May I tell you about 'Lise-Lott'? Her childhood was marked by poverty, with a mother who had long lived in chaos and addiction. The stepfather molested her from the time she was ten. She first got drunk when she was twelve, took amphetamines when she was fifteen, and injected heroin before she was twenty.
She doesn't remember how many times she sold sex to get drugs, or how many times she was raped. Sometimes, she says, the line is fluid.
Lise-Lott finally received evidence-based treatment, paired with human consideration. She started with the drug buprenorphine, recommended by the National Board of Health and Welfare because it suppresses heroin addiction, protects against overdoses and greatly reduces mortality. But she repeatedly missed the reception visits. Life continued to be chaotic. Efforts from social services and healthcare were in vain.
After that, she said, the buzzing she always had in her head stopped. She stopped missing appointments
Finally, an experienced doctor could see that Lise-Lott showed pronounced signs of ADHD. She received drug treatment. After that, she said, the buzzing she always had in her head stopped. She stopped missing appointments. Addiction treatment began to work, and one could switch to monthly depot injections. She got housing< and arranged work herself.
But after a while, Lise-Lott had to change reception. Here she was told that ADHD is mostly a myth, that the effects of the drugs are questionable, and that there are better ways to deal with their problems. Here you had to stop taking ADHD medication in order to receive your addiction treatment.
It took less than six weeks before Lise-Lott missed her injection. After that she relapsed, and was soon back on the street. One night she was brutally raped by an intended customer. Whether the overdose that followed was intentional or an accident is difficult to know. In the intensive care unit, it was uncertain whether she would survive. But she did.
Now she has changed reception. She is once again on ADHD medication, hasn't missed an appointment in a long time, and is thinking about starting to read in high school qualifications.
I don't usually base conclusions on single patient cases. But recently, a number of debaters have presented the ADHD diagnosis as almost arbitrary, and treatment with drugs as wrong. Therefore, it is important to tell people who are affected what this can be about. Most of the time, of course, it is not as dramatic as for Lise-Lott. But having a schooling disrupted, having an accident or being drawn into crime is bad enough for a young person.
The patient story illustrates a state of knowledge that is relatively clear. Well-done studies published in leading scientific journals have time and again shown the same thing.
● First: Individual differences in the risk of developing pronounced and persistent difficulties with concentration and executive functions – to plan, execute, and evaluate – are caused to about 75 percent by genetic factors. Even there, of course, the oft-repeated thesis that ADHD is an arbitrary label falls apart. Studies cannot find a genetic risk for something that does not exist, or that only varies in a situational way. For genetic influence to be measurable at all, there must be a way in which the individual functions that is reasonably stable over time.
Research has also shown that treatment reduces self-harm, accidents and crime
● Second: The research clearly shows the beneficial effects of drug treatment in ADHD. Contrary to what is often said, the effects of treatment are not just short-term either. When people who had been treated for more than two years were randomly assigned to switch to placebo or continue, without either patients or therapists being told who was in which group, the placebo group did significantly worse. Swedish, internationally recognized research has also shown that the treatment reduces total mortality by approximately 20 percent. Lise-Lott is not alone: For her and many others, these can be matters of life and death. Research has also shown that treatment reduces self-harm, accidents and crime.
● Third: Both on a genetic and clinical level, there is a strong connection between ADHD and addictive disorders. The research clearly shows that drug treatment of ADHD in patients with such co-morbidity significantly improves the patients' chances of successful addiction treatment. However, these patients require treatment with higher doses of drugs.
There is a legitimate and important debate about the quality of the diagnosis that underlies treatment decisions, and where it is reasonable to draw the line before treating. I and most of my colleagues welcome such a discussion. Mats Adler, who led the work on guidelines for psychiatric diagnostics for the Swedish Psychiatric Association, has recently written wisely about this (SvD 30/8). That discussion is not fundamentally different from when we discuss diagnostics and treatment of high blood pressure or diabetes. Of course, the cure must not be worse than the soot.
There is a lot of overdiagnosis of ADHD that needs to be tightened up. An investigation industry that does not take a treatment responsibility creates problems. At the same time, there are challenges in addressing these issues without leaving high-need patients without help. So here is reason for reflection.
Argumentation of this kind would never be given space in the media if it was about vaccine resistance
Unfortunately, that is not the discussion being had. Instead, much media space is given to radical messages based on opinion rather than science. In SVT's Skavlan (1/10), for example, we heard from Uppsala doctor Johan Bengtsson that ADHD does not explain anything, that ADHD cannot be inherited, and that the dominant reason for treatment is that the pharmaceutical industry wants to make money. Similar messages have been repeated in a large number of newspaper articles from Bengtsson and others. It may sound like words of wisdom, but it simply goes against the international state of knowledge.
Argumentation of this kind would never be given space in the media if it was about vaccine resistance. We do not usually determine what is evidence-based treatment through debates in the media. The question is why psychiatric patients should not have the same right to treatment according to science and proven experience as other patient groups.
Footnote: Lise-Lott is actually called something else. Details have been changed to prevent identification.
Read more articles from DN Debatt:
Chief physician Linda van Paaschen: "As a young person today, I would have received free amphetamines"
