ADHD is a commonly misunderstood neurological condition, which is significantly underdiagnosed in Aotearoa. It affects the prefrontal cortex – that's the part of your brain that sits behind the forehead and helps you do things like regulate your emotions, plan ahead and decide what to pay attention to.
ADHD is a developmental condition, which, like other neurodevelopmental conditions, means that the brain is wired differently, like other neurodevelopmental conditions. Dopamine, responsible for reward, doesn’t move through the brain like it does for neurotypical people which can make it difficult to get motivated or sustain focus on some activities.
Stimulant use, bad food and screen time don’t cause ADHD, but those with the condition can be more prone to relying on them for quick and easy hits of dopamine to address this deficiency. For some, ADHD is hugely disabling and can mean poor impulse control, emotional dysregulation and even a quick temper. It’s not all bad though – the ADHD brain lends itself to positive traits too, like high levels of creative thinking and the ability to remain focused in a crisis.
Around 5% of the population has ADHD with only 1-2% being diagnosed, according to Darrin Bull, Chairman of ADHD New Zealand. Underdiagnosis of ADHD disproportionately affects women, Māori and others, including those who are unable to cover the excessive cost of medical diagnosis. It costs $600 per appointment on average to see a psychiatrist and some can expect to have multiple appointments before being officially diagnosed and prescribed medication.
So we wanted to know: where does that leave those with ADHD who have fallen through the cracks of diagnosis, and what are they doing to get by?
Unsurprisingly… the answer is often mind-altering substances and behaviours. We spoke to some of these people here in Aotearoa about how their ADHD has impacted their relationship with drugs.
Self-medication with speedy drugs and exercise
From exercising twice a day to smoking cones before writing an assignment that’s due midnight, people with ADHD we spoke to said they sometimes need to get creative with finding ways to get their brain to do what they need it to.
One person we spoke to described his methods for coping while at uni: “I was... taking my books to the gym, I was reading my synopsis of psychiatry book while I was lifting weights.”
Many of the people we spoke to said they rely on illicitly obtained substances like amphetamine (speed), methamphetamine or MDMA to use in their everyday life to complete tasks, which maybe isn’t surprising when we know that stimulants like Ritalin and Adderall are in the psychiatric toolkit of ADHD treatment.
Research has shown that ADHD is a ‘risk factor’ for methamphetamine use, both because adults with untreated ADHD can be more inclined to take risks, and because methamphetamine may be used to self-medicate core symptoms, similar to the way prescribed stimulants do.
Stephanie* told us that her substance use was how she learnt she had ADHD. “The first time I tried methamphetamine it just clicked. It wasn't anything like the scare campaigns, I just sat down and read a book.”
Daisy* felt that meth worked similarly for her. “For me, methamphetamine helped me get stuff done, it stopped the procrastinating and I could focus on a task and get it done, and then get on to the next task and get it done. It was just normal things like being able to do the dishes or do the washing or to mow the lawns.”
But Daisy says that stigma can get in the way of having open conversations about her drug use, and it can affect who the public thinks of as a ‘drug user’.
“I’ve definitely been trying to like, open up that conversation but you can see on people’s faces that there’s just such a big stigma about it… but once you’ve been in the scene and you see actually who’s taking it, you know, we walk down the street and judge the homeless guy like ‘oh, he probably smoked P’ but it’s the guy walking next to you in a business suit who’s also smoking P.” – Daisy
While some of the people we spoke to found methamphetamine helped with their ADHD symptoms, there’s a reason that Adderall and Ritalin are prescribed medically – they have less euphoric effects and are significantly less addictive than methamphetamine.
Another factor to consider when taking drugs as a person with ADHD is how predisposed you might be to addiction and how to manage this.
Managing impulse control
Difficulties with impulse control in people with ADHD has potential to increase the risk of excessive and harmful drug use.
Ariana* told us that “The impulse control piece means that I have often been someone who has used more substances than others, that I’ll keep taking them later into the night/morning than others - and have a bit of a ‘fuck it, yeah why not’ answer to whether I want more. It also means that where others might say no, or not as much, or not take it due to it being an unknown or unclear substance - I haven’t had the same restraints and have absolutely put myself in more dangerous positions because of that.”
Harm reduction measures can be useful in curbing excessive drug use. Simple things like only leaving the house with your planned dose, making sure you are around people who can check on you, always eating before a night out and doing your research on drugs and interactions before using are all great ways to be safer.
Finally, awareness is key – if you know you have ADHD, consider how this might make you more susceptible to drug-related harm and take the necessary precautions.
“My impulse control is very poor because of my ADHD, so I would often just take whatever drugs were offered to me at parties, sometimes without even knowing what they were really. I also found it (and still find it) really difficult to stop after one drink or back when I was taking drugs to stop at any point.” – Catherine
Talking to health professionals
Here in Aotearoa, psychiatrists are among the only people licensed to treat ADHD with medication. This means that someone must be either referred for diagnosis by their GP, or already seeing a psychiatrist to be diagnosed. This has left a vast number of people undiagnosed and left to self-medicate or cope with their condition on their own.
To complicate matters, disclosing drug use to a psychiatrist can come with the risk of being denied treatment. There are many stories of people being refused treatment after admitting to prior illicit drug use. Health professionals are understandably concerned about patients misusing prescription medications, and it’s up to the healthcare professional to determine how strong that risk is.
One person we spoke to had disclosed cocaine use twice over a year-long period and was consequently denied access to prescription stimulants by their psychiatrist. “I just felt completely discriminated against, it was really harmful. I was very concerned about people being denied treatment who were at risk of self-harm. That is a position where someone would be at immense risk.”
Although this is far from the case with all health professionals, it is worth knowing your rights as a patient before entering into the process of diagnosis.
It’s clear from the people we talked to that navigating the health system and seeking support as an adult with ADHD is tough. If you or anyone you know is struggling with this experience, please check out ADHD NZ’s list of resources that are available to you.
Four people chat about how their mental health and drug use impact each other.