You may have noticed that we've changed our name to EpiphanyClinic BC. Otherwise, everything else is the same. There will be, however, one important difference: EpiphanyClinic BC will be offering psychedelic-assisted psychotherapy starting in May 2023 at our previous location at Lonsdale Quay. You will be able to access this novel and effective means of managing difficult to access emotional challenges. It promises to be a game changer. Email us at info@northshoreADHD.com if you have questions while we are waiting for the website to be updated.
To whom it may concern,
The impact that EpiphanyClinic Vancouver has had on my life is inexpressible. When I came to see Dr. Ocana it felt like there were so many moving pieces. I didn't have the tools to communicate my needs. Anyways, he just cut right through all the static. It changed everything and set me on the path to --not just actualizing my potential-- but finding contentment within myself (I can't overstate the difference it makes to a confused kid, just having somebody on your side; someone to speak for you, when you aren’t able to speak for yourself)
It was a real turning point in my life. He made a difference. Sorry if it's a little cheesy, I just don't think I've ever properly thanked him.
The Overlapping Genetics of ADHD, Addiction and homelessness
ADHD is the most common neuro-developmental disorder in children. It is more heritable than eye color. It's more common than anxiety and bipolar disorder combined. At least 50% of those kids grow up to be adults with ADHD.
Sure, it's not caused by genetics, and yes, it's made worse by childhood trauma, but it's not caused by trauma.
Yes, trauma results in epigenetic changes, but the genetic predisposition has to be there. Epigenetics may determine whether a tomato is red or green, but it won't change a tomato into a red-pepper.
People who have ADHD are twice as likely to drop out of school, become parents in their teens, have their electricity cut off, get fired, go bankrupt. They are three times more likely to fail in relationships, get divorced or get injured in car accidents.
But the greatest injury of all, is the steady decline in self-esteem that accompanies repeated failure, despite their best effort. That's a catastrophe.
Low self esteem is the common denominator in homelessness and I've a assessed a lot of homeless and hopelessly addicted people. ADHD is a factor. I don't know the exact numbers, but it's a lot.
ADHD is not a religion that you have to "believe" in. A physician saying they don't believe in ADHD is like a cardiologist saying they don't believe in diabetes.
Decreased perfusion in the pre-frontal cortex. It's not just a neurological difference, it's a neurological disadvantage in every aspect of work, daily life and communication.
On the topic of substances... since I have started treating my ADHD, I have been able to deal with things that have been piling up for the last 5 years or more. It's been very liberating.
This medical intervention has also changed the way I approach music. I have clarity, because I'm not stoned or drunk, which has allowed me to play at a completely different level...the best shows of my life, actually. The experience is overwhelming.
Artists, as you know, are prone to self sabotage. I am getting a lot of praise and I'm not used to it. So, last night I reached for the bottle again. It's a bad habit. But I have to say, it was largely unsatisfying.
I know it's a bit of a long answer, but I guess I'm prone to that.
The Overlapping Neurobiology of ADHD and Addiction
Decreased perfusion in the pre-frontal cortex
Addiction, like ADHD is marked by decreased dopamine neurotransmission in the circuits that govern cognition, executive function, motor control, impulsivity and reward.
In people with severe addictions: the voltage in their dopamine circuits is lower at baseline, and they fluctuate more, compared to people without addiction challenges.
In other words, people with severe addiction, feel worse when they don't use, basically all the time. Then when they use substances, they feel good, too good. Once you get used to that, it's hard to go back.
Their dopamine voltage does not just rise and fall gently, it spikes and crashes. It is this instability in dopamine transmission that remains, even in recovery.
When your dopamine crashes, it feels really bad. You want to do something, anything, to equilibrate. We all do this. We do it all the time. The difference in people with dependency issues is that their coping tools are more limited.
Mother nature designed us to correlate natural dopamine-raising behaviors like sex, socializing and eating with survival. The bad news is that drugs and alcohol also raise dopamine, faster and higher than normal rewards, so your brain correlates drugs with survival. Tell a person with a heroin addiction that they should quit and they'll look at you like you just told them to jump off a bridge.
When you take dopamine away, suddenly from a person who is addicted it feels, literally, like they are dying.
If you've ever seen someone in full opiate detox, you'll know what I mean. That is why people with substance addictions who find recovery, often do so, by trading drugs or alcohol for another substance or addictive behavior like sex, smoking, gambling, shopping or eating.
ADHD, like Addiction, manifests as impulsive behavior. People. with severe addictions may also have ADHD. In the residential facilities addiction facilities where I have worked, I have found that more than 70% of those inpatients also meet strict criteria for ADHD. If you look at people with methamphetamine addiction, that number goes up to 95%. That is astonishing.
Therefore, if a person with addiction also has ADHD, not only will they suffer from their dependency, but they also show symptoms of poor concentration, disorganization, impulsivity and hyperactivity. Of note, these will persist even in recovery. It's not persistent post-withdrawal syndrome; it's co-morbid, untreated ADHD.
Treating my ADHD... again
Hello EpiphanyClinic Vancouver,
As I sit here at my desk with a coffee on a rainy day, I'm reflecting on all that has transpired in the last 6 months: I finally decided to treat my ADHD, again, and I wanted to share the changes I have noticed.
I can manage my efforts better at work. I am meeting my deadlines. When I need more time, I ask for it, instead of being late.
Things are more orderly at home. When it does get messy. I don't obsess about it. I dont feel bad about it.
My moods are not so extreme. There are no more huge-highs, or low-lows. I feel like normal people. I can feel sad without feeling depressed. And, I am sleeping really well, which is weird for me.
I wasn't taking care of myself. On what planet would someone not fix their teeth. You were the only one who called me on it. I guess you don't know what you dont know, until you feel better.
My dad passed away recently. During his illness, I realized that my mom and I had always had this painful dynamic. Now we spent the week together in the hsopital and we didn't clash. I did not get triggered by what she would say. That would not have happened before I started seeing you again. There is no way.
Last year, my partner and I had split and were living apart. Since I restarted my medication, we saw a counselor and now we are moving back in together. That is the other place where I used to explode. Now, I can ask for what I need, without blowing up and scaring the shit out of him.
My diet Is better. I make sure, I eat so I don't have the side-effects that I used to have.
My fitness took a nose dive since COVID. But I'm walking, at least. It should be better, but I don't beat myself up anymore. It is what is is.
After you retired in 2019, I went off all my medication and I got to feel all my problems. Now you're back. I'm back too.
ADHD, Addiction and Compulsive Behavior
Addiction to substances like cocaine and heroin, are governed by the same neurobiology as compulsive gambling, gaming, shopping, sex, status and risk taking. Behind all these, is the quest for dopamine.
The feelings and emotions associated with dopamine became, through natural selection, the signal that a behavior was associated with survival.
That's why people with the most severe addictions would do anything, even kill themselves for dopamine.
Therefore you can't treat ADHD or Addiction or Compulsive behaviours until you stabilize their circuits, helping craving and withdrawal recede, and allowing them to better regulate their emotions and themselves.
That is why treating people to regulate themselves works. Whether it's meditation, contemplation, psychotherapy, hugs, group support or medication. Whatever it takes.
The first month follow-up
Hi Dr. O, This my first follow-up visit and I wanted to let you know how much better I feel.
The meds are working super-great. Things got better with each higher dose. My work became more consistent and my side effects got less. My sleep was a bit off for the first week, but it's back to normal now.
I was able to focus on tasks. I am retaining information. I am able to be more organized. I did my taxes for Christ's sake. I have not done them in 2 years.
My mood is better. I am a lot more self-confident, less depressed, which is really crazy, by taking medication for ADHD. There's obviously a lot more to it than that. But seriously, I feel better now than with any anti-depressant.
I still struggle with spending. It's better, but I still slipped a few times. The feelings afterward used to overwhelm me: self-deprecation, doubt and shame. They are not gone, but my thoughts are not as intrusive. I can filter them out.
I did not realize how life-changing this could be. Now, I see what I am capable of, as opposed to feeling like it's not even worth trying.
The fog is nearly gone, I feel awake during the day, not as tired in the afternoon. I am so much more motivated, it is almost unrecognizable. I am waking up at 7 am and it feels really great, then I go for a walk and I feel even better.
I am planning to go back to school. I am planning for the future. Really, it's been like night and day.