An Interview with an Addictionologist
I started taking antidepressants about a year and a half after my accident in 2013. At the time, I felt deep shame that I needed a drug to feel like myself again, however, I quickly repressed that feeling and started to like the idea that by simply taking a pill, it could magically “fix me”. Although I now have come to peace with antidepressants and their healing benefits, my mental space at the time raised a red flag that I was looking for an easy fix to help me cope with a trauma that took internal work.
If you’ve ever taken antidepressants, which now in 2023 they say 70.9 million are, you know that it may take a few tries to figure out the best SSRS for you. I went from Prozac to Cymbalta, to Zoloft. When I was deep into my Adderall addiction, it was clear that my antidepressant was not working. My therapist knew early on that I had an unhealthy obsession with Adderall. She hinted that it’s likely my antidepressants aren’t working because of the drug. At the time, I was not ready to hear her.
After rehab, I was recommended an “Addictionologist”, a physician certified in the field of addiction medicine usually specializing in the areas of drug and alcohol abuse. His job is to help stabilize the brain chemistry after years of abuse and additionally in my case, a wrongly prescribed patient.
Now that I am officially off Adderall, I know my antidepressants have positively impacted my day-to-day life, and am beyond grateful for how it’s helped me stabilize the chemicals in my brain that were damaged due to the impact of not only trauma but Adderall itself. This made me question how many others are not reaping the benefits of taking an SSRI due to Adderall. How does Adderall impact SSRIs but how is the combination of both impact the human brain? Why the hell does everyone say Adderall is like taking meth and if that’s the case, why was I prescribed meth? So we sat down together and I interviewed him:
Before I begin, to give you some context on Dr. Master Matthews, he started his practice because addiction runs heavily in his family. His life’s work is to help the population with addiction. To continue his mission, he generously offered an hour of unpaid time to go over my questions.
Notes before reading the interview:
Dr. Masters is not against Adderall, he believes it can be life-changing for people who actually have ADHD, he simply treats the patients who were misdiagnosed to Adderall (like me) which led to addiction
The answers he gives to my questions are partially scientific and partially his own experience based on his patients.
The interview:
Who do you typically treat? My work is 80% opioid addiction, 15% alcohol, and 5% other (aka meth/or Adderall)
What happens to your brain once you are in recovery from Adderall? Part of the pathology related to Adderall is that it depletes the brain of neurotransmitters so typically patients that get admitted to inpatient clinics for meth or coke stay for 3 to 4 days and sleep for most of two to three days and when they aren’t sleeping they aren’t eating they are depressed and craving Adderall/meth/coke. My standard treatment for people in that situation is to put them on Prozac and the reason why is because all of the neurotransmitters particularly the serotonin have been depleted from their brain Prozac results in an increase in serotonin in the brain but change doesn’t happen immediately. It takes 2 to 6 weeks before Prozac or other transmitters can change the chemical imbalance in the brain. Side note: Based on my experience in the “detox center” at rehab, this was the case. I slept for two days straight and was severely depressed. When I look back on my journal entries from that time, they are actually comical about how paranoid and dramatic I was. I thought my world was over and that my boyfriend was going to leave me. Luckily, that was not the case.
Obviously, I have to ask… is it more likely for men to get addicted over women visa versa? In general is much more common for men than women, however, but he doesn’t know the exact number for meth/Adderall. His psych opinion is not based on scientific fact but his experience is that men are more likely to become an addict or alcoholics because of social conditioning, “It’s not ladylike”. Now don’t go after him for this, whether you like it or not, this is his experience and opinion. In addition, he said, men tend to be more aggressive more selfish than women and that puts them in situations where they become more angry and resentful regarding not getting what they want or something like that also there’s the element of adrenaline junkies, far more men are adrenaline junkies than women. You don't see a whole lot of women wearing squirrel suits jumping off mountains…..
Is the joke “Adderall is pharmaceutical meth” true? Dr. Masters hit me with the facts: the only difference between Adderall and meth is the manufacturer. In other words, meth is made in the countryside in a white sketchy van and Adderall is made in a lab. In the brain of someone who has ADHD, Adderall can be a life-changing drug in a positive sense, but when misdiagnosed it can result in addiction and dependence. What meth and Adderall does is rings all the serotonin, dopamine, and norepinephrine, out of the brain. All of the neurotransmitters that we try to increase in the setting of depression are markedly decreased by methamphetamine. The same thing happens with cocaine except it doesn’t last as long meth= 6 hrs cocaine=1 hour. This explains why I liked Adderall so much more in college. Adderall and Methamphetamine have the same mechanism of action in the brain. They increase the amount of Dopamine in the synaptic left(the space between neurons in the brain--the place at which neurotransmitters have their effect). Addicts deplete these brain chemicals (a.k.a. neurotransmitters) by overuse of amphetamines leading to the craving, relapse, depression, addiction, change in neural pathways, etc. There are chemical differences between Adderall and Meth, but the net effect on the brain is the same from the standpoint of their clinical effects.
You mentioned that you aren’t “against” Adderall and you believe it can be beneficial to people who actually have ADHD, how do you know actually has ADHD? A careful assessment of ADHD is essential because the medications that are best at managing it (i.e. amphetamines) are highly addictive. Other psychiatric disorders (e.g., anxiety, depression, bipolar, etc.) can also present with decreased attention, focus, and memory and therefore it is necessary to exclude these entities prior to concluding that the patient has ADHD. In my population of addicts and alcoholics, I am careful not to prescribe amphetamines unless the patient has a well-established history of ADHD that manifested by the age of 8 in the second grade. Also, the history of their response to Cocaine or Meth will give one a clue about whether they genuinely have ADHD or not. Most people with true ADHD don't get high with their initial use of Cocaine or Meth, it just allows them to focus and concentrate and they get their homework done. They don't like it as a party drug. When I first took Adderall I felt a euphoria so strong I never wanted to lose that feeling again. Over time the euphoria went away which is why I was persistent on upping the dosage to get it back. This is exactly what happens to drug addicts, they constantly chase a high that no longer exists.
Why is Adderall so misdiagnosed? It’s hard to test for ADHD because people have an agenda to get Adderall to know how to answer the questions. In addition, anxiety symptoms such as the inability to focus can show up as ADHD symptoms on tests.
What happens to your central nervous system? It gets drained of neurotransmitters and you can become psychotic from sleep deprivation and you manifest all the symptoms of an acute psychosis leaving you paranoid. Another case they’ve seen, mostly in women, is “face picking”, and in both men and women, teeth rotting because amphetamines dehydrate you and so they don’t produce saliva, and saliva is what prevents your teeth from rotting.
Why are trauma/and or PTSD patients candidates for antidepressants? Antidepressants are prescribed frequently following trauma or PTSD, however, they are not the indicated treatment for PTSD. The indicated treatment for trauma and PTSD is EMDR or prolonged exposure therapy which is a form of psychological counseling that takes the patient back through the traumatic events. PTSD, the event from the past, can assert itself into the present and makes the patient miserable that’s where the antidepressants come in to help stabilize your neurons.
How does Adderall affect SSRIs? At the University of Washington medical school, mark gold, got a lot of publicity for a picture of his that was published by a biological psychologist and it was slides of rat brains. The first slide was a normal rat brain 2nd was a rat hit over the head with a hammer 3rd was a rat affected with methane= Adderall and the pathologist could not tell the difference between the hammer brain and the meth brain. What meth or Adderall does is it rings all the serotonin, dopamine, and norepinephrine, out of the brain. All of the neurotransmitters that we try to increase in the setting of depression are markedly decreased by methamphetamine. The same thing happens with cocaine except it doesn’t last as long as meth= 6 hrs.
What is your favorite natural solution to Adderall? That’s out of my field. I loved this answer because from what I’ve seen after all the doctors I’ve gone to have my accident, is that when doctors (typically men… don’t come after me, it’s just my experience) let their egos take over and start claiming facts that are not in their field. I had a doctor tell me he could fix me through his chiropractor practice and I said straight up to him that I am sick of paying out of pocket for all of these treatments and if you don’t fix me, I’d like half my money back. Of course, he did not fix me, but he did keep his word and I have rewarded half my money back.
Advice from an Addictionologist
Do you have any words of wisdom you give your patients who struggle with prescription addiction? There’s a mechanism of disease in cancer and there’s a mechanism in addiction but just as there are different types of cancers that require different types of treatments there are different types of addictions that require different types of treatments. Sometimes if all you have is a hammer everything is a nail, and back in the early days when all we had was AA everything was a hammer and a nail, and that’s not true nowadays and that observation is particularly relevant to opioid dependence which is treated through Suboxone. Unfortunately, we do not have a medication for amphetamine addiction or cocaine that does the same thing so that’s why adherence to treatment is so poor.
Humble brag Dr. Masters said, I am above the average of people who can make it through recovery because the craving relapse, and withdrawal are so strong in methamphetamines. I equate this to the injuries from my accident, my nervous system was so out of wack that my body was literally screaming at me for something to change. Learn more about how your body speaks to you through this book Body Keeps The Score.
Dr. Masters finished with something I would like my readers to digest: People need to understand that the more potent the drug is the more addictive it is especially with methamphetamines. Right now the meth on the street is coming from the drug cartels in Mexico and it is pharmaceutical quality. The number of deaths is way up because the quality and the addictiveness are much greater than it was. If we look at the inherent addictive quality. Meth and Adderall do the same thing in the brain, the problem is with meth, you don’t know how strong it is when you buy it on the street whereas with Adderall is that since it’s a prescription drug it is pharmaceutically produced you know exactly what you’re getting.
Some Factual Resources for My Skeptics
What are good sites for my readers to get accurate statistics?
SAMHSA substance abuse mental health services administration “excellent information”
NIDA national institutes or drug abuse
NIH national institutes of Health
Random question… what are the statistics of addiction?
Nicotine 33%
Opined 27%
Meth or Coke 25%
Alcohol 15% for men 10% for women
Pot 10%
From my personal experience, I haven’t had an issue with alcohol since I stopped taking Adderall is there a one size fits for all addicts when it comes to prescribing antidepressants?
Every patient is different. When you’re treating SSRIs for depression it works out in the rule of 3rds. One-third of people only need to be treated once for 4 to 9 months, the second 3rd may require treatments twice for 4 to 9 months in their lifetime but not substituent treatment, 3rd antidepressants on an ongoing basis without them they get depressed.
When will you know your patients are ready to get off of the drug?
Through clinical evaluations (Clinical evaluation is a set of ongoing activities that use scientifically sound methods for the assessment and analysis of clinical data to verify the safety, clinical performance, and/or effectiveness of the medical device when used as intended by the manufacturer) Prozac is the easiest SSRI to come off of because it has a long half-life and it comes out of your body slowly.
