So we’re not talking about strategies, or counselling to manage anxiety or depression, or for that matter, the ADHD itself. The question at hand is whether to take medication.
The ADHD Is Mild
If your ADHD is mild, and if you have good strategies that make you successful both at work and in your personal life, and IF no one is complaining – your partner, your kids, then just maybe you don’t need to go on medication. Doesn’t necessarily imply you shouldn’t have been on medication at some previous point – in school or when you had young kids, or when you were bucking for a promotion or before you had an assistant to keep you on track but now you’re mostly ok and those around you agree.
Meds Caused More Problems Than They Were Worth
This is a common scenario, though there are some ifs buts and ands. This assumes that you have worked with an experienced clinician over at least several months and on for a dozen visits to make a concerted effort to optimize medication. It means you’ve tried both stimulants, methylphenidate and amphetamine. It means you’ve tried various brands and delivery mechanisms, and adjustments to dosing and scheduling to maximize effect and minimize side effects. It means you’ve tried alternatives to the usual medications, and if need be tried antidepressants.
If after all that, you’re still struggling, either with lack of effect or too many side effects, then fair enough, maybe medication just isn’t worth it for you. Even then, it would probably be worth getting a second opinion just in case something was overlooked – an additional or alternative diagnosis or a medication trick that would make things go a lot more smoothly (classic example here is problems with sleep – often there are ways to fix this if it is specifically related to the ADHD treatment).
This assumes that you haven’t shot yourself in the foot by combining with daily use of marijuana or alcohol to excess, or didn’t try backing off caffeine. Maybe medication didn’t work because you still had little motivation to stop procrastinating and were expecting miracles from your medication, or you were expecting to be a different person (six inches taller and 30 lb. thinner would be good) when all you really got was a significant reduction in your adhd symptoms.
Treating ADHD doesn’t fix all marital problems and sometimes, even if it really helps, there has been enough damage done to the relationship that it’s hard if not impossible to rebuild it. If you’ve been an asshole for 20 years, should you really expect your partner to suddenly forgive and forget, especially if you have never admitted to being a shit in the first place or reflected after getting treatment in the second (and apologizing).
While it’s true that people who get treatment for their adhd have less addictive behaviours, it would be naive to think that significant alcoholism or other addiction is going to be ‘cured’ by treating your adhd. More than likely, counselling, programmes, AA, and even residential programmes may be needed in addition to treating the ADHD – but perhaps it explains why such treatments have failed in the past and might now be successful.
Good chance if you are significantly addicted, you won’t see much benefit from treating only the ADHD.
Strategies Work For Me
If you are someone who is naturally organized, or who has learned to effectively apply strategies without a lot of anxiety, then quite possibly you won’t need medication. It would be important to do a full ADHD assessment to be sure that all aspects of your life are going well using your strategies, and that those around you are in agreement that they work.
A common scenario is that strategies are applied in the workplace – because it’s important, and there are consequences for not doing so, but at home, it ‘doesn’t matter as much’ and there are ‘no consequences’. This is frankly very inconsiderate of you. If your strategies can’t help you control your temper with your family, or manage money well, or listen effectively, then you risk being resented, rejected, despised or displaced. Imagine that on your tombstone!
BUT – there are many people who do successfully use strategies and counselling to effectively control their adhd in all aspects of their lives and simply don’t need treatment – and their families, staff, bosses and employees will back them on that.
These are people who are very self aware – who see that they can’t remember if they don’t write it down, who know the value of a shopping list, and will go back for it if need be because they won’t delude them selves into thinking – oh well, I’m manage ok, this time – when experience suggests otherwise. They are aware that procrastinating generally just makes things worse, that in tacking large or prolonged projects, breaking them up in to manageable segments makes them less daunting, and achieving a single step feels good.
They may have arrived at this effective management through the school of hard knocks – if you get your power or phone cut off, you might learn from the experience – or perhaps they had a parent who taught them effective strategies rather than simply taking over for them. It might have been a great teacher, or perhaps being in cadets or scouts or guides that gave them that experience.