November 17, 2025 • 48 mins
When ADHD goes undiagnosed, the line between coping and addiction can blur fast. In this candid conversation, Christina and her guest, psychotherapist Kathleen Killen, both therapists, explore how late ADHD diagnosis can reshape the story of substance use, recovery, and self-understanding. Together, they unpack the grief of missed years, the fear of taking stimulants in sobriety, and the ongoing work of emotional regulation and healing.
This episode is a grounded look at what “real recovery” means when ADHD is part of the picture.
Resources for After the Show:
Learn more about ADHD and Substance Use: The ADHD Resource Hub/Substance Use
About our Guest: Kathleen Killen is a Registered Psychotherapist, and the founder of Kathleen Killen Psychotherapy. As a relationship therapist, she works with both individuals and couples who are navigating disconnection, conflict, or patterns that feel hard to break. Her work focuses on helping people build healthier, more authentic relationships—whether with a partner or with themselves.
Find Kathleen: Sisters in Sobriety | @coupleswithkathleen (Instagram and YouTube)
Find Christina (CRPO #3908): Website | Find an ADHD Therapist | Instagram | Get an ADHD Assessment and Treatment
A gentle reminder that this is not therapy, and Christina is not your therapist. If you would appreciate one on one support or treatment, please check out the links posted above or our Resources page on our website.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:11):
Hello everybody, welcome to the Christina Crow Podcast where we
connect the dots and search for more balanced mental health.
I'm your host psychotherapist, Christina Crowe, and today I am
talking to Kathleen Killen aboutnew research we found shedding
light on women with ADHD's experiences with substance use
(00:33):
and substance use disorders. Kathleen Killen is a registered
psychotherapist and the founder of Kathleen Killen
Psychotherapy. As a relationship therapist, she
works with both individuals and couples who are navigating
disconnection, conflict, or patterns that feel hard to
break. Her work focuses on helping
people build healthier, more authentic relationships, whether
(00:54):
with a partner or themselves. Outside of the therapy room.
Kathleen Co host Sisters and Sobriety, a podcast centered on
exploring sobriety through healing, connection, and growth.
She also shares relationship tools and insights on her
YouTube channel, offering accessible resources for people
who want to better understand themselves and their
relationships. As a parent, partner, and nature
(01:17):
lover, Kathleen knows that relationships are both beautiful
and complex. Whether she's working with
clients or speaking behind the mic, she's passionate about
helping people feel more connected, more understood, and
more aligned in their relationships.
Welcome to the show, Kathleen. Thank you so much.
I'm so happy to be. Here, That's very cool.
So I read a paper and then I immediately thought of you,
(01:40):
messaged you and said, hey, let's talk about this on the
podcast. And he said yes.
So here we are. Here we are.
And then I read the paper. Send me the paper you wrote.
Yeah, I'm really glad you sent this to me, though.
I mean, I guess we'll talk a little bit about it, but was
anything shocking to you? It wasn't so much to me, but
maybe it's because of the lived experience I have.
(02:02):
We both have ADHD which we talked.
About SO. It's OK to say that.
Yeah, totally. I think we were both late
diagnosed too. I was not diagnosed till I was
3839. OK, seeking.
Suspicion and then probably formally I was 40 or 41.
I was 42 when I was formally diagnosed and those.
Years. Yeah, no idea.
(02:23):
Before I had. No idea, no idea at all.
So like not even a hankering. So I, I try to remind myself,
like when we're a therapist working in this space, years and
years and years. Like it's a decade for me.
It's quite a while for you. Plus there's lived experience of
living with undiagnosed ADHD, the life you had before.
(02:43):
You know what you know Now the one thing is that I think I
forget what it was like before Iknew all the things.
And I also forget what definitions of things are for
non therapists sometimes. So when I say substance use
personally, I'm not just talkingabout drugs and alcohol.
I'm talking about sex, drugs, rock'n'roll, shopping, potato
(03:07):
chips, porn, everything, everything under the the sun
that you could get dopamine hitsoff, including conflict seeking
behavior and then and then because that's what shows up in
the session room. But luckily, there's a lot of
research now on and new ways of understanding the mechanisms of
(03:28):
substance use, like the pathwaysin the brain connected to an
ADHD brain, right? And we talked about that when I
came on your podcast, which was a lot of fun.
And then the research sticks to drugs and alcohol usually.
And then is there anything that's striking to what's
striking to me? Is it it tends to center on men?
(03:53):
Yes, generally it does. Yeah, like when you think about
ADHD and substance use disorder,who pops into your mind?
Well, me now to be honest, not to be super self-centered about
it, but when I was diagnosed with ADHD, I was also diagnosed
with substance use disorder and that was a huge shocker to me.
(04:14):
Huge. That was like a mic drop moment
because I never, it never occurred to me that I had
substance use disorder. It maybe occurred to me that I
had a problematic use of things and I'm saying things I it
occurred to me that I had a problematic use Once Upon a time
(04:37):
with cocaine, which we can get more into why that particularly.
Yeah, it's probably been used todifferentiate.
That we need to differentiate that one and definitely had a
problematic use with alcohol, but never would have considered
it. And I really appreciate that you
just said, you know, when you define substance use disorder,
it's all the other things. Because I would still say I
(04:59):
struggle with food, with with food.
I still do. So yeah, I never really, first
of all, when I was diagnosed with ADHDI understood it to a
point of like where a general therapist would understand ADHD.
I understand it much more now, obviously, but I didn't know the
link. And then once I saw, once I was
(05:22):
told, it became much more clear to me.
Oh, right. That's why it became a problem
for me. I think you're right.
What you mentioned, we often look at men in research.
It's still all research is generally skewed to men still.
But what was surprising to me isthat I was very high functioning
(05:44):
and a lot of the clients I see and potentially you might see
are high functioning. They're getting through life
ish, but then there are other things happening.
There's anxiety, there's substance use and really there's
a root there, which is the ADHD that's not been diagnosed or
seen, especially in women. Thank you for sharing that
(06:07):
because I also think as a old Gen.
Xer, I also see like generational trends in my
clients attitudes towards recreational drug use or
drinking, right? That I think is just really
interesting. So I don't know if it's a
function of me being inattentivein my teen years or 20s, but I
(06:30):
don't feel like I knew people that just dabbled in cocaine on
the weekend, right? But I feel like that's a
completely like nobody would batan eye at that these days,
especially in certain careers. Well, that's the thing.
Yeah. And so we can talk about what we
think those might be or what youprobably know those are.
So I think our attitudes around it have changed.
(06:53):
But in talking to my clients, I don't have my own experience
with cocaine, but I really get into it with people because I
want to know what do you get outof it?
What is it like? And, and the way people with
ADHD talk about the benefit I'm doing her quotes and the moment
of coke or cannabis, for example, is really different
(07:15):
than the wave Fickles do. And in cannabis in particular,
to a certain point, people feel normal when they take it.
And then there's a place where you cross that line and it's you
get into the not good stuff. So that always suggests to me,
if someone doesn't know they have ADHD, Oh, there's something
brain driven here. Like my first, my first instinct
(07:37):
is not, it's trauma. You've got a willpower problem.
You've got all this stuff. I'm like, have you ever had ADHD
ruled out? Because if you haven't had it
ruled out, we got to do that. It's easy to do.
Let's just do it because then atleast boom, that's out of the
way. And then I know how to change my
treatment approach based on thatMy, my therapeutic approach will
(07:59):
be completely different for somebody with ADHD versus
somebody without, right? 100% and gosh we're so much more
ADHD informed now I think. But I mean, I've seen several
therapists. What was us?
I feel you guys out there. We know.
We I had, but not one of them had ever.
(08:20):
Ever. Did they ask you point blank
about recreational drug use? Oh, yes, they asked me point
blank about recreational drug. I I'm sure I lied.
I'm sure I lied because of fear of the legalities of it at some
point. But I was in my 20s when I was a
heavy or cocaine user. I was definitely seeing a
(08:41):
therapist. But what you just said,
Christina, my friends would be dancing on tables and I was
cool, calm, clear, totally regulated in my.
Brain My exam now in the bar. Oh yeah, 100%.
That's one of the reasons why I used it is because I was able to
(09:01):
regulate be calm, cool and. The downside of that was.
Well, the downside of it was I didn't feel great the next day.
The downside was that I had lotsof heart palpitations.
The downside was that I became dependent on it to be able to
(09:24):
focus and regulate. And you need increasing amounts,
right? The physiological dependency is
that you need more and more and more to achieve the same end.
Was for me, yeah. Yeah, and to be clear, that
doesn't happen with prescriptionmedication to treat ADHD.
In fact, that's what allows you to stay sober.
(09:44):
Correct. That's right.
And it was a concern of mine even being a therapist when I
was diagnosed with ADHD and substance use disorder.
And then they were like, OK, nowyou need, you know, we're
suggesting you go on a stimulant.
I was like, no way. I'm no way.
I am sober from drugs and alcohol and have been for many
years. So I was like no way am I
(10:05):
risking that but I had to go down a path of learning more
about it and I even still to this day will question should I
go off of my medication? No.
Should you go? Ahead water because you're mad
that we depend on. It every day, right?
But it's for me, it's not about I just sometimes will be like,
(10:25):
oh, does it mean I'm not sober anymore?
But obviously, no, it actually helps me stay sober.
That's right. It helps me.
Yeah, yeah. That's right.
I mean, I think and its core ADHD is like a medical situation
that if it's not treated properly, turns into a
psychological problem. Agreed.
Right. So if you start with the
beginning, it's like the, the closest analogy to other
(10:49):
conditions is diabetes, like type 1 diabetes.
Like you're born. I say my clients are probably
rolling their eyes cause they'veheard me say this a million
times. But you know, you're born, your
pancreas is pooched. It's not, you know, producing
the insulin that it needs to produce at the rate of the time
that it does. And so we don't have to like
freak out or we just replace that insulin and off you go.
(11:11):
You still have to wear sunscreenand not smoke and, you know,
look both ways before you cross the street and be active.
And all the things that all people have to do to be healthy.
And, and we don't demonize you or stigmatize you and all the
people around you because you were born with a pancreas that
doesn't make the insulin that itneeds to organically.
(11:34):
And, and similarly, I mean, withADHD, not it can get
oversimplified a lot to just like a dopamine, It's not just a
dopamine situation. It's like dopamine,
norepinephrine, serotonin, GABA,it's all of those things.
It's functional, it's structuraland neurotransmitter and all
those ways that can intersect. But at its core, we've got
(11:55):
deficiencies in either how much dopamine we make for example, or
how much we use and keep of whatwe are already organically
making. And so the medication targets
those in various ways. And when that happens early
enough, what you see from the long term trials is it
completely changes the trajectory of someone's course
(12:18):
of ADHD. Had they gone a lifetime
untreated and and all the risks that come with that.
Because I think for me, the first stat when I was learning
about all the stuff that just stopped me in my tracks was
something along the lines of thethe general, the Gen. pop rate
of addiction is like 12 to 13% for everybody in the world, all
(12:42):
things considered. For people with untreated ADHD,
it's like 60%. Holy shit.
And and of course, I know peoplein my life that I love and adore
that I've watched struggle so hard to stay sober in all
different ways. And they are 100% people with
(13:02):
ADHD that never got diagnosed askids and they're still not
treated properly and they had togo through hell to get
diagnosed. And even if they do get sort of
started treating exactly what you said, they want to stay at a
low dose because they're worriedthat titrating up to target
their symptoms means they need more or they're using because
(13:23):
that stigma is around even getting to the optimal dose of
your medication. But the delta between the low
dose they're at and the ADHD symptoms that are ratcheting up
is like such a battle for them to face because you're trying to
like, use willpower on a biological problem.
It's totally. And that also like relates
(13:45):
strongly to the substance use disorders, right?
Like it's not just the brain chemistry that's going on like
it is, but it's also coming out in behavioral.
For example, I had an issue withimpulsivity.
Well, what would I do when I wasimpulsive?
Like I would use drugs and alcohol.
I would also make other really poor decisions in my life.
But my impulsivity, the medication helps me with my
(14:08):
impulsivity, which would therefore help me with any
substance use. Yeah, and I always think it
comes back to the three. It's so funny on social media,
there's like 87 things that people are like, oh, I didn't
know this is because people withADHD and I'm like, OK, there's
like infinite variations of how impulsivity, hyperactivity,
(14:28):
internalized or not, and inattention show up in your
life. Those 3 core symptoms show up in
a bazillion ways. So yes, there will be a lot of
things people have in common with other people, but it's
important to trace back to thoseone of those three and to figure
out what am I trying to target here?
(14:50):
Like what's tying my shoelaces together?
Work gets the best of me, my clients get the best of me, my
colleagues get the best of me. I come home and I'm a shit to my
family. I'm like, that sucks.
This isn't good. Right.
Yeah. So even therapists have this
problem. They sure do, but.
Then I'm kind of like, OK, what's my problem?
(15:11):
Is it an attention? Like I don't know what I'm
walking into? I walk into the same thing every
night for some reason. It's a shock every day.
Why am I not addressing this problem?
Or is it impulsivity? Or is it just my wheels are
spinning in my head and I don't know how to calm myself down.
My meds have worn off. I don't have the executive
function to find myself a quiet corner for a minute.
(15:31):
You know what I mean? Knowing those things is really
important. And then I find the evening time
is when women have a lot of strain on them and they've lost
the benefit of the medication coverage they had during the
day. So then the whole like, wine
o'clock culture. Having a glass of wine with
dinner when you're making it, putting yourself to bed with a
(15:54):
glass of wine, all that stuff islike socially accepted.
Yes, very much so. And before you know it, boom.
You're. Middle-aged and totally
dependent, right? Yeah, And I think like, you
know, my Co host Sonia and I talk about this on our podcast a
lot. You know, problematic drinking
(16:14):
doesn't mean you're fall down drunk five days, six days, seven
days a week at all. Not not even close.
And it can slowly creep up. It can.
And so you're right, Christina, I think that medications wearing
off your executive function is not necessarily where it it
would need to be to do all the things when you get home.
(16:35):
The acceptance of wine, o'clock and mommy's, you know, little
helper type drink. It can just and you know, it
happens. It can happen with not just
alcohol. And like I when we started
talking at the top of this podcast, I still struggle with
food, with with substance use. Yeah, I'll take a bag of potato
(16:56):
chips over a glass of wine any day.
Me too. Because it's accessible.
It's right there. I didn't grow up with parents
that drank a lot, but we sure enjoyed our meals to.
Me, it's sugar, but I still haveto put the same practices in
place that I did with drugs and alcohol in a sense, to other
things. And I have to just be aware of
(17:16):
it. And I am then aware, oh, my
medication is wearing off. I have less ability right now to
say no to the sugar, so I have to do other things in order to
not do that. Yeah, and set those things up in
your on medication hours. Exactly.
So you have the structure and the routine to protect you.
Routine protects people with a DHDA lot and asking other people
(17:39):
to help and all there's all kinds of, there's medication
strategies too to help for the evening more.
But I think there's so much morewe have to do.
And then the complications of the relational stuff pull in.
So for any women that are listening to this and they're
like, oh, like this is me, right?
What could anyone have said to you back then that would have
(18:02):
made a difference at different points?
I had a friend tell me in my 20sthat she didn't think my cocaine
use was healthy. Yay friend.
Yay friend. That's a good friend for me to
die though. No, but I remembered it.
I thought about it. I think that for me, I don't
(18:24):
think there was anything anyone could have said.
It was I had to just do. Like I had to feel my life
without drugs and alcohol to seein a way how much clearer I was,
even though I was quite clear when I was using cocaine.
But I needed to feel the difference in my body and yeah.
(18:44):
It's nice to have a 12 hour duration of action.
Well, 100% it is. It is.
But the other piece I really learned, like I learned my about
my ADHD because of a client actually, because it was I was a
coach before I was a therapist. And one of my first coaching
(19:06):
clients came to me and said, oh,my therapist, I was just
diagnosed with ADHD. And in my mind I was like, what?
How can this be? This person is so much like me.
This is in my mind. And I was like, what?
And that's when I started looking at it.
And I think so. I think really, it's like I had
the openness to just see myself.I had the openness.
(19:30):
And I also would have never saidthat I had a substance use
disorder until I was diagnosed. But then when I started hearing
other women's stories, especially other women's stories
with ADHD, I was like, oh, my goodness, this is me.
Yeah. It's neat to see.
So we just attended Kadra, the big ADHD medical conference out
(19:53):
in Vancouver a couple weeks ago.And every year there's more and
more research that's differentiating the experience
of women and men. The researchers were doing
amazing jobs in going backwards through data, retrospectively
designing trials, looking forward that really help get a
better handle on the experience of girls and women for sure.
(20:15):
And, and so the, the one paper that I, the paper that I shared
with you, I'll link it in the show notes.
It's called. Prevalence of substance use
disorder in individuals with ADHD, associations with sex and
psychiatric comorbidity. So we're looking at are there
comorbidities, meaning other conditions that go with ADHD
(20:36):
that you're more vulnerable to whether you're male or female,
basically, right. And so to walk people through
this paper, they examined, I think the total was over 31,000
men and over almost 19,000 women.
And then they compared that to people without ADHD, like over
(20:58):
380,000 and over 306. So these are huge, huge
registries that they're pulling data from, right?
It's a registry review. So one of the things that they
found that I wrote down from part of the paper was that when
people get treated with psychostimulant medication
(21:19):
specifically indicated for ADHD as prescribed to you by an ADHD
treating physician or nurse practitioner, that that's
associated with beneficial effects that include reducing
the risks of suicidal behaviors.It reduces substance misuse, it
reduces transport accidents, single car accidents, death by
(21:42):
misadventure, criminality and accidental injuries.
So that's that's a pretty big deal.
It's a really big deal. Yeah.
Yeah, it's it's a really big deal.
I might be a bit more careful with cocaine use disorder, but
it it doesn't scare me because of this one paper, I think we
(22:02):
talked about it last time that Ialso found that says that
cocaine use disorder actually predicts for better outcomes in
people with ADHD. If you're going to use Liz
dexamphetamine, which is super cool to see something like that.
So that made me not sweat it andjust be, you know, pay attention
very carefully to all the thingsI need to pay attention to.
But with cannabis in particular,what I tend to find is as people
(22:27):
titrate up to an effective dose where they feel like more of
themselves, there's no numbing. You're past the point of
annoying side effects. And you found like a humming
dose that you get what you need out of it and you feel good.
Like you don't feel like your shoelaces are tied together
anymore. Right as you get to that
(22:48):
targeted dose, the drive or the craving, the things that drove
you to go drug seek or find stuff or food seek before go
away. Whatever's leftover is the stuff
I can address behaviorally. Psychosocial interventions,
therapy, new patterns, relational support structure.
(23:11):
But everything below that was all brain function driven.
And I know what that feeds feelslike for food.
And I can imagine I was like a pretty cheeky cigarette.
Bummer back in my day. Yeah, me too back.
At pub I was bombing smokes off people, so I know the joy of the
(23:33):
inhalation of a cigarette. Like a old fashioned cigarette.
Doesn't matter if it's -40 I viscerally remember what that
feels like. Yes.
Obviously I didn't know I had ADHD back then, so I get why
people like smoking. Anyone who's still smoking
dudes, you please go get screened.
You're the people left that we're still looking for, I would
say. But do you remember what it was
(23:57):
like? Because it sounds like you got
sober 1st and then tried Vyvanse.
Yeah, not even Vyvanse, But yes,I got sober when I was around 30
and it was sort of an unintentional rehab.
So I didn't know I had a substance use disorder.
And I had signed myself up to doa yoga teacher training for a
(24:19):
month in Mexico. And the night before I left, I
was leaving really early in the morning.
I went out partying, did a ton of cocaine, was supposed to be
treating my body like a temple, but did not, and got on a plane
without cocaine and went to Mexico and then was not allowed
(24:41):
sugar, drugs, alcohol, any substance of any kind when I was
there. I.
Can only imagine how uncomfortable that was.
I was not well my first week. I was not well.
I wanted to leave. I was going to leave and then
something in me told me just stay.
(25:02):
I was doing yoga and meditating 8 hours a day.
And I, I get, I get what I'm saying is like from a place of
privilege, like I, I get that. But I, I really hadn't felt what
it was like to be without something, some substance
probably in since I was a teenager because I smoked,
(25:23):
drank, did all those things and ate tons of sugar, all of that.
And so for the first time in a very, very long time, my body
didn't have any of that. And I couldn't believe the
difference. And I came home and I never
touched cocaine again. Wow, that's not necessarily a
typical story. I still drank occasionally and
(25:45):
then I stopped drinking alcohol as well.
But it was only a decade later that I was prescribed Vyvanse
first, Which? Wasn't good for me.
I did. I did white knuckled it.
I white knuckled it through and then found I, I was eventually
put on Concerta and that's what has been amazing and life
(26:10):
changing for me. But you know.
How hard was the white knucklingpart?
Because some people, they love the white knuckle.
They're like, no, I'm doing it this way.
And I'm like, dude, life is hard.
It doesn't have to be this hard.Like why are you doing this to
yourself? Well, I didn't know I had ADHD.
Right. So I didn't know for another
decade that I had ADHD and I hada failed marriage, not just
(26:32):
because of those symptoms, but definitely they contributed.
Yeah, I did well in my work, very well in my work, but at a
great cost to my mind and body. Relationships aren't
one-size-fits-all, especially when ADHD, mixed neurotypes, and
(26:55):
different communication styles are part of the picture.
I dig a little deeper. Are trained couples therapists
help you and your partner move from frustration to
understanding, using practical tools that you can use right
away? Whether you're struggling to
reconnect or just want to strengthen your bond, we're here
to help. Book a consult with one of our
(27:15):
couples therapists at Dig a Little deeper.ca.
Did your doctor feel bad that they didn't catch it?
My doctor still didn't catch it.Yeah, jeez, man.
My doctor still didn't catch it.I'm the one who pursued A
diagnosis and I went to my doctor to get a referral, but
(27:39):
that was it. And I went to a big fancy clinic
because it wasn't that accessible, to be honest at that
time. Yeah, I know, 10 years ago
things were still pretty old school.
Yeah. And then I was diagnosed with
combined type ADHD and everything made I oh gosh, the
grief that I felt, which I thinkis pretty common.
(28:00):
Tell me what that was like. Like from where you were at that
point? I felt such grief that I didn't
know before because I felt like,wow, so much of my life maybe
could have been different. That was a real process for me
to get through, to come to termswith that grief and and the
(28:22):
grief and then the gratitude that I am diagnosed, that I have
treatment, that I've been able to learn Now in my practice.
I'm a relationship therapist butI am like a hawk for ADHD and
relationships. I don't know what you think.
Like I find it so easy to spot between couples.
Me too. And there's like mixed neurotype
(28:43):
relationships. Often what I see is one person
knows they have ADHD and the other person's pretty sure they
don't have it. And I'm like, uh huh, OK, we'll
see, right? Because we know that that people
with similar neurotypes are for sure attracted to each other.
They just present differently right And then and it and it's
hard because the person with ADHD comes to couples therapy
(29:05):
with the message that they're the problem.
Yes. They're the one that's ruining
everything. And the other part is just like,
just fix this, man. Like I want to get back to who
we were, blah, blah, blah. And it's a very common thing.
And then it takes a really different turn sometimes.
And I think being able to what, what I love about working with
(29:25):
ADHD couples is that I love, I don't know if it's like this for
you, but I, I can easily feel into the relational dynamic and
the deep love these people have for each other.
Like I can tell when we're goingto be OK in the first session
(29:46):
almost. And it's different for
everybody. But if ADHD is the, I guess the
one thing I want to say is if ADHD is the core problem that's
bringing you in, we will get past that if both people want
to. This is a completely solvable
problem in so many ways, right? A way easier problem to solve
(30:07):
than a lot of the other problemsthat people can come to couples
therapy with. But if people are coming in with
their heels dug in, knowing it'sa problem, being curious but not
wanting to do anything about it,there's reasons for that.
But I can understand why there'sa big failure rate in couples
(30:29):
therapy too, as a result of that.
Because if you don't know what you're dealing with, I mean, you
must as a couples therapist, throw your hands up.
And and I think that's when I had some fun with one of my
supervision groups this morning.And I'm like, we're not going to
use the R word anymore. I want everyone to discuss the
place that they're stuck withoutusing the R word.
And the R word for me is resistant.
(30:51):
OK? I don't want anyone saying a
client is showing me that they're resistant.
How else can we describe the struggle that is happening?
No more R word. And it was actually, it's funny
because we, we don't think that way.
It's just that's how we're taught to speak about like being
stuck in therapy. So I'm like, but that's what
(31:12):
happens. We're we're taught to blame the
person for choosing to not want to make the relationship better
because if they would, they could, or if they could, they
would or, you know, if they really wanted to.
It was that he's just not that into you movie with Bradley
Cooper from a long time ago. That screwed up a whole
generation of what? It sure did, yeah.
It's interesting because the kind of therapy I practice,
(31:36):
mostly, I'm trained in a few modalities.
But is relational life therapy OK?
Yeah. We take a side, man.
We we call it the underdog. We do.
We do. So I I'm currently being
certified by Terry for Yeah, yeah.
So I am into that therapy. And one of the things is we
don't actually treat couples when there is an undiagnosed.
(31:59):
Well, no one's supposed to. It's a contraindication to
couples therapy. That's right, I have an
undiagnosed or unmanaged condition that prevents you from
fully showing up to therapy. That's right.
And so obviously as therapists, we're often trained in like
anxiety, depression. But the, the thing about a
(32:21):
relationship therapist, if they do, they can't diagnose if
you're a psychotherapist here in, in Ontario.
But I have to have so many things on my brain when someone,
a couple comes and sees me. And so I'm so grateful that I
can see ADHD so quickly, or at least and because it does, I can
(32:41):
scream for it. I can screen for it easily and
then I can refer out and then they can come back to couples
therapy or that they can even continue if it's being treated.
But it is like I can't imagine being a couples therapist in in
today's day and age and not having the the knowledge about
ADHD, about substance use disorder actually like about I
(33:04):
can't even imagine. Say all that person doesn't
really want to be in the relationship, they just must not
really be into it. And don't settle.
Don't settle for less. Like just take your show on the
road, girl. Right?
Like that's the narrative that'sout there.
And I guess it breaks my heart to think of how many broken
families and relationships thereare, because that was the one
(33:25):
stone nobody looked under. 100% I mean, I would say that that I
I wouldn't I won't say that my marriage ended because I had
ADHD for sure not, but oh boy it.
Sure, makes it harder. It sure makes it harder.
I mean, I think that like there was substance use disorder in my
marriage for my partner. There was me with substance use
(33:47):
disorder and ADHD and no one, noone caught that.
Not that it's their responsibility necessarily, but
it wasn't. And so that is part of the grief
to go back to that question thatyou had is the grief that my
marriage ended for various reasons, but what could have
been. And now I'm in a very healthy
relationship partnership. My partner is neurotypical,
(34:11):
actually. I know it's hard.
Is it? It's hard, yeah.
Make it easier. No, it doesn't.
Come on. He's very consistent.
He's very and he knows things like he knows now don't change
plans on me super fast like I amnot good with like right away
(34:33):
fast like I'm. Prizes.
I don't want to change plans. Don't tell me something that I
didn't know about. No, exactly.
Bring it on me. Exactly.
Exactly. So he's learning.
Yeah, I'm happy to hear that. I think that's beautiful because
I think there's a reason why we didn't get it uncovered when we
did. Like there was, I, I, I do feel
(34:53):
like there's, there's things that it's OK that we don't
understand why things happen theway they did.
What we can work with is what we've got now that makes sense
of it. Try to be with people and be in
relationships that help bring the best parts of ourselves
forward all the time instead of the worst parts, right?
And that can certainly happen when you go back and you think
(35:14):
about that grieving period. Are there specific things that
you think people necessarily need to come to terms with to
get through that part? I think I had to come to terms
with the just that my life was the way it was before.
(35:35):
Like I had to come to this acceptance.
I couldn't change what was from before.
I couldn't. I also had to come to terms,
quite frankly, I had to take ownership for some of how I
showed up in relationships. That's hard to do.
It's really hard, so hard. It would be so much easier for
(35:58):
you to blame or but it I had to take ownership for how I showed
up and it wasn't, well, in some cases like it wasn't.
So I had to take ownership for that.
And then I really had to get serious about, for me, my
substance use disorder, which I didn't really know I had, but
(36:19):
totally did and do. And I had to get serious with my
ADHD treatment in terms of what my life looked like.
And that means I have non negotiables in my life.
I have non negotiables. What are some of those do you
mind sharing? Yeah, not at all.
I have to move my body every single day.
(36:39):
If I don't, I am not good. So everything else I have like
that's my anchor habit. I'm not like super fit by any
means, but I still need to move my body and in a way it doesn't
matter how, but it has to happen.
I also need to have routine and I need to, for me, I need to
(37:02):
have spiritual practices. I never really did a 12 step
program, but actually am now starting really to do.
Yeah, I'm starting to do a 12 step program because what?
Part Do you feel like from that you need or will benefit from?
The structure, I do need the structure around it.
And for me, I always know like for, for me, I if I don't treat,
(37:26):
if I'm not emotionally sober, then the other sobriety falls
away. And so even though we mentioned
eating food, I can tell that my use of sugar like food is not
healthy, like it is not from an emotionally sober place.
Yeah, like what's driving you inany particular moment to tackle
(37:46):
that box of cookies or whatever,right.
Is the the questions always like, OK, so if, if biologically
in that moment, your, your brain's not emotional in a sense
that it's just trying to like ratchet up or ratchet down what
it's dopamine level. So in the night, we're trying to
(38:07):
calm down and settle down. So we need dopamine for that.
And in the morning we're trying to get going, we need dopamine
for that. So every fight you pick during
the day, every nitpicky thing that you do, that's all just
your brain trying to just get enough juice or gas to do its
basic functions, right. So then if you're driven to the
same thing, it's like, are thereother things in your environment
(38:29):
that are healthier for you that can give you that?
Yeah, right. Yeah.
That's right. So.
The emotional thing, it doesn't have to be like you're depressed
or sad. It could be you're bored, it
could be. Oh, for sure.
You're you want to talk about something with your partner, but
you don't want to get into a fight because it's 9:00 what
now? Like, And then you're spinning
(38:50):
in your head and you don't have the maybe meditative
self-awareness to be like, oh, this is not going to be good for
me trying to get to sleep and noodle away on this.
Can I choose to put it away and think about something else that
will allow me to put myself to bed at a regular time?
Right. So I have an executive function
to do that. Right.
So to me, that's actually part of emotional sobriety, OK?
(39:13):
Meaning that if I can say I'm anemotionally sober person when it
comes to drugs and alcohol, likeI'm able to make a choice if it
were in front of me right now that I will not use that, I will
go and do something else. If I fell to craving, I would
have the awareness to be like, what's happening for me right
now, what's going on for me. But with food, I don't have that
(39:36):
right now because food is such alike, you don't go to the
grocery store and see packets ofcocaine, right?
But you go and you see packets of sugar and junk food.
And so it's just so widely accessible.
And I realized recently that I'mnot fully emotionally sober when
it comes to food. Well, I think there's a lot of
taboos in our culture, so it's hard to talk about food as a
(40:00):
therapist because there's so much stigma out there.
I want to be body positive. I also want to help people not
end up with type 2 diabetes, which is not a choice.
It's genetic. There's like all kinds of stuff
that plays into that. But people with untreated ADHD
have more type 2 diabetes. And that's because one of the
(40:21):
ways we dopamine seek is by food.
A lot of people with ADHD have this yo-yo, up and down, chubby
skinny kid, chubby skinny kid, chubby teenager, skinny
teenager, like this flex all theway.
We're constantly battling that. And if you don't know that
you're being driven to that, notbecause you know there's
something wrong with you if you have a character flaw, but
(40:42):
because you just got a brain quirk, then then you don't know
what you don't know. Right.
Yeah. And I remember in the 90s
hearing as an undergrad in the 2000s that if you want to be
skinny, that's why you should smoke.
That's why women smoke is because it keeps them skinny.
Well, guess what? That mediates the same pathway
as. That's right.
(41:03):
Cocaine as chips as like, that'sright.
You know, sex, drugs and rock'n'roll.
That's right. So it is.
It does matter. Like understanding the brain,
Physiology does matter. It does matter and I also say
that like food from a place of two, like it's not about my
issue is not about how I look actually like from a place of
(41:25):
body part. It is 100% how I am feeling as I
reach for that food, like what'sgoing on for me.
What's it going to do for you inthat moment?
What's it going to do for me? And it's it and and then this
goes to the substance use disorder, my pattern of behavior
around it, hiding it. Yes.
(41:48):
Not like lying about it, right? And I'm like, hmm, this is
familiar. What are the phrase you're
telling familiar exactly? Ransack your kitchen cover at.
Sunday exactly. Yeah.
So I want to be clear, it's not about how I look.
I started to see that this is problematic and what my behavior
(42:09):
of why I am seeking. Yeah, I think that's like really
these nuanced conversations are really important.
I know you've got a JET, so I'm conscious of time.
I want to say from my end, like from a resource point of view
for people that are listening, if you're a therapist listening,
we're going to have some links in the show notes.
I highly recommend the new KadraSubstance Use Program CE that
(42:36):
they've got that's free for members and it's really
accessible and affordable. If you're not a member of CADRA
CADDRA, I'll link it in the website.
It's the Canadian Resource Alliance for ADHD Professionals
and it's really important because it's very obviously ADHD
affirming. It sets forth new treatment
(42:58):
guidelines and the newer ways weare to look at treating a whole
person, not stigmatizing somebody, certainly not
withholding treatment to wait for someone to get sober.
That's not the way anymore. And so, yeah, I wanted to just,
I'll link it in the show notes. I think it's a great course.
I really highly recommend HealthCanada supported the development
(43:20):
of it as well as I think it's important to mention too.
Are there any like resources, Kathleen, that you think are
important to share with either not therapists or therapists or
other people who are just interested in this?
I mean, if from a terms of substance use disorder, I think
there are several programs that I definitely support, like even
(43:42):
12 step programs, they're not for everybody, but any A, A or
NA or OA, again, 12 steps are pretty amazing.
It's also free. And one of the key pieces in
terms of substance use disorder is community being community.
And that's something that is so important.
(44:03):
And also there's SMART Recovery,which is a non 12 step.
It's more CBT based. Yeah, I've.
Heard about that. Physicians refer patients to
that. Yeah.
And so I think that I think bothof those those are are good in
terms of substance use disorder.I definitely the community piece
is huge and that's one of the reasons we started our podcast
(44:25):
sisters and Sobriety, because women often feel alone in their
substance use. A journey.
And you know, my Co host Sonia and I, both of us were really
high functioning. My Co host is sober from alcohol
and I'm sober from drugs and alcohol.
She's drugs as well. But and I think just finding
(44:45):
community around you, you're notalone.
There are so many women who struggle with this.
Really. It's a process for every person
you've met who's made you feel stigmatized or judged for it,
there's a whole bunch of the rest of us out here waiting to
meet you who are understanding of what's going on.
(45:10):
And I think also what the good stuff is that still lays ahead.
And because we watch people get better every single day.
Like I love working with people with ADHD, with any
constellation of comorbidities, to be honest with you, nothing
really scares me because people get better.
(45:30):
So it's, it's gratifying, it's inspiring.
I quite, I quite love it. It almost feels like it cheats
sometimes because like there is such a well prescribed pathway
that when people actually followthe guidelines, it's like, well,
that was easy, you know? Well, you're doing amazing work
because one of my other resources is I do send people to
(45:52):
your website. The information is all there for
free. Appreciate that because I was
like, well, you shouldn't have to just be able to afford to pay
a therapist to have the right information.
So I think it's, I put everything out there information
wise, anyone can access it. And that's just kind of an
important thing that we do. But I think it's important to
tell people where they can find you.
(46:13):
At kathleenkillen.com, OK ATHL EE N&KILLE, n.com and I have
also lots of free resources on my website and on my YouTube
channel for those in relationships.
Are you taking new couple clients right now?
I have another therapist on my team who is, but I currently
(46:34):
have a wait list. All right.
Thank you so much for coming andfor sharing of yourself so
generously. I really appreciate it and I'm
I'm sure our listening audience does as well and I think there's
a million other things I want toget to, but we might have to do
a Part 2 because I, I wouldn't mind also talking about rehab.
What happens in rehab? Like the scene of rehab is in
(46:57):
Canada to this day. I have thoughts and opinions and
I'm sure you do too. So that would be cool if we can
do that, that'd. Be cool for a follow up.
Absolutely. Yeah, absolutely.
Thanks for having me on. OK.
Thanks. Thanks for joining me today as I
(47:17):
continue to try to make the invisible visible.
My hope is that these conversations help you feel a
little more seen and supported as you navigate your own
journey. If you're curious to
digdeeperyoullfindmoreresourcesarticlesandepisodes@digalittledeeper.caand if something today you heard
stirred something inside of you,please know that reaching out to
(47:41):
a licensed professional can be an important next step.
You certainly are not alone, andyou don't have to carry it or
figure anything out on your own.I'm Christina Crow, reminding
you that mental health is health.
Take care and I'll see you next time.
Hello everybody, welcome to the Christina Crow Podcast where we
connect the dots and search for more balanced mental health.
I'm your host psychotherapist, Christina Crowe, and today I am
talking to Kathleen Killen aboutnew research we found shedding
light on women with ADHD's experiences with substance use
(00:33):
and substance use disorders. Kathleen Killen is a registered
psychotherapist and the founder of Kathleen Killen
Psychotherapy. As a relationship therapist, she
works with both individuals and couples who are navigating
disconnection, conflict, or patterns that feel hard to
break. Her work focuses on helping
people build healthier, more authentic relationships, whether
(00:54):
with a partner or themselves. Outside of the therapy room.
Kathleen Co host Sisters and Sobriety, a podcast centered on
exploring sobriety through healing, connection, and growth.
She also shares relationship tools and insights on her
YouTube channel, offering accessible resources for people
who want to better understand themselves and their
relationships. As a parent, partner, and nature
(01:17):
lover, Kathleen knows that relationships are both beautiful
and complex. Whether she's working with
clients or speaking behind the mic, she's passionate about
helping people feel more connected, more understood, and
more aligned in their relationships.
Welcome to the show, Kathleen. Thank you so much.
I'm so happy to be. Here, That's very cool.
So I read a paper and then I immediately thought of you,
(01:40):
messaged you and said, hey, let's talk about this on the
podcast. And he said yes.
So here we are. Here we are.
And then I read the paper. Send me the paper you wrote.
Yeah, I'm really glad you sent this to me, though.
I mean, I guess we'll talk a little bit about it, but was
anything shocking to you? It wasn't so much to me, but
maybe it's because of the lived experience I have.
(02:02):
We both have ADHD which we talked.
About SO. It's OK to say that.
Yeah, totally. I think we were both late
diagnosed too. I was not diagnosed till I was
3839. OK, seeking.
Suspicion and then probably formally I was 40 or 41.
I was 42 when I was formally diagnosed and those.
Years. Yeah, no idea.
(02:23):
Before I had. No idea, no idea at all.
So like not even a hankering. So I, I try to remind myself,
like when we're a therapist working in this space, years and
years and years. Like it's a decade for me.
It's quite a while for you. Plus there's lived experience of
living with undiagnosed ADHD, the life you had before.
(02:43):
You know what you know Now the one thing is that I think I
forget what it was like before Iknew all the things.
And I also forget what definitions of things are for
non therapists sometimes. So when I say substance use
personally, I'm not just talkingabout drugs and alcohol.
I'm talking about sex, drugs, rock'n'roll, shopping, potato
(03:07):
chips, porn, everything, everything under the the sun
that you could get dopamine hitsoff, including conflict seeking
behavior and then and then because that's what shows up in
the session room. But luckily, there's a lot of
research now on and new ways of understanding the mechanisms of
(03:28):
substance use, like the pathwaysin the brain connected to an
ADHD brain, right? And we talked about that when I
came on your podcast, which was a lot of fun.
And then the research sticks to drugs and alcohol usually.
And then is there anything that's striking to what's
striking to me? Is it it tends to center on men?
(03:53):
Yes, generally it does. Yeah, like when you think about
ADHD and substance use disorder,who pops into your mind?
Well, me now to be honest, not to be super self-centered about
it, but when I was diagnosed with ADHD, I was also diagnosed
with substance use disorder and that was a huge shocker to me.
(04:14):
Huge. That was like a mic drop moment
because I never, it never occurred to me that I had
substance use disorder. It maybe occurred to me that I
had a problematic use of things and I'm saying things I it
occurred to me that I had a problematic use Once Upon a time
(04:37):
with cocaine, which we can get more into why that particularly.
Yeah, it's probably been used todifferentiate.
That we need to differentiate that one and definitely had a
problematic use with alcohol, but never would have considered
it. And I really appreciate that you
just said, you know, when you define substance use disorder,
it's all the other things. Because I would still say I
(04:59):
struggle with food, with with food.
I still do. So yeah, I never really, first
of all, when I was diagnosed with ADHDI understood it to a
point of like where a general therapist would understand ADHD.
I understand it much more now, obviously, but I didn't know the
link. And then once I saw, once I was
(05:22):
told, it became much more clear to me.
Oh, right. That's why it became a problem
for me. I think you're right.
What you mentioned, we often look at men in research.
It's still all research is generally skewed to men still.
But what was surprising to me isthat I was very high functioning
(05:44):
and a lot of the clients I see and potentially you might see
are high functioning. They're getting through life
ish, but then there are other things happening.
There's anxiety, there's substance use and really there's
a root there, which is the ADHD that's not been diagnosed or
seen, especially in women. Thank you for sharing that
(06:07):
because I also think as a old Gen.
Xer, I also see like generational trends in my
clients attitudes towards recreational drug use or
drinking, right? That I think is just really
interesting. So I don't know if it's a
function of me being inattentivein my teen years or 20s, but I
(06:30):
don't feel like I knew people that just dabbled in cocaine on
the weekend, right? But I feel like that's a
completely like nobody would batan eye at that these days,
especially in certain careers. Well, that's the thing.
Yeah. And so we can talk about what we
think those might be or what youprobably know those are.
So I think our attitudes around it have changed.
(06:53):
But in talking to my clients, I don't have my own experience
with cocaine, but I really get into it with people because I
want to know what do you get outof it?
What is it like? And, and the way people with
ADHD talk about the benefit I'm doing her quotes and the moment
of coke or cannabis, for example, is really different
(07:15):
than the wave Fickles do. And in cannabis in particular,
to a certain point, people feel normal when they take it.
And then there's a place where you cross that line and it's you
get into the not good stuff. So that always suggests to me,
if someone doesn't know they have ADHD, Oh, there's something
brain driven here. Like my first, my first instinct
(07:37):
is not, it's trauma. You've got a willpower problem.
You've got all this stuff. I'm like, have you ever had ADHD
ruled out? Because if you haven't had it
ruled out, we got to do that. It's easy to do.
Let's just do it because then atleast boom, that's out of the
way. And then I know how to change my
treatment approach based on thatMy, my therapeutic approach will
(07:59):
be completely different for somebody with ADHD versus
somebody without, right? 100% and gosh we're so much more
ADHD informed now I think. But I mean, I've seen several
therapists. What was us?
I feel you guys out there. We know.
We I had, but not one of them had ever.
(08:20):
Ever. Did they ask you point blank
about recreational drug use? Oh, yes, they asked me point
blank about recreational drug. I I'm sure I lied.
I'm sure I lied because of fear of the legalities of it at some
point. But I was in my 20s when I was a
heavy or cocaine user. I was definitely seeing a
(08:41):
therapist. But what you just said,
Christina, my friends would be dancing on tables and I was
cool, calm, clear, totally regulated in my.
Brain My exam now in the bar. Oh yeah, 100%.
That's one of the reasons why I used it is because I was able to
(09:01):
regulate be calm, cool and. The downside of that was.
Well, the downside of it was I didn't feel great the next day.
The downside was that I had lotsof heart palpitations.
The downside was that I became dependent on it to be able to
(09:24):
focus and regulate. And you need increasing amounts,
right? The physiological dependency is
that you need more and more and more to achieve the same end.
Was for me, yeah. Yeah, and to be clear, that
doesn't happen with prescriptionmedication to treat ADHD.
In fact, that's what allows you to stay sober.
(09:44):
Correct. That's right.
And it was a concern of mine even being a therapist when I
was diagnosed with ADHD and substance use disorder.
And then they were like, OK, nowyou need, you know, we're
suggesting you go on a stimulant.
I was like, no way. I'm no way.
I am sober from drugs and alcohol and have been for many
years. So I was like no way am I
(10:05):
risking that but I had to go down a path of learning more
about it and I even still to this day will question should I
go off of my medication? No.
Should you go? Ahead water because you're mad
that we depend on. It every day, right?
But it's for me, it's not about I just sometimes will be like,
(10:25):
oh, does it mean I'm not sober anymore?
But obviously, no, it actually helps me stay sober.
That's right. It helps me.
Yeah, yeah. That's right.
I mean, I think and its core ADHD is like a medical situation
that if it's not treated properly, turns into a
psychological problem. Agreed.
Right. So if you start with the
beginning, it's like the, the closest analogy to other
(10:49):
conditions is diabetes, like type 1 diabetes.
Like you're born. I say my clients are probably
rolling their eyes cause they'veheard me say this a million
times. But you know, you're born, your
pancreas is pooched. It's not, you know, producing
the insulin that it needs to produce at the rate of the time
that it does. And so we don't have to like
freak out or we just replace that insulin and off you go.
(11:11):
You still have to wear sunscreenand not smoke and, you know,
look both ways before you cross the street and be active.
And all the things that all people have to do to be healthy.
And, and we don't demonize you or stigmatize you and all the
people around you because you were born with a pancreas that
doesn't make the insulin that itneeds to organically.
(11:34):
And, and similarly, I mean, withADHD, not it can get
oversimplified a lot to just like a dopamine, It's not just a
dopamine situation. It's like dopamine,
norepinephrine, serotonin, GABA,it's all of those things.
It's functional, it's structuraland neurotransmitter and all
those ways that can intersect. But at its core, we've got
(11:55):
deficiencies in either how much dopamine we make for example, or
how much we use and keep of whatwe are already organically
making. And so the medication targets
those in various ways. And when that happens early
enough, what you see from the long term trials is it
completely changes the trajectory of someone's course
(12:18):
of ADHD. Had they gone a lifetime
untreated and and all the risks that come with that.
Because I think for me, the first stat when I was learning
about all the stuff that just stopped me in my tracks was
something along the lines of thethe general, the Gen. pop rate
of addiction is like 12 to 13% for everybody in the world, all
(12:42):
things considered. For people with untreated ADHD,
it's like 60%. Holy shit.
And and of course, I know peoplein my life that I love and adore
that I've watched struggle so hard to stay sober in all
different ways. And they are 100% people with
(13:02):
ADHD that never got diagnosed askids and they're still not
treated properly and they had togo through hell to get
diagnosed. And even if they do get sort of
started treating exactly what you said, they want to stay at a
low dose because they're worriedthat titrating up to target
their symptoms means they need more or they're using because
(13:23):
that stigma is around even getting to the optimal dose of
your medication. But the delta between the low
dose they're at and the ADHD symptoms that are ratcheting up
is like such a battle for them to face because you're trying to
like, use willpower on a biological problem.
It's totally. And that also like relates
(13:45):
strongly to the substance use disorders, right?
Like it's not just the brain chemistry that's going on like
it is, but it's also coming out in behavioral.
For example, I had an issue withimpulsivity.
Well, what would I do when I wasimpulsive?
Like I would use drugs and alcohol.
I would also make other really poor decisions in my life.
But my impulsivity, the medication helps me with my
(14:08):
impulsivity, which would therefore help me with any
substance use. Yeah, and I always think it
comes back to the three. It's so funny on social media,
there's like 87 things that people are like, oh, I didn't
know this is because people withADHD and I'm like, OK, there's
like infinite variations of how impulsivity, hyperactivity,
(14:28):
internalized or not, and inattention show up in your
life. Those 3 core symptoms show up in
a bazillion ways. So yes, there will be a lot of
things people have in common with other people, but it's
important to trace back to thoseone of those three and to figure
out what am I trying to target here?
(14:50):
Like what's tying my shoelaces together?
Work gets the best of me, my clients get the best of me, my
colleagues get the best of me. I come home and I'm a shit to my
family. I'm like, that sucks.
This isn't good. Right.
Yeah. So even therapists have this
problem. They sure do, but.
Then I'm kind of like, OK, what's my problem?
(15:11):
Is it an attention? Like I don't know what I'm
walking into? I walk into the same thing every
night for some reason. It's a shock every day.
Why am I not addressing this problem?
Or is it impulsivity? Or is it just my wheels are
spinning in my head and I don't know how to calm myself down.
My meds have worn off. I don't have the executive
function to find myself a quiet corner for a minute.
(15:31):
You know what I mean? Knowing those things is really
important. And then I find the evening time
is when women have a lot of strain on them and they've lost
the benefit of the medication coverage they had during the
day. So then the whole like, wine
o'clock culture. Having a glass of wine with
dinner when you're making it, putting yourself to bed with a
(15:54):
glass of wine, all that stuff islike socially accepted.
Yes, very much so. And before you know it, boom.
You're. Middle-aged and totally
dependent, right? Yeah, And I think like, you
know, my Co host Sonia and I talk about this on our podcast a
lot. You know, problematic drinking
(16:14):
doesn't mean you're fall down drunk five days, six days, seven
days a week at all. Not not even close.
And it can slowly creep up. It can.
And so you're right, Christina, I think that medications wearing
off your executive function is not necessarily where it it
would need to be to do all the things when you get home.
(16:35):
The acceptance of wine, o'clock and mommy's, you know, little
helper type drink. It can just and you know, it
happens. It can happen with not just
alcohol. And like I when we started
talking at the top of this podcast, I still struggle with
food, with with substance use. Yeah, I'll take a bag of potato
(16:56):
chips over a glass of wine any day.
Me too. Because it's accessible.
It's right there. I didn't grow up with parents
that drank a lot, but we sure enjoyed our meals to.
Me, it's sugar, but I still haveto put the same practices in
place that I did with drugs and alcohol in a sense, to other
things. And I have to just be aware of
(17:16):
it. And I am then aware, oh, my
medication is wearing off. I have less ability right now to
say no to the sugar, so I have to do other things in order to
not do that. Yeah, and set those things up in
your on medication hours. Exactly.
So you have the structure and the routine to protect you.
Routine protects people with a DHDA lot and asking other people
(17:39):
to help and all there's all kinds of, there's medication
strategies too to help for the evening more.
But I think there's so much morewe have to do.
And then the complications of the relational stuff pull in.
So for any women that are listening to this and they're
like, oh, like this is me, right?
What could anyone have said to you back then that would have
(18:02):
made a difference at different points?
I had a friend tell me in my 20sthat she didn't think my cocaine
use was healthy. Yay friend.
Yay friend. That's a good friend for me to
die though. No, but I remembered it.
I thought about it. I think that for me, I don't
(18:24):
think there was anything anyone could have said.
It was I had to just do. Like I had to feel my life
without drugs and alcohol to seein a way how much clearer I was,
even though I was quite clear when I was using cocaine.
But I needed to feel the difference in my body and yeah.
(18:44):
It's nice to have a 12 hour duration of action.
Well, 100% it is. It is.
But the other piece I really learned, like I learned my about
my ADHD because of a client actually, because it was I was a
coach before I was a therapist. And one of my first coaching
(19:06):
clients came to me and said, oh,my therapist, I was just
diagnosed with ADHD. And in my mind I was like, what?
How can this be? This person is so much like me.
This is in my mind. And I was like, what?
And that's when I started looking at it.
And I think so. I think really, it's like I had
the openness to just see myself.I had the openness.
(19:30):
And I also would have never saidthat I had a substance use
disorder until I was diagnosed. But then when I started hearing
other women's stories, especially other women's stories
with ADHD, I was like, oh, my goodness, this is me.
Yeah. It's neat to see.
So we just attended Kadra, the big ADHD medical conference out
(19:53):
in Vancouver a couple weeks ago.And every year there's more and
more research that's differentiating the experience
of women and men. The researchers were doing
amazing jobs in going backwards through data, retrospectively
designing trials, looking forward that really help get a
better handle on the experience of girls and women for sure.
(20:15):
And, and so the, the one paper that I, the paper that I shared
with you, I'll link it in the show notes.
It's called. Prevalence of substance use
disorder in individuals with ADHD, associations with sex and
psychiatric comorbidity. So we're looking at are there
comorbidities, meaning other conditions that go with ADHD
(20:36):
that you're more vulnerable to whether you're male or female,
basically, right. And so to walk people through
this paper, they examined, I think the total was over 31,000
men and over almost 19,000 women.
And then they compared that to people without ADHD, like over
(20:58):
380,000 and over 306. So these are huge, huge
registries that they're pulling data from, right?
It's a registry review. So one of the things that they
found that I wrote down from part of the paper was that when
people get treated with psychostimulant medication
(21:19):
specifically indicated for ADHD as prescribed to you by an ADHD
treating physician or nurse practitioner, that that's
associated with beneficial effects that include reducing
the risks of suicidal behaviors.It reduces substance misuse, it
reduces transport accidents, single car accidents, death by
(21:42):
misadventure, criminality and accidental injuries.
So that's that's a pretty big deal.
It's a really big deal. Yeah.
Yeah, it's it's a really big deal.
I might be a bit more careful with cocaine use disorder, but
it it doesn't scare me because of this one paper, I think we
(22:02):
talked about it last time that Ialso found that says that
cocaine use disorder actually predicts for better outcomes in
people with ADHD. If you're going to use Liz
dexamphetamine, which is super cool to see something like that.
So that made me not sweat it andjust be, you know, pay attention
very carefully to all the thingsI need to pay attention to.
But with cannabis in particular,what I tend to find is as people
(22:27):
titrate up to an effective dose where they feel like more of
themselves, there's no numbing. You're past the point of
annoying side effects. And you found like a humming
dose that you get what you need out of it and you feel good.
Like you don't feel like your shoelaces are tied together
anymore. Right as you get to that
(22:48):
targeted dose, the drive or the craving, the things that drove
you to go drug seek or find stuff or food seek before go
away. Whatever's leftover is the stuff
I can address behaviorally. Psychosocial interventions,
therapy, new patterns, relational support structure.
(23:11):
But everything below that was all brain function driven.
And I know what that feeds feelslike for food.
And I can imagine I was like a pretty cheeky cigarette.
Bummer back in my day. Yeah, me too back.
At pub I was bombing smokes off people, so I know the joy of the
(23:33):
inhalation of a cigarette. Like a old fashioned cigarette.
Doesn't matter if it's -40 I viscerally remember what that
feels like. Yes.
Obviously I didn't know I had ADHD back then, so I get why
people like smoking. Anyone who's still smoking
dudes, you please go get screened.
You're the people left that we're still looking for, I would
say. But do you remember what it was
(23:57):
like? Because it sounds like you got
sober 1st and then tried Vyvanse.
Yeah, not even Vyvanse, But yes,I got sober when I was around 30
and it was sort of an unintentional rehab.
So I didn't know I had a substance use disorder.
And I had signed myself up to doa yoga teacher training for a
(24:19):
month in Mexico. And the night before I left, I
was leaving really early in the morning.
I went out partying, did a ton of cocaine, was supposed to be
treating my body like a temple, but did not, and got on a plane
without cocaine and went to Mexico and then was not allowed
(24:41):
sugar, drugs, alcohol, any substance of any kind when I was
there. I.
Can only imagine how uncomfortable that was.
I was not well my first week. I was not well.
I wanted to leave. I was going to leave and then
something in me told me just stay.
(25:02):
I was doing yoga and meditating 8 hours a day.
And I, I get, I get what I'm saying is like from a place of
privilege, like I, I get that. But I, I really hadn't felt what
it was like to be without something, some substance
probably in since I was a teenager because I smoked,
(25:23):
drank, did all those things and ate tons of sugar, all of that.
And so for the first time in a very, very long time, my body
didn't have any of that. And I couldn't believe the
difference. And I came home and I never
touched cocaine again. Wow, that's not necessarily a
typical story. I still drank occasionally and
(25:45):
then I stopped drinking alcohol as well.
But it was only a decade later that I was prescribed Vyvanse
first, Which? Wasn't good for me.
I did. I did white knuckled it.
I white knuckled it through and then found I, I was eventually
put on Concerta and that's what has been amazing and life
(26:10):
changing for me. But you know.
How hard was the white knucklingpart?
Because some people, they love the white knuckle.
They're like, no, I'm doing it this way.
And I'm like, dude, life is hard.
It doesn't have to be this hard.Like why are you doing this to
yourself? Well, I didn't know I had ADHD.
Right. So I didn't know for another
decade that I had ADHD and I hada failed marriage, not just
(26:32):
because of those symptoms, but definitely they contributed.
Yeah, I did well in my work, very well in my work, but at a
great cost to my mind and body. Relationships aren't
one-size-fits-all, especially when ADHD, mixed neurotypes, and
(26:55):
different communication styles are part of the picture.
I dig a little deeper. Are trained couples therapists
help you and your partner move from frustration to
understanding, using practical tools that you can use right
away? Whether you're struggling to
reconnect or just want to strengthen your bond, we're here
to help. Book a consult with one of our
(27:15):
couples therapists at Dig a Little deeper.ca.
Did your doctor feel bad that they didn't catch it?
My doctor still didn't catch it.Yeah, jeez, man.
My doctor still didn't catch it.I'm the one who pursued A
diagnosis and I went to my doctor to get a referral, but
(27:39):
that was it. And I went to a big fancy clinic
because it wasn't that accessible, to be honest at that
time. Yeah, I know, 10 years ago
things were still pretty old school.
Yeah. And then I was diagnosed with
combined type ADHD and everything made I oh gosh, the
grief that I felt, which I thinkis pretty common.
(28:00):
Tell me what that was like. Like from where you were at that
point? I felt such grief that I didn't
know before because I felt like,wow, so much of my life maybe
could have been different. That was a real process for me
to get through, to come to termswith that grief and and the
(28:22):
grief and then the gratitude that I am diagnosed, that I have
treatment, that I've been able to learn Now in my practice.
I'm a relationship therapist butI am like a hawk for ADHD and
relationships. I don't know what you think.
Like I find it so easy to spot between couples.
Me too. And there's like mixed neurotype
(28:43):
relationships. Often what I see is one person
knows they have ADHD and the other person's pretty sure they
don't have it. And I'm like, uh huh, OK, we'll
see, right? Because we know that that people
with similar neurotypes are for sure attracted to each other.
They just present differently right And then and it and it's
hard because the person with ADHD comes to couples therapy
(29:05):
with the message that they're the problem.
Yes. They're the one that's ruining
everything. And the other part is just like,
just fix this, man. Like I want to get back to who
we were, blah, blah, blah. And it's a very common thing.
And then it takes a really different turn sometimes.
And I think being able to what, what I love about working with
(29:25):
ADHD couples is that I love, I don't know if it's like this for
you, but I, I can easily feel into the relational dynamic and
the deep love these people have for each other.
Like I can tell when we're goingto be OK in the first session
(29:46):
almost. And it's different for
everybody. But if ADHD is the, I guess the
one thing I want to say is if ADHD is the core problem that's
bringing you in, we will get past that if both people want
to. This is a completely solvable
problem in so many ways, right? A way easier problem to solve
(30:07):
than a lot of the other problemsthat people can come to couples
therapy with. But if people are coming in with
their heels dug in, knowing it'sa problem, being curious but not
wanting to do anything about it,there's reasons for that.
But I can understand why there'sa big failure rate in couples
(30:29):
therapy too, as a result of that.
Because if you don't know what you're dealing with, I mean, you
must as a couples therapist, throw your hands up.
And and I think that's when I had some fun with one of my
supervision groups this morning.And I'm like, we're not going to
use the R word anymore. I want everyone to discuss the
place that they're stuck withoutusing the R word.
And the R word for me is resistant.
(30:51):
OK? I don't want anyone saying a
client is showing me that they're resistant.
How else can we describe the struggle that is happening?
No more R word. And it was actually, it's funny
because we, we don't think that way.
It's just that's how we're taught to speak about like being
stuck in therapy. So I'm like, but that's what
(31:12):
happens. We're we're taught to blame the
person for choosing to not want to make the relationship better
because if they would, they could, or if they could, they
would or, you know, if they really wanted to.
It was that he's just not that into you movie with Bradley
Cooper from a long time ago. That screwed up a whole
generation of what? It sure did, yeah.
It's interesting because the kind of therapy I practice,
(31:36):
mostly, I'm trained in a few modalities.
But is relational life therapy OK?
Yeah. We take a side, man.
We we call it the underdog. We do.
We do. So I I'm currently being
certified by Terry for Yeah, yeah.
So I am into that therapy. And one of the things is we
don't actually treat couples when there is an undiagnosed.
(31:59):
Well, no one's supposed to. It's a contraindication to
couples therapy. That's right, I have an
undiagnosed or unmanaged condition that prevents you from
fully showing up to therapy. That's right.
And so obviously as therapists, we're often trained in like
anxiety, depression. But the, the thing about a
(32:21):
relationship therapist, if they do, they can't diagnose if
you're a psychotherapist here in, in Ontario.
But I have to have so many things on my brain when someone,
a couple comes and sees me. And so I'm so grateful that I
can see ADHD so quickly, or at least and because it does, I can
(32:41):
scream for it. I can screen for it easily and
then I can refer out and then they can come back to couples
therapy or that they can even continue if it's being treated.
But it is like I can't imagine being a couples therapist in in
today's day and age and not having the the knowledge about
ADHD, about substance use disorder actually like about I
(33:04):
can't even imagine. Say all that person doesn't
really want to be in the relationship, they just must not
really be into it. And don't settle.
Don't settle for less. Like just take your show on the
road, girl. Right?
Like that's the narrative that'sout there.
And I guess it breaks my heart to think of how many broken
families and relationships thereare, because that was the one
(33:25):
stone nobody looked under. 100% I mean, I would say that that I
I wouldn't I won't say that my marriage ended because I had
ADHD for sure not, but oh boy it.
Sure, makes it harder. It sure makes it harder.
I mean, I think that like there was substance use disorder in my
marriage for my partner. There was me with substance use
(33:47):
disorder and ADHD and no one, noone caught that.
Not that it's their responsibility necessarily, but
it wasn't. And so that is part of the grief
to go back to that question thatyou had is the grief that my
marriage ended for various reasons, but what could have
been. And now I'm in a very healthy
relationship partnership. My partner is neurotypical,
(34:11):
actually. I know it's hard.
Is it? It's hard, yeah.
Make it easier. No, it doesn't.
Come on. He's very consistent.
He's very and he knows things like he knows now don't change
plans on me super fast like I amnot good with like right away
(34:33):
fast like I'm. Prizes.
I don't want to change plans. Don't tell me something that I
didn't know about. No, exactly.
Bring it on me. Exactly.
Exactly. So he's learning.
Yeah, I'm happy to hear that. I think that's beautiful because
I think there's a reason why we didn't get it uncovered when we
did. Like there was, I, I, I do feel
(34:53):
like there's, there's things that it's OK that we don't
understand why things happen theway they did.
What we can work with is what we've got now that makes sense
of it. Try to be with people and be in
relationships that help bring the best parts of ourselves
forward all the time instead of the worst parts, right?
And that can certainly happen when you go back and you think
(35:14):
about that grieving period. Are there specific things that
you think people necessarily need to come to terms with to
get through that part? I think I had to come to terms
with the just that my life was the way it was before.
(35:35):
Like I had to come to this acceptance.
I couldn't change what was from before.
I couldn't. I also had to come to terms,
quite frankly, I had to take ownership for some of how I
showed up in relationships. That's hard to do.
It's really hard, so hard. It would be so much easier for
(35:58):
you to blame or but it I had to take ownership for how I showed
up and it wasn't, well, in some cases like it wasn't.
So I had to take ownership for that.
And then I really had to get serious about, for me, my
substance use disorder, which I didn't really know I had, but
(36:19):
totally did and do. And I had to get serious with my
ADHD treatment in terms of what my life looked like.
And that means I have non negotiables in my life.
I have non negotiables. What are some of those do you
mind sharing? Yeah, not at all.
I have to move my body every single day.
(36:39):
If I don't, I am not good. So everything else I have like
that's my anchor habit. I'm not like super fit by any
means, but I still need to move my body and in a way it doesn't
matter how, but it has to happen.
I also need to have routine and I need to, for me, I need to
(37:02):
have spiritual practices. I never really did a 12 step
program, but actually am now starting really to do.
Yeah, I'm starting to do a 12 step program because what?
Part Do you feel like from that you need or will benefit from?
The structure, I do need the structure around it.
And for me, I always know like for, for me, I if I don't treat,
(37:26):
if I'm not emotionally sober, then the other sobriety falls
away. And so even though we mentioned
eating food, I can tell that my use of sugar like food is not
healthy, like it is not from an emotionally sober place.
Yeah, like what's driving you inany particular moment to tackle
(37:46):
that box of cookies or whatever,right.
Is the the questions always like, OK, so if, if biologically
in that moment, your, your brain's not emotional in a sense
that it's just trying to like ratchet up or ratchet down what
it's dopamine level. So in the night, we're trying to
(38:07):
calm down and settle down. So we need dopamine for that.
And in the morning we're trying to get going, we need dopamine
for that. So every fight you pick during
the day, every nitpicky thing that you do, that's all just
your brain trying to just get enough juice or gas to do its
basic functions, right. So then if you're driven to the
same thing, it's like, are thereother things in your environment
(38:29):
that are healthier for you that can give you that?
Yeah, right. Yeah.
That's right. So.
The emotional thing, it doesn't have to be like you're depressed
or sad. It could be you're bored, it
could be. Oh, for sure.
You're you want to talk about something with your partner, but
you don't want to get into a fight because it's 9:00 what
now? Like, And then you're spinning
(38:50):
in your head and you don't have the maybe meditative
self-awareness to be like, oh, this is not going to be good for
me trying to get to sleep and noodle away on this.
Can I choose to put it away and think about something else that
will allow me to put myself to bed at a regular time?
Right. So I have an executive function
to do that. Right.
So to me, that's actually part of emotional sobriety, OK?
(39:13):
Meaning that if I can say I'm anemotionally sober person when it
comes to drugs and alcohol, likeI'm able to make a choice if it
were in front of me right now that I will not use that, I will
go and do something else. If I fell to craving, I would
have the awareness to be like, what's happening for me right
now, what's going on for me. But with food, I don't have that
(39:36):
right now because food is such alike, you don't go to the
grocery store and see packets ofcocaine, right?
But you go and you see packets of sugar and junk food.
And so it's just so widely accessible.
And I realized recently that I'mnot fully emotionally sober when
it comes to food. Well, I think there's a lot of
taboos in our culture, so it's hard to talk about food as a
(40:00):
therapist because there's so much stigma out there.
I want to be body positive. I also want to help people not
end up with type 2 diabetes, which is not a choice.
It's genetic. There's like all kinds of stuff
that plays into that. But people with untreated ADHD
have more type 2 diabetes. And that's because one of the
(40:21):
ways we dopamine seek is by food.
A lot of people with ADHD have this yo-yo, up and down, chubby
skinny kid, chubby skinny kid, chubby teenager, skinny
teenager, like this flex all theway.
We're constantly battling that. And if you don't know that
you're being driven to that, notbecause you know there's
something wrong with you if you have a character flaw, but
(40:42):
because you just got a brain quirk, then then you don't know
what you don't know. Right.
Yeah. And I remember in the 90s
hearing as an undergrad in the 2000s that if you want to be
skinny, that's why you should smoke.
That's why women smoke is because it keeps them skinny.
Well, guess what? That mediates the same pathway
as. That's right.
(41:03):
Cocaine as chips as like, that'sright.
You know, sex, drugs and rock'n'roll.
That's right. So it is.
It does matter. Like understanding the brain,
Physiology does matter. It does matter and I also say
that like food from a place of two, like it's not about my
issue is not about how I look actually like from a place of
(41:25):
body part. It is 100% how I am feeling as I
reach for that food, like what'sgoing on for me.
What's it going to do for you inthat moment?
What's it going to do for me? And it's it and and then this
goes to the substance use disorder, my pattern of behavior
around it, hiding it. Yes.
(41:48):
Not like lying about it, right? And I'm like, hmm, this is
familiar. What are the phrase you're
telling familiar exactly? Ransack your kitchen cover at.
Sunday exactly. Yeah.
So I want to be clear, it's not about how I look.
I started to see that this is problematic and what my behavior
(42:09):
of why I am seeking. Yeah, I think that's like really
these nuanced conversations are really important.
I know you've got a JET, so I'm conscious of time.
I want to say from my end, like from a resource point of view
for people that are listening, if you're a therapist listening,
we're going to have some links in the show notes.
I highly recommend the new KadraSubstance Use Program CE that
(42:36):
they've got that's free for members and it's really
accessible and affordable. If you're not a member of CADRA
CADDRA, I'll link it in the website.
It's the Canadian Resource Alliance for ADHD Professionals
and it's really important because it's very obviously ADHD
affirming. It sets forth new treatment
(42:58):
guidelines and the newer ways weare to look at treating a whole
person, not stigmatizing somebody, certainly not
withholding treatment to wait for someone to get sober.
That's not the way anymore. And so, yeah, I wanted to just,
I'll link it in the show notes. I think it's a great course.
I really highly recommend HealthCanada supported the development
(43:20):
of it as well as I think it's important to mention too.
Are there any like resources, Kathleen, that you think are
important to share with either not therapists or therapists or
other people who are just interested in this?
I mean, if from a terms of substance use disorder, I think
there are several programs that I definitely support, like even
(43:42):
12 step programs, they're not for everybody, but any A, A or
NA or OA, again, 12 steps are pretty amazing.
It's also free. And one of the key pieces in
terms of substance use disorder is community being community.
And that's something that is so important.
(44:03):
And also there's SMART Recovery,which is a non 12 step.
It's more CBT based. Yeah, I've.
Heard about that. Physicians refer patients to
that. Yeah.
And so I think that I think bothof those those are are good in
terms of substance use disorder.I definitely the community piece
is huge and that's one of the reasons we started our podcast
(44:25):
sisters and Sobriety, because women often feel alone in their
substance use. A journey.
And you know, my Co host Sonia and I, both of us were really
high functioning. My Co host is sober from alcohol
and I'm sober from drugs and alcohol.
She's drugs as well. But and I think just finding
(44:45):
community around you, you're notalone.
There are so many women who struggle with this.
Really. It's a process for every person
you've met who's made you feel stigmatized or judged for it,
there's a whole bunch of the rest of us out here waiting to
meet you who are understanding of what's going on.
(45:10):
And I think also what the good stuff is that still lays ahead.
And because we watch people get better every single day.
Like I love working with people with ADHD, with any
constellation of comorbidities, to be honest with you, nothing
really scares me because people get better.
(45:30):
So it's, it's gratifying, it's inspiring.
I quite, I quite love it. It almost feels like it cheats
sometimes because like there is such a well prescribed pathway
that when people actually followthe guidelines, it's like, well,
that was easy, you know? Well, you're doing amazing work
because one of my other resources is I do send people to
(45:52):
your website. The information is all there for
free. Appreciate that because I was
like, well, you shouldn't have to just be able to afford to pay
a therapist to have the right information.
So I think it's, I put everything out there information
wise, anyone can access it. And that's just kind of an
important thing that we do. But I think it's important to
tell people where they can find you.
(46:13):
At kathleenkillen.com, OK ATHL EE N&KILLE, n.com and I have
also lots of free resources on my website and on my YouTube
channel for those in relationships.
Are you taking new couple clients right now?
I have another therapist on my team who is, but I currently
(46:34):
have a wait list. All right.
Thank you so much for coming andfor sharing of yourself so
generously. I really appreciate it and I'm
I'm sure our listening audience does as well and I think there's
a million other things I want toget to, but we might have to do
a Part 2 because I, I wouldn't mind also talking about rehab.
What happens in rehab? Like the scene of rehab is in
(46:57):
Canada to this day. I have thoughts and opinions and
I'm sure you do too. So that would be cool if we can
do that, that'd. Be cool for a follow up.
Absolutely. Yeah, absolutely.
Thanks for having me on. OK.
Thanks. Thanks for joining me today as I
(47:17):
continue to try to make the invisible visible.
My hope is that these conversations help you feel a
little more seen and supported as you navigate your own
journey. If you're curious to
digdeeperyoullfindmoreresourcesarticlesandepisodes@digalittledeeper.caand if something today you heard
stirred something inside of you,please know that reaching out to
(47:41):
a licensed professional can be an important next step.
You certainly are not alone, andyou don't have to carry it or
figure anything out on your own.I'm Christina Crow, reminding
you that mental health is health.
Take care and I'll see you next time.
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