Lots of ADHD spouses are uncomfortable with the idea of trying medication as treatment for their ADHD – and some number flatly refuse.  If you’re stuck in a battle with your partner over the importance of medication, here are four tips for you.

Tip 1 – Back Off

Medication has been shown to be a very effective way to start the treatment of ADHD, therefore many non-ADHD partners see meds as critical to turning their relationship around.  This leads to very heated conversations around meds in which the ADHD partner digs in to his or her position that they aren’t needed.  Parent/child dynamics reinforce the conflict – “You must try meds because it’s important!” is met with some version of “you’re not the boss of me!”  Because of an ADHD partner’s tendency to dig in when being told what to do, this approach simply doesn’t work.  Back off and try a more respectful approach that acknowledges that it’s your partner’s body, not yours.

Tip 2 – Understand What’s Underneath

After becoming comfortable with me, ADHD spouses frequently tell me that fear drives their desire to stay away from meds.  These fears are varied – they’ve read that meds might “change” them or make them less creative.  They fear they will become addicted or that the meds won’t actually work, making their future prospects even more bleak as their partner gives up hope.  They fear that taking meds is an admission of how bad their ADHD is - the equivalent to taking the blame for their relationship troubles.  They fear any medication targeted to the brain.  When your partner refuses meds he or she may not express these ideas…but they may well be there.  One can’t overcome fear with aggression.  Be patient, instead.

Another thing that commonly underlies a refusal to take medication is that an ADHD partner doesn't see the impact of their ADHD on others around them - even if you've been talking about it in a very straightforward way.  Explain, in as non-threatening a way as possible, the impact.  Make sure you have your partner's full attention and that this is done seriously.  Nagging and berating or making negative comments in passing is NOT effective and should NEVER be the way you express your displeasure at your partner's unresponsiveness (see my book on this!)  You must sit down and calmly explain how ADHD symptoms got in BOTH of your ways that week (or day) and how difficult it is for you to function in a relationship so filled with inconsistency and broken promises.  This is not an easy story - sometimes books can help.  Ned Hallowell's Driven to Distraction and Delivered from Distraction are favorites for better understanding ADHD, and my book The ADHD Effect on Marriage for driving home its impact on relationships.

Tip 3 – Get Educated

ADHD is the result of a chemistry issue in the brain (not enough dopamine, among other things,) which is why ADHD meds work – they balance out the chemistry by adding dopamine production or dopamine retention.  A good parallel to treating ADHD with meds is treating diabetes with meds.  Just as with ADHD, you can make some progress with dietary and lifestyle changes, but your best results come when you take insulin to improve the chemistry.

There are lots of other important facts about meds, some of which include:

• Stimulant meds are in and out of your system in between 4 – 8 hours.  If you don’t like them, you simply stop taking them.
• Research and clinical experience suggests that 70-80% of patients can find a medication that helps them improve their symptoms with no significant side effects.
• Research also suggests that medication (along with behavioral changes) allows 50% of those with ADHD to almost completely or completely control their symptoms and another 20+% see significant improvement.  This means that statistically speaking, you will most likely benefit from trying medication as part of your treatment for ADHD.
• In the case of ADHD, finding the right dose and medication is a matter of experimentation under the supervision of your doctor.  You start slow and work to higher doses.  If one med doesn’t help, you try another.  As stated above, most people eventually find something they like
• Try medication sends a really important signal to your partner – that you’re ready to take your ADHD seriously.  Not trying medication (unless you have a medical reason for it, such as high blood pressure) sends the opposite signal.  You get a whole lot of brownie points for trying meds, even if you find out they don’t work for you.
• There is significant upside to meds because of the statistical likelihood they will improve your life, even in ways that you may not anticipate.  There is virtually no downside.  (Having said this – the decision remains firmly in the hands of the person with ADHD – and must be respected.)
• Because medication combined with behavioral changes is one of the most effective ways to manage ADHD, not taking medication increases the likelihood that you will end up unhappy or divorced, as it increases the likelihood that nothing will change.  Since the status quo is unacceptable to your partner, no change is not the best direction to take.  (Another caveat – improvements to ADHD can be made without medications, however they can be very hard to sustain because the innate chemical imbalance in your brain fights against sustained behavioral changes.  Some people, particularly those with milder ADHD don’t need medication, but many do.)

Tip 4 – Don’t Extract Promises

Make it clear to your partner – trying medications does not commit him or her to taking them forever…or even for a week.  They are in charge of their body.  If they don’t like the medication they try something else or stop entirely.  Unhooking trying meds from continuing meds takes a lot of the pressure off the ADHD spouse and relieves some fears.

This Probably Makes You Nervous

I understand that your reaction to these ideas may well be something like this:  "I'm exhausted and hopeless.  My partner doesn't want to even admit his ADHD is an issue and his unwillingness to deal with it is making me crazy.  How can I possibly back off or start listening to his complaints about ME when he is so unwilling to look at himself?"  But the reality is that no amount of pushing on your part will force him to take meds.  Your role, if you are going to be successful, is one of encourager rather than parent or enforcer.  Education about ADHD and about meds plays a big role in slowly wearing down your partner's wariness about what taking meds might mean for him or her.  And remember that being patient and respectful doesn't mean you can't ever get your needs met - in fact I would posit that it's the best way to get your needs met because it creates the environment in which your partner is most likely to feel safe enough to look at him (or her) self and admit that you might just have a point.

So stay firm but respectful around stating your needs and asking for your partner's reasonable participation in addressing them.  Let your partner figure out how he or she is going to attempt to address the needs.  Together, measure his success.  Make sure to provide praise where it's due.  And get information to your partner about medications and options in as unthreatening and un-parenting a way as possible.  This approach takes time and patience...but aside from involving a third party, it's the only one I've seen that works.