Addiction and ADHD (What if you have both?!?!)

ADHD and addiction go hand in hand, like they're pretty much best friends. That's why I am super excited to be able to bring you this interview with Dr. Heather Brannan, an ADHD specialist. She's going to tell us all about the connection between ADHD and addiction, and she's going to weigh in on topics like medicating people that are in recovery with stimulants, which meds are helpful, which meds are not so helpful, and how ADHD impacts the recovery process. I think you're going to be pretty surprised by some of the things that she says now. One last confession before you meet Dr. Brannon. I forgot my good equipment on the.

Day that I was going to interview Dr. Brannon, and so I had to.

Do with what I had, which was my husband holding my cell phone. But the information is so good, I really wanted you to have it, so I went ahead and recorded it anyway.

Is it my imagination or is there, like, a super strong correlation? Because a ton of our clients have.

ADD or ADHD feel like they. Because they made it through their day, they have to reward themselves. They need something to help them calm down because the day was so stressful and they were so overwhelmed. And so it's like, I got to the end of the day, I gotta have a beer or I gotta smoke a joint. So I see it a lot.

That's interesting, because to me, that connects a little bit to the willpower issue. Because I usually tell people as you go through your day, you use up your willpower. And then by the end of the day, you know, it's like when you say, I'm gonna get up at 5am I'm gonna go work out. You're good all day long, and you've resisted temptation. You've worked hard. At the end of the day, your willpower supply is also gone. And I think for people with adhd, that's like, even more sort of exacerbated, I guess.

And the way that I. That was an issue is because I kept having people after I would treat them, and their medicine was optimized. I kept having people come back saying, something's wrong. Like, I don't even think about drinking.

When I get home.

What's up with that? That's weird.

So it happens all the time.

So is what you're saying about the Brandon is that properly medicating ADHD can.

Reduce your risk for addiction?

Oh, definitely.

Because a lot of people that we see have concern. A lot of parents we see have concern. If you medic, if they medicate their child for ADHD early. Does that set them up to have an increased chance for addiction?

No, a decreased chance. So especially that middle age, those middle age, especially those middle school years, those are key, those are important. Those are the times when we tell parents and kids, do not stop taking your medicine in the summertime. Because those are the times when kids are starting to experiment and they're starting to do drugs. If they're taking their medicine regularly, they're much less likely to even start doing that.

I'm really glad you said that because I'm one of the people that say if you take ADHD medicine, take it all the time. Because we hear that a lot and even people's doctor will tell them that, like don't take it when you're not in school or on the weekends or if you don't have a test. I've heard and I disagree because there's so many other symptoms of adhd. The impulse control, the relationship problems, all those other things that happen all the days of the week and in the summer. Now, how often do you see people that you're treating for adhd, how often do you see people abusing their meds?

So, you know, this is, I was surprised, I was really surprised. How, how often it doesn't happen. So I've been treating ADHD probably for 13, 14 years and exclusively treating ADHD for the past seven years. Okay. And I can count on one hand the number of patients I've had trouble with. So people who are taking their medicine when they weren't supposed to, they were taking more, they were getting it from other people. Most of the time it's completely the opposite. Most of the time they keep trying to decrease their medicine. I keep trying to tell them, you need to take more. And you know, because these are perfectionists and they don't want anybody thinking badly about them. They don't want me thinking badly about them. So they keep, so they think that that means they should take as little as possible. But like they don't want to look.

Like they're direct seek.

Right.

Because they have a, like a self consciousness about that. Right, right. And people with adhd, a lot of times they don't like to take their medicine. Especially young people.

Adults too. I can't tell you how many patients, I can't tell you how many patients I've had for, on their new patient appointment, they'll say, not just, I don't really, I don't really like taking medicine. They're adamant, doc, I don't take Medicine. I don't even take medicine for headache because it means they're weak, they're perfectionists.

Something about the ego gets in the way of that. Right. I think it's interesting that you say that you haven't had that many people abusing their medicines, because in the entire time I've been doing addiction counseling, I think I can count on one hand the amount of times that that, like a stimulant med, like an ADHD med, was the reason that someone come to see me, like, addicted to stimulants. It's happened, but not very much. I don't include cocaine in that, but I do mean like, like amphetamines, basically.

So the interesting thing is a lot of people I get phone calls from, from parents, from spouses, from friends saying that their loved one is addicted, they're acting addicted, but it's really not addiction. It's the fact that they're taking something that works. So they think that they. The fact that they get upset if they're not taking their medicine. They think that's part of. That's the definition of addiction. Like that.

That must mean a bad sign, right?

Because they're so dependent on it. But, you know, this is. We're talking about balancing brain chemicals, just like balancing chemicals. If you're a post menopausal woman and you need your estrogen balance, right? So if you're a post menopausal woman and you're not taking your estrogen and you're gonna have. Yeah, you're cranky and you're gonna have hot flashes. So. So yeah, if you take your medicine, the hot flashes go away. It's the same. It's the same kind of process going on. So it's. Just because their medicine works and they need it doesn't mean they're addicted.

Addiction means obsession, right? Compulsion, interfering with your life. Because I say all the time there's a difference between being dependent on a medicine and being addicted to a medicine. And I think people get that confused sometimes.

The other thing is, most, actually all of my patients, once we find the dose that works, that's it. That's the dose that works. I don't have to keep going up and up and up on doses. If somebody's been on a dose for a long time and it's not going well, there's something else going on. It's not that the medicine suddenly didn't or suddenly stopped working. So it's. I mean, I have people I've been seeing for 12 years who are taking exactly the same dose of medicine that they took 12 years ago.

What do you think about people in recovery taking ADHD meds?

Because that.

That is something that comes up in our office all the time. Yeah. Do you have, like, rules about that? Do you have professional opinions about that?

I have more opinions. I don't know about rules. Well, and I listen to you guys because you let us know when you think somebody is ready or not ready.

But.

But I think it makes things go much better. You know, balancing brain chemicals. You know, we keep talking about it, but then also that they can listen to their therapist and they can see things clearly and maybe they can look at their life more clearly, you know, their past and they're interested in conversations in a group setting. You know, I mean, there are just so many different ways that helps.

That's a really good point, because I found that people that have adhd, that's not appropriately medicated, they don't do well in those longer therapy sessions. Like, they don't tolerate, and they become.

Really disruptive to the group.

It affects their relationship. So for me, there are several reasons why, if you don't medicate someone in recovery who has severe adhd, that you set them up for increased risk of relapse. Are there any times where you would not want to medicate someone for ADHD if they were in recovery?

If they're stable in recovery? I guess that's not really. There's like, the subset of people who. They're there, but are they really there? And are they really doing what they're supposed to? So with you guys, we know that. We know whether they're there or not, but with some other. If they're just seeing Joe Schmo therapists, you know, for their. For their recovery, I don't really know that.

They're like, are they working a program?

Right.

Are they saying, I'm in recovery?

Right. Okay. And how successful is it? How's it going? You know, I'm not getting any kind of feedback from anybody, so it's kind of someone who's relapsing and remitting, you know, yeah, I'm taking my medicine, but I'm off over here taking all these other drugs, and maybe every third weekend I'm binging. That's not safe.

Sometimes I'm a little leery about if someone's drug of choice has been cocaine or methamphetamines. There's not really a black and white answer to some of those questions. But what you're saying is you're flexible and open Minded about the issue more than a lot of doctors.

Because it's going to help. I mean, it really is. You know, if you're already starting out behind the eight ball, then you know you need as much help as you can get. And if it's safe, then.

Right. So do you think as a, as a whole, do you think ADHD is over diagnosed or under diagnosed?

I think it's way underdiagnosed.

You think it's under diagnosed? Okay. I think a lot of people will be surprised by that.

Oh, way under. Well, so if you, if you recognize that 75% of adults who have anxiety actually have ADHD, then if you think about all the people you know who have anxiety, who feel overwhelmed, that overwhelm is adhd.

How do you know the difference if you have anxiety? That's really ADHD versus anxiety to something else.

So something else. Anxiety is usually a low serotonin level. So that's someone who worries about things that may or may not happen. Starving children in Africa. What happens if my house catches on fire? What happens if I drive off the road? What happens if I say the wrong thing in just the next second?

The what ifs.

If they have the what ifs.

Right.

Okay.

But the other people are the ones who are just so stressed out because they can't get anything done.

I call it. It's a sensation of impatience. That's the way I describe it. Like it's a constant feeling of pressurized versus worry. It's kind of like a.

The best options are going to be the longest, the longer acting, the longest acting. So I have lots and lots of patients on short acting. Adderall, short acting, Ritalin, short acting. But you get lots of ups and downs. And I think that down creates some cravings that they don't necessarily need. So something that's just much more steady is going to be much more physiologic.

And.

Isn'T going to feed into their cravings. You know, before Vyvanse was the best thing that we had and it would last, you know, 8,8ish hours if you're lucky. But now that we have my Deus, the last 16 hours, it's. I mean, it's just, it's amazing.

It's kind of like on cruise control rather than on a roller coaster feeling like really up here and really down. It's kind of normal, right?