From Benzedrine to Smartphones: Unraveling the Dopamine Dilemma in ADHD Medication Usage

By | Addiction, Mental Illness | No Comments

On the eve of the Great Depression, Dr Charles Bradley fresh out of his residency as a pediatrician took up the role of Medical Director at the Emma Pendleton Bradley Home for the treatment of children in Connecticut. The name wasn’t a coincidence. The Home had been established by a bequest from Bradley’s great uncle, George Bradley. George had made his fortune working with Alexander Graham Bell marketing the first telephones.

His beloved only child Emma had contracted encephalitis – a type of brain tissue inflammation causing intense headaches and seizures – when she was just seven.  George and his wife, employed round-the-clock carers for Emma at their summer home while they travelled the world seeking treatment without success.  When George died, his will contained provision for the creation of the Home using his Rhode Island estate (pictured).  It was to become the first facility in the United States expressly designed to treat children with neurological and mental health disorders.  An express provision of the will required that parents not be charged unless they could afford it.

The Emma Pendleton Bradley Home treated a range of physical disabilities, but Charles Bradley focused on children with behavioral disorders.  Those children usually came from distressed, often poor, families coping with serious drug or alcohol addiction and often extreme family violence.  The Home had no shortage of patients in depression era New England. The children were highly reactive, oppositional, and refused to conform to ‘accepted social standards’ of behavior. The patients, whose hospitalization came as a relief to their families, were described as ‘inattentive, restless, rambunctious, and selfish.’

Bradley’s approach of getting the children away from their stressors and providing them with a stable home complete with access to extensive sporting facilities did have some success, but he was always on the lookout for ways to improve treatment.

In the mid thirties, American pharmaceutical company, Smith Kline and French (SKF – now GlaxoSmithKline) was scouting around for ways to increase revenue from its newly patented over the counter nasal decongestant Benzedrine.  Benzedrine’s active ingredient was amphetamine, or what is today more commonly known as ‘speed’.  SKF was keen to encourage trials to see if there was a bigger market for their drug than people with runny noses, so they offered free supplies to any doctor who agreed to conduct research. Speed worked as a decongestant because it constricted nasal mucus membranes. Bradley thought that membrane constricting effect might help with the intense headaches experienced by his patients because of a diagnostic procedure which replaced cerebral fluid with air to improve the quality of brain x-rays.

In 1937, Bradley commenced his study with 30 residents of the Home diagnosed with behavioral disorders. Throughout the three-week study, a nurse observed each child closely. During the first week, the children were not administered any drugs. In the second week, the children were given a dose of Benzedrine each morning. In the third and final week, the drug was withdrawn.

The drug did nothing for the headaches but had a miraculous effect on the children’s behaviour.  It also seemed to instill in them a previously missing ‘drive to accomplish as much as possible.’  The kids were calmer, behaved better, were more focused and performed much better at school.  The cognitive improvements reinforced the results SKF had obtained from a trial the preceding year at a New Jersey detention facility for delinquent boys.  That trial had demonstrated verifiable improvements in standardized test scores.

Bradley expanded his trial to 100 children in 1941 and the results were undeniable.  Amphetamine appeared to ‘cure’ behavioural disorders in children but only for as long as they were taking the drug.  As soon as they stopped, the behaviour reverted.  There was no residue effect.  It was not so much a cure as a very effective daily treatment.  Bradley felt it was a useful supplement to his primary approach, removing the sources of stress from the child’s surroundings, which his own data told him did produce long term effects.

SKF had been looking for a mass market for amphetamine.  The New Jersey study suggested that market might be school kids looking to improve academic performance.  But reports were starting to appear suggesting people were becoming addicted to Benzedrine with some suffering psychotic episodes as a result. People had begun to realise that they valued the Benzedrine’s stimulant effects more than a clear nose. They started prying open the inhaler and either eating or injecting the amphetamine.  It was clear that selling amphetamine to school kids was not going to be the mass market they were after and selling them to Bradley’s hyperactive kids was even less appealing.  Luckily for SKF’s bottom line, the Japanese brought the US into the Second World War on December 7, 1941.

By 1942, substantial orders were being placed with SKF by the US Military, as it became evident that amphetamine was highly beneficial against combat fatigue or what we now call PTSD. The drug dramatically altered the way soldiers performed their duties, instilling confidence and purpose in individuals who might have otherwise shown fear or anxiety.  The US Military handed out Bennies (Benzidrine tablets) like lollipops and SKF made money hand over fist.  Any thought of marketing amphetamine as a treatment for rambunctious kids faded into the background.

Amphetamine would not be used as a regular treatment for “misbehavior” until the 1950s, when psychiatrists began to focus on the specific behavioral disorder of that by then had been christened ‘hyperactivity.’ Bradley’s successor at the Home, Dr Maurice W. Laufer, rediscovered Bradley’s work and by 1956 the profession was again using amphetamine and related stimulant drugs, like the newly released Ritalin – named after the discoverer’s wife, Rita – to improve the behavior of hyperactive children.

The idea of giving stimulants to kids who were bouncing off the walls was certainly counterintuitive, and the doctors had no clue why the drugs calmed them down, but there was little doubt that they did.  And so by the 1960s, amphetamine and its ilk became a mainstream treatment for hyperactivity.

Why were amphetamine and other stimulants so effective? The answer only become clear within the last few decades. Those drugs increase dopamine levels and dopamine helps us focus. It stops our brains jumping from thought to thought in the haphazard way that we now suspect drives hyperactivity.

Have you ever struggled to get to sleep because your mind is racing? You jump from one thought to the next as an overwhelming sense of panic and urgency surges through your brain.  Now imagine you have that feeling all the time.  This is your brain telling you don’t have access to sufficient dopamine to allow you to focus.  And this in turn leads to difficulties in concentration, impulsivity, restlessness, memory lapses. Managing time, emotions, and social interactions will be an ongoing challenge. When we are low on dopamine, we cannot remain focused on anything for more than a minute without our thoughts jumping the rails.  If our brain came with a dashboard, at this point the ‘Low Focus’ light would be flashing red.

We need dopamine to stay focused.  But the amount we need is determined by how frequently we are exposed to dopamine surges.  Dopamine is the neurochemical which motivates us to run towards rewards and away from danger.  But we develop resistance to it in highly rewarding or dangerous environments.

The kids being admitted to Dr Bradley’s Home were growing up in high danger surroundings. They were stressed by family alcoholism, poverty and abuse.  They were receiving constant dopamine hits and their brain’s coping mechanism was to develop resistance to dopamine.  This lowered the degree to which constant stress would affect them, but it also impaired their ability to focus.

Normal levels of dopamine were no longer enough for those kids.  They were acclimatized to an environment where dopamine was constantly being spiked by stress.  To just feel normal, they needed large amounts of dopamine.  To the outside world that looked like the ‘rambunctious’ children Bradley encountered. They couldn’t focus.  They had poor impulse control. They were reactive and irritable. And they couldn’t stay on task – any task.

He didn’t know it at the time, but when Bradley gave those kids amphetamine, what he was actually doing was providing them with dopamine stimulators.  He could have achieved the same results with cocaine (popular with the British military), methamphetamine (popular with the German military) or heroin.  For as long as the drug was in their systems (about 4 hours) the kids’ dopamine levels were boosted and they could behave and focus like other kids.

It wasn’t a cure for anything. In fact it could actually make the problem worse over time because the dopamine hits from the drugs would just increase the dopamine resistance. This is why people became addicted to Benzadrine.  But Bradley’s trials did show that the drug could be used as a temporary treatment as long as the underlying cause, chronic stress, was being addressed.

The ‘rambunctious’ kids Bradley was treating would today be diagnosed as having ADHD (Attention Deficit Hyperactivity Disorder). According to data revealed this week by the health department, over the past five years the number of Australians receiving prescriptions for ADHD medications has more than doubled. A total of 3.2 million prescriptions were dispensed in Australia during 2022. This represents a massive rise over the 1.4 million prescriptions written in 2018.

Surely modern-day Australia is not so much more stressful than the Great Depression or the Second World War. Why do we suddenly need to prescribe massive amounts of stimulants? The answer is that dopamine stimulants are both a cause and a treatment.  Dopamine resistance is not only created by chronic stress.  Chronic exposure to dopamine stimulants does the trick too. This is what was causing the addiction and psychosis among the Benzedrine sniffers. Modern day Australia is not as stressful a place as Depression era Australia but it does have unprecedented access to stimulants.

We can no longer buy amphetamine over the counter, but every time we smoke a cigarette, have a drink, or consume some of the less legal stimulants like speed, meth, heroin or opioids, we are stimulating dopamine and adding to our dopamine resistance.  But we can also do it without ingesting anything. Every time we place a bet, watch porn, play an online game or interact with social media we are doing it too.

No, most of us probably aren’t the victim of the chronic stressors suffered by Dr Bradley’s Depression era kids, but we are likely to be getting even more dopamine hits in a typical day.  And we are likely to be getting them from the phone we carry around in our pocket.  The reason ADHD medication usage is exploding is that many, many more of us need the dopamine hit it provides, just to let us feel normal. The only way we can focus at all is when we have continuous access to high levels of dopamine stimulation.  Ironically, as Dr Bradley observed at the dawn of the ADHD drug revolution, that is not a cure for anything if we don’t also address the underlying problem.

In Dr Bradley’s day the long term fix was to remove the chaos from the kids’ environment so as to allow their dopamine system time to reset.  In our day it is that, plus removing the cloud of dopamine stimulants pouring from everybody’s phone. Our dependence on stimulant medication is a warning. The number of us now needing it just to live a normal life is accelerating wildly.  But it will not cure anything, it just gets us through the day. If want a different outcome, we need to start acknowledging the cause of dopamine resistance and immediately acting to stop it. It’s time for phones to become once again, well, just phones.

Yes sugar really does make kids hyper, but not for the reasons you think

By | Addiction, Sugar, Teens | No Comments

I really thought we had moved on from the kind of codswallop I noticed being recycled in the paper last weekend.  But apparently not.

In a feeble attempt to encourage higher levels of sugar consumption someone had the hoary old ‘sugar doesn’t make kids hyper’ story dusted off and wheeled out.  It is, no doubt, stored next to the ‘chocolate is good for you’ piece that gets regurgitated every Easter.

The article looks at the science and concludes its not the sugar making your kids crazy it’s the food colouring or it’s parents telling the kids they will go nuts and the kids obliging or it’s that it’s an exciting event like a birthday party. In short it’s anything but the sugar.

Dietitian Miriam Raleigh is worried a mistaken belief that sugar makes kids hyper may lead to parents, gasp, limiting their children’s sugar intake.  The article even goes on to suggest that doing so may result in the child developing an eating disorder.  Miriam decides the solution is to eat sugar in moderation, a phrase that means exactly nothing.  Or more precisely and conveniently, means you eat as much as you think is moderate.

So, are we wrong to demonise sugar for its effect on kids?  Of course we’re not. It is very bad for them. It causes tooth decay, obesity, type 2 diabetes and kidney disease (at least and its benefits are, well, nothing.  So whether it causes hyperactivity is really neither here nor there.  Even so, it does.

Sugar is addictive.  Like all addictive substances, we crave the dopamine hit it delivers.  Each hit increases our tolerance for dopamine until we just can’t focus or function without those dopamine hits.  When we have less dopamine than our addicted brain thinks we need, we struggle to focus and we become hyperactive, symptoms that look a lot like ADHD.

Does sugar make our kids more hyperactive immediately after consumption?  No.  If anything, it is likely to calm them down as they get the dopamine hit they have been craving.  Does it create symptoms that look a lot like ADHD in the longer term?  Yes, because the dopamine acclimatisation makes us dopamine deficient in between sugar hits.  And when we are dopamine deficient, we struggle to hold a coherent thought in our head for even a few seconds.  We acquire the attention span of the proverbial gnat and the meditative practices of a Mexican jumping bean.

If we add other sources of dopamine into the mix like gaming or social media, then we can significantly accelerate the effect of sugar.  You can probably induce ADHD like symptoms in half the time if the kid is sucking down sugar while shooting his friends on Fortnite.

So no matter how many times you see this sugar is really not that bad chestnut recycled in the local paper, remember just one thing, its nonsense.  Sugar is very bad for children (and adults) and it also makes them hyper.  And no amount of moderation by dietitians or marketing by the sugar industry will change that.

Seed Oil Deception: The Untold Story of How ‘Heart-Healthy’ Oils Can Harm Your Body

By | Big Fat Lies, Vegetable Oils | 5 Comments

In a world where our choices dictate our health, a silent epidemic has been brewing – one that has gone largely unnoticed. It’s a story of the hidden dangers lurking in the most unsuspecting places, where the heroes and villains are anything but clear-cut. This is the story of seed oils and the biochemistry that connects them to the nefarious world of smoking and alcohol.

At the heart of this tale are yeast – single-celled organisms that make up the fungus kingdom. These microscopic creatures have mastered the art of survival, thriving by producing ethanol, a toxic byproduct that eliminates their competition. Ethanol, the same ingredient found in hand sanitizers and disinfectants, is also present in rotting fruits and vegetables, and it fuels our alcoholic beverages.

As humans, we’ve evolved defense mechanisms to deal with ethanol, starting with ADH, an enzyme that converts ethanol into acetaldehyde – a substance 30 times more toxic. But why would our bodies make such a counterintuitive move? The answer lies in time. By turning ethanol into acetaldehyde, we buy ourselves precious moments to convert the toxic substance into harmless acetic acid.

This delicate dance between ethanol and acetaldehyde has consequences. When acetaldehyde lingers in our system, it brings hangovers, nausea, and more severe health issues. Some people, particularly those of Northeast Asian descent, possess a genetic mutation that makes them more susceptible to the dangers of acetaldehyde. This “Asian Flush” may deter alcoholism but puts them at a higher risk for liver damage, dementia, and cancer.

The villainous aldehydes don’t stop at acetaldehyde. Our bodies also encounter acrolein, a cancer-causing compound produced when plants burn, such as in cigarette smoke. And then there’s 4-HNE, a lethal aldehyde derived from omega-6 polyunsaturated fats found in nuts, seeds, and legumes.

In the past, our consumption of omega-6 fats was limited. But with the rise of seed oils in the 19th and 20th centuries, we now consume over ten times the ancestral amounts. These oils, marketed as heart-healthy and endorsed by dietitians, have infiltrated our food supply.

From margarine to mayonnaise and even restaurant fryers, seed oils are inescapable. Our bodies create 4-HNE from these oils, but we also consume it directly when we cook with them, inhaling and ingesting a double dose of the toxic compound.

Like its aldehyde cousins, 4-HNE wreaks havoc on our DNA and proteins, leading to an array of diseases, including Alzheimer’s, Parkinson’s, heart disease, and cancer. In a sinister twist, 4-HNE even undermines our genetic defenses against cancer.

While smoking and alcohol consumption are not marketed as healthy choices, seed oils have been cloaked in a veil of “heart-healthy” propaganda. The dangers of aldehydes produced by these oils far outweigh those from alcohol and smoking. The science behind this may be new, but it’s not so new that our health authorities should be unaware.

As this story unfolds, it’s clear that we can no longer afford to ignore the hidden dangers of seed oils. It’s time to reevaluate our relationship with these omnipresent substances and reconsider the choices we make in the name of health.

Aldehydes cause cancer. So why are health experts telling us to consume them?

By | Big Fat Lies, Vegetable Oils | One Comment

No-one would suggest smoking or drinking are good for us. But recently scientists have discovered the biochemistry of how they cause harm has a lot in common with seed oils. The difference is you get a choice about how and when you drink or smoke, but seed oils are now an inseparable component of the food supply and we are being actively encouraged to consume them.  Never before have so many been harmed by so few for so much money.

Yeast are single cell organisms which are part of the fungus kingdom. Like all organisms, their job is to win the replication game. Yeast win by killing the competition with their waste.  When they turn sugars into energy a by-product is ethanol, a substance which is lethal to most organisms. This is why it is a primary ingredient in Hand Sanitizer and disinfectants used to eliminate bacteria and viruses. Ethanol is also found in rotting fruit and vegetables and the active ingredient in alcoholic drinks.

Fruit is a naturally rich source of sugar, so as it rots, yeast produce more and more ethanol. Any animal that eats overripe or rotting fruit needs to have evolved a defence mechanism against poisonous ethanol.  In humans that defensive mechanism starts with ADH (Alcohol dehydrogenase), a group of enzymes which diffuse alcohol.

The ADH oxidizes ethanol into acetaldehyde, a Class 1 Carcinogen.  At first glance this is not the smartest thing to do.  Acetaldehyde is up to 30 times more toxic than ethanol. But we do it to buy time. The body diffuses an acutely toxic substance, ethanol, by turning it into a substance which while more toxic, takes longer to do harm. All being well, we use that extra time to oxidise the acetaldehyde to relatively harmless acetic acid (the primary ingredient in vinegar). We do that using ALDH (Acetaldehyde dehydrogenase) enzymes.

Acetaldehyde is the part of the process responsible for the consequences of alcohol abuse such as hangovers, nausea and ultimately liver damage and cancer. The longer it remains in our system, the worse and longer lasting those effects will be. We can however only process so much acetaldehyde at a time, so front loading the system by binge drinking means it stays with us for longer and does more harm.

For some people acetaldehyde can be even more dangerous. Up to 80% of people of Northeast Asian descent possess a mutation of ALDH which is less effective at diffusing Acetaldehyde.  This causes a condition nicknamed the “Asian Flush”. Their face goes red, they become nauseous, and their heart and respiration rates increase.  That reaction is sure to put you off the booze and the research shows people affected by Asian Flush are less likely to become alcoholics.

A similar logic is used with the drug Antabuse (disulfiram) which impairs ALDH, effectively causing Asian flush in people not otherwise affected.  It makes people less keen on drinking and is sold as a treatment for alcoholism.

The downside to Asian Flush and Antabuse induced Asian Flush is that it happens because it is slowing down the disposal of an extraordinarily toxic aldehyde. So while they are less likely to become alcoholics, these people are more likely to suffer the consequences of aldehyde exposure such as liver damage, dementia, and cancer.

Acetaldehyde is not the only aldehyde we are likely to encounter and it is not the only one that ALDH can deal with. It also diffuses Acrolein, one of the primary cancer-causing aldehydes created when plants are burned.  We are most likely to encounter acrolein in cigarette smoke but most smoke contains it. Even more importantly ALDH removes one of the most lethal carcinogenic aldehydes, 4-HNE.

4-Hydroxynonenal (4-HNE), first discovered in 1991, is created from omega-6 polyunsaturated fats. Nuts, seeds and legumes and the meat of animals that eat those things are the primary sources of omega-6 fats in the ancestral human diet.  Just as with limited ancestral alcohol and smoke exposure, our ALDH system has evolved to deal with the relatively small amounts of 4-HNE created by eating those foods.

But the modern diet contains a vast new source of those fats which dwarfs ancestral quantities, seed oils.  The invention and introduction of mass produced, cheap seed oils during the 19th and 20th centuries has resulted in the average person increasing their consumption of omega-6 fats more than 10 fold, well beyond any evolutionary limit.

Seed oils are extracted from seeds (such as Canola/Rapeseed, Sunflower, Safflower, Grape, Corn, Almond, Cotton, Hemp and Sesame) or legumes (such as Soy and Peanuts).  They all have one thing in common – very high levels of omega-6 fat. They are marketed as heart healthy vegetable oils and have received Dietitians’ seal of approval. This is why, since the 1990’s almost everything on the supermarket shelves contains it. And why everything cooked in a fryer in a restaurant or a burger ‘restaurant’ or a fish and chip shop is fried in it (although Maccas resisted Heart Foundation pressure until 2004 and KFC held out until 2012). Even the humble take-away sandwich is swimming in the stuff.  It is in the margarine smeared on the canola filled bread and the primary ingredient of the mayonnaise or most other dressings.

Our body creates 4-HNE from the seed oils we eat.  But that isn’t the only source. We directly consume it as well.  4-HNE is produced when food containing seed oils is cooked.  If we are nearby when it is cooking, we will inhale it directly. And if we then eat that food we are, in effect, receiving a double dose.

Just like acetaldehyde and acrolein, 4-HNE is dangerous because, when it exceeds our ability to remove it, it reacts with DNA and proteins that are critical components of our cells.  Accumulate enough damaged DNA or proteins and those cells begin to malfunction or die.  This is why 4-HNE has (so far) been linked to Alzheimer’s disease, Parkinson’s disease, Multiple Sclerosis, Heart Disease, Stroke, Type II Diabetes, Liver disease and almost every form of cancer.  It is so diabolical that when created or consumed in excess, it even alters the parts of our DNA which defend us against cancer.  It not only causes the attack but also disables the defence.

Messaging around smoking and the consumption of alcohol is clear.  They are not sold as health foods.  And it is up to us to choose how much of these substances we are exposed to.  ‘Heart Healthy’ Vegetable (really seed) oils are significantly more dangerous and yet have been relentlessly promoted by our peak health bodies ensuring they are everywhere in our food chain

Aldehydes produced by drinking and smoking are dangerous, but they are insignificant compared to those produced by consuming ‘heart healthy’ oils. The science on this is new but it is not so new that those we trust with our health should not be aware of it.  And yet, they continue to behave like sales agents for the seed oil industry.  This must stop now.

Wordle is addictive. And that’s a good thing.

By | Addiction, Mental Illness | No Comments

Last year, Josh Wardle, a Brooklyn software engineer created Wordle, a guessing game for his partner Palak Shah. It’s a simple game loosely based on a combination of the New York Times Spelling Bee and Mastermind, the guess the colour game.

To play you guess a five letter word in the first row. Each letter is colour coded as a clue.  A grey letter is not in the word in any position. A yellow letter is in the word but not in that position and a green letter is in the correct position. Based on those clues you guess another word in the next row. You ‘win’ when you get five green letters.  After you finish, your stats appear. The game keeps track of how many times you get the word and how many rows it takes you. There is no time limit but once you press ‘enter’ on a row it is locked in for the day. Only one wordle puzzle is released every 24 hours so think carefully before hitting that key – there are no do-overs.  No matter how much you love Wordle you can’t binge it. But helpfully a timer counts down how long you need to wait for the next puzzle after you finish.

In many ways Wordle is like a newspaper crossword that you can keep open in a tab and come back to throughout the day.  Unlike a crossword (for most people), it is incredibly addictive. Wardle’s family and friends were enjoying the daily puzzles he posted so much that in October he posted it on a public website.

By 1 November there were 90 people playing Wordle every day. In mid-December, after noticing people were sharing their Wordle results on Twitter, Wardle added a feature which allowed people to, ahem, show-off, without spoiling the puzzle for others, by sharing their coloured clue grid and the number of rows they took to solve the puzzle.

The sharing lit a fuse under Wordle. At the beginning of January there were 300,000 daily players. Today there are over 2.7 million and doubtless by the time you read this there will be millions more.

Wordle is addictive because it stimulates dopamine.  We need to focus hard if we are to have a hope of solving the puzzle. That is enough to get the dopamine flowing, but layer on the uncertainty of not knowing if we will get it out (5-10% of us don’t on any given day) and the anticipation of the once-a-day release of new puzzle and you have a genuine dopamine supercharger.  It is not so hard that we don’t stand a chance, but it is not so easy that we can do it without focused attention.  It is right in the sweet spot for getting us to focus without giving up.

Throw in the oxytocin fuelled dopamine hit we get from modestly telling the world about our prowess and you have the secret sauce for next level addictive power.

One of the most effective ways to break an addiction is to identify habits which have dopamine generating rewards at their core then switch out the dopamine generator for something less harmful.

If you are in the habit of buying a muffin every time you get a coffee, the dopamine generated by the sugar hit from the muffin is the glue keeping you in that habit loop.  Switching the muffin to Wordle will replace the muffin dopamine hit and help break your sugar addiction.

If you are in the habit of having a cigarette every morning at 10am, switching the cigarette to something just as pleasurable but without the smoke will help you break the addiction. Instead of the cigarette, reach for your Wordle page when the craving strikes.  Your brain will still get its dopamine hit but without all the lung disease and cancer and stuff.

Of course Wordle is not the only way to force yourself to get a dopamine hit from focused thinking but it is handy, pitched at just the right difficulty for most of us and it refuses to allow us to become full-blown addicts by limiting us to just one hit a day.  Give it a try.

How to use habits to quit sugar

By | Addiction, Sugar, Sweet Poison | One Comment

If your New Year resolution was to be healthier then you could do a lot worse than quitting sugar. Sugar makes us fat, gives us Type II diabetes, hypertension, heart disease, kidney disease, fatty liver disease and makes us more prone to infection, just to name a few of its greatest hits. The only problem is that it is just a wee bit addictive, so quitting is an awful lot easier said than done. Happily, the emerging science of ‘habits’ might be just the ticket we need to eliminate the Sweet Poison from our lives.

We do a lot of things habitually. A habit is a low energy automated thought process. We use them all the time to do repetitive tasks. We use them help us navigate to a place we travel to every day. We use them to catch a ball and we use them to cook our dinner.  I am using them now to type this article. I don’t need to know where the keys are. My brain just knows and lets me focus on what I am typing rather than how I am typing it.

Habits are procedures that we have assigned to the ‘auto-pilot’ domain in our brain (the basal ganglia) so we can do some higher order thinking (or watch Netflix) at the same time. It’s as close as the human brain comes to parallel processing.  We shove as much of our thinking into Habit subroutines as we can. Our brain is constantly on the lookout for repetitive actions that can be packaged up as a habit because every habit we can create decreases our brain’s energy requirement or increases the amount of thinking we can get done.

Uncertainty creates habits

To record a habit, we need dopamine.  Dopamine is generated if the procedure being coded either, requires we make lots of decisions or generates a reward or both. When we learn the route (without navigation) to a new destination we are on high alert because we have high levels of uncertainty about every decision we make – do I turn left before or after the McDonalds?  The uncertainty ensures dopamine levels are high and our learning is quickly encoded into a habit routine.  This is why manually learned routes are ‘memorable’ but routes ‘learned’ with the assistance of Google Maps are not. Using an app is outsourcing your habit formation routines to the software.

Sugar creates habits

Sometimes the behaviour itself generates the dopamine. Some substances artificially stimulate it, ensuring any behaviour associated with obtaining the substance is efficiently packaged as a habit. Sugar is one of these substances. This is why we develop habits around consuming it.

We go to the same coffee shop every morning and buy the same muffin. We see the same drink machine in the same place each day and automatically buy a Coke.  We walk past the sweets bowl on the receptionist’s desk and automatically take one. We relax in front of the telly and automatically reach for ice-cream.  We buy a pie and automatically add sauce. These are all habits.  They all happen without us really thinking about them at all.  And we will do them all over and over again without a moment’s thought – literally.

Just because we don’t think about habits, doesn’t mean we can’t.  We can manually override a habit subroutine, but it does require persistent effort.  As soon as you aren’t watching you will slip back into the habit subroutine unless you break the habit.

Breaking sugar habits

There are four steps to breaking a habit created by an addictive (dopamine generating) substance:

  1. Identify the habit
  2. Remove the sugar from the habit
  3. Neutralize the craving
  4. Find support

Identify the Habit

Identifying a habit is a simple as making a list (or preparing a fearless self-inventory as Step 4 of Alcoholic Anonymous puts it).  You can do it now. Think about your day today. Now fearlessly list each and every time you consumed something that obviously contained sugar. Your list might look like:

  1. Ate Sultana Bran for breakfast
  2. Drank orange juice for breakfast
  3. Purchased muffin with morning coffee
  4. Ate birthday cake at afternoon tea in office
  5. Took handful of jellybeans from co-worker’s lolly jar
  6. Bought energy drink from vending machine at train station
  7. Had ice-cream in front of TV after dinner.

Every one of those things is likely to be something you do most of the time.  And in each case, you probably barely remember doing it. Indeed, you probably struggled to list them at all and even now you’re not sure you got them all – amiright?

Remove Sugar

You could progressively eliminate each habit in its entirety but that will be hard going. The science tells us it is easier to change an element of a habit than it is to delete it altogether.  Your brain went to a lot of trouble to create these habits and it will not let go of them easily.  So, I suggest that the best approach is to remove the sugar containing element but otherwise leave the habit intact.

So, for the first two listed above this means having breakfast as usual but substituting a low or no sugar alternative – say Week-bix instead of Sultana Bran and water, milk or a hot beverage instead of the juice.  You are still executing the habit routine; you are just doing it without the dopamine generating sugar.

Nix the Craving

Needless to say, it will not be that easy. Cravings for dopamine generating substances do not just vanish because you changed your breakfast one morning. Repeated dopamine hits cause our brain to temporarily rewire so that we crave more hits. You will need more than a simple substitution plan.

The craving will fade but it can take up to three months and you will need help while it does. Two things will help you get through the withdrawal phase, dopamine hit substitution, and peer reinforcement. Substitution is the strategy used in many drug assisted addiction programs. They substitute methadone for heroin or nicotine patches for cigarettes. The idea is to replace the addictive substance with one that is still potentially addictive but delivers a lower dopamine hit, then lower the dose over time.  If you wanted to implement it with sugar, then caffeine could be the way to go.  Replace a sugar hit with a coffee (without sugar) in habits that permit it. Substitution can work but, on its own, it is not particularly effective.

Find Support

A recent review of all popular smoking cessation programs available in the UK found that of the available pharmacological interventions, the most likely to succeed is varenicline, a drug which produces a less powerful dopamine release than nicotine. The next most effective method is a combination of nicotine patch with nicotine gum or spray. With each method, the counselling that goes with it makes a massive difference.

The counselling sessions are based on a variety of theoretical models that have very little in common. It seems the model used does not materially affect the outcome. The important things seem to be the existence and scheduled nature of counselling and whether or not it is in a group setting. Group therapy, being able to talk to other people who have quit or are quitting, triples the effectiveness of all pharmacological treatments. Similarly, the group meetings are likely to be the secret to the success of Alcoholics Anonymous.

The most effective method we know of for breaking addiction is anything involving group therapy. It doesn’t seem to matter what that group therapy entails if there is regular contact with people in the same boat. That contact can be in person or online, but it must be regular. There is something about the group dynamic which makes us want to do what the group values; that is, remaining abstinent. The research shows we can quit on our own but three times as many of us succeed if we can regularly interact with people who are quitting or have quit.

Addiction is not a choice we make. People don’t choose to keep doing something that will kill them. In fact, most don’t want to keep doing it. Most smokers would quit tomorrow if they could. Simply telling yourself that ugly things will happen to you if you keep going with the addictive behaviour or substance has no effect whatsoever. That is just stressful information, and the thing most people are likely to do to relieve stress is turn to their favourite addiction.

The key is to find the sugar hidden in your daily habits, admit it is there, plan for it not to be there and do it all with others who are in the same boat.  It might sound like tinkering, but these small changes to cravings driven routines will cumulatively drag you kicking and screaming away from sugar addiction. Suddenly you will be in a place where you, and not an addictive substance, determine what you will eat and the circumstances in which you eat it.

 

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Stress, Uncertainty, and Isolation – a perfect storm for alcohol abuse

By | Addiction, Mental Illness | 2 Comments

Australia may have avoided the worst of COVID, but the lock-down mentality may have driven many of us into the arms of one of the hardest addictions to break.

Last quarter, Australia’s economy suffered the third largest decline since records began (-1.9%).  The worst was in June 2020 (-7%) and the second worst was in June 1974 (-2%). But there was one sector laughing all the way to the bank.  Retail alcohol sales were not restricted at any time and they have had a rocket strapped their back since the start of COVID.  They were up almost 30% in 2020, and 2021 looks like it will be even more profitable by the time the Christmas surge hits the cash registers.

Even before COVID, Australia had a drinking problem. Thirty-five per cent of all Australians treated for substance abuse were seeking that treatment for alcohol addiction. But the COVID driven explosion in home consumption is driving massive increases in the diseases that flow from alcohol addiction. Calls to the National Alcohol and Other Drug Hotline doubled between early 2019 and early 2020, and ABS surveys similarly found that people exhibiting signs of anxiety almost doubled.  Calls to mental health hotlines like Lifeline and Beyond Blue have set new records every month, with total volume up around 30%.  It is also probable that the explosion in in-home alcohol consumption is driving unprecedented increases in assault and domestic violence.

Why we like booze

In the last two years, we have all experienced a significant increase in uncertainty and stress. We like alcohol because it is a stress reliever. It directly stimulates the release of extra dopamine, producing two to three times as much as our normal level. This acts as a temporary cure for DDS, the low dopamine state which causes ADHD-like symptoms, anxiety and depression. Initially alcohol stimulates dopamine production, making us want it more. But if the dose is big enough, it eventually sedates us. It does this because, like anaesthetics, it interacts with GABA receptors. GABA is our ‘calm down’ hormone. It turns off dopamine and allows us to relax.

Teens, Addicts and People under stress are more susceptible

The sedative effect of alcohol is highly dependent on the amount of GABA we have available. Teenagers have less GABA because it is dialled down during puberty.  We also have less GABA when we are stressed or addicted because the mechanism that allows us to tolerate higher dopamine levels also shuts down GABA.  This low GABA state enhances the addiction potential of alcohol and makes consuming more dangerous for us and the people around us. This is why teens and alcoholics can drink very large amounts but not appear to be drunk. Don’t be fooled, they very much are.

How much is too much?

If we are not a teenager or suffering DDS due to stress or addiction, two to three drinks in an hour is sufficient to lower the average adult male’s impulse control (make him feel a little disinhibited). The average adult female can get there on one to two drinks. They are what most of us would describe as ‘tipsy’. They’ll have a blood alcohol reading somewhere between 0.03 and 0.12. They are probably too impaired to drive because their response times, attention and judgement will be sub-par.

If they have an extra drink in that hour (up to five for men and up to four for women), then they will begin to experience emotional instability, start to lose their balance, start to experience blurry vision and start to feel drowsy. Their blood alcohol reading will be somewhere between 0.09 and 0.25. In other words, they are visibly drunk. This is the point where good friends would be ordering a cab and bundling them off home.

Drink any more than that in an hour and you will probably not be able to stand. If you can walk, it will be a stagger and you will be extremely confused. You will probably forget most of what happens from this point onward. In this way, the potential harm from alcohol is somewhat self-limiting. Before a drinker is in a position to do themselves and others real harm, they’ll probably be incapable of any coordinated action and fall asleep.

But different rules apply to adolescents and DDS sufferers

People between the ages of fourteen and 25 would say they can drink way more than that before they are uncoordinated or pass out. And they’d be right. We’ve known for at least two decades, that adolescent rats and mice get more bang for their buck from booze. They become socially disinhibited and find alcohol more rewarding, more quickly. They are also capable of drinking significantly more before their ability to control their body is impaired. And they can drink much more before they pass out. Their blood alcohol readings are exactly the same as adults and their judgement is just as impaired as adults but their body is capable of functioning normally and they will not suffer a (somewhat protective) bout of drowsiness or unconsciousness anywhere near as quickly. This is why, all of a sudden in your early to mid-twenties, you can no longer party like you used to.

I’m talking about rats and mice because picky do-gooders think there is something wrong with doing experiments aimed at getting teenagers so drunk that they can’t stand up – sheesh! We are however reasonably certain that the same thing applies to humans because there is a rare 1983 study in humans which produced the same results. In that study, the authors noted that they ‘were impressed by how little gross behavioural change occurred in the (eight- to fifteen-year-old) children . . . after a dose of alcohol which had been intoxicating in an adult population.’

Alcohol enhances the effect of GABA. In a healthy adult, this has a sedative effect. It impairs our motor-sensory control and makes us drowsy. But because an adolescent has repressed GABA, it has much less motor effect.  The same applies to someone who is suffering from DDS due to addiction or stress.

Someone with impaired GABA can still operate their legs and fists effectively – even with significantly impaired judgement and impulse control – and can keep drinking well past the point anyone else would be forced to stop (by unconsciousness). This is likely to be a big part of why, according to the latest Australian National Drug Survey, the average 20–24 year old is 35 per cent more likely than a 25–34 year old to have been a victim of alcohol-related physical injury in the last twelve months.

Questionable karaoke and dancing on tables are not the worst we can expect from booze. Alcohol can be an extremely addictive and dangerous drug.  Our society needs to understand and accept this if we are to interact with it safely.

Isolation may have saved us from the worst of COVID, but if we do not act now, the long tail will be endemic addiction and mental illness, the likes of which few human populations have ever endured. The early signs of the coming disaster are more obvious every day, but they need to be read, understood and acted on. Our governments were swift to lock us down. Now they need to be equally swift to act on alcohol abuse.

 

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A Good Night’s Sleep is the first step to resetting our brain

By | Addiction, Books, Mental Illness | No Comments

In Part One of this series, I minted a new term for the way our brain is destabilised by dopamine producing behaviours and stress.  Dopamine Deficit Syndrome (DDS) occurs when we repeatedly stimulate the reward or stress circuits. We develop a tolerance for dopamine which is a semi-permanent rewiring of our brain. It increases the amount of dopamine required to make us feel normal. We develop a tolerance for risk and reward.  Now something must be extra dangerous or extra rewarding or we will ignore it.  Now our normal levels of dopamine are not enough.  Not enough to reward us, not enough to scare us and not enough to keep our attention in general.  That rewired state pushes us into addiction, anxiety and depression and sleep is the first step on the pathway out.

You may not feel like you have an addiction, are under stress, are anxious or depressed, but if you persistently have trouble getting to sleep or staying asleep, there is a very good chance you are on that destructive pathway. Sleep, or rather the lack of it, is the canary in the coal mine for damage to our dopamine pathways. It is the very first sign of DDS.

Anxiety and depression are the two primary outcomes of DDS. They arise when the amount of dopamine we produce is not sufficient in comparison to the level our brain thinks it needs. And how much it thinks it needs is determined by how much dopamine stimulation we generally engage in.

We can directly stimulate dopamine using substances like sugar, nicotine, cocaine and methamphetamines or we can do it using software designed for that purpose such as social media, gaming and gambling apps. However we do it, the more we hit the dopamine button the more we need.

When we are sleep deprived our brain generates more dopamine, so a home grown ‘solution’ to DDS is to stay awake. Insomnia is an early warning sign of DDS. Our body attempts to fill the dopamine deficit by making more dopamine. Higher baseline levels of dopamine initially make us feel less depressed but will also make it very hard for us to sleep.

Our desire to sleep is driven by a hormone called melatonin. When it gets dark, we produce more meltonin and start to feel like sleeping.  Dopamine inhibits melatonin production and keeps us awake, no matter how tired we feel. This in turn produces more dopamine but it is a vicious cycle. Too much dopamine causes lack of sleep which causes too much dopamine.

This is why, somewhat paradoxically, sleep deprivation therapy is sometimes used to treat depression. About half of all depressed patients who miss one night’s sleep experience a rapid reduction in symptoms of depression. Unfortunately, the effect is very short-lived, with around 80% of those that benefit relapsing as soon as they get a good night’s sleep.

Dopamine can only keep us awake for so long. Eventually, we crash. and that just makes the problem worse because all the extra dopamine increased our adaptation to it and the level of our DDS. Given this, it is not surprising that there is a very strong association between depression and sleep disorders. A significant UK study found that 97% of people suffering from diagnosed depression also suffer at least one sleep disturbance symptom. Seven in ten suffered from diagnosable insomnia.

The majority believed their sleep problems started at the same time as their depression but major studies on sleep deprivation have shown that insomnia is a strong predictor of depression before there are enough other symptoms to make a diagnosis. Some researchers have even suggested that depression should not be the diagnosis where there is no sign of insomnia.

Sleep deprivation works as a short-term antidepressant because the increase in dopamine levels is enough to lift us out of the DDS trough that is depression. Drugs that increase dopamine, such as Ritalin, Levodopa or cocaine, have the same short-term effect. The downside to this quick relief is that, of course, the body responds by ratcheting up our need for dopamine, making depression even worse in the longer term. The real answer is that sleep, and not sleep deprivation, is part of the cure to the reward pathway failure caused by DDS.

The problem is that to sleep more we need to cure DDS and in order to cure DDS we need to sleep more. The answer to that conundrum lies in serotonin. Serotonin is the opposite to dopamine in the way it makes us feel. Dopamine makes us edgy and ready for reward. Seratonin is the reward.  Serotonin is always present in the background. It is in large part responsible for our overall mood, but when we achieve something, we get a spike in serotonin that suppresses the stimulating effect of the dopamine and makes us feel calm, happy and sleepy. We stop chasing and start enjoying. Serotonin is the neurotransmitter that makes us feel good after sex, after a good meal or after achieving a goal. Bad things could be happening all around us but the serotonin surge will make us feel content. It is also required as a building block for the brain’s manufacture of melatonin.

We need to seek our behaviours which are inherently rewarding, not just dopamine-producing.

This gives us some insight into things we can do which combat addition. We need to seek our behaviours which are inherently rewarding, not just dopamine-producing. Artificial dopamine stimulants do not produce the serotonin hit that real life rewards do. To receive the serotonin hit we need to have real sex instead of porn, real socialisation instead of social media and real endorphin producing exercise instead of gaming.

The start of the cure to DDS is to sleep more. And the way to sleep more, is not to get our dopamine hits from simulations and drugs but from the real life activities they mimic.

 

 

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Nice People are addicts too

By | Addiction, Books, Mental Illness | 2 Comments

Why Addiction should be called ‘Dopamine Deficit Syndrome’

Addiction is a loaded word. Calling someone an addict will definitely get you removed from their Christmas Card list.  We see addicts as dirty people, criminals, deviants or just plain sad.  We think they lack self-control. They hang out in dark alleys swapping cash for Molly. They lose money they don’t have at the track. They prostitute themselves for a hit.  They beat their wives. The next ‘high’ rules their lives. It is not a compliment, and it carries a lot of moral judgement baggage.

And yet at the same time we’ll often describe ourselves as addicts.  We’re addicted to our phone, or coffee or we’re gym junkies or chocoholics. But we don’t mean we’re real addicts.  We’re not meth heads or ice junkies. We’re not THAT type of addict. And yet the science says there is no discernible difference in the biochemistry between a chocoholic and a cocaine addict.

This is why we need a new name for addiction. We need a name that describes exactly what it is without all the stigma. We need the new name so we can understand how that biochemistry can affect anyone and, more importantly, what we can do about it.  I suggest Dopamine Deficit Syndrome.  Let me explain why.

We’ve all met people wearing a fragrance that could kill a cat at twenty paces, but we are barely able to smell it at all after being with them for a while. Olfactory adaptation or nose blindness is a temporary inability to detect an odour after prolonged exposure.  Evolutionary biologists suggest neural adaptations like this help us screen out constants in our environment so that we can more efficiently detect changes.  It is not life-prolonging if the toxic aftershave hides the smell of an approaching bear for example.

We can develop a similar ‘blindness’ for dopamine for a similar reason. Dopamine is the neurochemical which motivates us to run towards rewards and away from danger.  And just as with odours, we will develop blindness to it in highly rewarding or dangerous environments.  If we live in a war zone, we need to develop a blindness to dopamine so we can detect when a gunshot sounds near enough to be a threat.  Similarly, if every player wins a prize, we need a bigger reward to make us keep playing.

Our brain does this by shifting the goalposts.  It increases the amount of dopamine required to make us take action. We develop a tolerance for risk and reward.  We become risk and reward blind.  Now something must be extra dangerous or extra rewarding or we will ignore it.  Now our normal levels of dopamine are not enough.  Not enough to reward us, not enough to scare us and not enough to keep our attention in general.

Dopamine’s job is to keep us focused on the task at hand. Without it, our brain continuously jumps the rails. We need more dopamine all the time just to feel normal. We are suffering from Dopamine Deficit Syndrome (DDS).

Our body knows how to cure DDS. It remembers the things that produce dopamine (even if we don’t). It knows if we stay awake, dopamine will ramp up.  It knows if we are in pain, or hungry dopamine will increase. It also knows we can consume substances that stimulate dopamine directly, things like sugar, caffeine, nicotine, cocaine, opioids etc.  And it knows we can watch porn,  play computer games, scroll the socials or dating apps or gamble and dopamine will be forthcoming.

All of this makes us feel better, but none of it cures DDS, it just makes it worse. The more dopamine we are able to generate, the more ‘blind’ we become and the more intense our DDS becomes. It is like ‘curing’ nose-blindness by snorting Eu de Cat-killer.

DDS symptoms are pretty easy to spot.  Sufferers have trouble sleeping, are irritable, lack impulse control, are anxious, depressed and paranoid and are unable to focus except when a dopamine hit is on offer.  They will have no trouble with concentration when playing an online game or betting on the next race, but they will really struggle to focus on a maths problem or reading a book.

When I wrote about quitting sugar, people would tell me they don’t add sugar to anything, so they couldn’t have a problem. What they didn’t know was that we no longer need to add sugar.  It is in everything. We can eat 20 teaspoons just by having a bowl of Sultana Bran and a glass of juice.

The story is similar with dopamine. We no longer need to seek out people with dubious hygiene in dark alleys to get a dopamine hit, they are embedded in everything. They are there when we browse our socials, when we watch YouTube, when we play an online game, when we eat a muffin with our coffee, when we have a quiet one or three after work, when we place a quick online bet and when we stay up past our bedtime doing any of these things. Excess dopamine hits are now everywhere and every time we get one, our brain moves the goalposts of feeling normal just that bit further away.

The good news is DDS is more curable than just about any disease we know.  When you walk out of the room and rest your nose for a few minutes.  Your nose blindness vanishes. You will smell Feline Assassin like it was the first time. Your olfactory sense is reset.  Exactly the same thing happens with DDS. The catch is it takes 3 months rather than a few minutes, and during those 3 months your brain will be telling you 24 hours a day to get a dopamine hit.

This makes curing it easier said than done, but the first step to that cure is understanding we are not filthy addicts with character faults. We are being driven by biochemistry and marketed to by people who can make a buck out of knowing that.  Our best defence is skipping the guilt and stigma associated with the word ‘addiction’ and applying what we know about that biochemistry to ensure we make it to the other side of withdrawal.

 

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Australia is developing a nasty addiction to ADHD drugs the WHO refuses to recommend

By | Addiction, Books, Education, Mental Illness | 3 Comments

In December 2018, the Australian Human Right’s Commission reported to the UN that “Australian is among the countries with the highest rate of ADHD diagnosis in the world for children 5-14 years, and the number of psychostimulant drugs prescriptions has increased dramatically.”  In the two short years since then, Australia has increased the prescription of these drugs by a 24 percent.

In 2020 the Australian Pharmaceutical Benefits Scheme (PBS) subsidised almost 1.5 million prescriptions for ADHD (attention deficit hyperactivity disorder) medication.  That is double what it was just 8 years ago and is ten times the number from 1997. We don’t have accurate current Australian statistics on ADHD but if the rate of growth in prescription drugs is any kind of guide, we have a very big problem, and it is growing at more than 10% a year.

ADHD is a neurological disorder defined by symptoms.  People with ADHD are inattentive,  impulsive, and in some cases, hyperactive.  The primary driver of those symptoms is an inability to focus.  In boys this often manifests as disruptive behaviour and in girls as inattentiveness.

Our ability to ‘focus’ is dependent on dopamine, a critical part of our reward system. It keeps us focused on chasing rewards and when there is danger, focuses us on avoiding it.  Even when rewards or danger are not in play, we keep our mind on the job with dopamine.

Like all mental illness, ADHD is likely attributable to an underlying propensity, but stress and addiction can significantly increase the likelihood of symptoms developing. The figures make it clear that we are creating disease. When we experience chronic stress due to uncertain housing, food insecurity or violence, for example we develop a tolerance to dopamine by increasing the baseline levels we need to focus. The same thing happens when we become addicted to things like sugar, online games, social media, porn, alcohol or other drugs.  When our brain is in that dopamine-adapted state, our dopamine levels are too low when we are not doing something addictive.

When dopamine levels are too low, we can’t focus.  Our mind feels like it is running too fast, and we struggle to hold a thought for more than a few seconds.  This is how addiction and stress leads directly to ADHD behaviour and it is why most people who are diagnosed with the condition are addicted or stressed or both. This rewired state also downgrades our impulse control. The net effect is that we have random and rapidly changing impulses and are more likely to act on them.

ADHD and classroom education mix about as well as oil and water.  Kids with ADHD are often compelled to move constantly, are easily distracted by noises or sights in or near the classroom, will frequently interrupt teachers and other students, struggle to translate learning into understanding and have trouble paying attention.  It is challenge for educators to remember that none of this behaviour is voluntary and not punish the child or demand that they be medicated.

The drugs dispensed at an increasingly frenetic rate to ADHD sufferers are dopamine stimulants. Just like any stimulant drug, they help us keep focus.  Their mechanism of action is similar to cocaine and amphetamines. They don’t do anything about the cause of the low dopamine state but, for as long as we take them, they can usually stimulate enough dopamine to stop our mind wandering off task. They can of course be highly addictive. This is why the World Health Organisation (WHO) has refused to add them to its list of effective and safe medicines. Yes, that’s right, the current ‘cure’ for lack of focus driven by addiction (or stress or both) it to give children addictive drugs which the WHO has refused to recommend.

As distressing as those numbers are, it’s worth remembering that ADHD medication prescriptions have doubled since that data was collected, so they are likely to be a significant underestimate.  Those same medication numbers tell us that just two decades ago ADHD was a tenth of the problem it is now. In other words, encountering a child with ADHD in the average classroom was a rare event.  The way the numbers are going, within 10 years it will be rare to encounter a child without ADHD.

We are on a fast track to having a generation of kids who are impossible to educate unless they are taking potentially addictive stimulants that predispose them to a life of addiction.  If you think that’s an exaggeration, take another look at the graph.  ADHD is a problem with a rocket and the current ‘solution’ is ignite the afterburner.  We need a plan that supports parents, reassures educators, and helps kids.  We need a plan that fixes the root causes, addiction and financial insecurity.  And we need that plan yesterday.

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