way that I couldn’t before – at least not without a huge dose of anxiety – and it means I can think about the problem without panicking. I can try to come up with solutions for problems that aren’t affected by medication, and I can take a step back and analyse the problems that should be improved by the meds, but somehow are still bothering me.
That’s when I realise they’re habits, and I need to start rethinking them.
The greatest victory is when I decide “No, I’m going to do this differently today,” and then I actually do it. It’s a marvel and a wonder to forge a new path for myself.
But it’s not over. It’s still a work in progress. I still don’t quite know what my ideal medication situation is (although I’m starting to figure that out). There’s a lot of stress at the moment which is clouding the situation (hence why this is up on Thursday and not Tuesday), and I’m still finding my feet.
So watch this space.