Navigating ADHD Medication in Sobriety: My Recovery Journey
Finding Balance Between Mental Health Treatment and Addiction Recovery
The Transparency of Mental Health Struggles
I have been quite open about my mental health challenges. I do this with purpose: to help reduce the stigma surrounding mental health issues so others feel more comfortable seeking help. If sharing my experiences can benefit even one person, then it's worthwhile.
Another important reason I discuss my struggles is the well-established correlation between mental health conditions and addiction. Growing up, I believed I was experiencing depression. Only in adulthood did I recognize the nuanced relationship between anxiety and depression. What I had interpreted as simply feeling "depressed" was actually accompanied by a persistent sense of fear—anxiety that I failed to identify as such. For me, depression typically manifested as the aftermath of anxiety episodes, a kind of emotional hangover.
School Struggles: Early Signs Overlooked
Throughout my academic years, I couldn't understand why I felt perpetually bored in school. To cope, I would mentally transport myself to more engaging scenarios or solve hypothetical problems, like contemplating how Luke Skywalker might better defeat the Empire.
Education presented significant challenges, even at the collegiate level. Subjects that captured my interest resulted in excellent grades because I could focus with laser-like precision. However, if a topic failed to engage me or was presented in a confusing manner, I would quickly lose focus, procrastinate on assignments, and delay studying.
Professional Challenges: The Pattern Continues
I always believed I could excel academically if given another opportunity, having discovered the "secret" to maintaining focus. This was self-deception, however, as I observed similar patterns in my professional life. Learning new job responsibilities was difficult, though once mastered, I excelled. The prospect of changing positions filled me with dread—I feared being unable to adapt.
This fear materialized in two particular roles. As an internal Lean process improvement consultant, I faced a steep learning curve without formal training. The experience was overwhelming and ultimately led to job loss. My subsequent position in customer service for a Department of Transportation compliance company proved even more challenging, with onboarding materials that failed to engage me.
My coping mechanism involved humility and asking questions—an effective but energy-intensive approach. I also took extensive notes to maintain focus, requiring significant effort.
The ADHD Diagnosis: A Missing Puzzle Piece
What I didn't realize until about a year ago was that I had been living with Attention-Deficit/Hyperactivity Disorder (ADHD) since childhood. This diagnosis illuminated how my other mental health issues stemmed from ADHD. My anxiety and depression were secondary effects of living with undiagnosed ADHD.
The constant stress from procrastination, inability to break the pattern, and feeling trapped in a cycle of self-defeat led to deeply negative self-perception. I questioned why I lacked the energy and drive of others, why I couldn't absorb information as readily. This negative self-talk, combined with childhood trauma and family history of alcoholism, created the perfect conditions for addiction to develop.
The ADHD-Alcoholism Connection: Research Insights
My research into the relationship between ADHD and alcoholism revealed striking statistics from the National Institute of Health1:
At least 25% of patients receiving treatment for alcohol and drug disorders also have ADHD
Between 20-50% of adults diagnosed with ADHD meet the criteria for an alcohol or drug use disorder
In high-risk populations targeted for prevention, ADHD rates may be as high as 50%
These figures helped me understand how my ADHD, among other factors, contributed to my alcohol dependency.
Seeking Appropriate Treatment
Recently, my ADHD symptoms have either intensified or my tolerance for managing them has diminished. This prompted me to pursue more effective treatment approaches. I've begun therapy with a practitioner specializing in Eye Movement Desensitization and Reprocessing (EMDR) for trauma. Additionally, while my general practitioner prescribed a non-stimulant medication for both anxiety and ADHD, it proved ineffective, leading to his recommendation that I consult a specialist.
Due to the scarcity of psychiatrists, I consulted an Advanced Practice Registered Nurse (APRN) who prescribed Vyvanse at a low dosage. Interestingly, this medication also treats Binge Eating Disorder, symptoms of which I've experienced.
The Recovery Dilemma: Stimulant Medication
Here lies my dilemma: Vyvanse is a stimulant—specifically, a Schedule II controlled substance in the amphetamine class, indicating high potential for abuse but recognized medical utility. Physicians are cautious about prescribing such medications due to their addictive properties.
As someone in recovery from alcoholism, I faced a challenging question: Should I take an addictive substance to address my debilitating ADHD symptoms?
Making an Informed Decision
For me, with guidance from my therapist and APRN, the decision was straightforward: I chose to take the medication. I recognize that some in 12-step programs might consider this a compromise of sobriety—there are even those who view over-the-counter pain relievers as incompatible with recovery.
Living with severe ADHD significantly impacts my quality of life and productivity. I'm taking this medication not for euphoric effects but to manage an otherwise unmanageable aspect of my life. The results were immediate and profound. My experience was comparable to wearing glasses for the first time—suddenly, the world came into focus. The mental fog lifted, and my energy levels normalized. This wasn't the jittery energy associated with caffeine but rather a transition from fatigue to a natural, rested state. My ability to focus, even on mundane tasks, improved dramatically, as did my capacity to redirect attention when it began to wander.
I've also noticed effects on my eating habits. At a recent gathering where delicious cupcakes were available—treats I typically struggle to resist—I experienced no desire to indulge. The food simply wasn't appealing, and I wasn't hungry.
Ongoing Treatment Refinement
I have a follow-up appointment with my APRN this week. Based on my research, I believe my current dosage may need adjustment, as finding the optimal level often requires incremental increases.
A Personal Choice in Recovery
I understand this approach may be controversial within the recovery community. While I believe the risk of developing a new addiction is minimal in my case, it's still a consideration I've weighed against continuing to live with debilitating ADHD symptoms.
I would not presume to recommend this path for everyone in recovery. The decision must be personalized based on individual circumstances, including one's specific substance use history and current needs.
Steve and I explore this topic further in this week's Sober Friends podcast episode.
I welcome your perspectives on this matter, even—especially—if they differ from mine. I read each comment and value your feedback. Please share your thoughts below.
https://pmc.ncbi.nlm.nih.gov/articles/PMC6683828/#:~:text=Abstract,ADHD%20and%20AOD%20use%20disorders.