Like many adults with ADHD, Justine Ruotolo took a stimulant (in her case Adderall XR) for its symptoms. Then, about 11 years ago, she started to meditate. Soon after, she started to shake after taking her pill. Ruotolo’s doctor reduced the dose, but 6 months later it started again. She decided to stop taking her medication and hasn’t regretted it since.
Ruotolo credits widely meditation to calm her down and focus her brain enough so that she no longer warrants a boost from the medication. She also did a lot of reading about her condition and received training from a ADHD Coach.
There are many reasons why a person ADHD could stop taking medication or never start in the first place. Some people hate the side effects. Others find it difficult to pay for drugs. Or, like Ruotolo, they find that non-drug strategies work well enough for them.
In the United States, there are no official treatment guidelines for adults with ADHD. But, “the best practice is to treat true ADHD with a stimulant unless there are contraindications,” says Craig Surman, MD, neuropsychiatrist and researcher at Harvard Medical School. Surman is co-author FASTMINDS: How to be successful if you have ADHD (or think you might). That said, he notes that not all people with ADHD have serious problems.
“Some people have what I would call ADHD traits rather than the full diagnosis,” he explains. Even people who tick all the boxes for ADHD might find that their symptoms improve in certain situations. For example, a graphic designer may have no trouble staying focused in a business where a boss takes a deep breath. But if this graphic designer becomes freelance, it might not be that easy to stay focused when managing his own schedule. “People with ADHD live on schedule,” Surman says.
If you take your medication well, it can be difficult to tell if you still need it. Surman often advises high achievers who have been on stimulants for a while to take occasional “drug vacations”. In other words, stop the drugs for a short time to see if they still need them. It’s probably a good idea to check with your doctor if you want to try this.
Alternatives to medication
Whether you are on medication or not, non-medication approaches are important to manage ADHD. “They are not mutually exclusive,” says Surman.
Ruotolo knows this both from personal experience and from working with other people with ADHD. She became an ADHD coach shortly after her diagnosis. She then obtained a master’s degree in clinical psychology and became a Certified Marriage and Family Therapist (LFMT) in addition to a trainer. Some of his clients thrive on a combination of drug and non-drug strategies. Others find that they can work well without medication and rely only on drug-free approaches like exercise, meditation and advice.
Going without medication will not provide enough symptom relief for everyone with ADHD. But some non-drug strategies, in addition to or in place of medicine, include:
“Understanding your ADHD is crucial,” says Surman. He recommends visiting CHADD.org to learn about the causes and symptoms of the disease. “You need to understand which of your challenges are due to ADHD and which are something else,” says Surman, who sits on the board of directors of Children and Adults with ADHD (CHADD). He also recommends exploring the resources provided by ADD ONE (Association for Attention Deficit Disorder). Support groups are another good way to learn more about the disease from your peers, he adds.
Cognitive Behavioral Therapy (CBT)
CBT can help adults with ADHD change their thinking patterns and develop skills that make living with ADHD easier. “It focuses on behaviors that help people take charge of their condition and stay organized,” says Surman. But organizational strategies are only part of it. CBT also helps retrain you the way you think it is. You learn to recognize the automatic negative thoughts that you tend to have in difficult situations. You learn to respond more positively and effectively in the future.
(Note: if you have another Mental Health condition and it is not already under control, Surman suggests seeking treatment for it first. Depression, anxiety, drug addiction and autism spectrum disorders frequently overlap with ADHD.)
Unlike CBT, coaching focuses only on your actions and organizational strategies (rather than how you feel about those things). “Some people will say, ‘I need someone to work with me to decide what to do first.’ This is where coaching can be very helpful, ”says Surman.
As a coach, Ruotolo focuses on the needs of a client. “We’re talking about specific organizational strategies, like how to clean your office and your home and how to live your life in an organized way,” says Ruotolo, author of ADD a land: the gift of ADD.
Mindfulness – which focuses on living in the present moment rather than the past or worrying about the future – is the foundation of Ruotolo’s practice. “Our brains are such that thoughts go on and on,” she says. “With mindfulness, you just notice a thought and observe it, but you don’t engage.” Over time, this practice changes the connections in your brain so that you respond to the world around you differently, Ruotolo adds.
Everyone needs to stay physically active, eat healthy and get enough to sleep. But these basic self-care measures are vital for anyone with ADHD. Lack of sleep can interfere with cognitive function, Surman says. Adequate exercise and suitable nutrition benefit your brain. While these types of simple adjustments on their own are unlikely to be enough to treat ADHD on its own, they are an important part of any self-care regimen.