Aldous Huxley predicts Adderall and champions alternative therapies

https://peterattiamd.com/trennasutcliffe/

It's like realizing that the reason you've been getting stuck in the mud is not that you're a bad driver.

It's just that people who don't are driving 4x4 trucks, and you've had a Nissan Z series sports car.

Turns out, farms and off-road are simply not the right environment for your vehicle, and when that environment has some accomodations, like the paved surface of a highway or a race track, you're literally running circles around people in the most common vehicles.

One profound effect of taking Adderall was feeling the clarity to understand that difference, and seeing the road instead of the endless mud fields in front of me.

It does help to get things done, but around 30% of ADHD'ers aren't responsive to it.

Understanding that you're getting stuck because your brain wasn't meant for that kind of driving, however, is universally useful.

That's why I made that ADHD wiki [1], and keep posting links to it.

It's an compilation of information that has helped me tremendously to understand the above; and I know this resource was helpful to others too in their journeys.

My perspective is that of a late-diagnosed adult who's been completely unaware of what ADHD is, and thought that they can't possibly have an attention deficit because to get anything done, they have to hyperfocus on it.

Again, learning that hyperfocus is a symptom of ADHD and understanding how it works)l had a profound impact. And medication helped with that too: it's easier to not get stuck hyperfocused on the wrong thing with Adderall.

Getting Adderall was like spraying WD-40 into rusty steering components. The immediate effect is that I can go where I want to go to, not the random direction my vehicle happens to face.

The long-term effect though was understanding what makes it difficult to steer, and how to maintain it better.

And even if I don't have power steering all the time like everyone else, I'm still better off with that experience.

My point here that it's never about medication VERSUS therapy and knowledge.

Medication is not an alternative, it's a BOOSTER.

When it works, it's just dropping the difficulty from Nightmare to Medium/Hard. It doesn't play the game for you.

The said, I'm very much happy the Nightmare mode days are behind me, and I'm very sad that the only reason I've been living my life that way is stigma and lack of information.

When I took Adderall, I unexpectedly had to grieve the future I'll never get to have after being held back by all the pain I've been needlessly subjected to over the preceding three decades.

That grief, too, is a common experience in ADHD late-diagnosed adults.

Thank you for sharing that link, and contributing to the discussion and awareness <3

[1] https://romankogan.net/adhd

The stigma also seems to accidentally admit that things like executive function and food noise aren't equally distributed, thus some people could benefit from intervention.

For example, if you've never been fat or you never binge eat or you've never procrastinated 15min of homework until 2am despite, then you're missing the irony when your solution for people who deal with these things is to try harder and to jump through hoops that you don't need to.

> For children with ADHD younger than 6 years of age, the American Academy of Pediatrics (AAP) recommends parent training in behavior management as the first line of treatment, before medication is tried.

> For children 6 years of age and older, the recommendations include medication and behavior therapy together—parent training in behavior management for children up to age 12 and other types of behavior therapy and training for adolescents. Schools can be part of the treatment as well. AAP recommendations also include adding behavioral classroom intervention and school supports. [1]

[1] https://www.cdc.gov/adhd/treatment/index.html

CBT works pretty well for adhd, studies are clear on this.

But medication seems even better, as does a combination of therapy and medication.

ADHD isn't unusual as far as the effectiveness of therapy, it's unusual in how well the medication is proven to work.

No, it doesn't. It _barely_ works and mostly consists of teaching people some coping mechanisms. Medication works _much_ better, especially when using in addition to the CBT.

The only things I’ve foung that actually works, is a daily combo of Vyvanse and dexis

But talk therapy can help some folks come to accept the differences that their ADHD means in terms of how to relate to other people or to better understand why how ADHD impacts their own behavior and self-perception.

I myself have found it’s much easier and happier to shape my life around my particular ADHD than trying to change my behavior (something that’s destined to fail and only compound the negative emotions associated with ADHD).

I want to share my counter example -- no amount of therapy could help me not almost loose it every time I drove my daughter in heavy traffic or deal with her just being a toddler.

But after 2 weeks being on concerta made lasting changes even months off the drug.

It was the best type o therapy -- you just do the thing that triggers you minus the bad part and learn it's not so bad and you can do it, it has profound implications.

It is not effective, and I would argue actively worsens, situations where you're feeling bad about your accurate view of things, such as when you're depressed because you're unable to ever get any of the things you need to do done despite knowing they need to be done. CBT is unable to help in that situation because most people can't simply go "oh, well its ok, its a mental health condition" - employer, while sometimes supportive, aren't going to continue employing someone who doesn't do the work they're being paid for, and reframing that would eventually result in losing their job.

The therapist that worked for me practiced ACT, and was more close to coaching when it came to ADHD.

Therapists are living databases of solutions to certain kinds of problems that people have.

Problems caused by ADHD certainly belong to that category, and if your therapist is specializing in that area, they can save you a lot of time and effort by suggesting approaches that you'd otherwise have to figure out on your own.

Finding such a therapist is, unfortunately, a bit like winning a lottery that most people in the US wouldn't have the resources to play.

> Using a random effects model, we found that CBTs had medium-to-large effects from pre- to posttreatment (self-reported ADHD symptoms: g = 1.00; 95% confidence interval [CI: 0.84, 1.16]; self-reported functioning g = .73; 95% CI [0.46, 1.00]) and small-to-medium effects versus control (g = .65; 95% CI [0.44, 0.86] for symptoms, .51; 95% CI [0.23, 0.79] for functioning). Effect sizes were heterogeneous for most outcome measures. Studies with active control groups showed smaller effect sizes. Neither participant medication status nor treatment format moderated pre-to-post treatment effects, and longer treatments were not associated with better outcomes. Conclusions: Current CBTs for adult ADHD show comparable effect sizes to behavioral treatments for children with ADHD, which are considered well-established treatments. Future treatment development could focus on identifying empirically supported principles of treatment-related change for adults with ADHD. We encourage researchers to report future findings in a way that is amenable to meta-analytic review.

Yeah, it's better at making people feel better. Not great but certainly OK at improving behaviour.

As I said, the evidence seems to suggest medication is extremely effective which is I guess is why people are quoting the first thing I wrote and acting like they disagree with me (they get mad for suggesting that CBT works a bit because they feel judged for using the arguably superior treatment?).

While it is true that therapy is not a replacement for how stimulants reinforce executive function, therapy can help folks with ADHD understand their behavior patterns and better manage some of the challenges that go along with the disorder.

In my experience, therapy helped me get over my lifetime guilt around my lack of achievements, better understanding my triggers, and prioritizing self care. I couldn't have gotten through COVID lockdown with my wife and two kids in our tiny house without it.