Day 42, with the program and B"H posting...

Thank you all for a life-saving and life-giving forum. Thank you Guard for caring and being there for all of us...

Posted recently on ADHD and Addiction here, here and here.

Here is another excellent article by Dr TE Brown on ADHD and Executive Function impairment that is easier to follow:

http://www.drthomasebrown.com/pdfs/Executive_Functions_by_Thomas_Brown.pdf

Here is a very important piece by Dr TE Brown on 10 common myths about ADHD:

10 Myths and Facts about Attention Deficit Disorder
(ADD/ADHD)
from Attention Deficit Disorder: The Unfocused Mind in Children and Adults,
by Thomas E. Brown, Ph.D. Associate Director of the Yale Clinic for Attention and
Related Disorders (Yale University Press, 2005)
MYTH: ADD is just a lack of willpower. Persons with ADD focus well on things
that interest them; they could focus on any other tasks if they really wanted
to.
FACT: ADD looks very much like a willpower problem, but it isn’t. It’s essentially
a chemical problem in the management systems of the brain.
MYTH: ADD is a simple problem of being hyperactive or not listening when
someone is talking to you.
FACT: ADD is a complex disorder that involves impairments in focus,
organization, motivation, emotional modulation, memory, and other
functions of the brain’s management system.
MYTH: Brains of persons with ADD are overactive and need medication to calm
down.
FACT: Underactivity of the brain’s management networks is typical of persons
with ADD. Effective medications increase alertness and improve
communication in the brain’s management system.
MYTH: ADD is simply a label for behavior problems; children with ADD jut refuse
to sit still and are unwilling to listen to teachers or parents.
FACT: Many with ADD have few behavior problems, Chronic inattention
symptoms cause more severe and longer-lasting problems for learning and
relationships for those with ADD.
MYTH: Those who have ADD as children usually outgrow it as they enter their
teens.
FACT: Often ADD impairments are not very noticeable until the teen years, when
more self-management is required in school and elsewhere. And ADD may
be subtle, but more disabling during adolescence than in childhood.
MYTH: Unless you have been diagnosed with ADD as a child, you can’t have it as
an adult.
FACT: Many adults have struggled all their lives with unrecognized ADD
impairments. They haven’t received help because they assumed that their
chronic difficulties, like depression or anxiety, were caused by other
impairments that did not respond to the usual treatments.
MYTH: Everybody has the symptoms of ADD, and anyone with adequate
intelligence can overcome these difficulties.
FACT: ADD affects persons of all levels of intelligence. And although everyone
sometimes has symptoms of ADD, only those with chronic impairments
from these symptoms warrant an ADD diagnosis.
MYTH: Someone can’t have ADD and also have depression, anxiety, or other
psychiatric problems.
FACT: A person with ADD is six times more likely to have another psychiatric or
learning disorder than most other people. ADD usually overlaps with other
disorders.
MYTH: Medications for ADD are likely to cause longer-term problems with
substance abuse or other health concerns, especially when used by
children.
FACT: The risks of using appropriate medications to treat ADD are minimal,
whereas the risks of not using medication to treat ADD are significant. The
medications used for ADD are among the best researched for any disorder.
MYTH: ADD doesn’t really cause much damage to a person’s life.
FACT: Untreated or inadequately treated ADD syndrome often severely impairs
leaning, family life, education, work life, social interactions, and driving
safely. Most of those with ADD who receive adequate treatment, however,
function quite well.

Source:http://www.drthomasebrown.com/pdfs/myths_and_facts.pdf

Additional reading on Sleep disorders and ADHD: http://www.drthomasebrown.com/pdfs/sleep_chapter.pdf

In general I have found Dr Brown's site to be an excellent resource.

In follow up email, a member of this forum mentioned his wife, who does not know about his addiction and is  not very positive to the idea of his taking medication. It's not easy to give advice in such circumstances and certainly the last thing I am going to do is make a blanket and public post about this. I do have several ideas and possible suggestions on how to get wives to come to terms with taking medication without revealing addiction. If, by any chance anyone is interested they can email me.

He also asked about the cause of the link between ADHD and addiction. That I can post here:

The link between ADHD and addiction

You asked about the nature and mechanics of the link between ADHD and addiction. I am aware of two neurophysical views on ADHD, both of which explain the connection between ADHD and addiction. One traces the source of ADHD to defficiency in a single neurotransmitter while another links ADHD to a disorder in a complex system of brain function involving many neural elements.

Some have suggested that ADHD is associated with below normal levels of one neurotransmitter, dopamine produced in the brain. Dopamine is believed to be an an integral part of the pleasure system. The theory is that people with untreated ADHD compensate for their low levels of dopamine by dosing heavily on substances and sex which increase the dopamine level.

See:

www.sciencedaily.com/releases/2007/08/070806164505.htm

The controversy over this is whether the low dopamine levels are the cause of the hyperactive and/or inattentive symptoms of ADHD or whether the low dopamine levels are just a symptom of ADHD.

Another view I am aware of, sees ADHD as, essentially a disorder of in a complex system of brain function involving many neural elements, the Executive Function (EF) of the brain. The proponents of this view are divided over whether ADHD is a fundamental disorder of EF or a selective disorder of EF for certain activities. Here is an excellent article examining the differing views of the connection between ADHD and EF, that is well worth the effort in understanding:

www.drthomasebrown.com/pdfs/ef-conflict.pdf

In this view in healthy people the key to avoiding addiction which is by definition pleasurable is in proper function of inhibition (being able to apply the brakes) which is a key part of the EF system (according to Barkley it is the key part of the EF system) and therefore people with ADHD who according to this view have a disordered EF are particularly vulnerable to addiction.

For what it is worth, I identify more with Brown's view but one thing is certain, people with untreated ADHD have a far more difficult time than their non-ADHD peers in separating themselves from activities which offer immediate pleasure and people with ADHD find that future negative consequences are unfortunately much less of a deterrent than they are for their non-ADHD peers.

Studies show that people with untreated ADHD are more vulnerable to addiction, drive faster and more recklessly, and are in general more likely than their peers to engage in high risk activities. So, if you have any addiction, including an addiction to porn, then the chances are higher than normal that you also have ADHD.

I got email from a member of these forums asking about the possibility of treating ADHD behaviorally and asking about the potential side effects of medication. My initial reply (with slight editing from the original to protect identities) is below including a piece on what ADHD medication will and will not do.

ADHD MEDICATION: SIDE-EFFECTS, BENEFITS, WHAT MEDICATION WILL AND WILL NOT DO

You wanted to know about the option of behavioral treatment. Studies show that at times of difficulty people with untreated ADHD are totally unchanged and unmoved by prior knowledge of consequences. To people with untreated ADHD in time of difficulty there is only now and not now and prior knowledge and future consequences do not exist. Therapy has been found to be only useful to the degree that it is used to create a physical environment in which there are effective immediate physical prompts and physical stimuli of immediate and short-term benefits and immediate physical warnings of immediate and short-term negative consequences. Imagine creating a workspace with prompts such as post-its, messages on a computer screen, work area etc and training to use them. It is not easy and the results are usually not great.

I know a therapist who told me that in a teaching course she was training a woman who was on ADHD medication. The woman was doing very well on ADHD medication and needed no therapy. Then she got pregnant and stopped the medication, and this student who was herself learning therapy got ADHD therapy from a faculty member. The therapist who was teaching her told me that even with the therapy this student was a fraction of her former self and that the results of therapy could not in any way be compared to the results of medication.

So what is medication like? How do I feel? Much of the time very normal (significantly better than before), often good and sometimes great. There are rarely any noticeable differences even to me and on several grounds I am convinced that no-one notices anything different. The rare and fleeting side effects that I have are a slight and very fleeting dryness of mouth in the middle of talking (30 seconds here and there up to 2 or 3 times a week) that even when it is there is just slightly uncomfortable. And for me that is it.

You are concerned about side-effects in general and being slowed down in particular. I was too, but I was really desperate and so I was ready to try it. Now I have tried it and am very pleased with the results, here is what I have learned and can share with you about your concerns.

First a little theory. The key to all psychiatric medication is good dosing. That means having a good psychiatrist who will start you on the right medication for you at a low dose and work gradually upwards.

You don't want to start high because that increases the risk of side-effects and even more importantly the medication is most effective and efficient at the correct dose. Anything beyond that will reduce the benefit in addition to increasing exposure to unwelcome short-term and ch"v long term side effects.

Now in terms of the risk of being slowed down, as far as that is concerned you can break the medications in two groups, stimulants (such as Ritalin, Concerta, Aderall and Vyvanse) and non-stimulants (such as Strattera).

The non-stimulants may slow you down and are a potential cause for concern in that respect. Now I am no Doctor, but nevertheless, I would advise anyone who is lively and energetic (most of us) to avoid Strattera which in my opinion is not a good personality fit for someone with ADHD and so I would recommend to go for a stimulant if your Doctor asks your preference. Unless that is, you have had prior issues with insomnia (meaning not being able to sleep once you have gone to bed as opposed to just not going to bed which is a staple of ADHD) in which case the insomnia would almost certainly become more severe with stimulants. For people suffering from insomnia Strattera is the best bet.

In my opinion stimulants are a really good fit for the majority of people with ADHD. At the correct dosing level you don't get overly wired or geared up and you do get a sense of control, purposefulness and to a certain extent even an increased sense of strength and power. That may sound a little scary to someone who has not tried them, but for me at least, it all manifests itself in a very good way, such that I can now be, Bechasdei Hashem on an everyday basis exactly like I used to be on a once in a blue moon rare excellent day.

So I find that I have not at all changed to a personality that was not myself, I am just able to have a good day every day. Now that doesn't mean that life becomes artificially good, medication is certainly no guarantee of a good day, it's not auto-pilot, it's only a tool and there are still many options for having a day that is almost as bad as the days before treatment. More about that later.

Now there are two types of stimulant, those like either Ritalin or Concerta on the one hand and those like Aderall or Vyvanse on the other. My Doctor told me that in his experience kids do better on Ritalin or Concerta and adults do better on Aderall or Vyvanse.

I would recommend that anyone with Adult ADHD try either Aderall (available generically) or Vyvanse under good and sound dosing and unlike Strattera which takes several weeks to get symptom relief it takes less than an hour to get instant symptom relief.

So what does medication help for and what will it not do?

Medication increases control and focus and gives you the option and ability to see a task through all the way to the end, no matter how difficult. It decreases the need to shift from one task to another and to be constantly be chasing new excitements. At proper dosing all that can be achieved without in any way undermining liveliness, energy and a sense of fun. I do not believe that stimulants turn anyone into a deadbeat.

But medications are not motivators and they are not an education. They give you the ability to do the things you wanted to do but could not (with untreated ADHD, the onset of anxiety or mental difficulties will undermine even the biggest motivation) but medications will not persuade you to do the things that you are not very interested in doing and they can help you focus even more on the distractions that you prefer when unmotivated.

Medications will give you the opportunity to create new habits but they will not give you the habits in pill form, so work is needed to create necessary habits that were until now unattainable.

ADHD medications will give you the perseverance to face anxiety, fear, anger and depression that often interfere with what we want to achieve but they will not treat those emotional difficulties and so work is still needed to improve and change.

But for me at least medication is a life saver. I have wanted and tried for over 20 years to change myself and I was never able to. I tried years and years of practical mussar, years and years of organizational methods and techniques, all to no avail.

Now, due to the challenges of years of neglect, years of bad habits and a deficit of good habits I need therapy but I see "mamash bechush" that without the medication I would not be able to implement the therapy at all. It even took going the whole way with the 12 steps groups before I could implement the therapy and without the medication I would never have been able to make the 12 steps groups a reality for myself.

wow! what activity on this forum! everybody is being truthful about themselves.as you know, this is the first step.the problem is, how to go on to the next step, which is to start acting on that wonderful knowledge.
addicts are manipulators - they can manipulate anyone, themselves, EVEN therapists, into believing that they cant move on.so we have to stop manipulating and start moving! what i'm trying to do is gently nudge the chevra.believe me, i know how hard it is.so allow yourself to be pushed from behind and pulled from the front - that's what this forum is for - pushing and pulling.i know you cant do it on your own.let the people on this forum help you, and surrender your addiction.

No, bichlal not. I was using the Torah only as an EXAMPLE of how any spiritual feat, whether it's "sweetness in Torah" or "conquering the Yetzer Hara", in order to truly achieve a true freedom and pleasure in the Avodah, it first requires that we are willing to die for it - or at least be willing to "feel like we are dying" and still not give in. If we can achieve that, Hashem does an amazing thing and suddenly the Avodah becomes sweet!

I was actually contrasting it to Torah and saying how with this struggle, it's even EASIER to acheive this freedom and sweetness than it is to achieve it in Limud Torah. Because in our case here, it just requires NOT doing anything - along with being willing to suffer whatever it takes NOT to fall. If we can achieve this kind of determination in our minds, at that point we will suddenly feel a TRUE freedom from the Yetzer Hara and it actually becomes pleasurable to serve Hashem and not the yetzer Hara.

It's truly an amazing revelation. Most people don't know this until they've achieved it. But I am revealing it here for everyone so that it will be easier for us all to take that initial leap of faith!

On another note:

This is something that has always driven me crazy. Are you saying, along with what others seem to imply, that the only eitzoh for this addiction and the only proper thing for anyone actually, is to be learining 15 hours a day?

Edited Later.

I just found the following in an article by Rabbi Asher Meir in "The "Jewish Ethicist" posted in JWR for today:

"... is that Jewish law acknowledges that setting some money aside for unexpected needs, within measure, can also be considered an essential expense. (Next week we will give an additional approach.) Here is an important source for this rule:

"The Shulchan Aruch (authoritative Code of Jewish law) states that eminent Torah scholars are exempt from many communal levies. Even if the Torah scholar has to work for a living and can't devote all his time to study, he is considered to be devoting all his free time to learning as long as he works only "enough for his livelihood, and not in order to enrich himself." (1) "

There is much more on this subject in the artiicle, wihich can be found at

www.jewishworldreview.com/jewish/ethicist_funds_fundamentals.php3  

be holy, you bring to light some fundamental points that post-addicts must realize. I myself have gone 6 months completely clean with very few test along the way.  And after that I fell.  I have learned from my own mistakes what needs to be in place after "escaping" the claws of the y"h.  

Firstly, the fact that you were able to go back to it so quickly is a sign that your brain is not rewired.  I read that it can take up to three years to rewire ones brain.  I have learned this lesson the hard way.  My ultimate down fall came at a very similar experience as yours, where I had access to open internet suddenly one day and the curiosity got the better of me, and  I was gone.  It is then that I realized that my brain has not really been rewired, some of the associations have been suppressed all those months but have not been erased.  So the first issue is that just because one thinks he is are cured, he is not.  We should realize and understand this.

Second issue is related to the first and that is the life of a baal teshuvah is different than the life beforehand.  A few weeks ago, I was invited to a neighbor's get together for the birth of their daughter (I think it is called a simchat bat, but I am not holding in these things).  These neighbors of mine have a different level of observance of mine and their event was co-ed.  I walked in to say mazel tov, and I saw men and women intermingled throughout this house.  Besides the fact that I was mortified by the site, I realized this is not a place for me.  It wasn't that I felt aroused by being there (B"H, I have greatly worked on myself in this area over the past few years), but I felt it was not appropriate for me to enter even to just say mazel tov.  So I am sure that this neighbor of mine will be insulted or whatever, but those are the sacrifices in life.  So we need to be extremely careful what we do, where we go, etc.  As a policy I do not go to certain places.  I even stay away from shopping centers if possible.  To what extreme a person decides to take upon himself is personal.  But the point is that a baal teshuva has to make  changes to life. He cannot think that life is back to normal again.  This is a fundamental mistake I made. I felt "cured" and my guard was down and before I knew it, i slowly made its way back into me.  

Third point: We need to not only make physical changes to our lives but perhaps more importantly we need to strive for heightened levels of kedusha.  As many on this forum pointed out סור מרע is not enough, you need עשה טוב.  This means begin building ones kedusha all around.  It starts by controlling one's body, which means not only controlling the movement of our hands which by now, for some, has been second nature.  It means working on the איסור of מקשה עצמו לדעת through the mind. It means knowing how to react when it happens accidentally.  I do not want to go into detail about how to do this as not to create חלישות הדעת.  But one must realize there are איסורים involved.  Then one works on הירהורים, and it keeps going.  I wish not to elaborate any longer. But the point is to grow in ruchniyus in general and kedusha specifically. Again, this is personalized.  One may feel he wants to work on his focus on gashmiyus in general.  Everyone is different.  But the principle is the same.  But it is really what be holy summed up by stating, "what do i want out of life? to be a prisoner of my body or a servant of hashem?".  Doing this, is not only by the power of refrain, but of through the power of positive growth.

The fourth and final point I would like to comment here is a less well-known yetzer hara called the yetzer hara of milestones.  There is a catch-22 many of us here on the forum are faced with.  We all encourage ourselves to strive for the top of the ladder of 90 days.  This is great as it helps us stayed focus.  But when a person hits a milestone in life, there is little voice telling him, "you did it! great!  You are the best!  Now you could go back and do a little of that bad stuff again."  We must realize that milestones in life are not the end but rather a beginning. When a person falls from his milestone (as I did), he did not mess up the past but the potential for the future.  But the whole y"h of milestone makes us look at the past not at the future.  We hit a point and look back at our accomplishments and forget our future ahead of us.  We forget the milestone's purpose was to enable us properly for the future.

I remember what it was like being a teenager, and what can begin as mere curiosity can quickly lead to a deeply ingrained addiciton. It's so easy to become addicted but BELIEVE ME, it's much more difficult to break free and escape once you've allowed yourself to become enslaved to lust or any other bad habit.

I just wish my dad had sat me down and told me of the dangers that young men face nowadays like masturbation when I was growing up- it would have made such a difference to my life and I could have avoided so much unecessary suffering.

You are in a privileged position in that you have a father who not only knows of these evils but is so concerned to protect you from them. Please listen to his thoughtful and kind advice- he only has your best interests at heart, even if it doesn't seem that way at the time.     

I am not sure I understand this post. Are you saying you used the live meeting to act out? This is indeed a risk for someone who is very badly addicted but has not yet truly hit bottom and realized yet that his life is totally unmanageable. I thought you were there already, maybe you weren't.

Maybe you are now.

Whenever you are TRULY at the point of utter-helplessness and feel that if you don't get your life back you'd rather DIE, at that point you are truly ready for the live 12-Steps groups and there is no more this fear of using the group to act out.

If you are NOT there yet, then stick to the phone meetings.

Gettinghelp, we are here for you. We will help you get your life back. Listen to your Neshama who speaks only the truth. Learn to differentiate between the addict inside you who tries to kill you each day anew, and your neshama that speaks the truth softly, deep inside you.

See the post called "Revelation" in the announcement board.

May Hashem guide you to the light.

In honor of the new baby and everyone's Kabalos, I want to reveal to you all one of the deepest secrets to winning this battle:

The moment a person decides that no matter how much it hurts or how bitter it is - he will do it anyway for Hashem's sake no matter what, and he is willing to suffer whatever pain it takes; an amazing thing happens then: It actually becomes EASY and SWEET!

This is the secret to true success in any spiritual feat, including Torah. Like it says: Zos Hatorah - Adam Ki Yamus Ba'Ohel. As soon as a person accepts upon himself the yoke of Torah to the point where he is ready and willing to suffer for it to the point of death - ZOS HATORAH; that is the Torah, and then he is Zoche to feel the true sweetness of Torah that by far exceeds any physical pleasure. But with Torah it is understandably harder to achieve this high madrega because it requires lots of doing and learning, such as getting up before dawn, going to sleep late, eating little and toiling day and night in Torah. This is indeed hard and requires a huge leap of faith before it starts to get truly sweet.

But when it comes to our struggle with this addiction, it is much easier. We don't have to do ANYTHING. We just have to STOP doing the bad things and accept upon ourselves that even if we feel like we are going to DIE if we don't give in, even if we feel such a deep void and depression that everything we do feels like eating "dirt" - still, we will not give in no matter what and we accept the challenge of this pain with JOY for Hashem's sake, then - and ONLY then - are we Zoche to feel the true sweetness and freedom from the Menuval once and for all forever!!

So take that leap of faith today, and accept upon yourself to succeed no matter how hard it is, and suddenly you will see that it gets easy and feels truly SWEET!

Yesterday was a very strange,difficult,hard upsetting one.I was a phone meeting and decided to go to my first live meeting.Howver even after asking advice from my sponosr,I was lying to him and especially myself about why I wanted to go.I was using my addicts ability to lie and manipulate to get my why.I tried and succeeded in doing what I set uot to do.Deep down I new I wanted to act out but did not ask for help.I am viewing as a lesson in giving up my controlling ways because they simply don't work.Looking back on this weak it has taught me agreat deal.#1 is that I am so obsessed with being right nothing else matters to me.It has to be my way or the hih way.Well that just sucks.I now know what being totally powerless truly means.Even when I am trying on the surface to get help by going to a meeting my desire to act out is stronger.During the meeting I was so concerned with someone coming in that might now me I was literaly shaking inside.But still I don't give a sh...... when I am acting out if someone sees me or doing it infront of Hashem.Boy do I need some serious help.I am powerless to this illness.It eats me up and spits me out but I keep wanting more.How do I ask myself and anyone to I get the desire to go in the direction of help.I want so badly to really want to get healthy.I WANT MY LIFE BACK NOW.

Mazal Tov!  I didn't see this thread until the announcement in today's Chizuk e-mail.  The last few days I've been checking every few hours for the Chizuk e-mai, I think I'm addicted!

You should see a lot of Nachas from all your children.  Some other time, I would like to hear your thoughts on how to be mechanech children in the area of shmiras einayim.  How does one remove the stigma of the topic so that it can be addressed in a way that is not superficial?  I'm sure that many of us on the forum were instructed on the dangers of the street, to one degree on another, in our youth.  Yet those lessons did not take root and only through hard work as mature adults are we finally able to learn them for ourselves.

Wecome yehuda and thanks for sharing!

I think that many of us do feel jealous of you as many of our nesyonos are very very intense. 

You have certainly come to the right place to help kick this terrible habit once and for all.

Hatzlacha!

Yehuda,

Baruch Haba!!! 

By joining us, you have helped weaken the yetzer Hara's power!

Chazak V'Ematz!