My journey from ADHD skeptic to Adderall enthusiast

And what it taught me about living with agency

At 22, I thought ADHD was fake. An excuse for underachieving kids to get “accommodations” for procrastinating on their homework. From what vague knowledge I had of stimulants like Adderall, I regarded them with the same scorn as the accommodations.

Seventeen years later, I credit Adderall with enabling me to build a 10x happier, healthier, more virtuous version of myself (to the chagrin of the countless Twitter trolls decrying my “meth addiction” in reply to this recent viral post). Here is my story.

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Coming out of college, I thought ADHD was a made-up diagnosis designed to give lazy, weak-willed kids an excuse to demand extra time on their school assignments. After all, I’d been the laziest and weakest-willed among them, and still managed to get through an insanely demanding curriculum with highest honors, no “extra time” required.

Never mind the torturesome all-nighters spent zoning in and out of panicked procrastination and finally vomiting out a 20-page paper in the final hours before (or sometimes after) it was due; the days spent chasing lost phones and wallets and backpacks; missed flights; the constant talking and interrupting that wore out the very sorts of friends I most wanted to keep; the apartment that had to be rush-cleaned into some semblance of a more ordinary “mess” on the rare occasions when I let anyone see it. As far as my inner drill sergeants and I were concerned, these were all shameful moral failings that I “should” have been able to fix by now, if only I were less lazy and weak-willed. If I could write a solid paper the morning it was due, then I should be able to write one anytime. And indeed, I could pretty much always muster enough focus and discipline when I wanted something badly enough to try.

Until I couldn’t.

A month into my job as a research assistant at Massachusetts General Hospital, I got my second warning: if I kept zoning out during trainings and making too many careless errors on study protocols, I might lose the job. This feedback hit me on a new level: this time I wasn’t just risking my grade in a class, but the integrity of real patient data that I was being paid and entrusted to collect. My chance at graduate school, my nascent reputation in the field, my financial independence, everything I cared about was on the line.

So I stepped up my efforts 10-fold: 9pm bedtime, gallons of coffee, color-coded highlights and sticky notes, extra practice sessions. And still I’d zone out mid-training; and still I’d skip an item or forget to start the timer when administering study protocols.

When research became mesearch

As luck would have it, two of the protocols I was struggling so much to administer were for adult ADHD studies. So even as I came face to face with my own limits, I interviewed dozens of study participants about symptoms that described me better than any of them. Meanwhile I heard the faculty present research on the thinner and slower-maturing prefrontal cortices, task- and context-specific cognitive performance deficits, and genetic heritabilities of people who share those symptoms.

Slowly, reluctantly, I started re-thinking what was and wasn’t “made up” about ADHD.

One night I Googled my way to a page describing undiagnosed adult ADHD, and I broke down in sobs. “Maybe you’ve been told you are morally weak, and you carry a lot of shame…”

The next day, I casually asked my supervisor for a referral. One evaluation later, I had a diagnosis, a prescription for Adderall XR, and a pill bottle waiting on my nightstand.

The first dose

At first, nothing seemed especially different.

It was a Saturday, so I decided to experiment with outling a short story I’d been stuck on for years.

Five glorious, uninterrupted hours later, it was done.

The “Tinges” and the Gear Shift

The next morning, I noticed an anxious unease (the “tinges,” I came to call it) about 30 minutes after taking Adderall. My psychiatrist cycled me through Focalin, Dexedrine, Vyvanse. Same dreaded “tinges,” same or smaller benefits. We circled back to Adderall. I took up mindfulness practice, which turned the tinges from a ruminative spiral into a barely noticeable blip.

What Adderall didn’t do: give me a high or erase my bad habits overnight.

What it did: turn my fleeting bursts of focus into something I could summon and sustain on demand. As a result, my efforts to change or override my habits went much further than they ever had before. If I put my phone away and set the intention of “listening and taking notes during this 2-hour training session,” that intention stayed with me for the entire 2 hours. Not only did I have more energy available (as would have been the case if I had guzzled coffee), but I could aim that energy more precisely and enduringly toward my chosen, values-aligned goal.

It was like I had gained access to a purer, more stable, and more malleable form of the raw material that powers my agency. What I did with that raw material was and is, as ever, up to me.

Imagine a car whose gear shift jerks unpredictably between Drive, Reverse, and Park unless you keep your hand on it, and sometimes gets stuck entirely. That’s how I experience my attention off Adderall. On Adderall, the gears click into place and stay until I decide to shift.

Compounding Returns

Since that first dose, Adderall has multiplied the intentionality and loving care I am able to bring to my work, my marriage (just ask @mbateman), my kids, my home.

Of course, your mileage may vary. There are real risks and downside cases, real problems with misdiagnosis, real potential for abuse and addiction (which I have treated more than once in my own practice), real ways these medications get coopted into a medicalizing narrative of what are in fact deficits of the educational system rather than the kid. But as for me, I’m eternally grateful for this genuinely miraculous medical technology and the fully-lived life it has unlocked for me. As Matt put it, largely based on his observations of Adderall’s impact on me:

I’ve also added plenty of other tools, from the above-mentioned mindfulness practice, to David Allen’s GTD system, to keeping an honesty log, to developing my own builder’s mindset. But given all the stigma and misinformation surrounding it, I want to be very clear that Adderall has been the most transformative intervention by far.

The Small Print (That’s Actually Big)

If there’s a unifying thread among the various symptoms of ADHD, it’s a weakness of executive function: the ability to aim and sustain mental energy toward your goals in context. For instance, if you tell yourself “I’m going to work on my book for the next hour,” to what extent do your cognitive resources get mobilized in service of that goal? Does your attention stay fixed on material related to the book, while filtering out irrelevant stimuli that would distract you (like email notifications or thoughts of what’s for dinner)? Are you able to keep secondary intentions like “keep track of the time so you can stop in an hour” on the periphery of your mind without either losing sight of them or being derailed by them? If and when you do notice the time is up, are you able to pry your attention away from the book and shift it to your next intended task, or else reassess your goals and priorities based on the context?

Your executive function isn’t static: it’s better when you’re rested, worse when you’re hungover, better when you care about the task and relate to it as a builder, worse when you self-deceive about your reasons for engaging in it. Biology also matters, with the latest heritability estimates putting it at 60–80%.

Executive function exists on a continuum. Diagnosis cutoffs are arbitrary. People with weaker executive function tend to benefit more from stimulants, but you don’t need to meet a diagnostic threshold to get value. In my ideal world, adults could weigh the upsides and tradeoffs without leaning on a formal diagnosis as a crutch.

Even absent this legal autonomy over what we ingest into our own bodies, we can still choose what and how much meaning we personally imbue in a diagnosis. When it comes to ADHD, I still prefer the framing of “My executive function is weak and benefits hugely from interventions like Adderall and GTD” over “I have ADHD,” which is too easily placed in service of an agency-undermining “disease victim” narrative.

Agency Above All

Executive function is one critical ingredient in human agency. You can exercise agency over it, in turn, by a bunch of different methods, stimulants like Adderall being foremost among them. You can work on strengthening your executive functions, or you can leverage your existing strengths in a way that largely lets you work around them. The point is: you get to decide. Just make sure it’s your life, not the false clarity of a diagnostic label or the Luddite preaching of internet trolls, that is your ultimate yardstick.