For a while, I was doing a podcast with a group of friends, where every week we’d take turns “deep diving” on a topic we found interesting. The Bench Ash Shirt podcast sorta died off as our lives got busy in different ways, but probably my favorite episode never happened. Or it did happen, but someone forgot to press record. And that someone was me. The episode being about ADHD, and the ADHD guy forgetting to press record was just so on the nose, it hurts.

ANYWAY, while I don’t have a recording of the episode, I do have my notes. I was talking to friend recently diagnosed with ADHD (hi Jake!), and on a whim looked for the notes I prepared for that particular deep dive. Usually my notes are terrible, with disjointed thoughts and single word triggers to remind me about a particular thing. For some reason, the notes I made for this episode are pretty elaborate. Even readable, for the most part. Anyway, I figured I’d share them here for anyone wanting to know more about ADHD, from someone who was diagnosed late in life.

SHAWN’S NOTES:

ADHD Podcast Deep Dive

First: ADD & ADHD

• It’s all ADHD now, ADD is an old term for “non-attentive” version vs “hyperactive” version.
• That’s a spectrum between the two though, and is largely just how a person’s personality responds to the underlying issues.
• So ADD is an outdated term, but you still hear it a lot – and I don’t correct people unless they are snotty and all “AKCTUALLY I have ADD, not ADHD”

Brain Chemicals

• Endorphins
  • Runner’s high
  • Allows us to push ourselves beyond normal limits
  • Released in response to pain
  • Why we enjoy laughing so hard it hurts our bellies
  • Dark Side: self-cutting releases endorphins
  • Labor pains release lots of endorphins, but also:
• Oxytocin
  • It’s why love, friendship feels good
  • Behind the feelings of trust, security
  • This is why we are social creatures – the oxytocin is our reward for caring for and being cared about by others.
  • That feeling you get from a long hug (consentual) – that’s a release of oxytocin
  • Dark Side: staying in a bad relationship chasing the love and security, ie, oxytocin
• Serotonin
  • Feeling of pride in what you do, what gives you a sense of being successful
  • Serotonin is released when a leader leads well
  • ALSO released when a follower impresses their leader. It’s why we strive to do well for others, regardless if we’re in a follower or leader role.
  • Self-worth is largely a serotonin-based metric
  • Dark Side: possibly narcissism (if you think you’re a great leader when you’re not really great) 
  • DEPRESSION is largely a lack of serotonin in the system, or the brain not regulating it correctly. No matter what the reality is, lack of serotonin leaves you feeling worthless with no way to make it better, because doing the “right stuff” doesn’t give you the proper feelings
    • SSRI – Selective Serotonin Reuptake Inhibitor. The brain vacuum that cleans up excess serotonin is possibly working overtime.
• Dopamine
  • That quick hit of joy from checking off an item on a list
  • Very short lived. Serotonin drugs take weeks to start working, because that is a slow release slow cleanup system. Dopamine is a quick hit.
  • Dopamine is addictive. It’s what video games, social media, and cocaine manipulate
  • Without dopamine, we’d never reach our goals – it’s the reason we take the steps toward larger goals. Without dopamine, there is no motivation to DO anything.
  • It seems like the least important brain chemical, because it is manipulated for evil all the time, candy crush, etc.

But ADHD is a dopamine issue. And because it’s tied to dopamine, that is why people often think ADHD isn’t really a big thing, or that everyone is ADHD, or when they hear the symptoms of ADHD, they identify with them because they’ve experienced the same things due to technology, etc.

And while there is a serious conversation that can be had with regard to society manipulating dopamine, ADHD isn’t just someone who is more susceptible to dopamine manipulation – their actual dopamine system is broken from the word go:

• That little “win” you receive from checking off an item on your to do list is a tiny hit of dopamine. ADHD brains either:
  • Don’t release that hit
  • Release far less of it
  • Clean up the dopamine before its effects are felt

Mind you, dopamine is how you know what to do. Your brain rewards you for doing things that are productive and work toward a larger goal. It’s the most basic of the chemicals we talked about.

• Eating releases dopamine, this kept us alive
• Sex releases dopamine, this kept us populated
• EVERYTHING we do is dictated by our brains leading us around with dopamine carrots

So, without that regulation, the ADHD mind is constantly switching from thought to thought, trying to figure out what it’s supposed to do. This is not a conscious “figure out” – it just knows that dopamine means it’s doing good. So it’s easily distracted, every (literally every) think being a potential source of dopamine, and thus guidance.

The hyperactivity is often physical in children (moreso in boys, thanks to society expecting boys to be boys). And since that physical hyperactivity tends to fade during the transition into adulthood, for many years it was assumed ADHD was merely a childhood affliction. BUT, the hyperactivity doesn’t go away, it just internalizes into racing, unmanageable thoughts. (Still manifests physically some, leg-shakers, etc)

AND, because not all hyperactivity (seeking dopamine guidance) is physical in children, it often goes underdiagnosed. Especially in girls.

AND, if a child is intellectually gifted, they either:

• Meet the standards for normal, so aren’t seen as needing diagnosis or treatment (although they’re likely performing WAY below where they could – these children are the ones who, “had such potential”)
• Internalize their hyperactivity in the same way adults generally do (perhaps due to introversion, societal expectations, etc), and so their struggles aren’t suspected to be ADHD related because they’re not hyper.
• Girls are often “dreamers” instead of seen as needing help.
• Boys, well, boys end up never living up to expectations and dyeing their hair green, not to put too fine a point on it.

WHAT ABOUT STIMULANTS?!?

You’ll likely hear that stimulants do the opposite for ADHDers. And on the surface that seems to be true. But that’s not really what’s happening. Now that you have a pseudo-understanding of what’s going on in the ADHD brain, let’s talk about stimulants. (Which are THE most effective psychoactive treatment drugs for their use case across all of psychology. The degree to which they work is off the charts effective.)

• Touched on it briefly but dopamine is released by the brain when we do something we’re supposed to do, it binds to neuroreceptors giving us the win, and is then reabsorbed. It’s very short lived, but that’s how the process basically goes.
• ADHD brains do one of two things, and sometimes both:
  • release less (often MUCH less) dopamine when something is accomplished
  • clean up that dopamine quicker than a typical brain
• There are (2) classes of stimulants used to treat ADHD. Amphetamines and Methylphenidate. (Adderall and Ritalin, respectively)
  • Adderall increases the amount of dopamine released
  • Ritalin slows down the reuptake of the dopamine
  • This is why some people respond better to one class of stimulants over the other. Some people have over active brain vacuums, some people have normal vacuums but don’t release the proper amount in the first place. Some have crappy boths.
• SO, either way, the stimulants increase the amount of “tonic dopamine” in the brain. How much is sitting around to assure the brain that it’s doing the right thing. So the brain calms TF down, reducing hyperactivity both mentally and physically.
  • The reason stimulants aren’t a good idea for people with high blood pressure is because the two classes of stimulants also cause the brain to release more norepinephrine. It’s related to epinephrine (Adrenaline) but works more on keeping blood pressure up so the brain is flushed with blood during high stress. (This seems to be less of an issue with standard doses, but more on that later when we talk about abuse)
  • Here’s the rub though: It calms down the frantic dopamine seeking so an ADHDer can function. BUT increased tonic dopamine just means there’s less jumping from topic to topic (or chair to chair) – it doesn’t FIX how dopamine works to REGULATE daily activities. So medicine is invaluable and even vital for success, but it’s not enough. Once medicated properly, a person with ADHD has to learn to use tools like reminders, lists, schedules, etc., because while they’re not in panic mode – they still don’t get direction from their brains on what to do. A medicated ADHDer just has the ABILITY to use the sorts of tools that people thing is all they need to have in the first place.

CAFFEINE?

So… what about caffeine?

It does increase dopamine (and norepinepherine) in a roundabout way. It blocks the adenosine receptors, which has the effect of increasing dopamine in the brain. But it’s not terribly efficient at it. Still, many adults with undiagnosed ADHD (and at least one with a diagnosis) drink FAR more caffeine during the day than would be considered normal. Basically it’s self-medicating for ADHD using whatever is at hand. Thinking is slightly better when hopped up caffeine, and so we tend to over indulge.

Oddly, many folks with ADHD do not respond to the adenosine blocking, which is the mechanism caffeine uses to keep most people awake. Perhaps it’s because they’ve built up a tolerance, but there seems to be more to it than that, and it’s not that way for everyone with ADHD. It’s possible it’s something else, or some aspect that isn’t well understood.

I’m one of the ADHDers who doesn’t get “hyped up” from caffeine. When I first approached my doctor about getting tested for ADHD, he asked if a cup of coffee at night would keep me awake. I told him that I have such horrible insomnia, I don’t drink caffeine at night because I can’t fall asleep anyway. He said some people with ADHD seem to be “immune” from the sleepless effects of caffeine, and some folks tend to sleep better. That night I took a cup of caffeinated black tea to bed with me, and drank the whole thing right before shutting the lights off. And I slept better than I could ever remember. The only way I can explain it is the caffeine seems to help me “focus” on falling asleep instead of my brain going 100mph all night. It has changed my life.

WHY PEOPLE ABUSE ADDERALL

When a person who doesn’t have ADHD takes adderall, it does the same thing to their brains. It increases tonic dopamine levels. But their levels were already a normal level, so now the levels are abnormally high. So it feels REALLY good. They have a constant “YOU DID A GOOD THING” feeling because they’re brains are flooded with dopamine, PLUS when they actually do something good, their brain releases MORE.

The effect is that a person with a typical brain chemistry on Adderall gets “hyper” because everything they do is rewarded with OMG SO MUCH DOPAMINE that they want to keep doing all the things! And college kids can study for HOURS or DAYS, because even if they’re body/brain is exhausted, all it knows is THIS IS EXACTLY WHAT I SHOULD BE DOING BECAUSE MY BRAIN SAYS SO!!!

They’re just high. And it feels GREAT. And the studying is often effective, even if there is a toll – they’re young so the toll is likely one they don’t notice. And because it feels good, they often take way more than what an ADHDer would take, so the blood pressure issues from the extra norepinephrine becomes a real concern. PLUS, all that extra dopamine might cause insensitivity in the neuroreceptors, which means more is required for the same high – and the physical addiction becomes real.

Someone with ADHD, taking the properly prescribed amount of a stimulant almost never get addicted, and while there are different titrations for each person, in general, once the proper dose is found, it works for decades without needing to increase it. Because again, it’s just bringing tonic dopamine levels up to normal amounts.

My point here is, people with ADHD don’t “get high” with a regular, prescribed dose of stimulants. They don’t have an advantage over neurotypical brains who don’t have stimulants. In fact, because their regulation system is still broken, they’re STILL at a disadvantage compared to un-medicated neurotypical students. Which is why accommodations are still appropriate. (There’s a whole other episode about what accommodations make sense for an ADHDer – the typical “more time on a test” is rarely helpful, unless they have secondary issues like dyslexia which would make more time helpful, but I digress)

SO ARE WE ALL A LITTLE ADHD?

There’s a worthwhile discussion to be had about whether technology is causing serious dopamine-related issues with us as a society. BUT, that would be different and/or in addition to ADHD, which is a deficiency in how the brain regulates dopamine.

And yes, I think it might be difficult to tell the difference without some testing designed specifically to look for ADHD in a dopamine driven world. And even with thoughtfully created testing, there still might be some confusion, especially when there is overlap between the two phenomena. But the tendency is to dismiss ADHD as not real because so many people have similar symptoms from dopamine addiction, especially when the people are the same person. (An ADHDer could get addicted to Candy Crush, even if the dopamine hit from making a match is significantly lower than a neurotypical brain)

WHAT ABOUT HYPERFOCUS?

Ha! If people with ADHD can’t focus, explain the “hyperfocus” thing.

• Everyone has experienced being in the zone
• For someone with ADHD, that sort of timelessness getting sucked into a project happens more frequently than with the standard population
• Many see it as a superpower.

But again, what’s actually going on? The phenomenon happens to ADHDers who are medicated and those who are not. Arguably more with unmedicated people, but that sorta makes sense when you realize what’s going on.

Remember that the dopamine response system is b0rked. So the mechanism to regulate what you should be doing at any moment isn’t responsive, or isn’t responsive enough to keep you on a task. So instead of dopamine regulation, an ADHD brain will follow something it’s interested in, and have no safeguards in place to turn back. Interested in the lack of tectonic activity on Venus? Why not start reading about it, and watching youtube videos. As long as it’s interesting to you, nothing will take your mind off of the topic. You’ll forget to eat, sleep, pick up your kids from school, take a shower… Because all that “what you should do” stuff is broken.

Someone on medication is perhaps less likely to fall into one of these holes, because they can more easily choose to do something they know they should be doing. Their minds aren’t racing to find something new or novel that might give them a hit of dopamine, or might at least catch their non-dopamine-influenced interest. So a medicated person isn’t more immune to the hyperfocus sessions, they’re just perhaps less likely to fumble about until something grabs them.

And superpower? Meh. If we could choose what or when we hyperfocus, maybe. But I find my hyperfocus sessions are usually so very, very dumb.

LITANY OF ODDITIES

There are so many other weird things that are often associated with people who have ADHD. Many anecdotal, because it’s difficult to test when not everyone has the same things but off the top of my head:

• Bad in relationships, often never building a deep relationship and once the newness wears off, look elsewhere for the thrill
  • not always
• Often VERY generous. Dopamine broken, but oxytocin works fine. Empathy to a fault.
• Forgetful
• Often don’t pay attention
• Itchy tags or uncomfortable clothes can consume attention
• co-morbidities (mine is major depressive disorder), is it a cause? Just coincide?
• VERY good in an emergency
  • thinking fast is normal, when there’s a clear, immediate task – ADHDers are BUILT for that
  • it’s crazy, i’ll go from spacey and distracted to 1000% problem-solving mode instantly. If there is a benefit to ADHD, this might be the only one that doesn’t have strings attached
• Thrill seekers.
  • Nothing motivates us, so extreme sports/actions/danger are attractive because excitement provides some fulfillment.
  • I’m not allowed on 4-wheelers, snowmobiles, motorcycles, or sports cars – because I can’t not be stupid
• Often drug abusers, for various reasons, various types of drugs – often also due to co-morbidities