30 days or 30 years? How Long People with ADD Should Take Medication

image via Flickr, Pink Sherbet Photography

image via Flickr, Pink Sherbet Photography

People with ADD show a great deal of variability in the length of time that they require medication as an aid to control weak attention. Because ADD is a biologically-based, constitutional problem that people do not out grow, some individuals require use of the medication for a lifetime.

Fifteen years ago, I more was more optimistic about helping individuals get to the place where they could be independent of the medication. With lots more experience, I now know that independence from medication is the exception rather than the rule.

Over the years, I have become particularly cautious about my patients’ being off medication when I know they will be behind the wheel of a car or in social situations where their decision-making has potentially serious ramifications.

When we look closely at all areas of life functioning, more than 75% of my patients continue to demonstrate a need for the aid of medication in adult life.

Pre-Requisites for Going Off ADD Medications

Some individuals do reach a point where they can “do it on their own” for varying periods of time. I have found that the key pre-requisites for a patient’s getting to this place include:

  • a firmly established balanced healthy daily routines
  • a keen awareness of what his problems are and how to control them, and
  • an ability to see at risk situations in advance and make the necessary adjustments.

My patients who are most likely to meet these pre-requisites generally have:

  • ADD that is moderate in its severity
  • a number of strengths that can be mobilized to compensate for attentional weaknesses, and
  • a history of close involvement with professionals

The Benefits of a Great Support Team

image via Flickr, Bruce McKay

image via Flickr, Bruce McKay

Additionally, my most successful patients who tackle ADD challenges without medication usually fully accept their differences, are highly motivated, and are surrounded by supportive family members, friends, teachers, and others.

The shortest period of time a person I have treated has needed the assistance of the medication has been three months. More commonly, individuals with ADD require medication for at least several years before they are able to function effectively without it at least for a brief period of time.

How We Transition Patients Off Medication

In my practice, when a patient appears to be ready for an extended trial off of medication based upon parent, spouse, teacher and other feedback, I have him stop medication for a couple of days and come into the office where we determine via testing and structured observation his readiness to discontinue the medication.

When everything suggests that he will be successful off medication, I have him remain off the medication for an additional 1-2 weeks. For the patient who is in school we notify teachers of the plan. I then have the patient come back to the office in two weeks to assess how he has performed day in and day out off of the medication. When he has done well, I see him monthly for six months, then quarterly.

Don’t Hesitate to Resume Medication When Needed!

Whenever I see signs of increased attentional problems that result in a significant life dysfunction, I resume the medication.  I’ve outlined my thoughts on a successful medication experience in 7 Keys to Successful (and Safe) Medication Treatment for ADD.


Dr. Liden’s clinic, The Being Well Center, offers free resources for people working through the challenges of living with ADD, both on medication and off.  Don’t miss the BWC resources page for free downloads and ideas that could help you or a friend today!

ADD Medications Reduce Drug Addiction Rates

image via Flickr, Alan Cleaver

image via Flickr, Alan Cleaver

Can the use of ADD/ADHD medications lead to drug addiction?

ADD medications, with the exception of Strattera, are controlled substances that can potentially be abused. This can be a source of concern because we use them in ADD individuals who are at a significantly higher risk for the development of alcoholism and drug addiction.

Interestingly, research now shows that when individuals with ADD are properly diagnosed and treated with these medications, their risk for substance use disorders is reduced to that of the general population.

I have never had a patient become addicted to one of the stimulants nor am I aware of any reports in the medical literature of someone developing addiction to a medication prescribed therapeutically for ADD.

I have had a rare patient who abused his medication, sold his medication, or was intimidated into giving his medication to a friend who wanted to crush and snort it. I would have to say that I am somewhat skeptical about what kind of “high” someone really gets from what turns out to be relatively mild stimulants.

Furthermore, when used properly, individuals do not develop a tolerance for the medications that require them to take ever-increasing dosages in order to obtain the same beneficial effects.

In fact, once the optimal dose is determined, there are only a few conditions under which a dose may need to be increased:

  • When substantial weight gain occurs in a growing child or adult, an increased dose may be necessary.
  • Similarly, refined feedback from significant others, over time, may indicate the need for further fine-tuning of the dosage level.
  • Finally, if there is a significant jump in expectations necessitating a further degree of refined attention, then a dosage increase might be necessary.

Can people with addictive disorders take these medications safely?

image via Flickr, Blake Danger Bentley

image via Flickr, Blake Danger Bentley

Interestingly enough, I have taken care of many adolescent and adult alcoholics and drug addicts who have ADD and who might not have “hit bottom” had they been involved in comprehensive treatment that included ADD medication and strategies to improve self-awareness, self-control, and problem-solving at an earlier age.

I currently use all of these medications in treating ADD individuals who have co-morbid addictive disorders, provided they participate in frequent follow-up visits to monitor their medication use.

I also insist that they are involved in counseling and a 12-step program such as Alcoholics Anonymous, Narcotics Anonymous, and Overeaters Anonymous. This careful approach has been very successful in addressing a key component to the addictive disorders of my patients. For some of them, medication use seems to be a critical factor in their success in establishing and maintaining sobriety.

Stattera does not have any abuse potential. For this reason, since it has become available, I preferentially select it as the first line of treatment in ADD patients struggling with substance use disorders.

I would not, however, hesitate to switch to one of the stimulants if I was not achieving therapeutic efficacy with Strattera.

I have learned that when they are managed properly, stimulants can be effectively and safely used in patients with addictive disorders.


Want more insights you can trust on effective ADD/ADHD treatment?  Dr. Liden shares a deeper, more clinical examination of proper use and administration of ADD/ADHD Drugs in ADD Basics 301: Rationale for Clinically Necessary Off-Label Use of Stimulant Medications in the Treatment of Attention Deficit Disorder / Attention Deficit Hyperactivity Disorder (ADD/ADHD).  Currently available as a free download ebook!

Do ADD Medications Interfere with Growth?

image via Flickr, aussiegall

image via Flickr, aussiegall

At one time it was believed that stimulant medications, used for prolonged periods of time, could interfere with growth.

In fact, it was for this reason that some physicians began recommending “drug holidays” to allow for a period of catch up growth.

However, most scientific studies suggest that medications for ADD do not significantly impact on growth. In those that have shown some impact on growth, the magnitude of the change is actually miniscule.

I monitor height and weight every three months in all patients for whom I am prescribing medication. After treating thousands of patients over many years, I have yet to see the first patient where medication treatment for ADD could be blamed for an alteration in growth.

Actually, my observations of growth patterns in children and adolescents with ADD are in sync with recent research. Many children with ADD have a relative deceleration of their growth rate as they approach and enter into puberty and tend to experience their growth spurt at a later point in puberty compared to their non-ADD peers.

Depending upon the age when ADD medication is instituted, this “normal ADD growth pattern” should be taken into account when interpreting any changes in growth rate that might occur.


Don’t miss other answers to tricky questions about ADD/ADHD Medication!  Sign up to receive Dr. Liden’s latest blog posts by entering your email address at the top of this page.

Does ADD Medication Create Zombies?

image via Flickr, Sean Dreilinger

image via Flickr, Sean Dreilinger

Can ADD/ADHD medications make a person a “zombie”?

When used properly, ADD/ADHD medications do not have a tranquilizing effect.

However, with the use of medication, activity level in some children is reduced and they become more reflective; they sit back and reflect rather than go-go-go.

Some adults lay back more in social situations and spend more time listening rather than impulsively spilling their guts.

In addition, as ADD individuals become more attentive, they are able to be more focused and serious about whatever they happen to be doing – studying, cleaning, working, watching TV, playing a game.

In some ADD individuals, these changes can be dramatic.  In response to such a profound change, parents, spouses, friends and others may react by saying the ADD individual is too subdued, overly quiet, blunted, a “zombie” – when in reality, his behavior is now actually more appropriate.

In some circumstances, this new behavior pattern may have been the person’s basic nature all along, but had just been “hidden” by ADD.

In some sensitive and intense individuals, the increased awareness that comes with medication use can trigger overly intense responses to stresses that may contribute to heightened anxiety and precipitate withdrawal reactions in certain situations.


For other FAQs about ADD/ADHD medication, check out other posts from the Pay Attention! series.  If you’re ready to dig deeper into ADD medication and its proper use, you’ll want to download Dr. Liden’s free ebook, ADD Basics 301: Rationale for Clinically Necessary Off-Label Use of Stimulant Medications in the Treatment of Attention Deficit Disorder / Attention Deficit Hyperactivity Disorder (ADD/ADHD)

Did My Personality Change, or Did I Just Take ADD Medication?

image via Flickr, Wewiorka Wagner

image via Flickr, Wewiorka Wagner

Do ADD/ADHD medications cause personality changes?

It is not uncommon to see new and different behaviors in the individuals starting ADD/ADHD medications. However, ADD medications are not really mood altering or personality changing drugs.

Commonly, upon beginning medication, most individuals report feeling more aware of what is going on around them. As a result of this increased awareness, some people, understandably, become sad or depressed as they, for the first time, tune into the mess that ADD has caused in their lives: failure in school, social isolation, financial difficulty, marital problems, etc.

For some individuals, this new appreciation of reality can be overwhelming. Without effective problem-solving skills, they often have no mechanism to make things better. Without adequate support, feelings of sadness can intensify and turn into depression.

Hitting Bottom Motivates Change

It can be disconcerting to parents, teachers, spouses, and friends to watch from the sidelines while someone they love goes through this period of “being down.” It is important to keep in mind that this hitting bottom can be a source of motivation for change provided that parents, teachers, spouses, doctors, counselors, and others are supportive and provide guidance. 

The significant behavioral and personality changes that can accompany the use of these medications can be misinterpreted when we fail to appreciate the powerful impact of weak attention.

“Tuned Out” Masks True Personality

The untreated ADD individual often misses many of the things that cause most of us to respond emotionally. When he fails to show an outward response (because he has failed to tune into the event), we make assumptions about his temperament or personality. The possibility that he has not tuned into the event does not usually enter into the equation.

image via Flickr, Jim Larrison

image via Flickr, Jim Larrison

Enhanced awareness often uncovers temperamental characteristics that may have always been present in the ADD person.

For example, the seemingly outgoing, happy-go-lucky child may suddenly become subdued and fearful; the easy-going child may suddenly appear to be more strong-willed, and the insensitive spouse starts crying for no apparent reason.

Uncover the Underlying Traits

None of these changes represent alterations of personality, rather, the uncovering of underlying traits such as low threshold, high intensity of response, slow adaptability, or withdrawal response to new situations that were always there. Prior to medication, these life events and circumstances that provide opportunities to understand an individual’s personality went unnoticed.

Such effects of medications are sometimes mistakenly seen as negative side effects of medication and parents or the ADD individual may choose to discontinue the medication rather than take the opportunity to work on controlling these intrinsic temperamental traits.

 Switch Medications if Temperament Issues Persist

In some cases, the enhanced manifestation of these temperamental characteristics can be so profound that it interferes with the individual’s learning better self-control.

In such circumstances, I have found it is wise to switch to a different medication.

In my experience, this more frequently occurs with the stimulants. I have rarely felt it necessary to switch from the non-stimulant, Strattera, in response to a patient’s struggles with his temperament.

It suffices to say there can be great individual variability among individuals and medications when it comes to the apparent impact on personality.


Dr. Liden and The Being Well Center believe strongly in treating the Whole Person.  That means we believe there’s a lot more to dealing with ADD/ADHD than just getting the medication right.  You might find our post on Temperament helpful in providing more guidance on personality.  Or browse the various topics in our popular Pay Attention! series.  We’re here to help you untangle the tricky problems present with ADD/ADHD, one knot at a time.