Before I was diagnosed with Attention Deficit Disorder, I struggled in school and had trouble focusing -- until the day I started using drugs
It has become such a workable way of life, for me, the most natural rhythm; I barely give it much thought. I know at which hours I will be most productive, and where; the best music to write to -- Bruce Springsteen, or Hole; and what to listen to while I read -- nothing. I've learned that to be somewhere by noon, I must tell myself 11:30, and I'll set my watch ahead to ensure this works out.
Even the medicinal maintenance of my Attention Deficit Disorder (ADD), the stimulant cocktail of four kinds of amphetamine salt -- manufactured by Shire Pharmaceuticals under the brand name Adderall -- is an automatic affair: My typing will become slower or sloppier, I'll forget my wording or leave something out, the same line will have to be reread several times over before it's finally processed. I'll become suddenly quite ravenous and restless. Typically loathsome tasks -- like unloading the dishwasher or fleecing my furniture of cat hair or replacing the too-high lightbulbs -- will seem urgent or enjoyable or both. Then I'll know it's time to take another pill.
I don't hop fences or collect speeding tickets. I've never broken a bone or run through pane-glass. My frenetic energy, my fragmented focus, is manifest inward.
It happens like this every day, always at the same times of day, and I am never wrong. But none of this much matters, unless I make one point: For the longest time, everything felt off. Or rather, everything in me felt off. Like a film playing in slow-motion, with its subtitles sped up. My mind would stall and surge, slippery with short-circuits, prone to laser-beam intensity one day and languishing the next.
I often struggled in school, was told I could and should do better, yet unable, believed myself intellectually inferior (peculiar only because of the precocious reading habit that was my sole sustained engagement). Jobs, internships, myriad extracurricular pursuits -- each of them thrilling upon first prospect -- fizzled-out early and often. No one saw anything too out of the ordinary. I was just "lazy," "irresponsible," "a careless student," "disorganized," and always in the throes of some procrastinated chaos. And because I'd never known any different -- it's not like I made things difficult for fun -- I believed that it was ultimately nothing, that this was just who I was and would be forever on. Passionless, aimless. unmoored.
The classic conception of ADD, the acute characterization, is that of a child on turbocharge: prolix and chatty, a blur of fingers and kneecaps; she will be running a marathon even when she is seated and still.
But I have never been an earthquake of activity. I don't hop fences or collect speeding tickets. I've never broken a bone or run through pane-glass. My frenetic energy, my fragmented focus, is manifest inward. It's marking 26-Across in 30-Down, in the Sunday puzzle, unnoticed and in pen. It's MetroCards misplaced, essays turned in late, library books long overdue. It's hundreds of dollars paid to collections agencies for forgotten overdrafts that started as single digits, and credit cards lost so often that the banks believe it is fraud. It's multiple concurrently-kept day-planners, and not one of them ever current. It's running out to the store for batteries and coming back with blank notebooks and tea.
As errors go, mine were far from exceptional. We are all overwhelmed. We all get distracted. None of us is privileged with an excess of time. There is nothing especially sympathetic about a girl who cannot keep a deadline. The problem is hers alone.
When I am 19, I have my first taste of cocaine, and soon things look not so bad. Because cocaine is so self-gratifying -- it's all you want and need and feel is important in the world -- and gratification is just about all I'd been looking for, I believe I have discovered my antidote. Daily, hourly, for many months, I carefully maintain this not high but level-feeling state of being. Each line sharpening my sight, I am made more consciously and comfortably present. And I have no intention of stopping this new, novel form of self-treatment. It seems almost too easy. And too easy not to let go.
All my apathy and line-towing really ought to have been enough, but of course it takes this most clearly identifiable state of crisis, a behavior so glaring, so explicitly ill-boding -- only with this does anyone pause to consider that there may be something actually wrong.
In the fall of 2008, I sit out what ought to be the first semester of my sophomore year of college, as much for the cocaine as for everything else. I go to therapy sessions and meet with doctors and specialists in all fields, desperate for something -- anything -- to jumpstart me out of this murky in-between of not caring and not caring to. I try Celexa, then Lexapro, then Wellbutrin, then others -- the idea being that the right antidepressant will lift me out from under this torpor. They do not help. Drugs are exactly what I need, but these are not right, they are treating the wrong thing; their logic is bad.
Months pass in this way, and I begin to wonder whether there might not be a better explanation, a surer solution for all my blue moods and lazy disinterest. Maybe we've ignored some effective, alternative treatment for depression. Or maybe it's not depression at all. Alone in this suspicion, and unable to bear the thought of another false fix, I resolve to find the answer for myself.
ADD had at no point been a planned area of inquiry, but somewhere along my circuitous path of research, co-morbid diagnoses become increasingly relevant; In my case, depression and anxiety seem the manifest symptoms of a larger unknown. I rule nothing out, yet the variables -- depression, anxiety, female, young adult -- point unfailingly to the same probable cause. I learn that girls, for whatever biological reason, tend to have ADD without the more obvious hyperactivity component; their primary symptom is distractibility. It would make sense, then, for unchecked ADD to be perceived as depression and anxiety: In school, one's performance is graded from any early age, and with the certain impediment of such chronic distraction, feelings of low self-worth are stoked with every admonishment and failing mark; the adult world is no more forgiving.
Sensing I'm on to something, I read Driven to Distraction: Recognizing and Coping with Attention Deficit Disorder From Childhood to Adulthood, by Dr. Edward Hallowell, and in it find my diagnosis.
As it happens, The Hallowell Center -- which offers diagnostic and treatment services for adults and children with ADD and its off-shoots -- opened an outpost on Manhattan's Upper West Side the year prior. So I call the office and ask for his next available appointment, feeling it kismet that I should be treated by the same doctor whose book brought me to this latest turn.
During the hour-long consult with Hallowell, I answer a battery of diagnostic questions, which we then discuss at relative length:
- Were you considered an underachiever in school? (Yes.)
- Given an unexpected chunk of free time, do you often find that you don't use it well or get depressed during it? (Yes.)
- Do you often find that you have an itch you cannot scratch, an appetite for something "more" and you're not sure what it is? (Yes.)
- If you have ever tried cocaine, do you find that it helped you focus and calmed you down, rather than making you high? (Yes.)
And so on.
I tell Hallowell about the cocaine, about how I'd never before had any interest in drugs, but that coke made me feel better, brighter; about how I feel lethargic and loopy from the passel of psychotropics cycling through my nervous system, and from the snuffed-out half-lives of the ones I've already quit. Like an old doorframe that has become over-tight from all its layers and layers of fresh paint, I am just not working right. Hallowell confirms the diagnosis and is the only practicing professional right-minded enough to defy the illogic of giving prescription speed to a past-tense coke user. "You should be on Adderall," he tells me. "And probably quite a lot."
Of course, no medication will rid a person of their ADD; as treatment, the chemical effects are corrective, not curative.
The pharmacodynamics of the drug are imprecise and largely speculative; the common thought is that the amphetamine stimulant works in the central nervous system to spark and speed up the release of neurotransmitters -- like dopamine and norepinephrine -- which, on its own, the ADD brain misdirects and manages inefficiently. With the neurotransmitters' circulation mediated in this way, such "executive" abilities as decision making, impulse control, and work/reward motivation -- all of which are typically ill-functioning in a brain with ADD -- will operate at optimal levels.
With my first dose comes the most trenchantly transformative feeling. Unlike cocaine, whose nasal dosing delivers a full-body chemical climax, Adderall's neural efficacy is localized, and its oral administration prevents the sudden surge of a cocaine "high."
Adderall comes in two distinct forms. The extended-release formula, Adderall XR, comes in a glossy cellulose capsule with a Tang-colored lip and a clear, colorless cup; within its plasticy shell are hundreds of amphetamine beads the color of Circus Peanuts candy. The beads comprise four types of amphetamine -- two sulfate salts and two dextro isomers -- which together and in this form allow the drug to be meted out through the bloodstream over a period of six to 10 hours. I swallow one 30 milligram extended-release pill each morning. Its effect is not particularly sensate, but it sustains me through the hours and days.
The second type of Adderall is an immediate-release amphetamine tablet. It is small and round like an eraser-head but flat as a nickel, with a bilateral score-line clear down its middle, and a taste sweet like Aspartame on my tongue. At 10 milligrams' strength, it is the color of melty blue cotton-candy. Three times daily, I swallow two of these pills, and within 15 minutes affect an almost-four-hour agency and efficiency to my workaday doings.
The medication grants me access to a chasm in my flip thinking, a narrow channel through which I may engage an idea or activity or project, see it through to completion, work without surcease. I make neat piles of all the books and magazines and loose paper clippings that have forever carpeted my life -- and I remember to read them. I scribble tiny notes on those sticky plastic tabs from the stationery store -- which I now buy in bulk -- and flock the pages with all my thoughts and ideas. I discover that writing -- which had only ever been a project of putting down enough words to fulfill the quota, something to do and be done with -- is something I can delight in and excel at, and I want to do it all the time.
Of course, no medication will rid a person of their ADD; as treatment, the chemical effects are corrective, not curative. And on the days I go without taking any, days when I'm sick or overtired or perhaps away on vacation to some slow-moving place, the soda goes flat. I may forget to remember things, leave my wet laundry in the washing machine overnight, lose scarves, trains of thought. But this happens less often. And everyone loses things, now and then.
What lasts, though, irrespective of the time elapsed since my last dose, is my revised self-perception. So much of my life was spent adrift, my every interest a fading thought, it's almost as if I'd been too distracted to recognize who I was or what I enjoyed. Since discovering that it wasn't just me -- or rather, that it is -- I've found the confidence and ambition I'd never before felt, the once missing parts of a person I'd not known myself capable of being. And because confidence tends to breed more confidence, I feel for the first time a sense of boundless potential.
In Driven to Distraction, Hallowell writes, "The syndrome is not one of attention deficit, but of attention inconsistency," and goes on to say that those with ADD are in fact able to hyperfocus at times. For me, figuring out what to hyperfocus on was the crucial part, and regulating my wandering mind was necessary for that to happen. Adderall, with all its illuminative abilities, didn't save me but provided the clarity I needed to find so much of myself. The pill collects my mind, makes it quiet and calm, a snowy radio retuned after losing its station.
Images: Wikimedia Commons.