Myth #9: Medication Only for Most Severe ADHD

ADHD medication only for severe cases

Myth #9: ADHD medication should be reserved only for severe cases.

Who made that rule? Who knows. Sounds Puritanical.

You might have heard ADHD called a spectrum condition. That is, it exhibits in varying degrees of severity.  Therefore, on the face of it, Myth #9 is partly true: Some people with milder ADHD find little need for medication. Instead, they opt to implement targeted strategies. Even people with more severe ADHD symptoms deserve to know all their options.

That’s not the point if this myth-busting post. The point is: Who gets to decide when you’ve suffered enough to meet their criteria for deserving medication?

A Question of Deserving?

The public often dismisses anything but the most severely impairing cases of ADHD as not deserving medication. As if one must first prove worthiness—by failing in life. Amazingly, even among some people affected by ADHD and benefiting from medication, there exists a certain self-centered myopia.

For example, you’ll  see variations on this sentiment expressed in the comments to any online article about ADHD:

Well, I know ADHD is real, because my child has it and has benefited greatly from medication.

But it simply cannot be that all these other children have ADHD and need medication. It’s way over-diagnosed, for sure, and over-medicated.

In other words, ADHD is real for me or my child. But for you or yours? Unlikely.ADHD medication only for severe cases

Physicians, Heal Thyselves

The public is further led astray by fringe physicians claiming ADHD expertise and making sensational claims about who deserves medication. The Anything-Goes Internet makes it oh-so-easy.

Upon closer examination, these physicians’ expertise typically lies more in self-promotion than clinical acumen. They give no indication that they are familiar with research or evidence-based practices. More concerning to me, however, is the reckless disregard they seem to have for their readers.

Instead, they use inflammatory rhetoric in order to exploit a science-ignorant public, vulnerable parents, and “in denial” adults with ADHD.

 

Consider this, from Dale Archer, MD (in “The High Price of a Quick, Quick Fix”):

“… I have come to understand that medication should only be a last resort, and even in those cases, people don’t need to be on these pills forever. But it has long been held that medication is oh so much easier in our pop-a-pill, immediate gratification culture.”

A last resort.

In other words, until you or your child are worn down to a nub, medication is off-limits.

Pop-a-pill.

As if finding a stimulant medication that works best for that individual is ever an easy fix.  Then there are the commonly co-existing conditions to consider. They complicate treatment and often require a fine-tuned balancing act with a second or third medication.

When Medical Doctors Peddle Disinformation

Archer is promoting his book,  The ADHD Advantage.

It’s been endorsed by that heretofore unknown Southern California suburban therapist, Marilyn Wedge (of “French Kids Don’t Have ADHD” infamy). (My response: French Kids Don’t Have ADHD? Wrong!).

Yet, an online ADHD-themed magazine promotes a webinar touting Archer as an “ADHD expert”. On what basis?

It’s no wonder, then, that the public continues to harshly judge people who take ADHD medication—or who give medication to their children. They have been authorized to do so by MDs.  No matter if the MD was board-certified in psychiatry eons ago and has no discernible expertise in ADHD.

(The same is true for fringe neurologist Richard Saul, of ADHD Does Not Exist—which made a big PR splash, thanks to publisher Rupert Murdoch’s largesse, but has since flopped. (See ADHD Does Not Exist? Wrong, Richard Saul)

It must be said: Being an MD who allegedly has ADHD does not automatically confer ADHD expertise.

The Risks Are Great

Actions have consequences. These online promoters risk millions of people never learning why they, or their loved ones, are continuously dogged by certain problems that feel out of their control. They risk millions of people never having the opportunity to choose to gain control, via medication.  They prey on an American tendency to hold grudges over someone gaining a perceived advantage they do not enjoy.

Borrowing a metaphor from my blog series ADHD, Eyeglasses, and Stigma: We might compare it to how some of us need eyeglasses to keep from walking into walls, but others need eyeglasses only to see finer details. As in reading.

Here in this 21st Century, reading is important. Don’t you find it equally important to see finer details, such as the word stop on that big red sign or a contract’s “fine print”  before you sign it?

These rogue physicians perpetuate misinformation that risks eroding ADHD public policy, including insurance coverage and medication.

ADHD medication only for severe casesDon’t Count On “Society” Being Logical

By the way, never assume that because millions of people suffer from a condition, society will acknowledge the need for treatment—even if it is readily available.

Consider the discovery that eating citrus fruit prevented scurvy in British sailors. It took more than 100 years for officials to start implementing those measures. What’s worse, scurvy’s symptoms were known, obvious (pallor and abundant spots), and fatal.

Have times changed? Not enough, experts warn.

Clinical Care Lags Behind Best Practices

Medical evidence can take 20 years or more to trickle down to the clinical standard of care—that is, what you’ll find in the average physician’s office. That goes for everything from hypertension to ADHD.

It also took years for our society to accept the widespread occurrence of depression and anxiety, conditions commonly linked to serotonin, among other brain chemicals.

Now, society is slowly accepting that, in a similar fashion, ADHD is linked to brain chemicals such as dopamine and norepinephrine.

We have a choice to make: embracing modern scientific discovery or languishing in old superstitions and misinformation that limits human potential.

I welcome your comments.
—Gina Pera

47 thoughts on “Myth #9: Medication Only for Most Severe ADHD”

  1. Challenging myths and misconceptions is important. Thank you Gina! I call ADHD a “condition” deliberately, because words and how we think is important. ADHD is not a “problem.” Sure, it can cause problems, but ADHD itself is a neurophysiological condition. It is not a mental illness. It’s not a behavior problem. It’s not a moral degeneration. Yet many folks have seen it as such, and still do. The objective of this BLOG is consistent with the mission of “The ADHD Guy” – to dispense with, and dispel the, at times, gross misunderstandings and myths that still exist out there about ADHD. Thank you for all that you do! – Shane Bruce

  2. Gina I may have made a huge mistake unknowingly the doctor that I’m seeing is an opiate addiction DR and works for the county of Ventura behavioral please let me know if I made a goof. He is reducing my Dexidrine medication and giving me dum answers.

    1. Jerry — of course I can’t really offer a useful opinion.

      But some addiction docs have seen more people who abuse stimulants than they’ve seen people with ADHD who use stimulants responsibly (and often forget to refill or even take!). So, he might have a “hole” in his knowledge base.

      g

  3. Yes Gina, I got the information but all I have is Medicare and at the end of each month I am flat broke because things keep going wrong. My medi-cal plan is Gold Coast health plan in Ventura I don’t know if they cover it or not. I’m not sure how to use the leads effectively that you gave me. How can I do anything like research and even talking correctly to someone. I honestly don’t even know if I’m doing your program correctly I don’t know computers and how do I know if I’m talking to you or the world. I’m very self conscious about sounding stupid about anything I say on the net. Would you kindly let me know where on your program I made mistakes or been in the wrong place when saying something.

    1. HI Jerry —

      Good. Thanks for letting me know.

      I understand. Medicare can be an issue when it comes to psychiatric services.

      Can you call maybe two of those resources I sent? And just talk to them? Maybe they take Medicare or would otherwise be willing to help you.

      If not that, about about a GP who takes medicare? Or county mental health? Here is a website:

      http://www.vchca.org/behavioral-health/clinics-and-services-locations

      Maybe you have a friend who would help you research this, in person? I’m sorry it is so difficult. 🙁

      Don’t worry about making mistakes here. You’re doing fine. I’ll always delete your last name, to retain your privacy.

      best,
      g

    2. This indicates I wanted to cancel my subscription I do not I maybe I pushed the wrong button. Do you have some kind of outline you showing how to respond to what and what button to push. Basically right now I’m just shooting in the dark in fact I can’t find all my comments that I made and if I want to keep a particular comment or comments how do I do that

    3. Hi Jerry,

      Just try to re-subscribe, with the same e-mail address as before.

      It won’t let you subscribe twice.

      As for searching for your comments, I don’t know of a way you can do that.

      best
      g

  4. Gina,

    Nice piece, you’ve indicted both medical professionals and social opinion in this piece. It makes me smile.

    The article is helpful in clarifying my approach to all those people with “mild ADHD” out there…who have been through divorce, addiction, bankruptcy, prison etc. The common perspective is they want to stay away from meds because of “side effects” because they has a “mild” case. This post will help them consider one of the most effective tools in managing ADHD symptoms.

    Again, you’ve elucidated something I am passionate about and created something valuable.

    Thank you,

    David

    1. Hi David,

      Thanks for visiting the roller coaster!

      You know, I never intend to indict anyone. 🙂 Rather, my intention is to caution the innocent. And protect.

      Thanks for your comment,
      g

  5. Eeika do your homework. Find a good Dr “quick” that understands ADHD. You’re lucky you’re in San Francisco with this problem I wish I was

    1. Jerry — Did you see the information I posted (in a comment) about ADHD specialists in Camarillo/Ventura? I also e-mailed it to you.

      Please respond to let me know you saw it.

      tx
      g

  6. I am absolutely positive that my 11yr old son has ADHD but am running into every road block imaginable (it’s too long of a story for here) getting him tested. Please, if you have any ideas of who I could take him to in the San Francisco bay area – the north bay – that would be covered by Anthem Blue Cross, I would be so appreciative of the help. My husband and I have tried every alternative therapy possible for him and I am finally ready to consider medication. I’m scared, but I’m willing. Please help?!

    1. Erika, don’t waste any time getting him the medication believe me Gina knows what she’s talking about. I’ve been there, under worse circumstances. I know what I’m talking about. Just do it tomorrow. It takes time just to find a doctor, then you find one that knows what he’s doing its going to take 3 to 4 weeks to get the appointment and it sounds like you need it now

  7. If you really do have ADHD it does not go away. It will never go away. It WILL take medication to keep you going.

    I was on medication for over 20 years. It seems that when you get over 70 years old doctors do not want to take the risk and will slow your meds down and even refused to give them to you. You cannot just stop taking meds because your life stops and if you have always been used of being on the go and getting things done and always developing new things otherwise keeping yourself busy and you cannot find a doctor that will prescribe what kept you going for that 20 some years then you have a good chance of dying and I don’t mean of natural causes I’m 75 years old I’ve been on the meds for 25 years now doctors won’t give them to me and because of the risk.

    When I ran out of medication and the doctor wouldn’t give me enough to function then I become very tired and feel very helpless all the time. I went through the Northridge earthquake and was on the fault line. Five years after that my wife committed suicide so suicide is no stranger to me and I’m smart enough to know that my life is over as I know it and without the proper amount of medcations there will be no future for me When an ADHDer goes to school as a child to learn they can not learn. If you need to do something or accomplish something you must figure it out yourself or in short you have to wing it or just get lucky which happened to me but only for five years..if a person is not adhd the medication will not work but if a person is actually adhd medication will work and it must be kept in your system every single day and above all, Dont forget a dose. I used alarms.

    It took aprox 2 yrs to figure out what worked, the dosag amout and how many doses per day. It took 6 doses of 25mg Dexidrine tablets every 2 1/2 hrs, ( SRs) didn’t work for me, neather did Adderall. I knew Gina Pera from over 20 years ago we had long talks. I was referred to her by Dr. J. From Canada. I recently moved from LA County to Ventura County. I had to acquire a new doctor and I am 75 years old now and the doctor is giving me 20 mg of Dexidrine insted of 30mg at 3 times a day insted of 6. I tried this 20 yrs. ago and it didn’t work. This tells me he just doesn’t care. He cares more about himself than his patient. He has over 20 years of documentation and letters.

    I’m not going to have near enough medication to do anything for me and I know where my life is going to go. If you have ADHD and you’re in my situation do not change doctors if you can help it. When you get older and have a situation which requires a new doctor he will not treat you with the correct amount of medication that you must have to function properly or function at all. The age of the patient seems to be 70 years old or older as far as doctors are concerned. Doctors these days are running scared of being sued because of the people that do not have ADHD but are abusing the medication they sniff it they even mix it with water and inject it in there vains and we have to pay for that sometimes with our lives.

    1. Hi again, Gerald,

      I am really outraged at your situation. I know that it happens — MDs refusing to prescribe stimulants for people older than 65 (or even younger) — because I’ve tried to help many people in that situation.

      I’ve made a few inquiries on your behalf, in the Camarillo area. I’ll let you know if I receive a response.

      You DESERVE your ADHD medications. Doctors are throwing entire pharmaceutical arsenals at older people these days, many of them that aren’t doing much good and can do much harm. Your medication can keep you healthy, happy, and active, and that’s what they need to understand.

      I’ll keep you posted, and you keep trying, okay?

      And, yes, I remember you!

      Gina

    2. I appreciate that very much Gina because my world seems to be crumbling underneath me all because the doctors won’t let me have a life.
      Jerry

    3. Hi Jerry,

      I found some leads!

      Here is a link: https://psychiatrists.psychologytoday.com/rms/prof_results.php?city=Camarillo&spec=6

      I left a message with Wendy Piper, but her webpage says that she treats seniors.

      I also called Joyce Weckl’s office (she, like Piper, is a psychiatric nurse). They treat seniors with ADHD as well. She is actually in Venture, not Camarillo, as the website says. 3585 Maple Street. They take some insurance (Aetna, etc.) but no Medicare. The first visit is $300, and thereafter $110.

      I hope this information is helpful! Please keep me posted.

      g

  8. Gina, I was referd to you by Dr “J” years ago and talked to you extensively about my fight with ADHD. If you recall our daughter, Kathleen, was the cause of my wife’s suicide . She had been practicing programming and mind control for years. Most of her material came from my Glamor Magazine”

    1. Hi Gerald,

      Indeed, ADHD can be hard on all relationships — marriage, parent-child, and one’s relationship with oneself.

      Again, my condolences on your loss.

      Gina

  9. Want to read a physician who is an expert? Go to the blog of Oren Mason, M.D. at
    attentionality.wordpress.com

    or purchase his book

    Reaching for a New Potential: A Life Guide for Adults with ADD (ADHD) from a Fellow Traveler.

    This book is a treasure. Ideally read by every physician.

    1. Hi Doug,

      Thank you for mentioning my friend Oren, who is indeed a very caring and informed physician! And referring to his excellent blog: http://attentionality.wordpress.com

      He has promised me a guest post. But, as you can imagine, he is very busy actually treating patients. Unlike some “ADHD experts” online. 😉

      best,
      g

  10. I wish I had medication growing up, but instead i “tried harder” and chewed every last fingernail and cuticle to get my homework done. I was constantly being told “you know better!” by adults because I was smart and motivated but also novelty-seeking and impulsive. I wrote a great field trip report, for example, but at the actual museum I kept getting scolded for touching everything. Meds would have equalized the impulsivity with the intelligence and given me a better self-concept.
    I think the biggest irony is that these new-ish hucksters on the scene, who are taking advantage of the latest craze of mistrusting the pharmaceutical industry, are making their own sweeping claims of panaceas. They are equally as magical-thinking oriented as the accuse the Rx providers and doctors to be. It just comes in the form of herbs, or fish oil, or strength-based support groups.

    1. Hi Kendra,

      that pains me to think of you “trying harder”…. 🙁

      Yes, I suspect the hucksters are hoping we don’t notice their mental legerdemain.

      Thanks for your comment
      g

  11. Thank you for this post (and the entire series). Just for impulsivity alone, medication can be extremely helpful. It gives you the extra few seconds to decide whether or not to say something in a given situation, instead of just blurting every thought out. A relationship preserver, for sure.

    Putting medication as a “last resort” option can truly be a disservice to people. It’s not surgery. Evidence shows that the vast majority of people will benefit and as these medications are designed to be fast-acting, you will know quickly if it is helping with focus, etc. or not. They are not akin to certain types of antidepressants, which need to be in people’s system for weeks before any benefit can be determined.

    While it may be an easier (and more popular, lucrative, etc.) route to simply dismiss medication as a viable treatment option, it us irresponsible for well-educated people to do so. I hope that if they truly knew the vast number of people with unmedicated ADHD were incarcerated, perhaps due to impulsive decisions, they might be open to reason. Maybe if they sat down with a parent whose child impulsively killed themselves, they would admit that for that child (and perhaps others), medication should have been an option, rather than villifying the parents who were just looking for ways to help their child before it was too late.

    The Hippocratic oath says to “do no harm”. This applies to ADHD experts as well.

    1. Hi Cat,

      You wrote: The Hippocratic oath says to “do no harm”. This applies to ADHD experts as well.

      I fully agree!

      Thanks for your comment.
      g

  12. I totally agree with you Gina. I’ve struggled all my life with dreams and intentions of things I’d accomplish in my life but never followed through,and hearing the statement of “you just need to apply yourself more” ringing in your head,you understand the truth,it might take time, but eventually you do.This truth is staying informed about what “sells” and what doesn’t. I was fortunate enough to have a diagnosis by Russell Barkley,who has never promoted one medication over the other or had dismissed the idea of strategic use for medications,along with a balance of competent therapies. This all takes time and knowledge, and most who want the “get rich quick scheme” tend to overlook for their own personal agenda. From my personal standpoint,medications alone help with the balancing act. The user has to incorporate the strategies that assist in balancing. I’ve found my teeter-totter has to be in good shape to provide for medications to keep the momentum going. This has been only through trial and error and educating myself, which I found most people with an actual diagnosis,truly brilliant in doing, when not overwhelmed by the boredom of responsibilities it takes for the average lifestyle in this country.

    1. Hi Dan,

      I appreciate so much your sharing your experience in this public forum, and I know others will benefit from it.

      Diagnosed by Dr. Barkley….wow, you went straight to the top, didn’t you? 🙂

      best,
      g

  13. Opinions like the one above are completely maddening to me because there is such a puritan ethic about medications in this country. You are strong if you avoid them and weak if you pop that pill.
    When did this get to be an ethical, rather than a medical decision? There is the old superstition that American’s are doping their kids that fails scrutiny when a little observation is done and that, lo and behold, these medications don’t make the kids into sleepy zombies. Far from it. And don’t get me started on the urban mamas who post proudly that a little fish oil and a gluten free diet did the trick ( usually while kid is behind her on the playground using the play equipment as a lethal weapon)

  14. For me, medication was the first resort after years of not understanding why I was the way I was. Starting with meds allowed me the space to learn about ADHD, benefit from therapy, and really improve my quality of life.

    More recently I’ve been able to rely on less medication, but that is ONLY because I had access to it early on and was able to put in place the structures I needed to thrive. I never could have done that without meds.

  15. Oh and…I am both a person who needs eyeglasses for a slight vision impairment. It may be slight, but you don’t want to be in my path if I drive at night without glasses. I also had trouble seeing well in a classroom in college, until I got glasses. Same with my ADHD – my ADHD is probably on the milder side, but it certainly impairs me in daily life. If it didn’t…I WOULD NOT HAVE SOUGHT OUT DIAGNOSIS AND MEDICATION. Sure, I CAN live without meds. And feel awful, and be less effective and get in my own way. By why would I want to? Certainly not because “Dale Archer” said so.

    1. I have tended to use my eyeglasses for reading as a last resort, not realizing this until just now. It occurred to me my ADHD is implemented here. It is so hard to see clearly/have awareness at times even though I have been appropriately medicated, and I have a long experience with knowing day to day ADD. I am so thankful for the clinicians I first encountered when diagnosed 20 years ago–research based and driven, informed, kind, patient, compassionate. I in turn wanted to be research driven, informed, etc.

      I am so thankful for this forum. It always helps to keep hearing these messages and facts over and over again because it’s so easy for the societal and self doubts to creep back in. I’ll remember next time to put on my glasses when reading.

      Thank you.

    2. Hi Irene,

      You were an early adopter! And a great support to me in my early days of self-doubts. Bless you!

      xo
      g

  16. The lag time that you talk about…the 20 years to trickle down…it just KILLS me. It’s completely unacceptable. I’m tired of living in the path of uninformed clinicians and cynical, self-serving marketing ploys like Archer’s. There’s this crazy thing called research…and another of my favorite “r” words, REALITY. I’m not listening to people like this anymore. I have the power to seek and consume information that is actually research-based and helpful to me and to my family.

    1. I would have to totally agree. I am 47 years old. I began taking medication about a year ago, after I talked to my doctor, because I saw the difference medication made in my sons life. We always knew he had it bad. I was just a “mild” case. (Yeah right). I have always managed to get through school with above average grades and I currently manage two businesses. However, the very first day I took a 10g aderal, my life changed. I have connected with my wife and kids on levels I never knew existed. I am so much more productive and I actually “feel” emotion. I am also enrolled and pursuing my masters with a 4.0.
      I always believed medication was for the “weak” ones. People who didn’t have the discipline. Well life will reveal many things to you along the way. Sometimes it will show you how wrong you are, and how being open minded can change your life.

    2. Dear Chuck,

      THANK YOU.

      And how exciting for you! And your family!

      Wishing great things for you in 2016!

      g

  17. Thank you for posting this. I was diagnosed with ADHD about seven years ago.

    A few weeks ago, I downloaded a sample of Archer’s latest book. I found the language offensive and huckster-ish. A few years ago, I, too, had bought into the idea that if I would just “suck it up”, exercise and take more vitamins, I would learn to manage my symptoms. So I stopped my ADHD medication. Over the course of six months, my life de-evolved into a nightmare. Once I restarted my meds, things gradually got much better.

    I’ve learned to stop judging my need for medication so negatively and ignore the hucksters and misinformed people that are promoting and profiting from widespread public ignorance.

    1. HI Lisa,

      Thank you for validating this post. I fully expected to get some flak for it. But it is the truth.

      I’m so glad you were strong and got your life back on track.

      Thanks for speaking up here.

      g

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