Dr. Joshua Masino, PSY.D.

First and foremost, I applaud you for reaching out to address this medical condition. Yes, it is a medical condition for which the treatment has evolved in the last decade. At the present time, addiction psychiatrists have the ability to prescribe medication that reduce the cravings that lead to the strong desire to continuing using that are the result of changes to the structure of the brain.

As a neuropsychologist, I identify the cognitive, behavioral, and emotional factors that have maintained the use the of substance. Secondary to a neuropsychological evaluation, I am able to work with the psychiatrist and clinical team to provide an individualized plan of care for each patient. For example, did you know that changes to the prefrontal cortex actually make it more difficult to stop using a substance independent of one's desire to do so? Once I have identified what areas are not functioning as well, then we use empirically based strategies to mitigate the likelihood of relapse as your brain heals, which it will!

As Russell Barkley said, "ADHD is a not a disorder of knowing what to do. It's a disorder of doing what you know." As an adjunct to medication, psychologist may help your daughter disengage from the present to see beyond it. First, a therapist can acknowledge and normalize your daughter's struggles caused by ADHD. Also, it is important for your daughter to learn that ADHD is a part of who she is, but not all of she is. More specifically, while it may affect how she lives her life, it doesn't rule her life. Also, she can improve her functioning by building skills. Finally, she can develop resilience, in that, she can learn to actively and directly address a problem after a setback, without become emotionally overwhelmed.

Good morning and thank you for reaching out. Like any chronic medical condition, the goal of substance abuse treatment is to keep it managed, which allows the brain to heal and opens up your life. May it be managed without medication? Yes, but research has indicated that the combination of medication and individual therapy significantly increases the likelihood of achieving and sustaining abstinence.

The safety and effectiveness of ADHD medication has been demonstrated in thousands of studies. Medication will improve her response inhibition, which will permit her executive functions to be applied more effectively. In essence, medication closes the gap between intentions and actions.

Extended release forms of stimulants are preferred, because they offer full day coverage with smoother blood levels. It also eliminates unintentional non-compliances from forgotten midday dose. If necessary, the coverage window may be extended with a small afternoon dose of the short-acting version. I'd recommend that she start with whatever extended-release version is cheapest.

If she has severe cardiac issues, insufficiently managed bipolar disorder, seizures, tics, or glaucoma, non-stimulants would be the second option, with a preference for Strattera that also has a positive effect on anxiety, if present. It will take her longer to benefit from a non-stimulant, which can provide 24/7 coverage.