ADHD, Dopamine, and the Likelihood of Delusions

I’m an individual diagnosed with ADHD and one who studies psychology (B.A. in psych) with a special interest in understanding subjective experiences including with drugs and mental illness-related experiences. This is my attempt to explain what my ADHD is. In this article, I propose a hypothesis that may be somewhat absurd: I suspect that individuals with ADHD might tend to experience less motivated reasoning or biases but also that such processes are useful for normal individuals in motivating action towards long-term goals. Keep in mind that this is hypothetical.

I was diagnosed ADHD at an early age, around 1st or 2nd grade. It felt like my memory initiated after I started taking the stimulant medication, Ritalin. As if I hadn’t even been alive before then. Some of my symptoms of my “ADHD” were odd. When I was born, I had restless behavior, often rocking back and forth. I actually continued rocking and various manifestations of restless movements well into college. Moving around produced a kind of euphoric effect that soothed me. I actually used to think that I might have autism due to symptoms like this, but when professionally evaluated, autism did not come up. I have since stopped the rocking behavior.

Sometimes (what seems to be) my ADHD feels like I lose awareness of what I should be doing and get lost in whatever I am actually doing. For example, while trying to apply to graduate school, I would end up having multiple conversations and looking through my phone or other stimuli without a meta-awareness that I am doing so. It is like I am distracted but I don’t yet realize that I am distracted, and I’ve lost track of the fact that I was supposed to be doing something. I’ve had other moments where I do have the awareness that I am supposed to be doing something but very often I don’t. The lack of meta-awareness makes it so that I don’t even realize that I am distracted. It is very similar to a flow state. Those of you who play musical instruments or video games and lose track of time may be able to relate. This may tie into the “hyperfocus” symptom that people suggest is part of ADHD.

Many times, I feel like I am not fully awake. I chase stimulation with coffee, but it never really works as much as I’d like. There is this constant annoying sensation of wanting to be satisfied that permeates my existence. Drugs that I use do not really satisfy this. Cannabis would acutely solve that feeling. Though, THC had its own issues, which will be made apparent further down.

Sometimes I am finally stimulated enough, and I enter a state in which it feels like I have more freedom or agency. I feel less compelled to chase hedonism and I am no longer confined to addressing my irritating cravings and more able to make choices consciously. Especially choices that are ordinarily very aversive to me, like cleaning or doing paperwork. In the sober state, it feels like I am not worried enough about the consequences of neglecting the tasks I must do.

My use of medication has departed me. When I was younger and medicated, I remember this feeling of urgency that would often come when the deadline of an important project was coming. I no longer experience such a feeling and it has been almost a decade since I’ve last felt it. I even remember the period of my life when I began to notice this feeling decaying away. It left me worried that I would slowly fail life altogether, since I often relied on such feelings of urgency to progress on these projects. I’ll note, my world didn’t collapse and my lifestyle and strategies for approaching projects have evolved over time. Even without medication, I’ve now passed through undergrad with a high GPA and good grades.

I’ve wondered if stimulants and other dopaminergic substances work by making one more “delusional” in a sense. Normally, the motivation to engage in a behavior is contingent on the belief that investing efforts leads to the desired outcome. Investing efforts is like a cost while the outcome is a reward. It isn’t necessarily about how much we want the reward but more a combination of wanting it and the likelihood that the outcome is even attainable. As much as I would find it fascinating to become a dolphin temporarily, this goal doesn’t seem attainable to me, so I have absolutely no motivation for this goal. Stimulants may increase the sense that an outcome is likely and thus make us more likely to engage in that goal.

At the extreme end, stimulants and dopaminergics may induce the development of delusional beliefs via a similar process that they enhance motivation. One might believe that grandiose outcomes are possible and begin investing in very sketchy gambles. Stimulants seem to signal to my mind that investing in a life choice or behavior is more worthy of my time than usual, causing me to take action on things I normally feel apathy for. The essence of this dopamine effect may be to increase the anticipation that a reward is likely or imminent. In regards to delusions, the reward is that the idea or hypothesis is true or possible, particularly when there are exceeding amounts of unknowns in the problem.

The most extreme form of this that I have experienced is with vaporizing THC. Strange beliefs and hypotheses appear to be far more likely as the drug is peaking. This caused me to brainstorm and go down mental rabbit holes on ideas that are quite absurd and unlikely. Maybe if I smoke enough weed, I could get to the level of delusional belief that becoming a dolphin through mad science is possible.

This may even be a mechanism of creativity. It is as if my mind says, “this hypothesis is worth investigating!” and I run with it and end up discovering tangential ideas that sometimes lead to the accidental discovery of epiphanies and treasures. Through trial and error, I end up finding new ideas that are sometimes absurd but also sometimes valuable. While sober, it is more like I have too little faith in random ideas and just move on to some other stimuli or idea and wait for one that really seems plausible on a strong level. Instant gratification behaviors are really the peak of plausible rewards. They often have the least cost and the highest guarantee of reward.

Within my ADHD apathy, it may be the lack of belief that certain goals are attainable that causes me to disengage with many goals, particularly when I haven’t sat and mentally walked through all of the steps that go into reaching that goal. Too many goals appear unlikely, much like the goal of becoming a dolphin temporarily. ADHD may sometimes lead to an agnostic approach to everything. This is totally anecdotal though. Though I haven’t tried it, one might be able to sit and intentionally walk oneself through the steps involved in reaching a long-term goal so that it feels more palatable and reasonable to take on.

This ADHD apathy seems bad, though I do believe there are possible benefits to this too. Like how the dopamine drugs could inspire creativity, I think the apathy towards ideas makes it more apparent which ideas are actually highly worth our time. In a weird sense, we might even have a stronger sense of which ideas or goals are more reasonable. Sadly, when you haven’t sat and explored the nuances and steps involved in long-term goals, all short-term goals and immediate sources of reward become the peak of plausible worthwhile investments of our time. The amount of time it takes for genuinely good ideas or goals to fall into our laps can seem like an eternity. This is a slow and depressing route in some ways. Perhaps there is another end of the spectrum in which a person would engage in many unlikely hypotheses. If this seems instantly sensible to you, perhaps you fall on that side of the spectrum!

This concept seems to fit well with the connection between dopamine and gambling. Beliefs are a gamble in some sense. Dopamine drugs may increase our willingness to bargain on such gambles (Moore, Glenmullen, & Mattison, 2014). Meanwhile, the low dopamine state may invoke an unwillingness to gamble on what most people consider to be reasonable gambles. Instead, low dopamine individuals may opt for more guaranteed rewards, such as immediate gratification since the path to those goals is much easier to perceive and thus the outcome is easier to have faith in. In past articles, I’ve argued that instant versus long-term gratification is actually about the certainty of a reward rather than length of time (though, it is probably both somewhat).

As an example of how this may play out in willingness to take on beliefs, I’m very fond of agnostic solipsism, the notion that we cannot really be certain of much in the external world besides that we seem to exist. We cannot even be certain that other people exist in the forms we believe them to. For example, people could be AIs in a simulation. Generally, it is hard for me to dedicate myself to a particular belief and I often take an agnostic approach. Fascinatingly, those with ADHD have been found to be less religious (Dew, Kollins, & Koenig, 2022).

The delusional individual may oppositely be willing to take gambles on the riskiest beliefs like “it is possible that I am a descendent of a god”. They may be willing to take on beliefs with far less support and thoughtfulness because the ideas simply feel more likely to be true. Similarly, “It’s likely a meaningful coincidence!” might not be too far off from “I’m likely to win this gamble!”. Perhaps dopamine plays some role in determining what appears to be likely or worthy of our time. Dopamine drugs sometimes produce delusions (Andreou et al., 2015; Fowler, Maderal, & Yosipovitch, 2019; Moore et al., 2015). Dopamine increasing drugs have also been shown to increase confirmation biases (Andreou et al., 2015).

So, I wonder if those with ADHD are less prone to confirmation biases. Research on this appears to be lacking. If I missed something, send it! All I saw was that ADHD people rate their abilities as higher, which might be a cope (Owens et al., 2007). Such tendency may exist as a reaction to the way that those with ADHD are viewed as mentally broken, rather than some innate predisposition to biases. I would likely rate my potential for becoming a scientist highly. Yet, in contrast to the faith-having motivated individual, I cannot even convince myself that continuing to apply towards my future is a legitimate goal, which is probably a fairly realistic goal, regardless of my subjective sense that it isn’t worth investment.

On the other hand, while on cannabis and Adderall, I occasionally formed unlikely plots akin to taking over the world through social engineering, which didn’t last terribly long. I’ve spent a ton of time consuming various dopaminergic drugs and have experienced psychotic symptoms quite a lot throughout my life. I may even naturally fluctuate between low and high states. I’ve pondered whether I’m bipolar and almost got diagnosed but left psychiatry before officially being diagnosed. On the psychological evaluation that I took a decade ago, I scored as possibly schizotypal.

. . .

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Reference

Andreou, C., Bozikas, V. P., Luedtke, T., & Moritz, S. (2015). Associations between visual perception accuracy and confidence in a dopaminergic manipulation studyFrontiers in psychology6, 414.

Andreou, C., Schneider, B. C., Braun, V., Kolbeck, K., Gallinat, J., & Moritz, S. (2015). Dopamine effects on evidence gathering and integrationJournal of Psychiatry and Neuroscience40(6), 422-428.

Dew, R. E., Kollins, S. H., & Koenig, H. G. (2022). ADHD, religiosity, and psychiatric comorbidity in adolescence and adulthoodJournal of Attention Disorders26(2), 307-318.

Flann, S., Shotbolt, J., Kessel, B., Vekaria, D., Taylor, R., Bewley, A., & Pembroke, A. (2010). Three cases of delusional parasitosis caused by dopamine agonistsClinical and Experimental Dermatology: Clinical dermatology35(7), 740-742.

Fowler, E., Maderal, A., & Yosipovitch, G. (2019). Treatment-induced delusions of infestation associated with increased brain dopamine levelsActa dermato-venereologica99(3), 327-328.

Moore, T. J., Glenmullen, J., & Mattison, D. R. (2014). Reports of pathological gambling, hypersexuality, and compulsive shopping associated with dopamine receptor agonist drugsJAMA internal medicine174(12), 1930-1933.

Owens, J. S., Goldfine, M. E., Evangelista, N. M., Hoza, B., & Kaiser, N. M. (2007). A critical review of self-perceptions and the positive illusory bias in children with ADHDClinical child and family psychology review10(4), 335-351.

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