Episode 034: Is my substance use helping or hurting?
David describes how when we hyper focus and launch ourselves into something, it can be hard to finish, because the hardest part is behind us. He heard then governor Gavin Newsom speak and he describe how there comes a point in running where you just have to keep kicking, you keep kicking your feet forward. For neurodivergent folx to recognize that we have to sit through the hard thing and just do it—it becomes important to honor just how painful and difficult that is. Self-soothing and grounding are helpful, but watching a show isn’t going to help you clean your room, watching the show would be a really good reward from cleaning your room. You need to offers when you’ve done something terrible, you need to be able to put your feet up and relax, but after you ran the race, not before you race at all. What does your system need to be effective? Are you angry or anxious for a reason, do you need to be stimulated? That’s what you need to be stimulated. Knowing that requires metacognition, knowing what you need for each moment. Isabelle describes her own difficulties delaying gratification, with black and white thinking and sequencing, and then the need to seek comfort, and wonders about the stats of folx with ADHD having more substance misuse, higher rates of divorce, accidents, etc. but as David points out, we do do more flips. But what is the warning or worst case scenario if you don’t clean your room, but what if the consequences are worse? David jumps into the substance abuse or misuse idea and wonders: if you have a marginalized, underserved, neurodivergent population and is neglected by a system--and they're using substances--and you think there's something wrong with them? For people with ADHD, a lot of people can fall into cannibis, or alcohol, or cocaine. For example, when you pour a depressant like alcohol into your system, your body tries to compensate by boosting your stimulation, because your body is seeking homeostasis. So if you don’t drink after drinking after drinking, your brain is released stimulants. Cocaine and cannibis are stimulants—and cannibis, as a dissociative stimulant—so folx with ADHD tend towards substances that are giving them the stimulation they are needing. When you look at people who struggle with delaying gratification, increased pain, more social rejection—wow, drinking can help them numb the pain and then they are doing stimulants when they would be prescribed stimulants to help with their medication condition. David sees this as a humanistic push toward health by people who have been given bad information. Our population is highly at risk because we’re in a lot of pain. David wants to highlight the pain we live in. “Unspoken expectations are premeditated resentments” and changing it for neurodivergent folx: “expectations are premeditated resentments.” All of our expectations, because of our black and white thinking, are that things are going to take away the pain, make us feel better, not hurt anymore, not be anxious anymore…when people make a decision that’s like “I’m going to bomb this test so I never have to think about it again” we get you, we understand that’s pain, you are in a lot of pain. There’s self-soothing to feel better to take a test, or bungee jump off a cliff, but when you’re in so much pain you look for ways to self-soothe your way through your entire life, we need to look at your expectations and get you the help you need. You are not broken, you are being serviced by the wrong technicians of the world, you are being given leaded gas, you have square tires, we need to get them off—it’s not your fault. It’s not David's fault that he misread that podcast that he screened, and he needed to be able to challenge it and face it, and lean on his support system. A lot of us have more courage than people understand, because we have a lot of anxiety and fear—if you’re not scared, it can’t be courage. Isabelle is so grateful for David naming this, and while neither one of them is a substance abuse expert, it is an important reminder to all of us. Isabelle thinks of the quote that sometimes when you think you’re the “crazy” one, it’s actually a very sane response to a “crazy” world. What is the appropriate response to what you are facing, and nobody told you this was in the water, and you’ve been drinking it your whole life, and the protestant U.S. work ethic of: “good things happen to you because you prove your worth, you earn it all” logic and it so does not match up with anyone’s experience, the “just world” hypothesis does not match up. Because it flips on you, if you did all the good things you missed the suffering, but if you suffer, it’s something you must work on it and solve it and pull yourself up by your own bootstraps. How much work is loaded on neurodivergent folx. We are not given the accurate operating instructions and we encounter more intensity of pain than people understand. There’s a lot of neglect in the world, we neglect things and pretend they’re fine. Of the drugs you can use in the U.S.- Caffeine, alcohol, and cannibis—nothing’s all bad. But using a substance to escape a feeling doesn’t help. Because your brain likes substances, and it will find the feelings to make you use it more often. So use them if you’re going to use them, but don’t justify it with a feeling. For Isabelle, this can tie back to what is self-soothing and what is avoidance. Sometimes keeping busy keeps you from feeling the feeling. Sometimes the task is not cleaning your room, it’s recognizing how much grief you’re in, sitting in the break up you just had, or facing the fact your parents are who you wanted them to be, the job you wanted was not as awesome as you thought it would be, it’s developing the frustration and distress tolerance for an emotional state that might beg for soothing away. You could always justify soothing it away, but how can you recognize and rise above and have a meta moment—are there feelings I’m running from? What am I used to run from those things? How can I build up the things that would help me tolerate them? David counters: how can I sit in them? We have to accept these things, not approve of them. The moment you stop escaping those feelings, all those feelings will come back. As Isabelle often hears it put, “what you resist, persists.” Now how to transition away from this? We could say “Schwarma!” And anything else. We could cite pickleball. Or we could say: this is complex. You’re not alone. You’ve got a family. An LD/ADHD family. We’re here for it! Isabelle thinks about this other therapist who works with trauma and kids and parenting, and how she describes how you can’t ever really help your child stop experiencing the pain, but what you can do is be there with them through it. You can do that with something that happened when you weren’t there. And the way you do that is by showing up and listening. Saying things like “I believe you.” “I hear you.” “Tell me more.” And just tolerating it, and the thing she said, for most of us, when we’re really little, we learn there are certain emotional states that we learn you have to deal with alone, because people are scared, or don’t know what to do. The difference is not how you can handle an emotion, it’s how you can practice not recognizing you don’t have to be alone in that emotion. Whatever you’re dealing with, to know you’re not alone, is not nothing, it doesn’t take the emotion or pain away, but there are people ready and willing and already there who want to listen. And it matters to us to hear from you. The reason we can be so vulnerable is because we’re hearing from you and knowing you’re listening, too, and that it’s helpful to you, it makes us want to bring it.
Stats for substance abuse or misuse in Children
-Children with ADHD are 2-3 times more likely to abuse substances than their neurotypical counterparts, and as-prescribed ADHD medication use does not increase the risk, it in fact lowers it by 7.3% (Source: Child Mind Institute)
For further reading, here's an article from Current Psychiatry Reports and more info from CHADD.org
Stats for substance abuse or misuse in adults
-Adults with ADHD are more likely to abuse substances than their neurotypical counterparts, at almost a 3:1 ratio, remission rates are slower, and the escalation to severe substance abuse may be connected to more severely untreated ADHD (Source: SAMHSA Advisory article)
DAVID’S DEFINITIONS
Black and White Thinking: Believing or acting as if there are only two ways of thinking right or wrong. This includes feeling like you did the thing or failed completely, and can be felt very intensely. Black and white thinking also makes it harder to see middle paths during an argument and makes it harder to back down and be flexible at times.
Metacognition: Thinking about thinking. Understanding and awareness of why you do the things you do. When you reach this point with any behavior, you’re more than halfway there.
Self Soothing: A task in an of itself. Engaging in a physical behavior (such a breathing, jumping, wearing sweatpants, lighting a candle, drinking some water) that is a task in and of itself, that addresses something your nervous system needs to ground or to energize. When thinking about self-soothing, the more you depend on something outside of yourself, the more it can breed dependency and aggression if that thing is taken away or not available. So think about diversifying your strategies, have a break glass in case of emergency one, have a smattering of things that you notice ground you or energize you and see that as a task to do. Think about when is the time to do the task of self-soothing: before you start? After you finish? During a break? Keep in mind that you also need to be uncomfortable and do the hard thing at some point, to experience the ultimate relief of getting that thing off your plate.
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Cover Art by: Sol Vázquez
Technical Support by: Bobby Richards