My claim to fame as a teenager was being one of the top ten GoldenEye: Source players in the world. I logged around 1000 hours in the game within a year, even competed in tournaments with my clan. I grew up on games, built my first pc when I was 15, but this time, I had something that I felt gave me laser-focus like never before. My secret weapon? A bong (well, a plastic waterfall I built myself named “Tom Clancy”). It’s no surprise that a decade later, I finally got my ADHD diagnosis.

Stimulants are the standard treatment for ADHD because they act directly on receptor sites to increase dopamine in a safe, controlled way. Problems arise with ADHD brains that are treatment-resistant to stimulants or cannot take them due to side effects or conflicting medical conditions. Enter cannabis.

Before diving into the science behind cannabis and ADHD, it’s helpful to lead with what my psychiatrist told me after a few years of searching for the proverbial Golden Pill: ADHD is a dopamine deficiency. How each brain figures out the best way to wring out dopamine is different—living down to the wire, skydiving, getting in a fight with strangers online—but the problem is that simple. Let’s get into it.

Cannabis and ADHD

Could phytocannabinoids work as well as stimulants?

Many undiagnosed ADHD folks self-medicate with cannabis. Even celebrities like Seth Rogen have been pretty blase about using cannabis to treat their ADHD. Mark Rogan, his father, explained that cannabis was the one thing that “finally made [Seth’s] cells relax.” Last March, the Pineapple Express star (who rolled all of the joints seen on screen during the film and was christened by Snoop Dogg as “the best joint roller he’s ever met”) celebrated launching his cannabis line, Houseplant, for medical and recreational use.

One of the reasons why many ADHD brains rely on cannabis is because phytocannabinoids may have a similar effect to stimulants. Fatty acid hydrolase (FAAH) production in ADHD brains is insufficient to break down excess anandamide. The result is a dopamine deficiency with high levels of anandamide. One of the common verbiages for this experience is “running on fumes.” Tongue in cheek? Maybe. Contradictory? Not at all. The name “Attention Deficit Hyperactivity Disorder” is just that misleading—wait until debilitating fatigue with ADHD is more widely acknowledged. 

The ADHD brain may use THC as an anandamide substitute, improving some of the core markers of ADHD like emotional regulation, memory and cognition. CBD, on the other hand, can modulate GABA activity. GABA is a neurotransmitter responsible for reducing neuronal excitability, and when inhibited, dopamine production increases. (1) CBD also stimulates adenosine receptors, encouraging dopamine release. CBD’s effect on GABA is also responsible for its anticonvulsant properties.

A wise man once said, “do you.”

Ultimately, the anandamide and dopamine deficiency connection are only a few broad strokes that make up the mosaic of how ADHD brains function. Otherwise, treatments would be more of a silver bullet rather than trial and error.

I’ve given up searching for my Golden Pill and given into the idea that the best treatment is multifactorial. Cannabis is just one tool that allows my ADHD brain to live my best life. In the words of Seth Rogen: “I wake up in the morning, I make a cup of coffee and I roll a joint.” We grok that.

Footnote(s)

1 - https://www.nature.com/articles/s41386-019-0333-8