Wednesday, February 01, 2023

Attention-deficit / hyperactivity disorder, better known as ADHD or ADD (in the past), has gained much attention in the last two decades. The statistics are startling: the rate of diagnosis is growing 3-6% a year (cdc. gov) while prescriptions for stimulants that treat the disorder have doubled among certain age groups. I have firsthand experience working with children, teenagers and even adults struggling with the frustrating, and sometimes even debilitating elements of this disorder, including impulsive behavior and disorganization.

When they are first confronted by these symptoms in their kids, many parents veer away from medical intervention. They prefer to utilize treatments that do not include amphetamines, a medication that falls into the same stimulant class as cocaine. The dangers of the medication, especially when not taken as prescribed, have been well documented.

At the same time, the benefits can often be life changing for children and adults who have often felt limited because of their symptoms. Working with addicts, I am confronted with a difficult reality on a regular basis. The rate of ADHD among adults in substance abuse treatment is about 25 percent. A long discussion could be had about the chicken or the egg. However, the reality is that while these individuals are attempting to transform their lives in recovery and address the wreckage stemming from their use, they also have to confront the difficult symptoms of ADHD. Their path becomes more difficult in recovery because a Class II, addictive narcotic with high potential for abuse is the primary standard of care. Cross-addiction, developing a new addiction or beginning to use a different drug, is a common risk for addicts in recovery. Therefore, including a medication like Ritalin or Adderall, is often not an option for them.

Together, my clients and I have sought various methods to address the symptoms of ADHD. In doing so, I have discovered that ADHD can be understood in vastly different ways, and that these divergent perspectives can greatly influence treatment options and successful outcomes.

One way of looking at it, through the medical model, is called the “broken brain.” Less ominous than it sounds, it suggests that there is some fundamental flaw in the neurological workings of the brain, a chemical imbalance or synaptic disconnect. In this approach, medication seems like the perfect option, a solution to any disparity. Alternatively, the symptoms of ADHD suggest a deficit of skill. Attention, focus, organization, tolerating distressing stimuli, internal regulation and patience are skills that can be learned just like hitting a baseball. They are generally referred to as “executive functions,” and many of us learn them organically as we grow up within familial and school systems. Our parents teach us to pay attention; they reprimand us when we ignore. Teachers help students remain organized and problem solve, while classrooms assist in developing the ability to task-switch and prioritize.

In an interview with ESPN, Michael Jordan once explained the effects of not making the team in high school, “Whenever I was working out and got tired and figured I ought to stop, I’d close my eyes and see that list in the locker room without my name on it…that usually got me going again.” He practiced day and night to become the greatest basketball player. I do not believe that the skills of executive function are unattainable. Through diligent practice and the right types of workouts, children and adults with ADHD can overcome their deficits. I watched a client of mine, a wealthy and successful businessman, struggle when he first stopped using drugs. Besides alcohol and illegal drugs, he was hooked on ADHD medications, which he excessively abused. At first he was distraught by the 70 percent drop in sales he experienced without pharmacological interventions. But through diligent work, lots of practice and focus, he was able to make significant changes and gains, surpassing his previous sales. In a mere seven months, he learned to master his ADHD, and actually use it as a tool in his business as opposed to an obstacle!!!

Avi Shteingart, LMSW CASAC, is a licensed therapist practicing in the tri-State area. He maintains offices in Queens and Bergen County. He specializes in substance abuse, gambling and other process and behavior addictions, and works with adolescents, young adults and adults struggling with anxiety, depression, social struggles and transitions.

By Avi Shteingart, LMSW CASAC

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