There are so many success stories in treating ADHD in the adult practice of Medicine, and in my office, one of them stands out. I have a patient who was coming in for the first time, 42 years old, a woman who is a single parent and an executive. She came in with a chief complaint of fatigue, anxiety and difficulty sleeping. When we really began to explore what wasBrendan_Montano_AIA_jZJbzO

going on, medically, she had some serious problems. There had been a heart attack. She had had two stents placed in her heart in the past and she was an exceptionally heavy smoker and still smoking.

During the interview, I did a screen to look for ADHD. The screen was time-efficient and it pointed me to think about this as a possible ideology for many of the problems she was having, including the heavy cigarette smoking. We begin to treat her and because of her cardio-vascular disease we treated her with a non-stimulant medication.

It became clear that she was suffering at work, almost to the point where she was going to lose her job. She was put on notice and had to report on a weekly basis with her boss, whether she having progress or not.

Over the course of treatment for her ADHD, her anxiety improved. She was able to sleep well. Her job performance dramatically improved and she got off of cigarettes. So all in all, the continuous stress that was driving her cardio-vascular disease and threatening another heart attack, the continuous stress abated. She was able to keep her job and her health improved dramatically.

Anthony_L_Rostain_MD_MA_-_ADHD_in_Adults
Let me tell you about a patient of mine named James who is 27 years old and has had a history of some serious substance abuse problems. Now James was diagnosed with ADHD in elementary school, and around middle school decided he didn’t want to take medications anymore. Beginning in late middle school and early high school he started experimenting with marijuana and alcohol, and eventually began to use other substances like cocaine, and finally, by the time he was finishing high school – and he barely graduated – James was using prescription opiates.

After high school he worked for a few years as a janitor, but this addiction to OxyContin got the better of him. He finally was in an accident, got a DUI, and was court mandated for treatment; and they discovered that he not only had an alcohol abuse problem, he also had marijuana and opiate addition. For this he was given the diagnosis of polysubstance abuse and was started in an outpatient treatment in our facility.

So James was started on suboxone to help him withdraw from opiates, and he was also started on citalopram because he was complaining of depression; and he was able to maintain sobriety, but he had a real tough time concentrating and getting simple things done. He wasn’t completing simple tasks around the house. He tried to go back to work and found it very difficult to stay focused on his job duties, and was reprimanded for coming in late.

So as a result, we then were asked to consult with, and lo and behold, we realized that, even though he was being treated for addition, he still had the ADHD that plagued him as a child. So we added OROS methylphenidate, and we began having him come for weekly cognitive behavioral therapy sessions in which he relearned what ADHD really is for someone his age, and where we began to help him overcome some of his negative attitudes about learning routines and doing things that required mental effort.

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James had dreams, wanted to do something with his life, but had always avoided them and had turned to substances to help him with things that made him anxious like social relationships.

As time went on, James began to talk about wanting to start his own business, and lo and behold, he was able to get started in this business. He sells collectibles online, and over the last few months he’s been so successful that he’s actually hired an assistant. What James likes to say now is that he wished that he had continued his treatment for administered; maybe he would have avoided substance use disorder. But he takes it all in stride.

He’s got a wonderful attitude, feels very positive about his life, and actually has offered to go and talk to some of the other patients in the recovery program to help them realize that some of them may, in fact, have ADHD that they ought to get treated.

So, I bring up this story of James in order to get you to think about the fact that maybe some of your patients who are in your office with other problems like substance use or alcoholism, or people who can’t quit smoking, maybe some of them have ADHD underlying all of their difficulties, and it would be worthwhile for you to learn how to assess them and maybe begin them in treatment because it could make a huge difference to their lives.