I can't ADD

May 31, 2012 12:47 PM

Am I fine? Is the doc a quack? Is this part of the process? Adult ADD content

I'm 25, supporting myself on my own, and after years of feeling like I'm always coming up short and doing some research on ADD, I decided to see a psychiatrist. The earliest appointment was mid June, but prior to that they scheduled me to see a counselor first. He asked me to come back in the next week, and after last appointment he wants to see me once more before my actual psych appointment. Also this is through a reputable clinic in USA, and I have insurance so only paying co-pays.

In the initial introduction discussion, I discussed with him how I always find myself just barely meeting work deadlines, always being late for everything, not being able to remember things, getting "planning anxiety" for any plans made more than 2 hours before the event, having lofty personal goals for myself that I can never seem to reach (or even get on track for reaching), and the fact that I fill my personal life with numerous tasks and hobbies which I never follow through on or complete. He also gave me a questionaire to fill out, and at the end of the session he said I seemed to show alot of symptoms of adult ADD and that he'd like to see me once more before my psych eval. Ok, fine by me.

2nd session, I was admittedly underslept and alittle irritated the whole day... he dug into alittle more detail regarding why I felt the symptoms I did and why I was seeking treatment. In my explanation of my symptoms, each one he sort of talked through rationally and how I could break tasks into manageable parts or look at things with a realistic perspective (like realizing it would only take 20 minutes to open my mail and respond to letters/pay bills rather than letting the mail pile up like an elephant in the room.) With each explanation, he asked if it made sense to me and sure, put that way verbally, it makes sense. But put into practice, totally different story. Also he became very critical (so it seemed to me) after I answered whether or not I drink... I'm 25, have an active social life, and guess what all my ~25 year old friends drink regularly, myself included. Asked how often, I honestly answered probably 4 nights a week, and on how much, I honestly answered 3-6 if its a weekday, and 6-12 on a weekend. I felt like after I said this, it invalidated any of my previous claims... his tone changed, focused on the alcohol like I had a "problem", and all of a sudden he started minimalizing my symptoms as "part of growing up" or "problems every adult faces."

Now prior to seeing him, I did a month sober, just as a personal experiment. It was part of why I moved forward seeking treatment (thinking if I saw a personality change while not drinking, then maybe I did have a drinking problem, however I had no real issue or social pressure to drink in that span of time.... I was bored at times, and realized hanging out with drunk people while your sober is way less fun, but I endured with no real issue. I finished up sober month and started socially drinking again.

The last appointment being a month before the psych appointment, he advised I stop drinking entirely leading up to the psych eval. Said the psychiatrist wouldn't take me seriously / treat me if she knew I was a social (I really just want to say "normal") drinker. I went out twice since then, but I think I'm gonna actually cut it out (as I really don't care) and just follow his advice. But whats the deal? He insisted he wanted to see me once more before my psychiatrist appointment... I ended our last discussion by asking if he had any advice for me, or if I should be doing anything special or monitoring anything, and he said no. So I have no idea what the topic of discussion will be next time I'm in, but I have the feeling he's see-sawing between either A.) I'm a textbook case and fit all of the symptoms of a fairly well studied condition or B.) I'm lazy and drink too much and am just seeking meds. Am I seeking meds? He asked whether I'd prefer to do regular talk therapy or take medication... the whole point of this is I feel like theres not enough hours in a day to get things done, so of course I stated this and said I don't want to waste time talking to someone every week, I'd rather "fix it" with a pill. But I want to improve my quality of life, I'm really not just trying to get high, which from what I read these meds don't do anyway.

So whats the deal?? He's insisting on another (pointless if you ask me) appointment, 1 week before my psychiatrist appointment. I know he'll be advising the psych to my background as its the same office. Reading about others' experiences in mental health often sound like pill roulette: "try this and see how you feel in a week. oh, didnt work? try this one then" but here he's like trying to figure out if I even have a problem or just need to buck up, even though any of his little tests and crap say that I fit his criteria. Maybe I'm reading into this too much?

I'm going to the appointment next week, but my question to MeFi is whether I'm wasting my time here or if this seems like a normal evaluation. I mentioned bouts of depression... they were brought on by outside variables, yet he dwelled really hard on them... I tried to stress that overall, I'm a happy person. But I had to hold my tongue last time to not question his bullshit. The standard MeFi answer to every question is always "get therapy", but how does it work????

Note: maybe its my perspective. Since theres no physical evidence or black and white diagnosis, I know his diagnosis is based purely on my feedback, so I'm probably subconsciously trying to convince him I have a problem. But on the other hand, my life often feels in shambles, and Yes it IS easier to just go have a half-dozen whiskey cokes with my friends who are prodding me to come out than clean my apartment or finish a project I started, but its not so much that I want to drink, just that I don't want to "work", which is how my brain equates anything-I-dont-want-to-do even if that thing is a means to an end I want to reach.

posted by el_yucateco to health & fitness (37 answers total)

The first thing that strikes me is that it doesn't have to be either/or. You could well have ADHD, AND your level of social drinking could simultaneously been interfering with your ability to accomplish your goals.

Also, think about this: you feel like you don't have enough hours in the day, and don't have enough time to go in to talk to a therapist for an hour a week, and yet you have enough time to go out drinking 4 nights a week on average? I can tell you, if you have ADHD, medication may improve your focus. But it is not going to fix "my life feels in shambles but I'd rather go hang out at the bar than do something that takes effort."
posted by drlith at 1:03 PM on May 31, 2012 [9 favorites]

I can't speak to the ADD part, but the Mayo Clinic defines "moderate" drinking as "up to one drink a day for women or two drinks a day for men." That's up to 7 a week if you're female, and up to 14 if you're male.

The drinking habits you've self-reported are definitely beyond that standard, perhaps double that standard at times. I think your doctor was right to be concerned.

I'm glad you had the wherewithal to abstain for a whole month, because if you wind up being prescribed any medication to help with your problems, you'll probably have to go back to being sober.
posted by hermitosis at 1:04 PM on May 31, 2012 [3 favorites]

Okay, first of all, most psychiatrists don't really do the therapy thing, not in the current medical model. They assess your situation and prescribe drugs, in conjunction with a counselor, who may do cognative and/or talk therapy.

You drink a lot. That's a fact. You don't drink more than your co-hort, but 4 times a week, and that many drinks each night, it's a lot.

Drinking helps nothing and can exacerbate ADHD/ADD, so not drinking can only help. And I nth what hermitosis says, no ADHD/ADD drug interacts well with ETOH.

You're in a decent place right now, you're seeking help for a problem, yet when the therapist suggests some modes of treatment, some ideas for making changes, you're rebelling against them.

Why would you think that a therapist who suggests sobriety in an effort to suss out what's wrong with your brain, would be a quack? You bring up depression, and when the therapist delves deeper you call it bullshit.

You're new at this, and that's cool. You should question the process, but discounting everything this therapist is doing because it's not what you expect is not going to help. From what you describe, you've got a pretty good therapist there. And I like that he's going through EVERYTHING prior to your Psych appointment, because you are going to be DISAPPOINTED in how perfunctory and quickly that appointment is going to go.

Oh, and there won't be a couch for you to lay on .
posted by Ruthless Bunny at 1:11 PM on May 31, 2012 [8 favorites]

I think the order of operations here is correct. Alcohol may or may not have something to do with your issues. However, trying to prescribe you any medication, much less experimenting to find the medication that works best for you, is a waste of time if the results are going to be skewed by alcohol interaction.
posted by almostmanda at 1:18 PM on May 31, 2012 [4 favorites]

You're definitely in the "abusing" range with your alcohol consumption. Are you addicted, or an alcoholic? I have no idea. But you're abusing it. Now, alcohol is a depressant. Most ADHD medication is stimulant-based, usually an amphetamine analogue of some sort (e.g. Adderal is just a different name for what used to be Dexedrine.) So you are wrong as far as not being able to get "high" off of certain ADHD meds.

Mixing depressants and stimulants is a rather bad idea (even if you're not doing speedballs), and as if you've already demonstrated abuse of one substance, that's good reason to suspect you'll abuse another. Your psychiatrist wants to make sure you're not going to accidentally poison yourself if he gives you a prescription for amphetamines.
posted by griphus at 1:20 PM on May 31, 2012 [2 favorites]

And take it from someone with an addictive personality, if you have a problem with self-control with regards to substances, you do NOT want to want to add Adderal into the mix, which is an amphetamine.

And think about this for second-- are you drinking because your friends are, or are you friends with them because they drink?

It honestly sounds to me like your doctor actually gives a shit about you and is trying to do things right. I would be grateful for that, personally.
posted by empath at 1:23 PM on May 31, 2012 [5 favorites]

Whether or not your drinking is moderate enough is beside the point. "Moderate drinking" varies quite a bit from country to country and even organization to organization. Here's a chart from 2003 with some guidelines from around the world. Someone posted a similar one to metafilter but I can't find it.

The question is: is the amount of alcohol you're drinking enough to screw with your brain chemistry?

If you were me, the answer would be "hell yes!" I'm sensitive to alcohol and sugar in general. Imagine if every drink were a twinkie and you'd be getting somewhere. When I drink as much as you do, or eat a comparable number of sweets, I have the same behavioral problems that you have. For me, even two drinks a night is too much. I don't get hungover particularly, besides that lack-of-sleep feeling, but my brain goes where yours seems to.

On the off chance you're in the same boat as me, cut out alcohol AND sugar (and white flour and white rice if you want to go whole hog) for a month and see if your brain works better.

And if you feel like your therapist is trying to get off easy by dismissing everything else, switch therapists.
posted by small_ruminant at 1:26 PM on May 31, 2012

Many doctors will play skeptic during an ADHD diagnosis only because people *do* push ADHD meds--not necessarily to snort, but they are regularly sold to non-ADHD college students--and so I don't blame the doctor for his initial suspicions.

However, nitpicking on something like drinking does seem odd to me. I won't comment on the amount you're drinking because I'm not a doctor myself (though it does seem higher than the amount doctors recommend), but if you're fairly certain that the problem persists even while sober, then you may be able to rule out the notion that your drinking is the cause of your ADHD. It's true that alcohol can affect your memory, but that's focusing on only one very specific symptom. ADHD is more a lifestyle than a list of symptoms. A few of those symptoms CAN be linked to excessive drinking, no doubt about it. Have you had ADHD since childhood? For some people, their ADHD was worse in childhood but became manageable in adulthood; for others the condition was incipient or nonexistent in childhood, and became a noticeable issue in adulthood when things got all grown-up and difficult. That's definitely me, but I can still trace my ADHD back to my early years somewhat. If you're like me and can even remotely trace it back to childhood, and you didn't notice any significant changes after you started drinking, then I think (from a purely non-medical-doctor perspective) it's probably safe to say your ADHD is not alcohol-inflicted, though I can't imagine that the amount you drink would help.

Medication did not work for me (for various reasons, mostly because I experience immense anxiety from stimulants, even caffeine). Therapy, on the other hand, has been great. Not overnight great, but work-in-progress-at-least-I'm-doing-something-about-it-great. Not that you should see this guy regularly, because he doesn't seem particularly knowledgeable about ADHD, let alone how to provide actual therapy for it. But I will attest to the awesomeness that is cognitive behavioural therapy. It made me change my thinking patterns and set realistic goals for myself. Intense exercise also really, really helps. You'll figure out your own path for this, and that may include meds, therapy, exercise, or other suggestions from the board (fish oil?). But don't let one doctor let you down -- you just have to find someone who actually knows what they're talking about, is sympathetic to the condition, and knows the methods that can help you overcome it.

Good luck. And welcome to the wacky ADHD club. I'd shake your hand but it's a little sticky from this granola bar that I half-ate 30 minutes ago, and have yet to finish because this e-book became really fascinating in the last ten pages...
posted by Menomena at 1:26 PM on May 31, 2012 [1 favorite]

Alcohol and amphetamine are not really contraindicated, for what it's worth.

I would feel put off if my doctor wanted to deal with issues besides my ADHD if I were there specifically for ADHD treatment and/or meds. That said, it's very likely in your best interest to deal with all the issues, and it's very doubtful your doctor is a quack.

And with *that* said, you should feel free to find a doctor you're happier or more comfortable with.
posted by wrok at 1:29 PM on May 31, 2012 [2 favorites]

And, I just want to say, that even assuming you aren't minimizing how much you drink, that is not normal. I was a DJ and often got paid for drinks, and spent hours a week in bars because of it, and I often felt that I was drinking too much and that sounds like more than I was drinking, and if you're downplaying it at all, it sounds like you might genuinely have a problem to me, especially since you don't seem to be able to quit when a doctor asks you to, for something you, yourself, claim is important to you.
posted by empath at 1:30 PM on May 31, 2012 [1 favorite]

Alcohol and amphetamine are not really contraindicated, for what it's worth.

Not directly (assuming you're correct) but stimulants tend to ward off impairment during drinking, leading to heavier drinking. If the OP is drinking the amount they do without the help of amphetamines, that number may very well start going up.
posted by griphus at 1:35 PM on May 31, 2012

The questions and behavior from the therapist seem pretty normal. That doesn't mean they're right and you're wrong. If you're not comfortable, find someone else. You did the right thing telling someone you're drinking a lot. Pretty much anybody who doesn't drink that much (which is 95% of the population) would consider that amount of drinking to be a potential problem. Look at it this way: what you're describing is using essentially all of your free time on drinking.

The ADD is a complete red herring at this point. You don't know if you have ADD. You had a counselor tell you you had some of the symptoms of ADD, and then you told them you drink a lot and have had depression issues since childhood, and then they began following up on those issues. Again, I'm not saying they're right - they might be full of shit - but what you're describing is consistent with their being careful and thorough.

I just want to point out that it is just wrong to say that if you still have problems when you cut down on your drinking, then that means you don't have a drinking problem. One, that doesn't make sense, and two, it's totally wrong. I would caution you not to buy into denial at this point, it could really cost you down the line.
posted by facetious at 1:40 PM on May 31, 2012 [1 favorite]

When you're in your early 20s it does seem like drinking that much is normal because so many people around you are doing it, but really: that's a lot.

I so often hear complaints from people that their doctors and therapists don't spend the time to get to know them and take their concerns seriously. I see you doing the exact opposite. This person seems to genuinely be trying to figure you out and help you. If you're serious about getting your life on track, why would you not accept the help?
posted by something something at 1:46 PM on May 31, 2012 [3 favorites]

I had a huge wall of responses types out, but deleted it.... thanks all for the feedback, glad to know this doctor is doing his job well. For the record, I'm going to follow his advice and stop drinking. As I'd quit for a month with no real issues, I don't see it being too challenging other than the social aspects. And for the record, if you think that the amount I drank was excessive, don't send your kids to a state university.
posted by el_yucateco at 2:05 PM on May 31, 2012 [5 favorites]

However, nitpicking on something like drinking does seem odd to me

I'm under the impression that, based on the OP's age (and possibly background), screening for substance abuse issues is the default for therapists and counselors. I say this as someone who has never had a substance abuse problem, or an eating disorder, but who was extensively screened for both at every college counseling center or office I've been to. I'm guessing it was a case of being in my twenties, and a women, and those two issues being absolutely relevant to those two populations, you know? It's probably something they just have to talk about and take into account, given how common they are.

I would feel put off if my doctor wanted to deal with issues besides my ADHD if I were there specifically for ADHD treatment and/or meds. That said, it's very likely in your best interest to deal with all the issues, and it's very doubtful your doctor is a quack.

Yeah, this. It was totally frustrating to have doctors deal with issues outside of the ADHD assessment I went in for. That said, after extensive talking, and an eventual in-depth assessment (which included ADHD), they were able to determine I was dealing with...General Anxiety Disorder! And environmental stress that would be stressful for anyone! Which required different treatment...kind of a relief, actually, since I was never keen on going on Adderall.

"Moderate drinking" varies quite a bit from country to country and even organization to organization.

Definitions of moderate drinking do vary, and are culturally bound, but that is why you have to consider individuals within their cultural context. If the OP were raised in the UK, with UK drinking culture and expectations, before coming to the US, then, yeah, maybe a therapist might moderate his or her assessment of the drinking. But, if the OP were raised in the US, with its drinking culture, then the OP would be, effectively, breaking the cultural norms which s/he has internalized and become accustomed to, which would probably be a red flag, at least.

I mean, it's similar to saying that you've been hearing god: if my extremely devout, foreign-born, Roman Catholic step-grandmother said this, it is far more likely that she's been having a religious experience that fits the cultural framework in which she is embedded. If (atheistic) me said this...maybe a screening for schizophrenia or another delusional disorder would be in order.

Just because drinking behaviors vary cross culturally does not mean it is impossible to identify drinking problems in an individual. It just requires a more global assessment.

I'm going to the appointment next week, but my question to MeFi is whether I'm wasting my time here or if this seems like a normal evaluation.

This does sound pretty normal. To be fair, the "this is what growing up is all about" thing would be aggravating as hell to me, and might warrant finding another therapist with whom I would have a better fit. But getting screened for disorders/conditions/stuff outside of, or in addition to, ADHD is to be expected, and may very well be to your benefit. Keep that in mind.
posted by sock puppet of mystery! at 2:06 PM on May 31, 2012

I see what other people are pointing out about the validity of the doctors concerns, but he's clearly not communicating them to you in the way that makes sense, or doesn't make you feel defensive and patronized. Even if he's right to be concerned about alcohol as a factor, he's not telling you about it in such a way that you appreciate his concerns. That to me is a possible signal of communication incompatibility. You seem fairly eloquent so if he's not able to express his concerns in such a way that you can appreciate them also, perhaps it's possible to look for a different therapist.
posted by tatiana131 at 2:08 PM on May 31, 2012 [1 favorite]

I've had it explained to me in the following way:

1) Alcohol is common method of self-medication. You need to stop self-medicating and start using healthy coping mechanisms.

2) Most ADHD drugs are highly restricted stimulants. The legal hoops put on doctors to ward off the potential for abuse includes being on the lookout for people with addictive personalities.

3) Drinking and any brain meds are not a good idea. Sure, it might not be contra-indicated. But your tolerance will change dramatically, and alcohol is a difficult thing to self-monitor.

Due to all of the above, it's generally a good idea to deal with all addictions before addressing the underlying cause. Or at the very least, watch very closely. For some people, the addictive nature makes it impossible for them to not abuse amphetamines. For others, treating the ADHD stops the desire to self-medicate.

My doctor had reservations prescribing Adderall, because I also have anxiety. I was told to immediately come back and switch to a non-stimulant if it increased my anxiety. Instead I found that being able to concentrate and address the problems in my life helped reduce a lot of the residual anxiety I was still dealing with on medication.

And yes, you drink a lot. I've had times in my life that I did as well. But college is about experimentation and it has an end date. When I made a concerted effort to cut back, I realized that socially, it's perfectly acceptable to nurse one beer all evening or take a night off because you feel a cold coming on. If you find it boring to hang out with your friends sober, you might want to seriously evaluate why you're getting drunk. Not because it's the worst thing in the world, but because it's incredibly relevant to your mental health.
posted by politikitty at 2:27 PM on May 31, 2012 [1 favorite]

It can feel really rough when your life is dissected and your actions criticized by someone else, even when you know the criticism is valid.

You drink, by your own admission (and most people downplay their drinking) anywhere from 15 to 36 drinks a week. Hell, yes, that's a lot!

You drink too much. You have a problem, and the counselor pointed it out. You may not like it, but I think even you know this is the truth.

People who aren't worried about their drinking don't "go sober" for a month to see if they can handle it, before they even go in to see a counselor. And they don't feel the need to defend their drinking on the internet, or ask strangers avout it, or want to avoid counseling sessions because the topic of their drinking might come up.

When you DON'T have a drinking problem, you'll often go days, weeks, months without drinking anything, and not even think twice about it. The idea that having that one "sober month" has to be endured is an alien concept. You're more often sober than not, anyway.

But as soon as that month was over, you went right back to drinking, even though your counsellor had suggested drinking could be responsible for part of your problems rather than ADD. And even now that your counsellor has told you outright that it would be best for you to stop drinking, the idea of facing time without alcohol bothers you so much that you went out and drank anyway, and now here you are on the internet trying to get validation that it is the counsellor, not you, who has a problem.

Someone upthread pointed out that you don't want to "waste time" in therapy, yet have plenty of time to go out with friends. It's been suggested your friends might be your friends because they like to go out drinking, too.

Isn't it at least possible that your life is "in shambles" because you are going out drinking to forget your problems rather than working on them? That maybe it isn't ADD, and a quick fix, that you need, but therapy and coping mechanisms like your counsellor was suggesting?

I don't think he is out of line at all.

Sounds to me like you're uncomfortable because he just hit too close to home.
posted by misha at 2:28 PM on May 31, 2012 [6 favorites]

My first thought when I was reading/scanning your rambling/tl;dr; question was "looks like ADD to me." But I'm having a lot of trouble getting past this statement:

...I'm really not just trying to get high, which from what I read these meds don't do anyway.


I believe that you have researched the topic of ADD, but I'm just not buying that you (or anyone capable of reading headlines while in the check-out lane) aren't aware of the potential "high" associated with amphetamines and ritalin. I'll stop here on the topic because if I continue to speculate about this, I'll sound like I'm accusing you of being dishonest, which I truly don't intend.

Re the alcohol, what everyone else already said. You mentioned that your drinking is inline with the others in your social circle. I'm wondering if anyone in the "probably 4 nights a week/3-6 if its a weekday, and 6-12 on a weekend" crowd is doing well in terms of career, relationships, and overall happiness.

(Just so you know, I'm 57 and I've been taking Adderall for about 10 years, but I was first "diagnosed" about age 19 by the special-ed majors in my crowd. They weren't being entirely serious—at the time it was thought that children eventually outgrew "hyperactivity".)
posted by she's not there at 2:29 PM on May 31, 2012

...if you think that the amount I drank was excessive, don't send your kids to a state university.

We all know that college kids drink a lot. Many/most of us did that and likely more when we were in school. But, you aren't a college student anymore.

I'm glad to see that you have read through and are seriously considering the advice, el_yucateco.

(OK, I'm starting to sound like "mom". Better log off before I start asking about your eating habits and that nice girl/boy you were seeing the last time we talked.)
posted by she's not there at 2:42 PM on May 31, 2012 [1 favorite]

You've had some thoughts about your drinking, and it's more than is healthy for your liver, cancer risk, etc. One strategy is to alternate regular beer and alcohol-free beer, or ginger ale. I drink, and learned that I tend to drink a lot if I'm out with friends because it's easy, and feels good, but it doesn't feel good the next day, and past a drink or 2, it doesn't really feel better. So reduce the quantity, and enjoy the drinks you have. Alcoholism creeps up on many people, and it's a whole lotta no fun, so the earlier and better you learn to control alcohol, the less alcohol will control you.

Read Driven to Distraction and Delivered From Distraction. There are self-tests for ADD on the web. There are self-tests for alcohol use on the web. Assessing and maintaining your health is a good skill to learn.
posted by theora55 at 3:59 PM on May 31, 2012 [1 favorite]

...if you think that the amount I drank was excessive, don't send your kids to a state university.

That goes back to the growing up thing. I mean, look, you are at a crossroads here. There is absolutely no reason that you need to start caring about having your shit together and getting treatment for ADD and quitting drinking.

You can keep partying and having a good time and being irresponsible and running up debt and so on. At 25, you still have a lot of friends in your early twenties and it's still cool. When you're thirty and all your friends are in their early twenties (because the ones you're hanging out with now are going to start getting married and having kids) and you're still out drinking all the time, it's less cool. When you are thirty-five, it's kind of pathetic.

So you don't need to go cold turkey and rush to settle down and be responsible, but I would recommend that you start looking for alternative ways to spend your time a few nights a week. Like, I dunno, playing video games or something that's going to introduce you to people that don't go out drinking 5 nights a week. You can still go out once a week and still keep up with your friends, and your doctor wouldn't take issue with it, I'm sure.
posted by empath at 4:14 PM on May 31, 2012 [2 favorites]

I just wanted to chime in and say, as a fellow 20-something, that I don't think the amount you're drinking is necessarily a problem, and your ability to stop drinking for a month without issues is a good sign. When I read 3 drinks every other weeknight, I think three glasses of wine or three beers over a few hours of hanging out with friends. This isn't enough to get me drunk or give me a hangover, though I might not do any heavy reading the rest of the night. Six drinks would definitely get me somewhat drunk, even over a few hours, but I don't think this is particularly unusual or unhealthy. As people get older and get involved in more serious relationships and careers or start families, the drinking will probably die down naturally. Enjoy your friends while you can!

On the other hand, as someone who is seeking treatment for a mixed bag of ADD/depression/anxiety symptoms, I can't overstate how helpful it is to not have a lot of chemicals in your system when you are trying to figure out what your brain is like on its own and what it's like when you add an anti-depressant or an amphetamine.

I know that the first time my psychiatrist said that alcohol was a depressant and might be affecting me, I sort of scoffed, because I was thinking about short-term effects - like if it made me sad or sleepy when I drank. But regularly having alcohol in your system can have very subtle, long-term effects, and there is a good reason therapists look out for it. You'll notice if you ever take an anti-depressant that what you immediately feel upon taking it, and what you feel for the first few weeks, are pretty much all side effects and the real effect is much more gradual and understated. It can be really frustrating and embarrassing to get treatment for ADD, so I wish you luck!


Oh god don't combine alcohol and adderall. You will not start feeling tipsy or feel any other cues for how much alcohol you have had, so you will keep drinking until BAM you are out and it will hurt.
posted by ke rose ne at 4:52 PM on May 31, 2012 [1 favorite]

The alcohol thing has been covered, so I'll talk about the therapist / psychiatrist angle since that struck a chord with me. I'm a little older than you and I think I'm leaving behind the just-out-of-school phase that you're in.

Years ago I went to therapy (CBT) for significant social anxiety. It was tremendously helpful - like, changed-my-life-in-18-months helpful. I've also struggled with procrastination problems and possible attention issues, and after years of feeling like I wasn't making much headway with those issues I went to therapy. I was kind of excited: after seeing so much benefit from therapy before, maybe this would be a big help to me.

After about 12 sessions, I fired my therapist and self-referred straight to a psychiatrist. It's not that I think therapy is useless for this sort of thing, but I think that particular therapist was not very skilled in ADD counseling. He didn't make me feel safe opening up to him. When we would talk about my issue, he framed it in macro terms like "priorities," but I know what my priorities are - but I needed help with in-the-moment ways to step away from the MetaFilter and get to work. It began to feel like talking to my parents, not a trusted professional. So after 3 months (and after having basically the same meeting for over a month), I left.

As I said, I went straight to a psychiatrist who specializes in attention issues. Instead of issuing a battery of tests, he discussed the problem with me, and after hearing my responses he described my symptoms better than I could have done it. He then suggested medication therapy to see if it was helpful - his theory was that we could do a battery of tests to put me on a scale, or he could trust his clinical judgement and see if I benefited, which is the desired result anyway. It was awfully fast for my tastes, but it was also a huge relief to feel like I wasn't being judged or accused - I just wanted someone to believe that I was having some kind of issue and offer to try to help. In the end, the meds have helped somewhat, but haven't totally solved the issue, so I'm still deciding if I'm going to continue down that path. But feeling like I have a legitimate issue and taking steps to address it has been a huge help, and honestly I think I'm getting a lot of mileage just out of thinking "I'm getting help for this. I can do it." Since going to the psychiatrist, I've read 400 pages of a textbook, and I've never read even 100 pages before - but some of the reading has been unmedicated. It's confusing and hard to figure out exactly what the issue is. But it's great to feel like whatever the problem is, I'm working on it instead of spinning my wheels.

Anyway, what I'm getting at is: the question that you need to answer is whether you are happy with your therapist, whether he is gaining your trust, and whether you're getting the help you need. His screening may or may not be warranted, but if he's not also gaining your trust then you're probably not going to get much from meeting with him. You don't necessarily need to drop therapy entirely, but if you don't feel like you're getting what you need from this particular therapist then you might want to seek out another one.

And feel free to advocate for yourself - if you really want to talk to someone about the meds route, go talk to someone about the meds route who can actually help. I don't think anyone should get access to meds just because they want them, but the psychiatrist is the person who can actually evaluate whether you're a candidate for meds. So go in there an answer his questions truthfully. If the alcohol is a problem, he'll say so, and you can abstain for a month and go back and tell him whether your symptoms have improved. From your story, it sounds like you're spinning your wheels a bit and trying to guess "am I a candidate for meds," and that question needs to go to a psychiatrist. A good therapist (who you trust and like) can help with the whole complex of issues around attention and procrastination, but it sounds like you could use a clear answer and a reevaluation of whether you're getting along with this particular therapist.
posted by Tehhund at 4:57 PM on May 31, 2012

ke rose ne, the OP is drinking up to 6 drinks every other night and up to 12 drinks per night on the weekend. If that doesn't seem unusual or unhealthy to you, I'd be surprised. I'm a physician, and in my experience, people underestimate their bad habits. They underestimate how many calories they eat, will lowball the estimate on how many cigarettes they smoke per day, and will downplay their alcohol consumption greatly. If someone tells me 6-12, I assume that means occasionally 6, but more likely than not 12.

Anyway, to the OP, I just wanted to mention that there is something called the CAGE questionnaire that doctors use to screen for alcoholism. CAGE stands for the following::
1. Have you ever felt you needed to Cut down on your drinking?
2. Have people Annoyed you by criticizing your drinking?
3. Have you ever felt Guilty about drinking?
4. Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?
"Two "yes" responses indicate that the possibility of alcoholism should be investigated further"

Based on what you've said here, I noted a yes to at least 2, if not 3 of those questions (whether you feel guilty was unclear). Your therapist has a valid concern. Think through it carefully.
posted by treehorn+bunny at 5:01 PM on May 31, 2012 [2 favorites]

treehorn+bunny: that's definitely true, I was for some reason just seeing the low end of the scale (3 drinks every other weeknight, 6 on weekends). But in any case, what I failed to say very clearly was that the number of drinks isn't necessarily the problem - but the underlying feelings about alcohol can be. Your questionnaire looks like it would definitely be helpful for the OP.
posted by ke rose ne at 6:09 PM on May 31, 2012

I agree with what most people here have said about your drinking. It's a lot. Also, when you go to a mental health person for an evaluation, it's a total mental health evaluation, just as when you go to your physician with a symptom, you might be asked a bunch of questions the purpose of which you might not understand -- but they're being asked because they're potentially related to your presenting problems. The therapist is being thorough and careful, and that's good.

However, I wouldn't be crazy about the moralistic tone ("maturity morality," that's called) of the therapist you've seen. That part might be a bad fit for you.
posted by DMelanogaster at 7:00 PM on May 31, 2012 [1 favorite]

It can feel really rough when your life is dissected and your actions criticized by someone else, even when you know the criticism is valid.

Yes. I have ADHD too, and in the course of my "free" counseling sessions that come with having to get a new prescription all the time, my psychiatrist will occasionally put his Freud hat on and blow my mind with some pointed questions. My reaction is always "dude, we've got this under control, why are you digging for trouble?" And then I'll spend the next few hours or days fretting and fuming. And then I'll realize that the question was meant to poke me a little and get my ass in gear about something.

And I've seen a number of untreated ADHD people self-medicate with booze. They like being drunk because it makes the pain of lack of focus go away, and being perpetually hung over gives them something to fight against. It is a lot harder to be unfocused when it feels like you are pulling a freight train behind you just to get out of bed.
posted by gjc at 8:15 PM on May 31, 2012

As I said, I went straight to a psychiatrist who specializes in attention issues. Instead of issuing a battery of tests, he discussed the problem with me, and after hearing my responses he described my symptoms better than I could have done it. He then suggested medication therapy to see if it was helpful - his theory was that we could do a battery of tests to put me on a scale, or he could trust his clinical judgement and see if I benefited, which is the desired result anyway. It was awfully fast for my tastes, but it was also a huge relief to feel like I wasn't being judged or accused - I just wanted someone to believe that I was having some kind of issue and offer to try to help. In the end, the meds have helped somewhat, but haven't totally solved the issue, so I'm still deciding if I'm going to continue down that path. But feeling like I have a legitimate issue and taking steps to address it has been a huge help, and honestly I think I'm getting a lot of mileage just out of thinking "I'm getting help for this. I can do it." Since going to the psychiatrist, I've read 400 pages of a textbook, and I've never read even 100 pages before - but some of the reading has been unmedicated. It's confusing and hard to figure out exactly what the issue is. But it's great to feel like whatever the problem is, I'm working on it instead of spinning my wheels.

My doctor did the same thing. I think there are a couple of hallmark symptoms that shine through when you are having that first "tell me why you are here" conversation. There is nothing wrong with the battery of tests, but they aren't always necessary.

And I agree about the medication being a double edged sword. It gives you focus, but it doesn't tell you what to focus on.
posted by gjc at 8:20 PM on May 31, 2012

Great feedback guys, I really appreciate all of it and its good to know I'm on the right track here, and from the nearly unanimous opinions on my drinking I guess I overdo it. I still won't say I have a "drinking problem", only because my councilor did not say that (I'll agree with him though if thats his assessment) but I AM going to stop for the sake of this therapeutic process.

For sake of perspective, this is the world I live in: I'm not trying to be in denial here, but trying to emphasize that the motivation for drinking is socially motivated more than alcohol motivated. A group of around a dozen young professionals and graduate students who built up a hefty alcohol tolerance in undergrad who all moved to the same hip area of a fairly big city and became great friends.... 4 of us went to highschool together, the rest met through location / work / college pals / friends of friends. Everyone has their own hobbies, but theres one thing everyone has in common: M-F 9-5, a newly discovered cashflow that was nonexistent in college, and a love of happy hours. When I wasnt drinking, I went out nearly as often, and slugged iced tea all night... and to those who doubt my drink ranges, since we're going out at 5:30-6, if I only stayed til 8, its 3. If I make it an all-nighter, its 6.... but I hate having no "down time" at home so very rarely would I go work > bar > bed. However, on weekends, the scale is indeed tipped further toward the max, because theres no bedtime and its not hard to drink 12 cocktails over a 6 hour span.

The REASON I see no real connection is, (I've done this multiple times this past month), I'll pick say, Wednesday, to "get shit done." All day I'll mentally prepare and plan to tackle tasks and projects at home, list them out, both the necessities and the fun projects. Even with an itemized, prioritized list, and no social obligations / upcoming plans / etc, I come home and change and prepare to list-tackle and thats where it happens. May focus on the first task, then get sidetracked or skip or pick up something else (I'm a musician and have a nasty habit of getting a new idea in my head, dropping everything to pick up a guitar or bass, figure out the riff, and then I look at the clock and 1.5 hours passed.) Or I'll go use the restroom and then half-clean it but realize I need Draino and hit it to CVS, like I can't help but reprioritizing and being inefficient. Or I'll start doing something but realize it has a prerequisite to complete and then spent an exorbitant amount of time on the prerequisite and then be drained/bored and not get to the main task. Eventually I realize my list was a lost cause, get discouraged, and watch some old Star Trek on Netflix.

So thats the distinction in my mind.... nowhere in that cluster do I get the urge to "drink away my problems", and the reality of it is if I could just be organized and do things efficiently and logically there'd be plenty of time to complete tasks 5pm-8 and go out 8-10 and kill 2 birds with one stone, but thats just what I logically think and it never works in practice. Tried meditation a few times, that equates to me wasting half an hour sitting on my couch and being right back where I started, only a half hour later.

All your feedback has been great, so cool to get an anonymous group reaction to my issues. I actually like the councelor, he seems like a good guy, I think I just am unfamiliar with the process and so was alittle taken aback by the road he was taking our conversation. Another thing he said was that I may be overloading myself unnecessarily, and yes its possible that due to my brain-intensive job I may need to relax my personal life but I don't buy that... I'm a work to live kinda guy, not the opposite. And if some lifestyle changes and medication could get me that work-life balance I desire, thats really what my goal is.
posted by el_yucateco at 5:50 AM on June 1, 2012

Note on the last thing I said regarding relaxing my personal life: I told HIM I didn't buy that, thats not just shouting to the internet or internalized. I responded that I felt like I didnt have the energy or focus to have a fully fulfilling life, and he accepted that response. That was one of his "prodding" questions... "Well you have a job, your own place, a girlfriend... you sound like you have it pretty well, why do you feel you need more?" I probably shouldn't have taken that question personally, but for some reason I did.
posted by el_yucateco at 5:58 AM on June 1, 2012

As people get older and get involved in more serious relationships and careers or start families, the drinking will probably die down naturally.

Yes, you would think that's the case. Habits you've indulged in for 10+ years (especially those that involve addictive substances) can be very hard to break. It will die down naturally... unless it just doesn't.
posted by hermitosis at 5:59 AM on June 1, 2012 [2 favorites]

Tried meditation a few times, that equates to me wasting half an hour sitting on my couch and being right back where I started, only a half hour later.

Medication may work wonders for you, I really hope it does. But don't be discouraged if it's not the life-changing pill you expected it to be. There are alternatives. As for meditation -- did you try this alone or in a group? It's almost impossible to meditate alone as a novice. I went to a secular chanting meditation group a few times, and it was such a revelation. I felt "in the zone" for a few hours after, during which I went to the gym. My trainer was incredulous on how focused I was during the exercises. There are valid alternatives to medication, but you do have to work for them.
posted by Menomena at 8:18 AM on June 1, 2012

Everyone above me seems to have covered the drinking issue, but I wanted to add, alcohol and stimulants are not contraindicated, but they don't always mix well. I would also estimate it would be difficult for a psychiatrist to determine with you the effectiveness or potential side effects of a medication if a patient was drinking as heavily as you were.

I am not a doctor (nor do I play one on mefi), but I'm a 20 sonething state school grad (who has since stopped drinking like one) who takes medication for ADHD. It's not a cure-all, and perhaps your therapist was trying to determine if you are also willing to make an effort beyond taking medication.
posted by inertia at 10:17 AM on June 1, 2012

Meditation helps me a lot, but I can only usually stand the moving kinds of meditation. For instance, a 3 mile run is meditation, or a mile swim.
posted by small_ruminant at 11:44 AM on June 1, 2012

Totally legit: There are studies that show that people with ADHD are more likely to have problems with alcohol. It's reasonable for the counselor to try to piece together how much your drinking is affecting your focus issues.

Medium-legit: Since most ADD medications are controlled substances, they're not supposed to be prescribed to people who have had problems with any sort of drug addiction. But determining an appropriate medication (if any) and dosage is exactly what the psychiatrist is for, and he/she will totally ask you about past drug use, alcohol use, etc. If the counselor is holding back on a preliminary diagnosis to stall your assessment by the psychiatrist because he doesn't want you to be prescribed amphetamines, that's inappropriate. (Not saying that's what's happening, though.)

Infuriatingly twisted: There is a school of thought that "most" adults diagnosed with ADD are "really" just alcoholics. I cannot for the life of me find a reference now, but I recall a brouhaha over someone fairly prominent in the field publicly espousing this theory a few years ago.
posted by desuetude at 1:35 AM on June 2, 2012

hi el_yucateco, there are a lot of very good and thorough responses, so i'll just respond to a small part that i could help you with, having been in the same place.

i've struggled with many of the same feelings mentioned in your second longer post - the sense of always falling behind, of never reaching my potential, of never FINISHING anything arrgh... and as a part of that, procrastination (hell, i'm doing it a bit right now! ;-)
really, the two best remedies for me were:

1. "Starting small"; or rather, "realizing that small is actually big"

that list you have for "Wednesday"? get everything on there, make it beautiful, shine it up.
And then cross off at least half of it, if not most of it.
In fact, for starters, make the list, and then choose just 1 thing to do on Wednesday.

This is for a few reasons - one, your list is really very likely too long for one afternoon, or even for a whole day.
It doesn't seem too long, but your personal experience as described in the post confirms this, as did my personal experiences when I started really examining it.
Your own words:
"if I could just be organized and do things efficiently and logically there'd be plenty of time to complete tasks 5pm-8 and go out 8-10 and kill 2 birds with one stone, but thats just what I logically think and it never works in practice."

Yes, exactly! It's all logic, theory, abstraction. In PRACTICE, I also consistently, grossly, overestimated how long a task would need, and, as you mentioned, didn't consider prerequisites or preparatory steps that slowed everything down.

if you can factor lots of "buffer time" into your plans, it won't seem so disappointing and horrible when it happens (i know that feeling), and you'll make better lists. Because honestly, the problems with finishing at task that you've described (the drano thing for example) sound COMPLETELY normal... but you're getting inordinately discouraged by it. Which leads me to my second remedy...

2. Be nicer to yourself by being more realistic

Your words:
"if I could just be organized and do things efficiently and logically..."

"Eventually I realize my list was a lost cause, get discouraged, and watch some old Star Trek on Netflix." (in other words, don't finish)

If you constantly berate yourself for not being more "organized and logical " (by whose standard, anyway?) of course you'll feel crappy about the way you're doing everything, which in turn leads to discouragement and premature giving-up. Same with "it's a lost cause."
But you have to realize, you've trained yourself, or are even deciding, to perceive it that unrealistic and negative way. It's not necessary. Be kind to yourself and just... relax about it, and DO something about it. Easier said than done, but here's an example:

Uptight negative crap: "Oh shit, forgot to get those documents together for doing my taxes. Damn it, I'm such an idiot, I should have been more efficient and stuff. Now I can't complete my list. Lost cause, time to wallow in Star Trek!" (although we don't call it wallowing in our heads, that's what it is)

Relaxed: "Oh shit, forgot to get those tax documents together." **take list** *cross out "Do Taxes" 6 times** *write "Get X Y Z document ready for next Wednesday** **do that instead!** .

Notice the lack of "talk" of any kind in the second example. I think it's important just to be realistic and/or as practical as possible. In "realistic/practical" approaches, there is not room for that kind of immature giving-up of responsibility. You just have to set yourself up for success, and I don't mean that in a "positive thinking" kind of way, but rather by reminding yourself of what's important - which is getting some shit done in this 3-hour window. Success is defined as finishing some shit. It may not be exactly the shit you wanted, but over time it will accumulate into a Lot of Stuff Done. And over time, that is a great self-trust builder, which is ultimately what I think you might be lacking.

tl;dr? 1. cross off 90% of your list because it's probably too much to do. 2. revise how you mentally and emotionally view task-completion - no more negativity - just get something done, and then feel good about that, and do it again and again and again until lots of stuff is done.
posted by Pieprz at 1:18 AM on June 22, 2012 [2 favorites]