Lindsay Guentzel (00:01):
Welcome back to Refocused. I’m your host, Lindsay Guentzel and on today’s show we’re diving into the Adderall shortage with columnist and fellow ADHD-er, Michael A. Cohen, who recently shared parts of his own experience navigating the medication shortage in the aptly titled The Adderall Shortage is the Mental Health Crisis No One’s Talking About, published by The Daily Beast on April 29th. If you’d like to read Michael’s piece before diving into today’s episode, which I highly recommend, I’ve shared the link in the show notes and for all of you, I listen better than I read, people, there is the option to listen to the article pinned at the top of the page.
Michael A. Cohen (00:57):
I used to always joke that I’m a multi-tasker and that’s always been who I am. I’ve always multi-tasked. And I’ll never forget, I was out with some people once and somebody mentioned some friend of his and he’s like, “Oh, he’s a classic ADHD, he wants to do 800 different things.” And I was like, “Oh.”
Lindsay Guentzel (01:14):
It’s no secret there’s been an increase in people seeking out ADHD assessments over the last few years. The pandemic and the sudden change in our routine opened up a lot of people’s eyes to behavior. They may have been controlling or masking simply by going to the office every day. Add in the growing popularity of ADHD TikTok, or really any social media platform, and people have been seeking out answers simply because for the first time they could actually see themselves reflected back. It’s also important to acknowledge the fact that we now know there is a genetic connection to ADHD, meaning every single parent who has been helping a child through the assessment process is now also thinking, “Maybe this is me.” Take that increase in ADHD diagnoses, throw in the fact that even though the DEA knew these diagnoses were on the rise, they chose not to increase the amount of Adderall being produced.
(02:12):
Adderall being one of the most commonly prescribed stimulants used to treat the disorder, toss in the hurdle of having to have your prescription transferred to a new pharmacy every time the pharmacy runs out of the drug you need, and it all came together to make life even more difficult for a group of people who already have it hard enough. Earlier this year, the DEA asked for comment from the public regarding the public health emergency. These were the guidelines set up during the pandemic that allowed stimulant medications to be prescribed through the telemedicine model, because remember a few years ago when we weren’t leaving our homes? Well, 38,000 people left comments on the proposed changes to the telemedicine rules. It’s a DEA record. Again, it’s just more science pointing to the fact that this, what we’re dealing with right now… the changes to telemedicine access, the ongoing Adderall shortage… it’s affecting a lot of people and yet no one is jumping in to get things fixed, at least no one with the power to actually do it.
(03:17):
On April 29th, the Daily Beast published the opinion piece The Adderall Shortage is the Mental Health Crisis No One’s Talking About, by Michael A. Cohen. Michael is the publisher of the newsletter Truth and Consequences. He’s a columnist for MSNBC and he’s a fellow at the Eurasia Group Foundation. He also has ADHD, and like so many Americans over the last few years, he found himself unable to fill his Adderall prescription. I applaud Michael for using his platform to bring new eyes and ears to this issue, because as you’ll hear, opening up about his own experience of course brought out the critics. It’s interesting to me that so many people who don’t have ADHD or who aren’t medical professionals have an opinion about how ADHD should be treated.
(04:06):
It’s one of the topics I get to with Michael, the power that stigma has played in not only how society views ADHD, but even the power stigma has played in how our leaders respond, right now referring back to the DEA and the control they have in who has access to the medications they need. One leader who is trying to make change happen is Representative Abigail Spanberger, a democrat from Virginia who on February 16th pressed into the DEA for more answers on what’s being done to address the growing concerns over Adderall shortages. Michael interviewed Representative Spanberger, he also interviewed Dr. Richard Friedman, a professor of clinical psychiatry and the director of the Psycho-Pharmacology Clinic at Weill Cornell Medical Center, as well as Matt Ford, whose tweet regarding his own issue getting his Adderall prescription filled went viral back in March.
(04:58):
The thing is, we’re long past the point of finding a quick fix for this, which is why I’m so grateful Michael chose to amplify not only the shortage but the ramifications of the shortage. I also really appreciate him finding time for us on Refocused so that we can have this conversation. This is important information for the neurodiverse community to be tuned into, and here’s a little challenge for you. It’s also something we should be looping our friends and families, the people we would call on as our advocates, into as well.
(05:37):
I’m hoping we can start by having you share a bit about your connection to ADHD and I want to read a piece from the article that you shared last month. You said, “The times I was without my medication this past winter left me puttering around my apartment searching for anything that would distract me from having to concentrate, which to the non ADHD sufferer will seem easy, but for those of us affected is a profound struggle. But I wasn’t just feeling inattentive, I was literally exhausted all the time.” For people with ADHD you paint a wonderful yet horrifying picture of what it is like to not be medicated, but I’m wondering if you can share a bit about your journey with ADHD to kind of set up why this piece was so important for you.
Michael A. Cohen (06:25):
Thank you for asking me that, and actually that’s kind of why I wanted to write about the piece, because I’ve been dealing with ADHD my entire life but I’ve been medicated for about the last 15 or so years with various medications I’ve used over that time. And the thing for me, what got me sort of wanting to write about this is, is that I saw other people talking about this issue and I realized I wasn’t alone in sort of struggling with trying to find my medication that I usually take. And I went through this, as you read, I went through this last winter where I had about a two-week period where I did not have medication, couldn’t get the medication I usually used, and it was terrible. It was really difficult to do anything. And it’s one of the things where I think people who don’t deal with ADHD, it’s hard to understand it. I think what got me wanting to write about this is that look, people have written about the Adderall shortage.
(07:19):
It’s not as though this hasn’t been sort of covered, although I don’t think anywhere covered as much as it should be. But I think for a lot of people it may not seem like a real crisis. It may not seem like a real problem because it’s hard to sort of understand what it’s like when you don’t have this kind of medication and when you suffer from this affliction. So that was my motivation for writing about it. I was inspired by people on Twitter particularly who sort of talked about their experience of not having it and how it affected them. Part of the rationale for writing this was to help people understand what it is those of us who deal with ADHD go through and why this shortage is such a crisis and why it deserves more attention.
Lindsay Guentzel (07:59):
There’s a lot that goes into the fact that this shortage is happening and I think one of the biggest problems is kind of the fact that we have these pandemic rules that were put in place, and the people in charge have been trying to change them on the fly, and the people, us, are trying to adjust to them. You’re also talking about a group of people who, if you tell us how to do something, we can be pretty good about following that. But changing things suddenly and making us stay up to date with things, you talk a lot about it in your piece about how it’s the worst group of people to be making do this. And I’m wondering when you sat down to start putting together this article, because this is not just like you sat down and started writing about why this is important. You went out and spoke to people who are really in the thick of it and I’m wondering if you can tell me a little bit about the conversations that you were having.
Michael A. Cohen (08:54):
Yeah, it’s really interesting. I reached out in a bunch of different places to talk to people about this and just to sort of get a sense of that I wasn’t alone, I guess, is what it comes down to, or to relate the experience. And what’s interesting I thought, I spoke to a few psychiatrists, a few people who prescribe medication, and they described different kinds of symptoms that was really interesting. I talked to this guy Matt Ford, who’s an editor at The New Republic, he had tweeted about this, which is what got me sort of wanting to write about it. And he said, for example, that it led to this great fear that he couldn’t actually do his job, that he would be unable to complete basic tasks, that it would affect his relationship with his spouse. These are things that I hadn’t really thought about in the same terms.
(09:37):
To me it’s more a question of if I don’t have this medication then I am just, as I said, tired and unable to focus, and it affects different people in different ways. The thing that’s interesting to me about this was that my sort of symptoms were not universal. In other words, the way I was affected by it, different people are affected different ways by this. And I’ve been struck by, since I wrote the piece, people who I’m friends with, people who I have known for years, people I’ve known literally for 30 years, telling me their own experience with this and the hacks that they have to go through to deal with ADHD. And how, I think, also, and this is something that we could probably talk about a little bit, is how the pandemic made our situation so much worse.
(10:23):
I’ve been a writer for most of my career and I’ve written from… not in an office for most of my career… either on the road or at home or elsewhere, but I always used to find that I had to write outside of my home because the temptations for procrastination were simply too great. And I’m sure anybody who’s dealing with ADHD is probably nodding their head when they hear about when I say that. During the pandemic, you couldn’t really do that. You were stuck at home. I couldn’t go to my co-working space where I go when I really need to focus on something. I couldn’t go to a coffee shop. And that you have to create these hacks, these ways of, I have to sit at certain places in my apartment. I have to create artificial deadlines for myself that I tell myself I must abide by.
(11:05):
And I was struck by how many people I spoke to who have similar experiences and have to make these kind of similar… and these are by people who are medicated and still have to find ways to work around ADHD. I will tell you one thing that’s very funny. I did speak with Congressman Spanberger from Virginia who has been really great on this issue, and has been really focusing on it, and she had a very funny line. I’d love to have the piece, it was a great line she said. Where, I joked about how a lot of journalists deal with this ADHD because we’re all procrastinators and all writers are, and I said something about do you see this with members on the hill? And she said, “I can sort of tell who is dealing with this and who isn’t by the ones who’ve written books and the ones who haven’t.”
(11:46):
She said, “I don’t know where they find the time to write a book while also being a member of Congress.” I said, “Literally I have written three books myself and I genuinely don’t know how, for example, the second book that I wrote, I actually wrote it. I don’t know how that actually occurred.” I know that it happened, it’s right behind me on the bookshelf here, but I don’t know how it actually happened. And I think it’s that experience of ADHD that there’s so many times when you just literally can’t focus and you can’t write and you can’t do anything. I have days like this where I literally just get nothing done.
(12:17):
So it was really gratifying in a way to hear that other people experience this as well. You feel less alone and you feel less like a freak. And I hate to use that word, but there are times when I feel that way. I’m like what is wrong with me? Why is it so hard to do what other people do so easily? And it was sort of gratifying to understand that you’re not alone and that other people experienced this as well. And these people who are very successful experienced this as well.
Lindsay Guentzel (12:43):
I’ll share my own because it actually happened this morning. I was speaking at a high school journalism class. I sent an email to the teacher confirming the address. I forwarded that email that she confirmed the address in to one of my producers who was joining me for the session. Did I read the email she sent? No. So I showed up to the wrong location while my producer, who I sent the email to, showed up to the right one. And I just walked in and was like, “Yeah.” I mean, it’s ADHD, you can be the highest functioning person to other people but the way our brains work, it just sometimes doesn’t click. And I want to go back to one of the things you mentioned about the pandemic. This idea that we’re in our homes and they’re just full of distractions and it’s also this reminder of all the stuff we haven’t done that we’re supposed to do.
(13:36):
So it’s extra hard for us. We had Dr. John Cruise on a couple of weeks ago. We were talking about how things have changed with ADHD and one of the things he mentioned was when the pandemic started experts said we are going to have higher rates of depression, higher rates of anxiety, higher rates of substance abuse, higher rates of spousal abuse, all of these things. And not one of the experts said we’re going to have higher rates of ADHD. And so I want to talk a little bit about the stigma that plays a role in this, because yes, we can fault the DEA for the fact that we haven’t had an update on the shortage in however many months, that it doesn’t feel like they’re being forthright with this info for a community that really needs it right now. And that’s a much bigger conversation. The one that I think is a lot harder to address is the stigma.
Michael A. Cohen (14:24):
It’s interesting that you bring that up because I don’t know that I fully appreciated it, because I do know some people who deal with this issue and I know some people who sort of say sometimes I wish I could take Adderall because I can’t focus. Some people I know are sympathetic to it. But I was struck by this conversation, again, that I had with Congressman Spanberger, who sort of implicitly said to me that one of the challenges in getting other folks involved in pressuring the DEA to increase manufacturing quotas or at least to address the issue, was that a lot of them just didn’t want to be associated with it. That it felt like a losing political issue. Look, I saw this with the responses I got to some of my Ps on Twitter that, oh, you’re just lazy, or oh, you’re addicted to this, it’s better if you’re not taking these drugs and it’s a good thing that you are off of them for a while.
(15:18):
Just a kind of dismissal of this as being a real thing. And I don’t know that I truly appreciated that there are people out there that sort of have that view. I mean, you sort of get the jokes, right, I mean I opened the piece with some of the jokes people make about ADHD. You hear the jokes about college students who cram for the final by taking Adderall, and there’s certainly, I think, there are people out there who probably don’t deal with this and who abuse medication and take it when they don’t need to. And I think that contributes to the stigma. But I just think there are a lot of people, again, this is why I wrote the piece and the piece kind of evolved as I was working on it. I realized it actually is important to break down that stigma that people don’t understand or appreciate the challenges here.
(15:59):
I think that’s a larger question about just how we think about mental health issues in general. It’s not just ADHD. I’ve seen this covering actually Trump as a political writer, which is my main job, for the past eight years, that you’re talking about somebody who is seriously and profoundly mentally ill. I sort of got that about him very early on and it took a long time to get others to sort of realize this isn’t somebody who’s going to change their behavior. This is somebody who is profoundly ill and unless treated is going to continue to do these things that they do. And I think it’s a lot for people to understand that because mental health is very hard, it’s hard to grasp why my brain works differently than your brain works. I seem like a normal person for the most part. I have a job, I have children, I do things people do, but I struggle to complete a lot of tasks other people do easily.
(16:54):
I think I said this earlier, but I see people who do lots of different stuff and are successful at it and I sort of wonder how do you do that? I don’t get it. My brain doesn’t work that way. And it’s hard to explain to people what that experience is like. And so I think it creates not just a stigma, I mean stigma obviously is part of it, I think it creates a misunderstanding and it creates confusion and it’s hard to get people to understand it. So again, one of the ideas writing this was to try to help people who don’t deal with this issue to understand this is what we go through and it’s not easy. And it’s also in our heads in a way that’s hard to help other people understand. And again, as I said, I think that’s a larger problem with explaining mental health issues to people.
(17:40):
The way we talk about mental health in this country is often not useful and not productive and not explanatory and is often defined kind of… it becomes a shorthand as opposed to sort of delving into… You say mental health issues, we all have some mental health issues, every one of us in some way. Some of them are more profound than others. And it’s really difficult, I think, for people who don’t have the same kind of profound illness I might have, just as it may be hard for me to understand what they go through. So I think there’s some usefulness, I hope, in writing this piece so then people understand that this is something that is in our heads, it’s debilitating and it’s not because we’re lazy or because we don’t want to work or we don’t want to focus. It’s because we can’t. I used to always joke that I’m a multi-tasker and that’s always been who I am.
(18:28):
I’ve always multi-tasked. And I’ll never forget, I was out with some people once and somebody mentioned some friend of his and he’s like, “Oh, he’s a classic ADHD, he wants to do 800 different things.” And I was like, “Oh, wait a minute, maybe I have ADHD.” I didn’t kind of understand that desire to do five, six, 10, 20 different things is part of that. And of course as you know, this is the funny thing about that, many of us are multi-taskers but then we have so many things on our plate that it overwhelms us that we can’t do any of them. That’s my issue. What happens to me is that it’s like I have to do X, Y and Z and it just feels so overwhelming maybe I could watch some TV while I’m just trying to figure out which one to do first.
Lindsay Guentzel (19:08):
There was an example you used and it was to describe kind of the misconception around how stimulant medications work. And you spoke to Dr. Richard Friedman at the Weill Cornell Medical Center. You wrote, “Another of the popular myths about ADHD and prescription stimulants is that those of us who take these drugs are addicted to them. But as Friedman pointed out, this is a common misunderstanding. Addiction means taking increasing amounts of a drug in order to get high. But when you take stimulants, you don’t get tolerant to it. You don’t need more of it. People aren’t taking Adderall to feel euphoric but rather to function.” And I listened to this part and I heard you describe that and share that piece of information in that connection, and it was so powerful because I don’t know that we’ve ever really got to the point of addressing what people really have a problem with. And to me, it’s the fact that we take medication.
Michael A. Cohen (20:07):
That’s exactly right. And this is, by the way, why you kind of do reporting and why you write pieces like this. I definitely seen this argument about addiction and I actually asked Dr. Friedman this question with the presupposition that this is an addiction, and he corrected me. And it sort of opened a little bit of an insight for me because you see this criticism a lot. This is something I hear people all the time that you’re just addicted to these drugs and it feels that way because I can’t function without them. That’s not really an addiction. That just means I need them to function. This is not a good example, not a good analogy, but I’ll just use it anyway because it comes to mind, it’s like a schizophrenic needs drugs to not be schizophrenic, to not hear voices [inaudible 00:20:51] internal stimuli.
(20:52):
And we’re not schizophrenic, that’s a very different kind of mental illness. But the point is the medication takes that schizophrenic to a place where they can function and they can be a member of society in a way that they could not if they didn’t take those drugs. This is on a different level, but I don’t think anyone would say those people are addicted to those drugs. No, they would say no, those people need those drugs to function and that’s a godsend for them. Right? They’re in a sense like a miracle. And that’s actually one word that someone said to me. I could not do what I do, I could not do my job, I couldn’t have my career without those drugs, without taking ADHD medication.
(21:29):
And so that’s a powerful notion. You’re right, I agree with you. And it’s one that I think people who might have a stereotype about people who take Adderall or other types of drugs, that it’s because they have a big test or they have a big work assignment they have to do, that that’s why they’re doing it. No, we’re doing it because literally it’d be hard to get out of bed without it. It would literally be difficult to sit here and do this interview today. It would be difficult for me to go after this interview and write, which I have to do.
Lindsay Guentzel (22:01):
In January I reached out to a pharmacist that I know and I asked about the shortage and what was going on, and this is what they wrote back to me. Now keep in mind I was asking why national chains aren’t making it easier for their customers to find medication. Kind of the same way Apple does when a new iPhone comes out and people want to find it as quickly as possible. And they said, “The national chains can look at inventory at their other stores, but to do this it would be a big headache because essentially you’d be making all of that information readily available for drug seekers or abusers, which is why the system is set up the way it is already.”
(22:40):
They also said, The pharmacy systems would never communicate in an effective manner to have this online inventory update automatically. It all would have to be done manually, which would be a big hassle and never accurate.” And then my pharmacist friend ended with this. They said, “Honestly, I don’t think the medical field views ADHD as that crucial and they are somewhat indifferent on the issue.” Now keep in mind that is the opinion of one pharmacist, but there’s so much to unpack just from what they said.
Michael A. Cohen (23:15):
This is why it got to this point about why has the shortage continued with such little attention being paid to it? And why is the DEA not made more of an effort, not just to end the shortage but even to communicate with people about why it’s happening and when it’s going to end? I couldn’t get a straight answer from anybody. Not only why it’s happening but when it’s going to end. I can’t speak to why the DEA and other national groups haven’t paid more attention to it. It’s never a simple explanation. A lot of the things I read in preparing to write this piece focused on the effect on children, and I don’t want to minimize that at all because I did talk to somebody, I didn’t quote them in the piece, who sort of talked about the experience of dealing with a child who didn’t have the medication and how in the period when they didn’t have their, I think it was Adderall but I don’t don’t remember for sure, that when they didn’t have it they were just impossible behaviorally.
(24:10):
And once they had it, it was like a night and day kind of situation. And I get why there’s a lot of focus on kids, but I think sometimes what is forgotten is that adults suffer from this as well. I’m speculating here, but I do feel as though there is a different attitude toward children than toward adults. Children, they can’t help themselves. We all know kids who are a little bit out of control. I have two kids of my own, they get a little nuts sometimes. I mean, it makes sense. But you’re an adult, you’re an adult how hard is it to concentrate? Give me a break. I do think there is a difference there and I think that’s part of that stigma too. And part of also why I think people didn’t think it was a big deal. I mean, you look at millions of Americans take these drugs, right, millions.
(24:53):
And except for one congresswoman from Virginia, the focus on the hill was non-existent. People just didn’t want to get involved in it. People didn’t focus on it. And even the Biden administration, I didn’t get a real sense the Biden administration that they were taking this seriously either. I realized there’s a lot of things going on, but this is a serious issue and it affects millions of people. And it was striking to me that in the sort of corridors of power, this wasn’t seen as something that was that important. Again, I’m speculating here. I think part of it is the stigma you spoke about earlier, but I think part of it’s just too that when it comes to adults who deal with the ADHD it’s just like, eh, suck it up, throw some dirt on it, you’ll be fine. I wish it was that simple. I’m sure we both do.
Lindsay Guentzel (25:32):
Absolutely, and I think the big problem that no one talks about is it’s not like you find the medication and then it’s solved. Now you have to do it again the next month and it’s just this cycle and it really is the worst.
Michael A. Cohen (25:48):
And you know what this is like, if you go to your pharmacy and they don’t have it… let’s say it’s a national chain, let’s say it’s CVS, maybe it’s different in Minnesota but in New York they can’t go to the other CVS in New York and say, “Oh, you can get it here, here and here.” No, you have to call each pharmacy directly. And then once you call them, you have to then contact your prescriber and have them send a prescription and hope that in the time when they do that and you go pick it up, it’s still there. You’re asking people who struggle at exactly that kind of task to do it in order to get medication. It’s like some kind of, I don’t know, Kafkaesque punishment that they’ve imposed upon us, that you ask us to do one thing that we can’t actually do to get our medication.
(26:31):
So it is very difficult, very, very difficult. Look, I’ll be honest, I have not been using Adderall for several months now. I’ve been using a different drug, which I don’t feel it works as effectively. And I have been dragging my feet and going back to my doctor and saying, “You’ve got to get me back on the Adderall.” It only makes the situation more challenging to put it honestly. And because of the way these drugs are handled, because they’re considered a controlled substance, it makes it so many more obstacles in front of us. And you know this and anybody who’s listening to this dealing with ADHD, the last thing we need is more obstacles. Right? It creates lots of potential exit ramps from accomplishing a task if there are obstacles in front of us.
Lindsay Guentzel (27:09):
You mentioned some of the people who have commented since the article was released two weeks ago. It’s the people who jump in, they have their armchair medical degrees wanting to tell everyone how to live their lives. What else have you heard since this came out?
Michael A. Cohen (27:25):
As I mentioned earlier, I think this is the thing that I was struck by, people that I have known for a long time talking about their own experiences with this. That was, for me, really eye-opening. A very good friend of mine I just spent some time on a trip with, read the piece and was talking about his own experience with it and how he talked about some of the hacks that he has to create in order to function, which are different than mine. This doesn’t affect people all in the same way. It’s not linear. It’s not a consistent way all of us are affected and also how we deal with it is not consistent. I also heard from a woman who reached out very angry actually, that I didn’t mention the fact that Adderall is incredibly useful for people with narcolepsy. I did not know that. I didn’t come across it on my reporting.
(28:02):
She explained it to me and I felt kind of bad that I hadn’t mentioned it in the piece. So she complained no one knows this. And I’m like, “Well, yeah, I didn’t know it actually.” So you hear from people who deal with this in different ways. This is sort of painful to acknowledge but the people who responded the loudest and the most frequently were the ones who said, “This isn’t a big deal.” And who said, “You’re just addicted to it and it’s better if you don’t have the drug. It weans you off your addiction.” It’s like saying to somebody who takes heart medication, eh, you don’t need it that badly, it’s a drug, you shouldn’t be on drugs all the time. And I mean, I’ll say this too, I think for me when I initially started taking it, I felt a little bit of that stigma as well.
(28:43):
I didn’t love the idea of being on a daily medication that I had to take in order to do my job. And it made me feel, I don’t know if inadequate is the right word, but it made me feel uncomfortable. It took me a long time to get to a point where I was comfortable with it. And I think also for me, just on a personal level, I’ve become more comfortable talking about it in recent years. I do a newsletter, which is difficult because you’re sort of self-starting, there’s no editor, it’s me. It can be a challenge. And I often am very honest with my readers that one of the reasons I might not have published this week is because I’m dealing with a lack of focus or I have other things going on and I can’t do both things at once.
(29:19):
So I think for me at least is to just be honest about the fact that I’m dealing with it and that others are as well. It’s funny because one thing that was actually amusing to me, it was a while ago before I wrote the piece, when I mentioned I had ADHD, and they said, “But you’re so productive.” And I said, “Oh, well, thank you, but you have no idea how difficult that is.” And it’s funny because I am really productive. I do write a lot, but it’s a struggle. And I feel, and I’m sure many people listening feel the same way, I could be more productive if not for the fact that I deal with this.
Lindsay Guentzel (29:47):
It’s the visual of the iceberg. People can see you are productive but they don’t see what’s happening underneath or how you got from point A to point B and all of those little hiccups that go in there. The last thing I want to ask you, from the conversations that you had, what is something that the everyday person could do right now to be working towards fixing this problem? And by that I mean are they contacting their representatives? Are they reaching out to their health insurance companies? Is there anything that we can send people, an actionable item to do, that will help send us in the right direction?
Michael A. Cohen (30:27):
I certainly think being in touch with your member of Congress reflecting how much of an issue this is for you is a useful thing to do. I mean, I just think a lot of people on the hill probably don’t understand how difficult this is. And I think one thing that I’ve always found is that having some contact with someone who deals with this, someone in your life, is often a way to break down the stigmas around it. And that’s certainly true, I think, of mental health in general, that if you see somebody else experience this it’s a lot easier to relate to somebody else. I think that’s the most immediate thing is just to talk to people about it. Talk to obviously members of Congress, talk to members of the media, talk to folks and sort of draw attention to it.
(31:04):
But certainly also just talk to your friends and families so they understand what kind of experience you’re going through. But I will say this, I think one thing that… this is a bit meta… but I do think that understanding how these sort of mental health issues impact everybody and impact people in a way that I think we don’t necessarily always appreciate or understand, so being a little [inaudible 00:31:23]. I wrote a piece in 2020, the summer 2020. Mary Trump, who was Trump’s niece, wrote a book and she wrote about Trump’s sort of profound mental health issues. And I came away from that and I actually kind of felt sorry for him, and I wrote a piece about how I felt sorry for Trump and I got a lot of pushback on it, as you can imagine. But I stand by that piece and I actually think it’s one of the ones I’m most proud of that I wrote, because what I tried to do in the piece was explain that I don’t like the man, I’m not a fan, but I also understand that he’s profoundly mentally ill.
(31:55):
A lot of things he does he doesn’t understand why they’re wrong or why they’re bad. And if you’ve dealt in your life with people like him, people who are narcissistic, it’s hard to like those people but it’s important to understand them. It’s important to understand why they do the things they do. And I think one thing I’ve sort of learned over the years is that very few people are actually bad. Very few people make the choice to be willingly bad, willing to do awful things. They’re often driven to that behavior because of mental health issues that drive them to that place. And I think it’s really important to be sort of understanding and empathetic to that issue. The iceberg analogy is a really good one, that we don’t necessarily see and may not be apparent to us, but often drives bad behavior and drives behavior that is antisocial or that strikes us as being inappropriate.
(32:41):
And I think one way to have a better understanding of those around us and those we disagree with, and that’s a big issue these days, is to understand some of those mental health issues. It doesn’t mean that you’re going to necessarily agree with them or you’re going to like them, but I think it creates a little more empathy, which is really important. It’s been difficult covering politics the last seven years to be empathetic to people I disagree with. But it’s important. That’s one thing to take away from this is it’s important to have that empathy for people and important to understand that some of us deal with issues that we can’t help and have been a product of our experience, a product of our environment, a product of our childhood, what have you. Being so empathetic, that is important. It creates a more conciliatory society, maybe a more empathetic society, maybe a more harmonious society. I don’t know, maybe.
Lindsay Guentzel (33:28):
Well, it’s a great message to send people with, just a little hope, but also the importance of empathy in everyday life, it’s crucial.
Michael A. Cohen (33:38):
This idea of empathy to people whose behavior we find abhorrent, whose views we find abhorrent, it’s such a difficult thing but it helps us understand sort of where people come from and what drives their behavior. And it may not excuse it, but it may help explain it a little better. And I think it’d be sort of a better society in general if we had a better understanding or a better appreciation for the fact that people struggle with these kinds of issues and that we don’t all follow the same sort of linear course of action in how we respond to things. It’s a lot to ask because people have visceral reactions to things and a lot of these mental illnesses are undiagnosed.
(34:12):
I mean, Trump’s mental illness is undiagnosed, but I feel pretty confident in saying that he suffers from profound mental illness. You don’t have to feel sorry for him, you don’t have to like him. I don’t. But I do feel sorry for him because it’s clearly that there’s something wrong with him and it caused him to act the way that he does. And it doesn’t mean you can change your opinion about him, but it certainly might help you understand a little better of why he is the way he is. I think that’s an important thing for all of us to understand better.
Lindsay Guentzel (34:38):
I think one of the most important things I’ve learned in the last year is acknowledging the difference between excuse and explanation and being comfortable using explanation whenever I want or need to.
Michael A. Cohen (34:51):
I couldn’t agree with you more, and it’s a really hard thing for people to grasp, that I can explain someone’s behavior it does not mean I’m excusing it. People don’t understand that often. And I had this whole conversation about this horrible incident in New York with this homeless man who was choked on a subway and I was appalled by it. It was horrible what happened to this man. But I tried to sort of maybe explain why people might have felt more fearful than those of us who weren’t there might have felt, and how that might’ve driven the behavior. I’m not excusing it, but maybe explaining it. You can’t have that conversation. People don’t really want to hear that kind of nuance and it’s difficult. But I think it’s important, I do, and I continue to do that and continue to lose Twitter followers and subscribers whenever I make that argument. But I will continue to do it because I think it’s important. Nuance is very difficult in our political discourse, in our cultural discourse also, but it actually is kind of important.
Lindsay Guentzel (35:45):
Michael, I’m so appreciative of your time. I’m so appreciative of the energy you put into this article. It is a fantastic read. Again, this is The Adderall Shortage is the Mental Health Crisis No One’s Talking About. It was published by The Daily Beast on April 29th. We have it linked for you in the show notes as well as a link to his newsletter, Truth and Consequences. Michael, thank you so much for your time and we’ll connect soon.
Michael A. Cohen (36:11):
Thank you, Lindsay. It was a pleasure.
Lindsay Guentzel (36:19):
I’ve shared plenty about my own experience taking stimulant medications to manage my ADHD symptoms. Have I felt judged? You bet. But my life, what I guess I’ll call before medication and while medicated, my life is so much better when I’m taking my Vyvanse every day. I feel so much better. My brain feels like it functions better and the ripple effect is real. So for me, any judgment from doctors, pharmacists or random loudmouths on the internet, it doesn’t bother me. It’s been such a drastic change for the better that I’ve decided I don’t have the energy to let that stuff get to me. But I know that not everyone can turn that off, and what’s taking place right now, this massive dismissal, is only making things worse.
(37:08):
I want to wrap this up by sharing a few tips on what a person with ADHD can and should be doing if they find themselves unable to fill their stimulant medication because of the shortage. To start, it’s so important to remember that once a stimulant prescription has been written it’s attached to the pharmacy it’s been sent to and the only person who can move it from that pharmacy is the prescriber. This restriction stands whether you need to transfer your medication to a new pharmacy because, like the shortage, they don’t have your medication in stock, or if you were moving and you found a new pharmacy that’s more convenient. Any transfers for a stimulant medication have to come from the provider. So if you’ve already experienced issues filling your stimulant prescription or have concerns you might start running into some, communicate this with your prescriber.
(37:59):
They can go over all of your options with you setting you up to make an informed decision if the situation presents itself. Because if you can’t get your Adderall but you haven’t discussed new options with your provider, they won’t be able to prescribe that new medication until they’re able to go over it with you. There’s also a number on the back of your insurance card that you should call, people working in member services whose job it is to help you. Communicating how the Adderall shortage is affecting you to your insurance company not only helps document the problem, your membership services team can also help you figure out what other medications are available to you under your current coverage.
(38:40):
You should also develop a line of communication with your pharmacist. Ask them questions, find out if they have the same medication in a different strength or if they have an alternative medication they recommend. You can take that information back to your provider to use as you work to find a solution. It’s also important to plan ahead, which feels really weird to say and I’m sure feels even more strange for you to hear. Yes, I’m well aware that planning ahead and ADHD don’t typically go together very well, but the unfortunate reality is right now this is what we’re working with. This is the system in place and planning ahead can make it less stressful. So I encourage you to find a reminder system that works for you so you are reordering your prescription with enough time that if your pharmacy is out of your medication you have time to pivot before going days without your stimulant medication.
(39:36):
Set up reminders on your calendar. Ask another ADHD friend to be your reorder reminder buddy. Use Post-It notes. I like to stick my to-do reminder Post-It notes on my car dash right by my radio. It’s one of the things I picked up from my mother, so every time I see it when I get into my car, I’m reminded of what I need to do, because any amount of buffer time is better than no buffer time. And it might be that you have to get creative and try a few things out before you find something that works for you. And please keep in mind, despite all of the legwork you have to do, you also have to come to the table willing to be a bit flexible. I know what you’re thinking, they just keep asking more of us, but hear me out on why it’s important to be flexible.
(40:20):
Let’s say you are able to find your prescription in a different strength at another pharmacy. It’s likely that your provider will need to adjust the number of pills to match the dosage they found. And because I am well aware that changing routine on the fly can be difficult for a lot of people with ADHD, it’s truly what sends my emotional dysregulation into a tailspin, I want you to be as prepared as possible as you head down that road. I do also think Michael has a point though on the importance of reaching out to your elected officials. It’s actually pretty easy and tends to be a lot more impactful than most of us like to think. For example, it took me well under five minutes to go to my representative’s website and send them an email that simply said, “I would like to encourage you to look into the ongoing Adderall shortage and how it’s affecting our country’s neurodiverse community.” Short and to the point.
(41:15):
And if you’ve been affected by the Adderall shortage and you want to share your story on Refocused, send us a note, [email protected]. Today’s show was edited and engineered by coordinating producer Phil Roderman. Our show’s managing editor is Sarah Platanitis and Al Chaplin leads our social content creation, which you can view by heading over to Instagram and giving us a follow @refocuspod. Our show art was created by Sissy Yee of Berlin Grey. Louis Inglis created our theme music and EXR Sounds and Vision is our go-to for sound engineering. Links to all of the partners we work with are available in the show notes.
(42:02):
Refocused is produced thanks to the support of ADHD online, a telemedicine mental healthcare company that provides affordable and accessible ADHD assessments and treatment plans, including medication management and teletherapy. To learn more about how they can help you on your journey, head to ADHDonline.com To connect with the show or with me, you can find us online @refocuspod as well as @LindsayGensel, and you can email the show directly. [email protected]. That’s [email protected]. We’ll see you guys back here soon. And in the meantime, take care of yourselves. And please, in an effort to reduce the unbelievable amount of stress we all carry around with us unnecessarily, be a little kinder to yourself this week.
