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Goals, not wishes-- I'm a doctor, not a genie.

Monday, June 26, 2017

ADD 101

Posted by fxckfeelings on March 8, 2010

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In my practice, I give patients with ADD a special appointment option. Instead of their taking responsibility for keeping a regularly scheduled appointment (which means they’re obliged to pay full freight, with no insurance support, if they don’t show up), I encourage them to line up for a walk-in appointment which may keep them waiting longer, but won’t cost them a cent if they forget to come. It’s not that I discriminate, I’m just trying to make the best of things. That, to me, exemplifies the best way to deal with Attention Deficit Disorder, both for my patients and as a third party; keep your expectations reasonable, your appetite for shit bottomless, and your shrink understanding.
Dr. Lastname

My roommate calls me the Ritalin vampire, because once my meds run out around 5, I become a different person (or really just a depressed, anxious mess). My mood drops so low so fast, and my nerves become so raw, that I have to drink just to get through the evening and get some sleep. It’s obviously driving my roommate crazy, but more than that, it’s messing up my life—I wake up hung-over, my boss is pissed, I feel sick all the time, so even when I’m not anxious and wired when I’m on my meds, I still feel like shit. My goal is to figure out how to get my ADD under control when the sun is down.

Most Ritalin users don’t have a terrible comedown with severe anxiety every time their meds wear off—what you have isn’t normal ADD, but ADD plus anxiety, plus, probably, alcohol dependence.

The medical term for your three-pronged disorder is a trifuckedta. Surprise, the prognosis ain’t so hot.

You might say, yes, that’s what I mean, I’m really, really, really fucked and that’s why I need three times as much help.

Here’s the hard part, though; there’s no good treatment, and nothing, but nothing, is likely to solve these problems to your satisfaction. Now that we have that out of the way, however, you know your goal is not to be fulfilled, so we can discuss how to make the best of things (starting with getting off the bottle).

Yes, I know you can’t stand the anxiety, but there are alternatives to booze. By learning some relaxation techniques and trying out some non-addictive meds, you too can get used to the idea that people often have to, and do, live with chronic pain.

Alcohol will make your anxiety worse in the long run, regardless of how much fast relief it provides, and letting alcohol and/or anxiety control your decisions will toilet your life in short order, causing more anxiety, more drinking, and more business for me (no, of course, I won’t waste your time, but everyone who loves you will be looking for help and running into my ever-loving arms).

Second, ask yourself whether you can reduce your weekly Ritalin consumption by changing your job and/or learning some organizational tricks that will help you keep it together even when your mind is flying apart.

Yes, there are a few medication strategies that might reduce your distress—trying another stimulant or adding a low dose in the late afternoon may help—but don’t expect a cure, or you’ll feel just as entitled to your medicinal alcohol as ever, and we’re back at square one.

Third, you need a philosophy for dealing with impulses and chronic pain. You can get it from the right parts of the Bible and other religious texts, the right friends/relatives/therapists, AA or similar groups, Neil Diamond records, whatever speaks to you. You’ll find it when you’re looking for strength, not relief.

I know, easier said than done, but don’t think for a moment you have a choice. Living with the trifuckeda isn’t easy, but your current choices are actually making life harder. Get sober, get your meds in order, get some good support, and get out of vampire mode for good.

STATEMENT:
Here’s a statement to keep you on track. “Because of my ADD and anxiety, I expect most of my decisions will be painful trade-offs between getting things done, tolerating pain, and controlling dangerous habits. On any day that I hit a healthy balance, I deserve great respect, regardless of how I feel at the end of the day, which will seldom be happy.”

My boyfriend and I are starting to get serious, but I’m not sure whether to move in together or break it off. On the one hand, he’s funny, caring, smart, and generally a good guy. On the other hand, he struggles with ADD, which is the reason he’s amassed massive credit card debt, and because he’s ashamed of his ADD, he didn’t tell me about it until we were dating for a year (that’s when he admitted to me that he had a problem and took medication). I don’t want to hold his disorder against him, because it’s not his fault and I don’t want to make his shame any worse, but I also don’t want to commit to a life with someone prone to major screw-ups. My goal is to make a decision based less on feelings (good, right?) and more on what’s smart.

Look at the positive: your boyfriend’s ADD may well be part of his most likeable qualities, including humor, spontaneity, and an ability to connect with others. In the right circumstances, it may help him make a living.

At its best, ADD is a style, not a disorder. I know, it’s called a disorder, but don’t believe it. It’s a disorder when you have to study in a classroom or do bookkeeping, but when you have to think of ideas or be at a party, it’s a huge help.

As for his sins, the cover-up is usually worse than the crime. If he lied about his credit card debt and spent more effort inventing reasons for his fuck-ups than correcting them, then he’s in trouble, as is anyone who depends on him.

The problem then isn’t his ADD, it’s the avoidant habits that have taken over his character and undermined his integrity. You’re saying he’s better than that; he ‘fessed up, and I assume he really wants to do better rather than slide by with a diagnostic excuse.

So here’s how you can check him out. See whether, with your help, he can set up a savings plan and retire the credit card debt (but by help, I don’t mean nagging). What you want to know is whether he can use you as a coach, friend, and provider of structure, not as a nag or mother.

Ask yourself whether you’re good at doing the things that are hard for him; (if you’re both hopeless with schedules and budgets, you won’t be good for one another). Work together and see if it works, and by work, I don’t mean feeling the joy of helping or taking care of him. I mean imagining the two of you getting the job done, whatever it is you want to do together, and with each doing his/her share.

Your boyfriend has problems, but, believe it or not, ADD might not be one of them. So assess his qualities as you would any other guy, without emotions (bravo!), or excuses.

STATEMENT:
Here’s a statement to guide the next phase of your partnership search. “I’ve found someone I love and respect, but I need to know whether he can manage his baggage and whether it will prevent us from being good partners. So, instead of avoiding the pain of going through stressful situations together, I’ll embrace them and see what they tell me.”

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