Managing ADHD without medication
June 7, 2019 8:18 AM   Subscribe

ADHDFilter: stimulant meds generally work well for me. But I'm traveling somewhere where they're illegal. For others with similar challenges, do you have any advice for managing without meds?

First off - you're not my doctor, I do have an appointment scheduled with my doctor, and I will absolutely be discussing this then.

I have ADHD which is fairly well-managed with a smallish dose (15mg) of Adderall XR on work days. When unmedicated, I find it very hard to focus on and fully process long meetings/discussions. For example, I wasn't diagnosed until my early 20s, and before that I literally changed college majors to avoid classes that relied heavily on lectures because I could not fully follow them no matter how hard I tried. On meds, I can process lectures easily. It's pretty much an attention thing; I'm not as concerned about impulsivity or hyperactivity - like many women with ADHD, that is not as big a part of how it manifests for me.

Unfortunately I just scheduled a weeklong work trip in about a month to a country where amphetamines are illegal. The trip will involve a lot of long meetings and discussions. I need to perform well there, and I'm kind of terrified. I need to figure out how to deal with it as best as possible.

I'm particularly interested in:
- pointers toward organizational strategies, focusing techniques, etc. that work well for you specifically to focus during long meetings
- any advice on how to make caffeine more effective as a stimulant (I usually get very jittery and anxious after >2 cups of coffee, but if there's anything I can eat/take with it to try to ameliorate that, then I imagine that might help.)
- anecdotal experience with nonstimulant ADHD meds, whether OTC or prescription (obviously, again, I will be consulting my doctor - but since I have a limited about of time to try and employ different things, I'm particularly interested in anything that has anecdotally worked well for those whom stimulants also worked for and/or anything that doesn't have a long ramp-up period.) (the only non-stimulant I've tried in the past was Wellbutrin; I found it didn't do much for me and I struggled with severe sleeplessness in the first two weeks so I'm not super keen to try it again.)

Here's what's already on my list to do:
- exercise regularly from now until my trip (and during my trip, logistics permitting)
- drink as much caffeine as is comfortable during the trip, including bringing some sort of backup caffeine delivery mechanism (chews? pills? five hour energy?) in case coffee is not easily available during the day
- seek out some sort of mental/organizational/mindfulness techniques to try (I know I've bought a few books on it that I've never read...)
- if all else fails, I'll disclose to a trusted coworker so that they feel comfortable nudging me if/when I'm spacing out. I don't really want to put that on them, though.
posted by anonymous to Health & Fitness (13 answers total) 13 users marked this as a favorite
Personally, I find the novelty of a new situation (especially a social one) kind of ameliorates my need for stimulant ADD meds. Obviously this may differ for you, but I've definitely done work trips without meds and everything has gone well. If I was just doing my same-old same-old in a cubicle, that wouldn't be the case.
posted by so fucking future at 8:22 AM on June 7 [1 favorite]

Consider stopping the meds a few days in advance at home, perhaps. When I take my meds regularly and daily for weeks/months, I experience brain fog worse than my unmedicated baseline for a day or so, until my body adjusts.

Another suggestion: ask your doc a couple of pills of concerta as a backup, in case of emergency? I believe concerta is legal in several countries where Adderall is not. Maybe one of these is your destination.

Would it help to record the days meetings and review them in your hotel room in the evenings at 1.5x speed? At least you can be sure essential points are not lost to time/the ether, even if you have really bad brain days while abroad
posted by shaademaan at 8:58 AM on June 7 [1 favorite]

I found amphetamine withdrawal hard, even on small doses. I'd be inclined to stop taking them a few days early, so that you're not trying to perform at your best during the worst of it.

(If you've had to miss days for other reasons, you'll know how you respond, so listen to your experience and not to me.)

You can disclose to a coworker without making it their job to keep you on task. It may for instance be helpful to have someone you can vent to or strategize with, even if they can't be at your side to elbow you when you drift off all the time.

Also, cynically, if I were in your situation and this trip crossed more than a time zone or two, I'd start making occasional small talk about how terrible jet lag is and how it always seems to hit me extra hard. Of course you still want to be at your best, but it would be nice for people to have a charitable explanation ready at hand just in case you're not.
posted by nebulawindphone at 9:03 AM on June 7 [3 favorites]

1) Espresso works better for me than drip coffee. Timing is also important. 30 minute before I need to focus - one shot of espresso. Around 2pm-3pm when my energy is flagging: one shot of espresso. For me it is more about timing than amount- too much caffeine backfires on me.

2) Good nutrition, lots of protein, vitamin B supplements, are all important.

3) Lots of walking. "Exercise" is great, but walking around in a new city with lots of new stuff to look at hits all those ADHD buttons of having my body moving while taking in lots of new information.

4) or to transcribe recorded lectures so I can review them as text because I process text better and faster than I do audio.
posted by annathea at 9:12 AM on June 7 [2 favorites]

You take extended release meds, so apply caffeine the same way, over time, maybe half a cup an hour or even less. Tea has caffeine, too and you may tolerate it better.

Do all the things - use your phone to keep you organized, keep lists and notes, project manage yourself and your time. I have an Android and a nifty 'Army Knife' app that has a timer and stopwatch, and I use it a lot.
posted by theora55 at 9:55 AM on June 7

The best non-pharmaceutical ADHD intervention I can recommend is writing. Try it at home first, but physically taking notes on paper may help you focus on and remember meetings and lectures even if no amount of mindfulness gets you anywhere, and even if you never read your notes.

Even if you've never been hyperactive, fidgeting/stimming might help more than you expect - having a pen or something to roll around in your hands might be nice.
posted by bagel at 10:36 AM on June 7 [3 favorites]

Are caffeine pills an option?
posted by DarlingBri at 12:59 PM on June 7

Some countries which ban certain substances will allow them with a prescription, so it might be worth checking if you can bring your meds after all
posted by Mistress at 1:12 PM on June 7 [1 favorite]

I traveled with a friend who relies on dexitrin to combat narcolepsy (and also some degree of ADHD) and couldn't bring it. He relied on instant coffee and took modafinil instead. I see modafinil is used off-label for ADHD so you could ask your doctor. You might be able to find caffeine pills in smaller doses but be careful as lots are pretty high dose. Ramping up the caffeine a day or two prior to the trip might help with the jitters.
posted by lookoutbelow at 1:34 PM on June 7 [1 favorite]

If you pair l-theanine with caffeine, it ameliorates a lot of the jittery feelings from coffee and other forms of caffeine.
posted by bookdragoness at 8:52 PM on June 7

Ugh, this is my nightmare and one of the reasons I'm not planning on traveling to Asia anytime soon. I'm a mess without Vyvanse. I'm so sorry you have to go through this.

That being said, Concerta is indeed permitted by some countries; if that's not an option, what works for me (though it's far inferior) are strong espressos.
posted by KTamas at 6:52 AM on June 8

Your mileage may extremely vary but I've used nicotine gum in similar circumstances; if chewing gum isn't an option because of the meetings you could try lozenges or patches instead. I would definitely test this out, with the smallest dose available, to make sure it doesn't make you feel worse, but I find it makes me less jittery than too much caffeine.

Non-chemical strategies: get as much exercise and sleep as possible, walk around during each break, make detailed notes as a way to keep from zoning out when other people are talking (and note down/outline points you want to make so you can refer to them when you need to participate).
posted by karayel at 1:36 PM on June 8 [1 favorite]

My coffee anxiety is 90% from black coffee causing me to have a stomach full of acid. So taking it in milky drinks works, as does taking antacids with it. I also only have one coffee a day, at a regular time, but I drink unlimited English tea with milk until 5pm, then stop.

The routine works well for me.
posted by ambrosen at 5:11 PM on June 8

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