I am diagnosed ADHD. I have used dexamphetamine as prescribed which worked pretty well, in moderate dosages because I am sensitive, but I came to dislike the effect it had on me: I felt like I was attached to a horse that kept pulling me around even when I just wanted to stop and take a break. And the fact that I would crash 5 hours later.
In 2020, before even knowing I had ADHD, let alone being medicated, I managed to quit my (vaped) nicotine habit after using progressively smaller patches; meanwhile my executive dysfunction grew so much, during the most stressful time of my entire life, that I literally had a major nervous breakdown. It took years of therapy, diagnosis with ADHD, medication, to connect the two factors: I had been self-medicating with nicotine by entire life, and as I reduced the amount of it in my bloodstream, the more scattered I became [1]
Then I tested my theory: I bought some nicotine patches, cut at very low dosage. And lo! it was as effective as dexamphetamine was, with much fewer of the side-effects, no pulling effect [2] and cheaper. It's been now a year and a half and honestly it's been working great. I slap on a small patch in the morning, it lasts MUCH longer than a pill, and it even allowed me to move and still lead a productive life in a country where ADHD is not even recognised. I asked my psychiatrist and they confirmed that nicotine is known to work as a third-line medication but usually amphetamines are preferred.
This is not medical advice, yadda yadda, but worked for me, and I've always wanted to write a post about it. Regarding addiction: pretty much none, patches take too long to take effect to create addiction (i.e. caused by a predicable spike in dopamine). My dosage (~7.5mg patch cut out from a larger one) has been the same for the past 18 months, and trying larger doses just makes me sleepy (nicotine has a U-shaped effectiveness curve). Nicotine is much maligned, but if you do the research, avoid the smoking and inhalation devices but only use patches, maybe you'll find it helps you as well.
---
1: I read that cigarette smoke during the formative years is associated with lifelong ADHD, and my pet (silly) theory is that the increasing stigma surrounding smoking of the past ~30 years might be one of the many factors we see ADHD on the rise. We might have 2 or 3 generations of smoking parents that were themselves self-medicating because of growing up in times where smoking was commonplace.
2: if I need to feel like a productive machine for a couple hours, coffee and a tyrosine pill can recreate the amphetamine feeling pretty well
That's what causes addiction though, which is a function of how quick and how large is the spike in dopamine levels over baseline. Nicotine patches take ~4 hours to reach peak dosage in the bloodstream, which is why I even considered them in the first place, as an ex-smoker that doesn't want to get addicted to the stuff ever again.
Nicotine from a cigarette, in comparison, takes about 7 seconds to cross the blood-brain barrier.
Great point. If addiction is a concern (and rightly so with nicotine), that makes faster onset a bug rather than a feature. For me it’s fine, because a single pack lasts me a year.
Fellow ADHDer here, I'm not a smoker but long before I was diagnosed, lyrics from a song of my favorite band/artist hit me particularly hard. It was Drag by Joey Cape/Lagwagon, a song about the struggles of smoking. Here's the part, especially the last two lines.
The drag on the next one
Is something I can look forward to
Something to slow the synapse
Something to do with my hands
I'm lucky enough to be properly medicated now and to have been shielded from smoking by a combination of favorable family environment, a great pediatrist back then and great prevention efforts in school, because if not I'm pretty sure I would have been a heavy smoker. The need for mental peace and focus was just too strong.
My experience parallels yours. I’ve been intermittently using cutdown patches, and B vitamins + magnesium, in an effort to have fewer complete nut-job breaks from reality.
Nicotine is a CNS stimulant, and cigarettes are somewhat of a fidget spinner, and social lubricant. What’s not to like.
For most people, long term nicotine use is probably less deleterious than long term amphetamine use.
More recently I starting testosterone, and that’s made me feel heaps less like a histrionic toddler.
> Nicotine is a CNS stimulant, and cigarettes are somewhat of a fidget spinner, and social lubricant. What’s not to like.
This was a joke?
> For most people, long term nicotine use is probably less deleterious than long term amphetamine use.
You meant most people prescribed amphetamines for medical conditions? Or most people?Recreational nicotine use is less deleterious than recreational amphetamine use probably. Comparing therapeutic use would include sources ideally.
Transdermal nicotine prescribed or self-administered for treatment of ADHD / ADHD like symptoms is probably less deleterious for the same patients than an amphetamine prescription.
There are no sources because nobody is really studying this, he's just speculating. Which he is allowed to do, since he didn't say it was a true thing. To me, it read very clearly that he was just speculating.
As ADHD "patient" that used both I usually tell the other way around. Ritalin has a weird crash and all the side effects for me while Dex is just like a super effective coffee with minimal crash or anything.
I also blame screens. My other pet theory is that in 30 years we'll discover there is really no such thing as ADHD, just pre-frontal dopaminergic dysfunction from a lot of different causes, such as addiction (there is a great presentation by Dr. Todd Love about how ADHD and drug addiction present exactly the same), superstimuli frying our reward systems and natural differences in drive between people. What we're doing now is just treating the symptoms.
I think screens can provoke AHDL-like symptoms or perhaps even trigger ADHD, but it existed before screens. Also a lot of illnesses are managed, even when we actually know the cause, we can't always undo the damage, just manage it.
Yes, but incidence rates are increasing. You can blame that on better diagnoses, or, more likely in my opinion, some other factors which didn't exist before.
It can be both though, there's ADHD as it is currently understood as a genetic/neurological issue where the dopaminergic system is impacted, and creates all the effects experienced by ADHD sufferers.
There might also be environmental issues, like you mention, that could be creating similar issues but not from the point of a genetic neurological divergence.
That is an important distinction since the treatment for one cause is very different to another.
The incidence rates increasing are very correlated to better diagnoses, 30 years ago most people with ADHD wouldn't be diagnosed unless they fit into the extreme cases of it. That was my experience, as a kid I was very bright but considered "lazy" since I couldn't focus as my peers did out of school, was always interested during classes, and excelled in school even though I could never do my homework or other assignments, constantly forgot important deadlines, it was always stressful but I found ways to manage it. Thirty years later and I fit in the criteria, no idea how my life would've turned out if I knew about it before, my coping/management mechanisms ended up being to lean into the stress and harness it, it made me achieve things but also created a whole other host of issues with anxiety later in life.
I was just recently talking to my fellow ADHD friends on the benefits that i felt when i started vaping this summer. It was like i was medicating away my ADHD. I turned to AI to investigate further, its response seemed to underwrite this observation
Gemini output:
Research is exploring nicotinic acetylcholine receptor (nAChR) agonists as a potential non-stimulant treatment for ADHD, sidestepping the issues of pure nicotine's high addiction liability.
The mechanism focuses on boosting dopamine (DA) and acetylcholine (ACh) release in brain areas governing attention and executive function, primarily by targeting the alpha4beta2 and alpha7 nAChR subtypes.
The goal is highly selective compounds that target the cognitive benefits (linked to alpha4beta2) while avoiding undesirable side effects and addiction pathways.
Selective alpha4beta2 Agonists (e.g., ABT-418, ABT-894/Sofinicline): These were developed to strongly activate the receptor most associated with DA release. Pilot and Phase II studies showed a signal of efficacy in adults with ADHD, with effect sizes similar to non-stimulant medications like atomoxetine.
Varenicline (Chantix/Champix): This is a partial alpha4beta2 agonist, FDA-approved for smoking cessation. Smaller trials suggested improvements in ADHD symptoms, but large-scale development for ADHD has been limited or terminated, and it is not approved for this indication.
Bupropion (Wellbutrin/Zyban): An established non-stimulant ADHD treatment (NDRI) and smoking cessation aid. While its main action is norepinephrine-dopamine reuptake inhibition, it also acts as a nicotinic receptor antagonist (blocking it), which is believed to help reduce nicotine craving. It is an approved non-stimulant option for ADHD.
In 2020, before even knowing I had ADHD, let alone being medicated, I managed to quit my (vaped) nicotine habit after using progressively smaller patches; meanwhile my executive dysfunction grew so much, during the most stressful time of my entire life, that I literally had a major nervous breakdown. It took years of therapy, diagnosis with ADHD, medication, to connect the two factors: I had been self-medicating with nicotine by entire life, and as I reduced the amount of it in my bloodstream, the more scattered I became [1]
Then I tested my theory: I bought some nicotine patches, cut at very low dosage. And lo! it was as effective as dexamphetamine was, with much fewer of the side-effects, no pulling effect [2] and cheaper. It's been now a year and a half and honestly it's been working great. I slap on a small patch in the morning, it lasts MUCH longer than a pill, and it even allowed me to move and still lead a productive life in a country where ADHD is not even recognised. I asked my psychiatrist and they confirmed that nicotine is known to work as a third-line medication but usually amphetamines are preferred.
This is not medical advice, yadda yadda, but worked for me, and I've always wanted to write a post about it. Regarding addiction: pretty much none, patches take too long to take effect to create addiction (i.e. caused by a predicable spike in dopamine). My dosage (~7.5mg patch cut out from a larger one) has been the same for the past 18 months, and trying larger doses just makes me sleepy (nicotine has a U-shaped effectiveness curve). Nicotine is much maligned, but if you do the research, avoid the smoking and inhalation devices but only use patches, maybe you'll find it helps you as well.
---
1: I read that cigarette smoke during the formative years is associated with lifelong ADHD, and my pet (silly) theory is that the increasing stigma surrounding smoking of the past ~30 years might be one of the many factors we see ADHD on the rise. We might have 2 or 3 generations of smoking parents that were themselves self-medicating because of growing up in times where smoking was commonplace.
2: if I need to feel like a productive machine for a couple hours, coffee and a tyrosine pill can recreate the amphetamine feeling pretty well