What’s interesting here is that in the drug treatment world it’s basically known that drug abuse is almost always a reaction to some kind of psychological trauma or disorder, and an awful lot of drugs (not just cocaine) play heavily with the dopamine pathways. The idea of dopamine as your brain’s signal that you’re safe fits about as neatly with that as can be.
(Of course, like everything in biology, dopamine also does about a gazillion other things, too, so it’s not quite that cut and dry, but it rhymes, at least.)
> in the drug treatment world it’s basically known that drug abuse is almost always a reaction to some kind of psychological trauma or disorder,
This is not true in the professional world. People engage in drug use for many reasons, including pure recreation.
Trauma can precede relapses or bouts of drug abuse, but it's not a universal explanation.
There are a lot of pop-culture ideas that explain everything away as trauma. These are popular on podcasts, Reddit, and other social media websites. There are also types of therapists who learned to treat trauma and then try to apply that to everything. "If all you have is a hammer, everything looks like a nail". These therapists will try to reframe everything as trauma because it's what they know how to teach.
They often reverse engineer a traumatic backstory as an explanation even when one doesn't exist. You can find podcasters and therapists who will even claim that being born imparts permanent trauma that explains things long into adulthood. There's no evidence behind this claim, but it's convenient for therapists who need to find a traumatic backstory before they can address something because everyone was born at some point.
> The idea of dopamine as your brain’s signal that you’re safe fits about as neatly with that as can be.
That idea is completely wrong, though.
The study is talking about dopamine signaling in one specific location of the brain.
Dopamine is used in other locations in the brain to encode aversive stimuli, among other things.
Dopamine (and other neurotransmitters) don't just do one single thing in the brain. They have diverse effects all over.
Also, many of the drugs that people associated with dopamine actually have much broader effects, such as on norepinephrine (stimulants) and serotonin (cocaine).
There are dopamine agonist drugs that go in and very precisely target different dopamine receptors in the brain, activating them directly. Many people are surprised to learn that a common side effect of these drugs is an irresistible urge to sleep when first taking them, for example.
> in the drug treatment world it’s basically known that drug abuse is almost always a reaction to some kind of psychological trauma or disorder
This is incorrect. While this is true for a substantial number of people, I want to offer some resistance to the pop-psychology axiom that "everything is because of trauma." Not only is is unsupported by science, it has lead to an expansion of the definition of the word "trauma" in popular culture that's so broad as to be nearly useless clinically or scientifically.
I had the unique experience as a youth in attending a school where a substantial portion of the school was funneled there by one of the many 1970s and 1980s troubled teen corporations that spun out of Synanon after it collapsed. This one specialized in drug addicts.
Almost all of my classmates (not me, unfortunately) were from exceptionally wealthy families and excepting one none of them ever mentioned any childhood trauma. Instead they were precocious partiers who got into drugs despite being underage and going to the nightclubs in the seedy part of town - no one at the time was turning away hot young women or gay(for pay or real) young men. And the club scene was a drug scene. It still is.
I don’t think trauma is actually at the root of almost all drug abusers. The only first class abusers (pot and alcohol in serious quantities daily) that I know at the moment grew up in perfectly fine suburban families and are in good, non-narcissistic/controlling/etc relationships with their families. They’re just addicts who can’t stop. One of them is going to die from it, eventually, given his level of alcohol consumption.
Indeed, I was surprised both at the fact that it literally makes me feel better because the drug makes you feel good but also that it calmed my brain down and let me access some inner peace. But also the focus modification is big and I learned so many good habits that now I need much less of it to get stuff done. I wake up and start doing my chores before I even have my first dose!
Generic Adderall Gang here, and in hindsight, I'm surprised at how little of it I need to realize a much better headspace. Makes me wonder if all of that caffeine in my undiagnosed youth was saying something...
Ritalin was a game changer. After the initial adjustment it just feels like it brings me up to normal, I'm not particularly stimulated (in fact my lack of wandering mind makes it easier to doze during the day), I just prefer coding to games etc. It feels like it unlocks access to natural reward mechanisms instead of chasing artificial feel-good rewards. I can't even listen to a YouTube video while coding when using it, which was a normal activity for me since my brain felt bored and went off on its own without it.
Just mentioning because curiously it almost entirely put me off caffeine. I still enjoy my morning coffee as a ritual, but sometimes don't finish it. If I have another then the side effects are severe, Ritalin massively boosts those - nerves, jitters, hitting the toilet. Not terrible or dangerous, but just interesting, and honestly caffeine never did a whole lot for me mentally so it's no big loss.
Take this with a grain of salt, but I use it as an ad-hoc benchmark: FDA recommended maximum daily limit on caffeine is 400mg. If you're regularly going above that, then (politely) consider whether you should be.
The problem with amphetamine is you pay for every benefit: focus now, lethargy later; energy now, anhedonia later.
But taking a small, consistent dose. Does that work? Do you feel you net benefits in life from taking the drug, discounting for withdrawal and/or tolerance?
IMO, that's always just been me. Now vs Later is hard to judge, though, because I tend to have "good focus" blocks of time, and "chill blocks". Exact timing depends on my overall weekly schedule leading up to a time period.
Also, I mentally classify different types of energy. Physical, social, and mental energies all have their different places in a day.
> small, consistent dose
For me, yeah, but YMMV based on brain chemistry and environmental variables. Since I use El Cheapo, I max out at 10mg 2x/day, but rarely adhere to that unless I'm planning ahead for it/have been on that roll for a while. This helps a lot with tolerance, especially when I have lazy weekends.
And from a personal perspective: It's a very simple drug to understand, which makes me feel at ease. Brain goes vroom, like an engine hitting a more comfortable RPM. Not every situation needs my full power.
In my experience, no. You just get used to it and it does fuck all. Maybe worse even. Adderall seems to take my creativity away entirely and I just feel like a zombie.
Theres a host of physical symptoms that come with it to that are not fun to manage: decreased appetite, dehydration, headaches, sleep loss, heart palpatstions.
I would say its far better to take it on a needed basis once in a while
No I havent, maybe its worth trying. Adderall worked so well for me initially I didnt want to experiment but yeah over time the negatives have outweighed the positives. I mean seriously first day 5mg worked better than 20mg a month or two later
I imagine the tolerance thing holds with all drugs so Im surprised people say it works for them long term (maybe placebo, or they're comparing it to withdrawal "Ive been on adderall for 10 years, if I go a day without it I feel like shit and cant function, so it works!" but maybe...
I think I know what you mean but the theory, as far as I understand it, is that those initial feelings of stimulant medications aren't meant to last, and a lot of it is technically a side effect
For the first few days we can experience significantly increased energy and some euphoria, along with the therapeutic effects. That's a really novel experience at first (which in itself helps ADHD brains focus) so it often works extremely well for a short while.
People get in trouble if they try to chase that initial feeling (high), mistaking it for the therapeutic value that the medication is supposed to provide. Eventually we're not supposed to feel it at all, and if it's the right medication for us at the right dosage, it should just quietly provide therapeutic value in the background, improving our executive functioning challenges, emotional regulation, etc.
As I understand it, the data on tolerance with stimulant medication is a bit mixed[1], some people develop tolerance but many people don't.
In your situation I'd definitely give different medications a try, it shouldn't make you feel like a zombie. It's pretty common for people to respond poorly one class of medications and respond well to another class. If Concerta (methylphenidate) didn't work for me I would personally consider Elvanse (lisdexamfetamine), then atomoxetine (an SNRI). There are also some other non-stimulant options like guanfacine and a few antidepressants that have been found to work well for ADHD but I don't know much about those.
I definitely got europhic feelings first time around, but slightly down the line, more energy, calm, focus. My euruka moment was just doing the dishes and actually somewhat enjoying it. Normally I DREAD simple tasks like that. I was just thinking is this what people normally feel?? I wish I was like that all the time.
After a while though Im not quite certain what the residual effects were. Maybe slightly more focus, but I still couldn't focus on my work, side projects, hobbies and any increased focus there was went to video games and bad habits.
Perhaps issue is Im beyond bored of my job that nothing can save it and need to make an active effort to be disciplined
In my experience the nonstimulant ones do jack. I feel it was a response to all the fear of putting kids on a mind altering medication. In my personal case it prevented getting good medicine for over a decade. Other kids on Strattera my age reported similar lack of success and bad side effects.
I can't find it right now but I recall seeing somewhere that around 40% of ADHD patients reported better effects on Ritalin (methylphenidate) or dexamphetamine roughly equally, another 40% says both are about as good as each other, and the final 20% don't find either very effective.
In my personal testing the Ritalin was much better, dexamphetamine was more up/down and shorter lived. However I didn't really get a crash or lethargy with either, it's just the focus wearing thin (and yes, the benefits were real and massive starting for the first time in my forties).
According to my psych, both have been around 70+ years and are fairly well understood. Longer term therapeutic doses shouldn't be habit forming and tolerance is minor after the initial phase, there's no withdrawal effects and it's easy to forget to take a dose if your routine changes. My morning coffee is far more demanding in that regard.
> The problem with amphetamine is you pay for every benefit: focus now, lethargy later; energy now, anhedonia later.
> But taking a small, consistent dose. Does that work? Do you feel you net benefits in life from taking the drug, discounting for withdrawal and/or tolerance?
There's a reason these medications are supposed to be taken regularly at the same dose in clinical practice. Patients should not be going through cycles of taking stimulants and then withdrawing all of the time.
There's a disconnect between the way some people try to use stimulants ad-hoc versus the therapeutic modality. The initial burst of confidence, energy, and positive mood that comes from intermittent use is a side effect, but people confuse it with a primary effect. They can get into cycles of chasing it with dose escalations or taking it on random days while they exist below baseline on others. This isn't a winnable battle over time because the brain will adapt, not to mention all of those off-days start to add up and people around them notice the extremely inconsistent mood and performance.
Unfortunately, misinformation about ADHD is all over the internet. I recommend ignoring basically anything that comes out of Reddit, Twitter, or TikTok because it's really that bad. Take medications as directed and set yourself up for some stability. Resist the urge to play with doses, take excess doses on some days, or try to play tolerance games. These never work in the long term.
There's a simple heuristic: When you reach stability, you shouldn't really feel the medication. It should be background noise. There's a reason why young people who have been properly titrated on stimulant medications don't understand what the big deal is with their peers taking large doses (without tolerance) and then speeding around for a while. It's where the myth about ADHD people reacting differently to stimulants comes from. Proper treatment will settle to equilibrium and shouldn't produce overt feelings of being drugged or hyperfocused.
The one issue I have never been able to overcome is that the medications are completely ineffective unless they induce hyperfocus. Now, it doesn't take me a lot to get into this state. I could easily enter such a state prior to medication, though I often needed (and still need) some kind of fuel -- intense desire or passion, impending deadline, etc..
With XR, I feel less hyperfocus and more sleepytime disruptions. It's less strong so I take more, but it lasts longer so I get its effects when I don't need it.
I feel like IR is actually less amenable to abuse.
Yes I was referring to MDMA assisted psychotherapy, which I am a huge proponent of. However I’ve found these materials to be quite effecting at healing when taken conscientiously outside of a traditional assisted therapy session. Of course there probably haven’t been a lot of studies on this because formal therapy studies are probably easier to get approved, so I wouldn’t take the absence of evidence as evidence of absence.
Seriously though as someone who suffers from extreme anxiety I am eternally grateful for this kind of work.
I would really like to see this combined with brain stimulation.