When it comes to why these shortages are happening now, there seem to be more questions than answers. Some experts suspect that the sheer increase in people being diagnosed with ADHD and are now in need of this medication has surpassed the rate at which manufacturers can produce it. To add insult to injury, other medications like Concerta and Ritalin have also become hard to fill for some people. This could be the result of so many people switching from Adderall to a different, more available, ADHD medication. The good news is there’s currently no official shortage of those other ADHD medications, per the FDA’s access data.
- Andrew Kahn, PsyD, clinical psychologist specializing in pediatric clients
And, while more people may be receiving ADHD diagnoses, misunderstandings about this condition abound. ADHD has picked up steam in mainstream conversations both in real life and in the pseudo-reality of social media spheres, like TikTok. The problem is that within these circles, ADHD is often reduced to a few personality quirks—like simply being distracted or having trouble focusing. For reference, ADHD is characterized by inattentiveness, impulsivity, and hyperactivity which can look like challenges in completing tasks, staying organized, managing finances, staying focused, and resisting impulsive behavior, among others, according to the National Institute for Mental Health.
The balance between exposure and nuanced understanding is always a bit of a tightrope walk, says Andrew Kahn, PsyD, associate director of behavior change & expertise at Understood.org, and it’s important to know how life-altering and challenging the disorder can be without treatment or accommodations. These challenges have become even more of a reality for people with ADHD who have struggled to get their prescription for Adderall filled since the Fall of 2022 (a shortage that is still affecting some folks in early 2023).
First, how does medication help treat ADHD symptoms?
Stimulants, like Adderall (amphetamine salts) and Ritalin (methylphenidate), have been used to treat ADHD for over 50 years. They are effective because, to put it in simple terms, they raise the level of dopamine and other neurotransmitters in the brain that people with ADHD can run low on. As a result of running low, reward-seeking and distractibility come into play when your brain is searching for extra dopamine. This is also what makes simple tasks like dishwashing or paying bills challenging for people with ADHD.
ADHD medications—specifically stimulant medications—help raise dopamine (and norepinephrine) levels in the brain to more typical levels. This boosting of key neurotransmitters helps neurons in the brain pass along messages to each other more efficiently, which can ease some of the symptoms of ADHD and improve the ability to filter out irrelevant information, and reduce impulsivity. In fact, research indicates that stimulant medications reduce symptoms for 70 to 80 percent of people who use them, according to the Centers for Disease Control and Prevention (CDC). And when medication is used in tandem with psychotherapy, the impact is even stronger, Dr. Kahn explains.
“Medication is often more effective with other therapy-based strategies, so it’s important for people to develop coping skills and be able to recognize the areas in their life where they may need support or accommodations.” —Andrew Kahn, PsyD
Are there ways to manage ADHD without medication?
Stimulants, like Adderall, are highly regulated controlled substances due to a risk of misuse. That said, for people with ADHD, these medications are very effective—which is why patients and practitioners alike are proponents of allowing people to continue to be able to access these medications. It can also be very upsetting not to be able to get the medication you need—whether it’s due to a national shortage, medical conditions barring you from taking it, affordability, or access to a provider.
However, the good news is that medication really isn’t the only way to treat ADHD, says Dr. Kahn, who says many people do well with stimulant therapy coupled with other accommodations. “Medication is often more effective with other therapy-based strategies, so it’s important for people to develop coping skills and be able to recognize the areas in their life where they may need support or accommodations,” he says.
Engaging in counseling and therapy services is an excellent way to develop these key skills, and daily situational strategies and accommodations can prove very helpful in navigating symptoms of ADHD at home, school, and work.
6 tips for how to manage ADHD without medication
Medication is only one tool in the toolbox of treatment and strategies for people with ADHD, says Dr. Kahn. However, it helps to have many tools at your disposal when it comes to lifelong neurodiversity like ADHD.
1. Identify key areas that you find challenging
Executive functioning, or the management system of the brain, is what we use every day to manage our thoughts, emotions, behaviors, actions, and activities. It’s about remembering everything you have to do for the day and the order in which you have to do them. For example, if you look at a messy room, you’d have to identify what needs to be done and then do it. By identifying problem areas you have with executive function, Dr. Kahn explains you can begin to zoom in closer and strengthen these skills like muscles.
One way to address this is through executive function coaching, like Beyond Book Smart. This type of tutoring can be an excellent way to hone in on improving these skills if you can afford it. If that won’t work for you, you could enlist the help of a trusted loved one or friend to hash out some goals in this area.
2. Ask for accommodations at home, school, and work
“People with ADHD benefit from consistently using situational and environmental strategies, especially at work. People with ADHD should also understand various workplace accommodations they can request to support their learning and productivity,” says Dr. Kahn. This can look like requesting to work from home part-time if the office environment is difficult for you or the commute is overstimulating. Your work or school may even be able to cover noise-canceling headphones for you if noise is distracting to you. It’s worth remembering that ADHD is a disability that you have a right to accommodate.
3. Optimize your environment for fewer distractions and more flexibility
“Creating a quiet and calm workspace with limited visual and environmental distractions can help individuals maintain attention to daily tasks. Additionally, ADHD-friendly workspaces should allow for people to work in a variety of positions or postures, including standing and sitting accommodations for ergonomic desks or flexible seating options can also support this,” says Dr. Kahn.
If this isn’t possible to do at your work or school, you can work with your administration to develop an Individualized Education Program (IEP) to attain the best possible learning or work environment.
4. Prioritize structure in your communication
“Interpersonal strategies can also be particularly helpful at work. Asking managers to email or write a list of priorities, for example, can help with setting clear expectations,” says Dr. Kahn. People with ADHD can tend to struggle with open-ended “whenever works for you” deadlines. Having a clear idea of what’s expected and lowering the number of random requests or tasks can give people with ADHD an easier time structuring their workload.
At home, this can also look like talking very literally about the sharing of domestic tasks and the mental load of a household. With friends, it can look like making sure you’re loved ones know that you’re not great at planning certain things or agreeing to last-minute plans and working together to find social parameters that fit everyone.
5. Utilize reminds, calendars, notebooks, and timers
Reminders and calendars can be either really helpful for people with ADHD or used for a few days and forgotten about completely. If this sounds familiar, it’s nothing to be ashamed of—sometimes the task of keeping a planner or bullet journal going can be overwhelming and hard to manage.
The best way to use tools like this is to choose very few or even one singular method: One planner, one calendar, a stack of sticky notes, or the bird-shaped kitchen timer that you got at the dollar store (just me?). Using these at a scheduled time over and over for the same purpose can create a sense of familiarity and structure when work can sometimes feel like the opposite.
6. Troubleshoot your medication and treatment plan with your doctor
At the end of the day, Dr. Kahn recommends you reach out to a provider if you are having trouble filling a medication script or getting a specific medicine covered. There are often other medicines that you can try if there is one that you can’t currently access. You could also utilize coupons from places like GoodRx if your insurance is not cooperating with coverage. Additionally, if a provider doesn’t seem to think you need medication, it’s always okay to seek another opinion. For some people, it is possible to manage ADHD without medication, while others may need the extra help.
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