On Adderall

I recently became aware of the Adderall shortage currently wreaking havoc across the nation, disrupting the lives of so many who are dependent on these medications to function.  Apparently there have been supply issues starting back in 2019, ever worsening, now with 7 of the 9 large manufacturers reporting shortages. 

There are over 41 million people in the US alone that are prescribed Adderall. This number grew over 10% year over year from 2020 to 2021, and actually exceeds the number of formal ADHD diagnoses in the country (~11% in children and 4.4% in adults).   Pandemic anxiety, work/school from home combined with the rising popularity of telehealth companies made it more desirable and easier than ever to snag one of these coveted prescriptions. Two of these companies (Cerebral and Done) are actually under investigation by the DOJ for violations of the Controlled Substances Act. 

Whether you are formally diagnosed or not, Adderall is a drug that comes with a high risk for dependency and abuse. When abruptly stopped, your dopamine and norepinephrine levels will drop, ultimately making you feel pretty crappy for a month or two until things recalibrate; and much worse for those with true diagnoses who depend on these meds to support executive functioning and emotional regulation. Often patients are weaned off Adderall slowly over time (usually over the course of a year) to avoid the jarring effects of cold-turkey withdrawal.

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I had never much paid attention to ADHD or the supporting class of drugs that have formed around it. If I am being totally honest, I had a bit of an eye-roll reaction, never bothering to educate myself out of my own skeptical ignorance. That all changed (of course) when I received my own diagnoses of Adult ADHD at the ripe old age of 34. An unexpected, albeit obvious, diagnosis coming out of a brain scan I had done last year at the Amen Clinic.

I was given a prescription for Adderall and encouraged to fill it; receiving promises of immediate change and what seemed like a whole new life: Extreme Makeover for the brain. I did a ton of research, going deeper on ADHD than I had ever bothered to do before.  Despite my progressively better understanding of these medications and how and why they work, I still did not fill my prescription. A personal history of addiction and a pile of previously conquered dependencies has taught me to proceed with caution whenever I encounter a new potential suitor. I also had a pretty good microdose protocol I was following that seemed to work just fine.

Three weeks ago, I finally tried Adderall for the first time in my life.  Yup, first time ever. Thanks to an early diagnosed heart issue, I have almost entirely avoided recreational stimulant use outside of caffeine. I found plenty of toxic companionship across the other classes of drugs to keep me occupied. 

It took a fixed heart, a generous friend, a red-eye, and a pile of work that needed to get done to bring me to the point where I finally was ready to give it a shot, see what I had been missing. I popped a 10mg Adderall given to me the day before at a conference by a similarly-diagnosed colleague who said, “It can’t hurt to just try a couple and see how you feel.” She gave me two to take home.  

45 minutes after I had taken it, I found myself crying. 

Clarity. 

Fuck. So THIS is how other people’s brains work?

Then...

Oooh… These are good drugs… 

I am a typically productive human.  On Adderall I was a machine.  I wasn’t as mentally fatigued by the end of the day as I normally was.  I didn’t even think about my usual evening wind-down joint.  I didn’t need it. I worked straight through 2am, all focus, no stress. A bit methy, but I felt great and perhaps more importantly… Balanced. I also didn’t have that Doubting Dickhead voice in my head, nagging and giving me shit at every turn. How pleasant was this?

Day 2 was as productive as Day 1. But Day 2 was the last of it. A familiar anxiety in my chest started to build as the day went on. Mostly though? I did alot of work. I also wrote more than I had in months. High productivity, no appetite, low stress, low desire for other substances.

I felt… fixed. 

But on Day 2, I had made a point to pay special attention to my intentions, my inner dialogue, the subtle nuances of human interaction. When managing a tricky addict’s brain, it is always best to take everything with a grain of salt, go a layer deeper. I know enough to trust nothing at face value. 

I noticed that there was more of a selfish tint to my thoughts when on Adderall vs. when microdosing psilocybin, perhaps slightly less empathy. There was an undertone of irritability that would flare up whenever I was interrupted. I noticed that I was also not as tuned in to the energies of other humans the way I am normally, as if the dial on one of my senses was turned down. The real kicker for me though was at the end of the day, when I felt for the first time in awhile that oh-so-familiar addict panic: Stash is out. Feels like a horse kick to the chest, hard to breathe (IYKYK). Only two days taking low doses of Adderall, the creepy convincing drug demon in my brain was back, as if she had never left all those years ago. She loved it like I thought she would, and now she wanted more. 

That alone was enough of a reason to hold off. My enthusiasm for the experience was one I recognized, one I didn’t trust based on past experiences. I have been conquering these dependency dragons since I was 18. I wasn’t ready to sign up for another, knowing how high my chances of getting attached would be.  

The next day I went back to my standard psilocybin microdose protocol.  Does it make me the productivity Jedi that Adderall does? No. If you are looking for the same level of effect from microdosing that straight amphetamine will give you: you will be disappointed. It does not knock out the struggle the way stronger narcotics might, but it helps. For now, that’s enough for me. I am okay with some struggle for the time being.

To be clear: I am not saying my approach is better than the prescribed route or any other for that matter.  It might be better for me, but I am not even sure of that. It’s possible I am taking on more struggle than is needed or reasonable and my risk assessment is overstated. I am totally fine to be wrong. I chose a less beaten path because I think it’s what is best for me right now. My shoes are a bit fucked and I have fallen into the canyon one too many times. I need to find a path further from the edge, even if it takes longer and has more obstacles. Everyone is different and should calibrate accordingly.

What we need is more widely accessible tools in the toolkit to care for ourselves. We shouldn’t ever be dependent on just one thing to remain stable: that makes us incredibly vulnerable. And while I am fully aboard the psychedelics train, I am certainly not drinking the Kool-Aid.  It is naive to think as we progress in our research that we won’t find risk with some or all of these substances that we may not be yet aware of.

As we get new information, we should all keep adjusting ourselves accordingly. Education and awareness is really what’s key. Nothing comes without risk, there is no panacea perfect solution. If you understand that and have accurate information on the benefits as well as the downsides for whatever you do, you can at least adjust accordingly to offset whatever those downsides may be.

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Despite the jokes online about the “coked out Millennials begging for pills ”, the Adderall shortage is disrupting lives across all age classes in this country, including children. I am grateful I don’t share this particular dependency right now. I have deep empathy for everyone struggling with it. Withdrawal is a stressful bitch. And untreated ADHD is really difficult to effectively manage if you don’t have other tools to support yourself.

We all struggle. Every single day, regardless of brain-type or circumstance. We are also ALL dependent on something to get us through, whether we are willing to admit it or not. This shortage serves as a reminder to us all that we must manage our dependencies, constantly adding tools to our own toolkits, removing vulnerabilities.  Dependency and using tools to help ourselves is part of human nature. It’s not dependency or the tools we have that’s the problem. It’s the lack of options. When we don’t have enough options, our dependencies become a single point of failure; causing major dysfunction when removed. We need to ADD MORE TOOLS to the toolkit so that when inevitable disruption occurs, we have other things to lean on.

It’s not about ridding ourselves from dependency. It’s about diversification.