Disclaimer: This post discusses topics related to drug use and addiction. I encourage you to recognize and respect your limitations in consuming sensitive content.
In my experience of working with people who used stimulant drugs (substances that elevate mood and increase alertness and energy), the most common drugs of abuse have been cocaine and methamphetamine. The following is a story of a man who struggled with cocaine addiction, used it to self-medicate his ADHD, and began to rediscover himself in recovery.
ADHD and Cocaine
When it comes to ADHD, the brain’s prefrontal cortex (the region that controls focus, planning, and impulse control) is under-stimulated. Cocaine (or “coke”) is highly addictive and has no physical withdrawal symptoms. In other words, the psychological high of cocaine is powerful enough to spur and maintain an addiction. While cocaine is much more potent and addictive than prescription medication for ADHD (attention-deficit/hyperactivity disorder), it stimulates the prefrontal cortex in a similar manner. Consequently, cocaine addiction can be partly perpetuated by a desire to self-medicate symptoms of ADHD (such as lack of concentration, problems focusing, and excessive restlessness).
I worked with a forty-year-old White man, whom I’ll refer to as “Z,” whose spiral into addiction began with cocaine and self-medication. He first tried cocaine at a party as a teenager and was captured by how focused he felt while on it. Don’t be mistaken, he also spoke about feeling euphorically high — and part of his high was the feeling of being grounded and calm. This surprised him because he saw others react very differently to cocaine — he saw them border on mania, a more typical reaction.
Searching for “Normal”
Prior to his first experience with cocaine, Z never thought much about his mental health or problems focusing in school. Unable to sit in one place for very long or focus on a topic without becoming restless and distracted, from a young age he realized that school was difficult for him. Side note: Many children struggle with attentiveness in school and do not have ADHD, though Z met criteria for ADHD as his symptoms were present in multiple settings and impaired his ability to perform well in school. He decided that his inability to focus was normal. However, this changed after he tried cocaine.
“Sana, I feel more grounded on coke — I feel more like myself,” he said to me as we sat in my office. Z’s impulsiveness, lack of focus, and restlessness were obsolete in the face of cocaine. I empathized with his desire to feel better and to feel like himself. Who wouldn’t want that? However, the reason he was sitting in my office was because his self-medication morphed into problematic polysubstance abuse and addiction (as it normally does). His addiction had led to a near-fatal stroke, brain damage, and the loss of over two hundred thousand dollars. Z wanted to feel normal — and he had to find a way to do this without cocaine.
Diagnosed — and at a Crossroads
On his journey to discover his new normal, he was finally assessed by a psychiatrist. I’ll note that he met with a psychiatrist after being on a waiting list for over three months — often the dilemma of many who seek psychiatric care but lose hope due to long wait times or being turned away. Z’s psychiatrist confirmed what he’d suspected for his whole life — he diagnosed him with ADHD. Having a formal diagnosis of ADHD was both a relief and challenge. He’d gone his whole life self-medicating and not discussing his mental health or addiction. However, he’d now been given a diagnosis that explained and normalized his experience. Between myself and his new psychiatrist, he was faced with a choice: accept his reality and embrace treatment or continue to do things the way he always had.
The Heart of Addiction
At the heart of addiction is the desire to fill a void. While substance abuse can quickly turn into physical dependence, it often begins, and is perpetuated by, the desire to satisfy an unmet need. As a clinician, the work I do with clients entails addressing their addiction while also addressing the void that their addiction has filled for so long. For example, this void may be related to grief, anxiety, apathy, or low self-worth. In Z’s case, he couldn’t recall the roots of his addiction and didn’t know how to feel normal or happy without cocaine.
The work that we did involved beginning to unearth the roots of his addiction, identify his triggers for use, and discover the person that he was without cocaine. Before he transitioned to another counselor due to my relocation, our relationship ended while he worked to maintain sobriety following a lapse. In our final session he said, “I don’t know what I’m looking for — but I know I’m looking for something.” I was inspired by his quest to rediscover himself while addressing the identity he had established around cocaine. I’m fortunate to have met him on this journey.