The Real Happy Pill

by Anders Hansen

  There are no blood tests or x-rays to tell you if you have ADHD. Instead, you must meet the conditions on a checklist of criteria. Other than having trouble with concentration, impulse control, and hyperactivity, these problems must also affect everyday living. Having problems at school is not enough, since that could be due to a poor academic environment. The problems should be apparent at home, at school, or in the workplace. The difficulties should also be obvious as early as childhood. ADHD isn’t something you catch; it’s a lifelong issue.

  Being diagnosed with ADHD requires that you have serious problems with concentration and impulse control. What does this mean, exactly? If you’ve had issues with concentration but were still able to graduate from university, does that indicate that you don’t have ADHD? At the risk of repeating myself here, there is no single answer to these questions. ADHD is, unlike many other medical diagnoses, a vast gray area. Without making any comparisons between ADHD and HIV other than the fact that they are both medical diagnoses, it’s impossible to “have a little bit of HIV”—either you’re infected, or you’re not—but you can suffer from “a little bit of ADHD.” An ADHD diagnosis is neither black nor white; it deals in qualities that are typically variable among us humans beings, and there is no clear line between ADHD and non-ADHD. We’re all somewhere along the ADHD spectrum, and we exhibit characteristics for the diagnosis to a lesser or greater degree. Some of us have more of them than others.

  THE REWARD SYSTEM IS THE BRAIN’S ENGINE

  Keeping in mind that ADHD includes problems that many of us grapple with, it’s wise to wonder if there’s anything, aside from medication, that could be of help even for people with concentration problems that aren’t sufficient to be diagnosed as ADHD. This is where exercise and training enter the picture. The connection between physical activity and concentration begins in an unexpected place, namely, in the area that makes you feel good when you eat tasty food, socialize with friends, or get praise at work: your brain’s reward system.

  The reward system is incredibly powerful and can be compared to an engine that pulls us toward certain behaviors. There are several important areas connected with reward, but the one we typically refer to when we say “reward center” is the nucleus accumbens—a pea-sized cluster of brain cells connected to many areas throughout the brain. This is where you get your “reward,” your feeling of pleasure. The nucleus accumbens is what drives you. There are several substances that act as messengers between brain cells, and in scientific parlance they are known as neurotransmitters, of which dopamine is the best known. Certain behaviors, such as eating good food, socializing with others, being physically active, and having sex increase levels of dopamine in the nucleus accumbens. The spike of dopamine gives you a positive feeling, which makes you want to repeat those behaviors because your brain is pushing you to engage in them. Why does your brain want you to eat, socialize, be physically active, and have sex? The answer is simple: from an evolutionary perspective, these behaviors increase your chances of survival and ensure that you’ll transmit your genes to the next generation. If there is a purely biological drive in life, it is to survive and transmit your genes (i.e., to have children), and the brain is programmed with that as its North Star. You need food to survive. Socializing with others is crucial for the survival of a herd animal, like a human. Having sex increases the likelihood of transmitting genes through procreation.

  ADHD

  What about exercise; why does that make you feel good? Probably because when our ancestors ran, they usually did it as part of hunting or finding new places to settle—activities that promoted survival, which consequently were rewarded by the brain. Unlike us, our ancestors didn’t run for the fun of it or for weight control, but because it increased their chances for survival. That’s why we also benefit from being physically active, even today.

  No concentration without reward

  By rewarding behaviors with good feelings, the nucleus accumbens steers you toward whatever actions increase your chances of survival and the transmittal of your genes. But the reward system is not only there to make you feel warm and fuzzy; it is also central to your ability to concentrate. The nucleus accumbens isn’t off most the time and turned on only because you’re eating a good meal, having sex, or finding out that you’ve won the lottery. It’s always active and providing feedback to the rest of your brain about whether what you’re up to is worth continuing or not. Let’s say you’re watching television. If your nucleus accumbens isn’t stimulated enough by the program (i.e., if your dopamine levels aren’t elevated), your attention will shift and you’ll look elsewhere for a hit of dopamine—maybe from what’s on your cell phone. If you constantly lose focus and scan your surroundings for something interesting, you’ll be perceived as restless and distracted.

  Our ancestors ran not because it was enjoyable or to control their weight, but because it increased their chances of survival. That’s why we also benefit from being physically active.

  Today we know that the reward system appears to be different from person to person. In some, it’s finely tuned as soon as they’re born, while in others it works less well. Many things indicate that people with significant concentration issues have a reward system that runs differently. What increases the dopamine levels for most of us isn’t enough for them.

  Their reward system requires more stimuli to become active, and that has major consequences. A reward system that is always underactivated will lead people to constantly change their focus and hunt for something that will give them a larger thrill. They opt for what delivers the best, most immediate pleasurable experience and ignore what is good for them in the long run. They have trouble setting up and following long-term goals and are interrupted by distractions big and small. They become careless, impulsive, and, in some cases, hyperactive.

  Many who have trouble focusing do learn a variety of strategies to cope with this, such as organizing their life and having clear routines to follow throughout the day. When things become turbulent, those routines are a buffer from distraction.

  It has been shown that the nucleus accumbens isn’t as active when a person with great concentration problems—someone with ADHD, for instance—is exposed to what normally would be considered a reward. More stimuli seem to be required to activate his or her reward center.

  Too few receivers in the reward center

  Nowadays we’ve begun to understand, at the molecular level, why there are differences in the reward centers of different people. For dopamine to have an effect in the reward center and to make you feel good, it must be able to bind to a receptor on the surface of the brain cell. The dopamine plugs in to the receptor, which sets off a reaction in the brain cell that makes you feel pleasure. However, nothing happens if there is no receptor for the dopamine to plug into, and the reaction does not occur. Interestingly, it looks like people with ADHD have fewer dopamine receptors in their reward centers. This means that their reward systems don’t work well, and that they require greater rewards to be responsive.

  This means that there are some people whose brain, from the onset, demands more stimulation to activate the reward center. What someone with a normal reward center deems sufficiently interesting to keep his or her attention—a work task, a television series, or what the teacher is writing on the blackboard—is not adequate; it doesn’t create enough activity in the reward center. This person becomes bored and attempts, subconsciously, to find further stimulation in some other way, and consequently loses his or her concentration. Concentrating on work or on what the teacher is writing becomes impossible. Then again, all of us are perched somewhere along the ADHD spectrum. We don’t have a reward system that works normally, yet we don’t have one that totally malfunctions. Most of us find ourselves somewhere in the middle.

  WORLD CHAMPION OF BAD DECISIONS

  “If there were such a thing, I would probably have been crowned world champion of bad decision making. I have always chosen what works for me in the present mom
ent, damn the long-term consequences. I could never sit still in school and had to be in a special education class where everyone behaved much like I did. My grades were awful, and I ended up running with a bad crowd and experimenting with drugs by the time I was thirteen. I quite quickly discovered amphetamines, which became my drug of choice. What made other people hyper had a calming effect on me.

  “Naturally, the combination of drugs and risk taking was a recipe for disaster, and as my drug addiction become more expensive, my criminal activities turned serious. It all ended with a spell in prison.

  “When I told my story to the prison doctor, he diagnosed me with ADHD. After I was put on medication I could suddenly focus—my life got clearer, and I began to get things done. It became easier to function every day and to socialize with friends; I could be present and not feel perpetually out of it, as if I were somewhere else.”

  This forty-four-year-old man’s story is pretty typical; I’ve heard similar accounts from hundreds of other patients. While each one of them suffered great strife due to a lack of concentration and impulse control, not many of them became addicts or criminals. What is striking is that this man looks markedly well trained and is very fit. He had made working out a priority his entire life despite his otherwise self-destructive ways, because he would feel calm after exhausting himself physically: “[After working out] I’d be like everyone else and could listen to others without being distracted by everything around me. Now I realize that, throughout my life, working out has been a type of ADHD medication.”

  Consciousness and attention

  The greatest mystery of the brain, and perhaps of all scientific mysteries, is how this collection of cells inside the cranium, weighing only slightly more than a kilogram (2¼ lbs), becomes conscious. How it turns into you. It was long believed that it was frivolous for scientists to even attempt to understand consciousness, a bit like trying to search for the meaning of life. But today’s scientific research into the conscious mind is as far from silly as you can get. Recent medical discoveries have provided us with a whole new set of tools for studying consciousness. It’s not only a matter of interest to neuroscientists; physicists, psychologists, and philosophers are also trying their best to figure out the riddle of how some cells—because that’s what we’re made of, after all—can become aware of their own existence. How can they even comprehend how they are built and what place they occupy in the universe’s space and time continuum?

  Where did this research lead us to? Where is our consciousness located? The short answer is: we don’t know. We don’t even know what consciousness is. Some of history’s great thinkers have put forth some ideas. Plato, for instance, didn’t believe our mortal body could create a consciousness. Polymath Leonardo da Vinci leaned toward the theory that consciousness was most likely connected to the brain but located in its fluid-filled cavities (i.e., the cerebral ventricles). The philosopher René Descartes suggested that our consciousness was situated in the pineal gland, a small gland in the brain that we now know secretes the hormone melatonin, which regulates sleep and wakefulness.

  No disrespect intended, but modern neurological research has proven the aforementioned geniuses to be mistaken. Today, no one disputes the fact that our consciousness is in fact in the brain, and that it is not in one singular location. Our senses of smell, sight, and hearing all have specific centers, but there isn’t a lone consciousness center. Instead, it seems that many areas in the cerebral cortex make up and work as an advanced network, and that consciousness is the result of the collaboration between the frontal and the temporal lobe, along with the centers for sensory impressions (like the sight and hearing centers).

  The thalamus is the part of the brain that acts like a junction. It is situated in the brain like the hub on a bicycle’s wheel, from which the spokes extend outward. To illustrate: information is brought into the thalamus from the brain’s different areas, like the centers for sensory impressions, and from there the data are spread out to the other areas through the advanced network. It is within this network that we believe our experience of consciousness is created.

  What does all this have to do with concentration? Well, consciousness isn’t just fascinating from a philosophical and scientific point of view; it is also closely connected to our ability to pay attention and focus. Your brain is constantly filled to bursting with activity, where information from different areas compete for a spot in your consciousness. You’re fed sensory information about what position your legs and arms are currently in, if the room is warm or cold, if you’re feeling pain anywhere, and what you’re seeing and hearing right now—which could be the words in this sentence or a car sounding its horn out in the street. Your consciousness sifts through all of this and decides what your brain should concentrate on—hopefully, it’s this sentence!—and what is unimportant.

  Dopamine turns off the din

  Let’s say you’re in a coffee shop and you’re reading a book. First, you’re aware of the murmur of the people in the background, but that sound slowly recedes and you can concentrate on what you’re reading. Even though you’re no longer listening to the voices, your brain still registers what is being said. If someone in the coffee shop says your name, you’ll probably react even though you weren’t actively listening. Part of your brain must still be hearing, without you being aware of it, and you’ll turn your attention in that direction. Obviously, this happens automatically. The brain possesses the amazing ability to process huge numbers of impressions without us being in on it, sounding the alarm and focusing our attention on what is deemed important.

  We need dopamine to turn down the din that our sensory centers bombard us with and to direct our attention toward whatever we are doing. Dopamine has considerably more responsibilities than just being a rewards compound; it is also critical for concentration. Lacking dopamine can lead us to become unfocused and jittery, distracted by background noise. We all go through this sometimes; we’ll feel unsettled, jumpy, and absentminded, especially if we’ve slept badly or we’ve drunk alcohol the night before.

  Oddly enough, there’s another kind of din in your head, a kind of inbuilt hum that doesn’t originate in the sensory centers. It’s something we all experience, and it doesn’t mean we’re going crazy. It’s probably caused by brain cells activating spontaneously from time to time. This happens continuously, but you probably don’t notice it because dopamine filters it out. However, without a finely tuned dopamine system, that interior noise—like the din from sensory centers—can become bothersome. Neurological tests have shown that persons with ADHD have a louder inbuilt hum that disturbs and impairs their ability to concentrate. The more interior noise there is, the worse the focus.

  It’s interesting to note that if dopamine levels increase, the interior, non-stimulus-driven thrum will stop. Both the noise from your sensory centers (the din in the café, for example) and the inbuilt hum call it quits. It’s like hearing the irritating sound of static in the background because no station is tuned in—and the dopamine lowers the volume and silences the hiss. There’s no more disturbance, and it gets easier to focus.

  NATURAL CONCENTRATION MEDICATION

  Low or incorrectly regulated dopamine levels can cause a din, which keeps the dopamine system insufficiently activated and makes it difficult to concentrate. Therefore, the obvious next step would be to try and treat the lack of focus, and increase and stabilize dopamine levels through artificial means. That’s the mechanism behind most ADHD medications: they boost dopamine levels, which in turn lead to improved focus. Many ADHD sufferers claim that their existence becomes sharper and clearer, which probably stems from the fact that the hum in their brain—internal and external—has been silenced. However, not everyone who’s on medication experiences this. Also, not everyone wants to take medication. Add to this all the people who occasionally have trouble concentrating without suffering from full-blown ADHD. Is there any other way to boost dopamine levels without resorting to pharmaceuticals? Ther
e is: move your body.

  Possibly the most important reason why exercise is good for concentration—whether you suffer from ADHD or not—is that physical activity raises dopamine levels and fine-tunes the systems for attention and reward. Today, we know that dopamine levels increase at first after you’ve been physically active. They rise a few minutes after a training session, and they remain there for several hours. This makes you feel sharp, focused, and calm after exercising. You feel better, and it’s easier for you to concentrate. The hum is hushed.

  It appears that the more strenuous the exercise, the higher dopamine levels rise, so from dopamine’s standpoint, going for a run is better than going for a walk. It’s all the more reason why you shouldn’t give up after your first run or bike ride if you don’t feel better right away or if your focus has not improved. The more you train, the more dopamine you’ll get. The brain seems to increase it more and more, so the more often you run on the trail or cycle that loop, the greater your dopamine reward. This means you’ll feel better every time you complete a session, since dopamine also affects your feeling of well-being, and your concentration will improve even more. In other words, exercise is effective medicine for improving concentration, with no side effects whatsoever. Furthermore, its effect is enhanced the longer you continue.

  Brain boss

  Dopamine has many important effects on the frontal lobe (which is located directly behind your frontal bone). It’s the frontal lobe, especially its anterior part—the prefrontal cortex—that makes the decisions in the brain. The prefrontal cortex is the brain’s boss, and its most developed area. The ability to set and follow through on long-term goals, instead of simply acting on impulse, is found here. The same is true for our advanced cognitive functions—those that separate us from other animals—such as abstract, mathematical, and logical thinking.