so it's #ADHDAwarenessMonth and there's a whole lot of making jabs at a Certain Orange Guy's potential abuse of Adderall, and because I have ADHD and a distinct inability to ever stop talking, I wanna talk about how stimulants actually work, and why this is not a great joke — 1/?

basically everyone knows someone, or knows someone who knows someone who's misused/abused stimulants intended for ADHD. it sucks, but it's true. there's been a lot of push to make stimulant medications even HARDER to get than they already are because of it. 2/

and a lot of this is down to public perception. 'Ritalin? they just push that on kids to make $$$.' 'Adderall is a study drug for rich college kids.' 'ADHD is fake, y'all just wanna be high on speed.' nope on all counts. ADHD is a measurable neurochemical Thing. 3/

so let me break it down for you exactly what ADHD is and how stimulants work with it (and this is going to be a gross oversimplification, because, well, Twitter length, man. I miss Tumblr, I could actually talk there...sigh now I just sound old) 4/

ADHD brains have abnormally low amounts of dopamine and norepinephrine. dopamine is largely known as 'the feel-good neurotransmitter' but that's actually fairly misleading. it's better understood as controlling "motivational salience," aka How Important Things Are. 5/

(of course it's got many other roles, all neurotransmitters do, but we're going to focus on ADHD here.) norepinephrine is less hyped, and has a lot to do with alertness and focus, as well as fight-or-flight response and memory formation. see where this is leading already? 6/

with ADHD, your brain doesn't maintain normal levels of these. without enough dopamine, you can't decide what to do, or how to do it, or even start doing things you know you need to do. the neural pathway literally won't perform: that's executive dysfunction, babey! 7/

without enough norepinephrine, you don't form memories quite right, and your attention is all over the place. when it can engage, without any motivational direction, it latches onto novelty instead, for the most part. that's the 'ooh shiny' stereotype we all kinda hate. 8/

stimulant medications increase dopamine and/or norepinephrine in the brain, which for people with chronically low levels, that's great. the brain finally can perform normally, or close to it, anyway. a therapeutic dose WILL NOT cause someone with ADHD to be 'high'... 9/

...because being high is a result of having too MUCH of one or several neurotransmitters. like spackling in a crack to make a wall pretty and smooth, ADHD medications fill in the gap to top the brain up to a normal level. now, if you don't have ADHD, that's different. 10/

that can make you high, yes, but that's also drug abuse. people with ADHD who are prescribed medications to treat their ADHD and use them as directed are not addicts, junkies, or dependent, any more than someone taking insulin for diabetes is addicted to insulin. 11/

(also hey let's have some empathy for people suffering from addiction, that shit ain't easy and is frequently ALSO down to a neurotransmitter deficit.)

so you can hopefully see the problem when the public perception of what ADHD meds are is the exact opposite of the reality. 12/

the vast majority of us, who just want to approximate normal brains so we can, you know, have relationships and jobs and nice things, just want to get our meds, never share, use as prescribed, and call it a day. but we have to jump through SO. MANY. HOOPS. to do that. 13/

and the hoops get higher up and harder all the time, and people applaud that, because they think they're somehow punishing 'bad' people who are just faking to get their sweet sweet drug candy. nah dawg you're just making me have to drive an hour both ways in Bay Area traffic. 14/

once a month. every month. ON time, all the goddamn time. I'm actually VERY lucky that I can do phone appointments for refills, that didn't used to be the case. pre-covid it was in person or nothing at all, because screw me for trying to refill a prescription I guess? 15/

and I'm lucky: I don't have mandatory drug testing or fingerprinting or insurance hassles or doctors arbitrarily deciding I'm drug-seeking (I guess I'm seeking appropriate treatment for a diagnosed issue, but that seems normal when you put it that way) 16/

so yeah, it's possible The Orange is in fact abusing stimulants, but when it's not a prescription, we call that shit 'speed' because that's what it is at that point. the compound might be the same, the result is NOT, and leaving people with ADHD out of it is Good And Cool. 17/

we got enough going on without being associated with That Guy and his probable self-destructive habits, when we're really out here just trying to live our best lives with approximately normal-ish brain chemistry like anyone else. 18/end thread