Coffee, Coping, and Compensation

This is more of a public service announcement than a regular ol’ post.

I’m writing it in the hope that maybe somebody, somewhere, will 1) come away with a better understanding of ADHD and what it is like to have it; and 2) join me in the loneliest of all crusades: pushing back on a simplistic public narrative which does nothing to help people with ADHD and does plenty to make their lives harder.

I’ve been mired in an unbearably irritating online conversation for the past two days about ADHD. The conversation has been playing out beneath a post of mine which, ironically, had nothing to do with ADHD.

Now, as backstory, this little anecdote took place in early afternoon on a school day. The kids were too young to be in school. Thus, they weren’t. There were three juice choices. Two had caffeine. One didn’t. The mother let the kids pick whichever they wanted. She was steering them neither towards caffeine nor away from it. She was letting her kids pick a drink. There was nothing more to it than that.

My post had been lighthearted. I don’t actually have an opinion about whether a little kid should or shouldn’t have some caffeine. I certainly don’t believe kids should NEVER have caffeine. Chocolate has caffeine. Kids have caffeine on occasion. I was making a joke as a parent about kids being more energetic.

Twitter being Twitter and then Threads being, well, like Twitter, can never just things less than literally. So, my replies filled with people suggesting why the situation I saw and glibly shorthanded might have somehow been something totally different than my poor powers to understand context were able to ascertain.

The leading claim was that the kids might have had ADHD and the caffeine might have been to treat it.

Y’all, I am not blessed with a boundless reservoir of patience for people who guess about shit they don’t remotely understand in general. My patience dries to a puddle when those people then argue with me as if their guesses are knowledge and my knowledge is ignorance.

Caffeine is a stimulant. It is always a stimulant. People with ADHD are helped in some ways by stimulants. However, the relationship between people with ADHD and stimulants is messy and imperfect.

Allow me to illustrate that…

If you read my last entry, you already caught wind of me, yet again, having gap in my access to ADHD medication. I was effectively off of Adderall for the first week of September and then back on it the second week.

When you abruptly go off Adderall, it tires the absolute shit out of you. You’re exhausted for a few days. There are entirely understandable biological reasons for that. The largest is that you’re tired because… you’re tired.

Adderall is a stimulant. It is an amphetamine. When taken responsibly and as directed, it is helpful to many ADHD patients. The ‘responsibly’ part is managing the two major side effects. Sleeplessness and appetite suppression.

It is extremely easy to get too little sleep while on Adderall. When my son was little and I was first divorced, I routinely pulled all-nighters. I once stayed up for 60 hours, got on a 6 a.m. train to D.C., took a cab to a meeting, and then presented for 3 hours. The evening before the presentation, I was mildly hallucinating. In the presentation, I was impressive. I knocked it out of the park. My firm won a big piece of business as a result.

The Adderall didn’t ‘keep me up’.

It made it easier to not feel the necessity to sleep. I can stay up all night with or without Adderall. ADHD does weird things to your relationship with sleep. There is no necessity of routine. There isn’t a compulsion to get ‘enough’ every night; and it takes very little in the way of distractions to make sleep just not what you want to do.

Have ADHD and take Adderall, you are going to have sleep issues to manage. Have ADHD at all, you are going to have sleep issues to manage.

Now, add to that, Adderall also suppresses the shit out of your appetite especially when you first go on it… or restart it.

People with ADHD often have messy eating schedules because they get caught up in things and simply don’t think about being hungry. Add an appetite suppressant and it is very easy to go a long time without eating or eating much.

Have ADHD and take Adderall, you’re going to have to manage your eating.

So, rewind to this past week. I had just restarted Adderall after a week entirely off. I had been running around all week and getting too little sleep.

And then Tuesday arrived.

I managed to get a post up. That was a huge relief. Down went all of my stress hormones like cortisol and adrenaline. I didn’t have my son that night, so I didn’t have to get up at 6 a.m.. I was free to just get in bed and sleep with nothing busying my mind or weighing on me.

I slept for 10 hours. Sleep of the fucking dead. Absolutely beautiful, wonderful sleep.

So, Wednesday, I woke up totally refreshed.

Then I went about my day the way I routinely do. Got up and got coffee. Went to do some writing later and got, ironically, the caffeinated drink referenced in the post above. Like I always do, I cut it with 50% seltzer; and then topped it off again on the way out. So, roughly the equivalent of a cup of coffee.

Wednesday night, I was wide awake. It wasn’t insomnia. I wasn’t tired. I wasn’t trying to sleep and failing. I was awake.

My friend was working the night shift at the hotel where I’ve been a regular this year. She came on at 11. I had been thinking of going to see her. Ultimately decided not to go before ‘bed’. Then I was wide awake until 4, fell asleep for an hour and a half, and was up for the day. Left at 5:30. Got coffee and a donut on the way. Had coffee with her. And then went on with my day. After school, I picked up my son and then ran around from place to place until around 6 pm.

When we got home, I ate a little bag of potato chips.

A little while later, I started to feel a little fluttery. A little arrhythmic. Like my heartbeat was a little irregular. I had experienced that before. It isn’t alarming as much as it is a “Pay Some Fucking Attention Now, Mike”.

I had eaten almost nothing all day between the 5:30 a.m. donut and the 6:00 p.m. bag of chips. I had eaten four Bellevita crackers. I hadn’t had much to drink other than the early coffees. I was coming off of an hour and a half of sleep.

I had gone about the day like business as usual both sleep-deprived and on a diet of stimulants and sodium. And it didn’t feel like anything other than a busy day.

In response, I hydrated and ate something and went to bed at 8:30 and slept for 12 hours. Again, sleep of the dead. Woke up refreshed. Avoided caffeine today. Ate regularly. Hydrated. Took only half a dose of Adderall. Voila. Systems out of the red and back in the green.

The thing that led me off the rails wasn’t Adderall or its side effects. It was the way I casually drink coffee and caffeinated drinks as a routine compensation. A low-grade part of my Living with ADHD routine. I stuck to that routine on Wednesday even though I was fully rested and refreshed because… it’s the routine… and I am often helped by it.

Fully refreshed though, the caffeine in combination with Adderall led to it being easy to just get up at 5:00 a.m. by choice because I wanted to go see my friend who got off at 7:00.

There are four drivers that get people with ADHD rolling: novelty, interest, challenge, and urgency.

Give a person with ADHD enough of any of those four, we don’t need food, water, or sleep.

Give us none of them, there ain’t nothing that is going to get us up for the task.

I had ‘interest’. That was enough fuel. Then I had a bunch of commitments with urgency. That was enough fuel. So, I didn’t have any actual fuel.

That’s just how ADHD works. The basic things regular ol’ neuro-normies feel all kinds of strong physical cues to go do, we often don’t. We often have to remember to eat as a task not because we feel hungry. We either just run on too little sleep until we crash and sleep gloriously or we have to have immense personal discipline to sleep when not feeling that tired. And along the way, a whole lot of us take in stimulants like coffee and nicotine just as ‘routine’ without actually noticing any discernible effects.

Add all of that up on a day like Wednesday and it gets really unhealthy in potentially dangerous ways.

Even well below that threshold though, not sleeping enough is bad. Not eating well is bad. Drinking coffee – a diuretic – and not hydrating is bad.

Having ADHD is a constant bouncing ball of dealing with where you are at that moment, on that day. Every day is a mixing board of how rested you are, what you have on your plate, how much self-medicating you do via Dunkin Donuts, and how that combo feels.

It is reckless and irresponsible to parrot the idea that caffeine is medication. It isn’t. It doesn’t treat ADHD. It isn’t a solution to ADHD. It isn’t without other peripheral effects. And it loses its effectiveness as kids get older. A kid who needs a cup of coffee before school in fifth grade to function in a way that pleases the adults will not be served by a cup of coffee when they’re a senior. They won’t be served by two cups. Coffee is not a long-term ADHD medication. Beyond early childhood, if it is effective even then, it is a coping mechanism. A compensation.

It is perfectly okay for parents to turn to a little caffeine before school if that is appropriate for their child with ADHD. However, there are strong cautions to consider and manage:

-         Caffeine suppresses sleep. If you aren’t meticulously enforcing a good sleep routine, the sleep impact will offset the benefit. The kid will be awake but not sharp and learning with a brain deprived of the brain-growth and maintenance benefit of full, deep sleep

-         Taking unprescribed stimulants as medication teaches kids with ADHD to self-medicate with one chemical, which brings me to the most important thing…

-         ADHD is a lifelong condition influenced by situational factors and with syndromic effects. ADHD isn’t ‘being fidgety’. It isn’t ‘not being focused in class’. Those are two of its observable impacts. It is a deficit of a specific neurotransmitter, dopamine, which is worsened by lack of challenge, urgency, novelty, or interest.

A child hating a class where stultifying lessons are taught by a boring teacher using one-size-fits-all curricula isn’t a sign they need caffeine. It is a sign that they are in a horribly ill-fitting learning environment. They are in the ADHD childhood version of hell. Getting them to sit still so the teacher won’t call home isn’t taking that kid out of hell. It is relieving the adults of having to fix what makes it hell using a chemical which creates other issues – which are mostly borne by the kid and invisible to the adults.

Coffee is not fucking medicine. ADHD isn’t a sitting still problem. It is a unique neurochemistry which makes kids and adults with it uniquely capable of doing some things easily and suffering others badly.

The pop culture understanding of ADHD is harmful. It gets in the way of people with ADHD understanding that the way their brain works is different, and that condition needs to be managed actively and continuously. It is a daily challenge. It is helped by embracing the totality of what healthy treatment looks like.

Otherwise, you end up in your 50s entirely used to drinking ample caffeine with a messy sleep routine, sketchy eating habits, and a heart that really doesn’t want that to continue.

These people insisting coffee is an ADHD treatment have no fucking idea just how wholly wrong that is and how inappropriate it is to teach kids otherwise.

ADHD is a condition with broad effects; it requires a holistic management approach beyond a fucking Dunkin Donuts gift card.