← ADHD for Smart Ass Women with Tracy Otsuka
ADHD for Smart Ass Women with Tracy Otsuka
EP. 372: Motherhood, Hormones, Trauma and Addiction with Dr. Anupriya Gogne
01:21:30
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- [00:00]
A
Before we start, a quick note. If you've been listening to this podcast and thinking, I need more than insight, I need support, this is for you. Your ADHD brain is not broken. It just never came with a map. That is why I created you'd ADHD Brain is a okay academy. It's my patented step by step framework to help you build a life. And that finally fits how your brain works. Ready to get started? Click the link in the show notes to sign up or book a free discovery call with me now. On with the show. Richard Branson, Michael Phelps, Justin Timberlake, James Carville. Wait a minute. Where are the women? Greta Gerwig, Lisa Ling, Audra McDonald, Simone Biles. That sounds like a list of highly successful titans in a variety of industries. They all have adhd, but you don't hear much about that now, do you? You know what else you don't hear about are the 43% of people with ADHD who are in excellent mental health. Why aren't we talking about them and what they are doing? I'm your host, Tracy Adsuka, and that's exactly what we do here. I'm a lawyer, not a doctor, a lifelong student, and now the author of my new book, ADHD for Smartass Women. I'm also a certified ADHD coach and the creator of youf ADHD Brain is aok, a patented system that helps ADHD women just like you get unstuck and fall in love with their brilliant brains. Here we embrace our too muchness and we focus on our strengths. My guests and I credit our ADHD for some of our greatest gifts. And to those who still think they're too much, too impulsive, too scattered, too disorganized, I say no one ever made a difference by being too little. I am your host, Tracy Otsuka. Thank you so much for joining me here for another episode of ADHD for Smartass Women. You know that my purpose is always to show show you who you are and then inspire you to be it. In the thousands of ADHD women that I've had the privilege of meeting, I've never met one that wasn't truly brilliant at something. Not one. So of course, our guest today is no exception. I am just delighted to introduce you to Anupriya Gogne. Dr. Anupriya Gogne is a board certified addiction psychiatrist specializing in perinatal and reproductive psychiatry. She currently works in outpatient psychiatry at Brown University Health and serves as an Assistant professor of Psychiatry and Human behavior at Brown University. For over eight years, Dr. Gogne has worked closely with pregnant and postpartum women struggling with addiction, many of whom also have undiagnosed neurodevelopmental differences and significant trauma histories. Her work sits at the intersection of of adhd, nvld, addiction, trauma, and reproductive mental health. Informed by both her clinical experience and her own late diagnoses of ADHD and NVLD, Dr. Gogue recently authored Neurodevelopmental Disorders in Adult Women. The book weaves together clinical vignettes, current research, and a practical multimodal treatment approach to better support neurodivergent women during pregnancy and the postpartum period. Welcome, Dr. Gogna. Did I get all of that right?
- [04:09]
B
Yes. Thank you for that introduction. It was very comprehensive. Thank you.
- [04:13]
A
When you listen to all that, do you impress yourself?
- [04:17]
B
I do and I don't. I think. I mean, being from a family of doctors and high achievers, it's seems like something. It doesn't sound that impressive, I guess, but if I think about it objectively, then yes, I can see that the hard work has paid off.
- [04:35]
A
So it was just kind of expected this is who you would become.
- [04:38]
B
Yeah. At least more was expected, but I think the medicine part was definitely expected.
- [04:45]
A
Do you feel like it has always been your calling or was it more an expectation? Oh, you do feel that?
- [04:52]
B
Yes, yes. So I think psychiatry is definitely my calling. Medicine in general. My parents were doctors and everyone in my family are doctors. And when I was growing up in India, we just had two options. You can become a doctor or an engineer. And that was kind of it. And I really like biology and organic chemistry and I really liked neurosciences. And so I chose medicine. And then I came to the US to do my psychiatry residency and further training. So I think eventually I ended up exactly in the right place at the right time. And yeah, so I'm lucky that way.
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A
And in the right decade too.
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B
Yep.
- [05:34]
A
Right. So much new that's happening. So in my family the rules were doctor, dentist, thank God, lawyer was in there because otherwise I would have starved. Or engineer. So I can completely relate. What I always like to talk about first with our guests is your ADHD diagnosis because it allows our listeners to really get to know you a little better. So would you mind sharing that?
- [06:01]
B
Yeah, not at all, because I think that's what started my self exploration process and also more training in adult ADHD and other neurodevelopmental disorders. But so I finished my. I was just at the end of my fellowship or residency basically, and I stayed in the same place as an attending and so what happens is overnight, all your protected time or your academic time, it goes away. So overnight, your caseload is doubled. Overnight, your expectations are doubled. And so that's one major change that had happened at that time. And I saw that I was having to stay back for later for finishing my notes and things like that, and administrative stuff, usually stuff I find very boring. It was taking me more and more time. I saw my colleagues, and they were not staying back. So I started to wonder what was going on. I was seeing a lot of it clinically in postpartum women especially. And at that time, you know, use of medications in pregnancy was not as common, and there wasn't as much data as there is today. So we were having a lot of symptomatic women, and I could see how it's affecting their life, and I could identify in some ways. So around the same time, in my personal life, what happened was I moved in with my boyfriend at the time and now husband, and we got a dog, and I had never had a pet, and we got, like, a baby.
- [07:32]
A
Husky, the hardest dog to train.
- [07:36]
B
And this is part of the impulsivity that we just looked at. Oh, my God, it's so cute. And we just got him without doing any research. But the first three months or so. Well, it's not the same as raising a baby, of course. A human baby, of course. But all these changes happening at the same time had a cumulative effect. And I felt. I kind of had a sense that I probably do have adhd.
- [08:00]
A
Anupriya. I think a baby is easier because you can put a baby in diapers.
- [08:07]
B
Yeah, that's actually good point. Yeah. And so, you know, I was already in therapy at that time, and there was another psychologist who did neuropsych testing, and I was just curious, Honestly, at that point, I was like, okay, let's. Let's just go through testing, see what it's like. Because I. In my clinical work, I was recommending it for patients and reading reports all the time. So I was like, okay, like, this is. This is some cool stuff. And so I did the testing, and then I got the results. And so the ADHD diagnosis happened around, like, six years into that, eight years of working, and that was a little bit expected. But what I didn't expect was the NVLD diagnosis, which, you know, is. Is a. Is a controversial diagnosis in itself, and it's not in the DSM yet. It's considered to be part of the spectrum. So learning more about that and learning more about adult autism and how it differently Presents in women was really a very eye opening process for me and I learned a lot.
- [09:17]
A
Let's pause here. Have you spent your whole life being told your way is the wrong way? If you try to use systems designed for a neurotypical brain, of course you'll feel like you're failing. But here's the truth. You were never the problem. You just have a different brain, which means you need different systems. That is exactly why I created the AOK Academy. It's my six step patented framework designed to help you reconnect with your intuition and build systems based on your unique strengths. Let me help you reconnect with your intuition, trust yourself again and build a life that actually works for you. You've had the answers all along. I'll help you see them. Look, it's time to stop second guessing and start trusting yourself again. Find the link in the show notes to sign up or book a free discovery call. Now let's get back to it. So can you explain a little bit more about nvld? Just, you know, what the acronym stands for, how it differ differs than autism?
- [10:35]
B
Yes, absolutely. And so nvld, I mean some people kind of classify it under the autism spectrum now because we just have one spectrum diagnosis, technically it would fall under that and the co occurrence of ADHD and autism. Now diagnostically, like people call it audhd. Audhd But NVLD basically stands for non Verbal Learning Disability. So it's a learning disability. So again it's part of neurodevelopment. But very specifically the visuospatial functioning is affected in this particular problem, in this particular learning difference. It can manifest socially, but also the social deficits as opposed to someone with more severe deficits as part of autism, the social deficits might not be as severe. And so I think that's why I was a little bit surprised when I got that diagnosis because actually in the neuropsychological testing for adults, they don't even ask you or screen you for social deficits if that was not part of the question for which the testing was done. My tester, it was interesting when she went over the report with me, she said, oh, your visuospatial stuff is, was really fascinating and it was surprising to me. I couldn't really put shapes together and I was like, what is going on? But then when she told me what it was, she was like, your textbook nvld. And we can see it in all the tests which have to do with positioning things, putting things in a bigger context, shapes, directions, right, left, Disorientation.
- [12:22]
A
I just think of myself like, I've been to New York City so many times I can't even count anymore. And I still have no idea where I am when I'm there. As far as direction, which subway, how it's ridiculous. Is that part of NVLD could be.
- [12:37]
B
I mean, it could be part of ADHD as well, because, like, part of inattention can be not really, like, going on autopilot, especially if you've been to a place many times and not noticing things. I think the NVLD part, how it manifests in that way for me is, like, in parking lots, I always forget where I parked my car, and I can't really tell. Everything looks the same, and all of them look the same to me. And, you know, judging the distance, I actually started driving only, like, eight years ago when I moved to Rhode Island. Before that, I had never driven in my life. I had never even tried because my sense of direction was so poor. But when I moved to Rhode Island, I kind of had to learn. I didn't have a choice. So I learned. But, you know, I could notice, like, judging the distance between cars, you know, when you're taking a left turn, then how much distance, like, those small things that we take for granted became very obvious to me that that's probably why it was happening.
- [13:39]
A
Can I ask you. One of the things I've noticed with myself is that if I am in a big city, I have less of a problem than if I am, for example, in, like, a country town, nature, where it's almost like every street looks exactly the same, versus, at least in a city, I can say, oh, well, there's Duane Reade, or, like, I can build landmarks. Is that your experience as well? Yeah.
- [14:04]
B
And I think that, like, what I have started to do is just pay attention with intention especially. It's a new place. And then making myself focus and pausing for a moment, because that's what causes the poor working memory in adhd, that you're not focused for long enough. And so I've started to do that. So even in, like, if we. My husband and I love to go hiking in the mountains and, like, areas where there's not a lot of buildings that you can use as landmarks. But, you know, sometimes there's like, a small hut in a valley somewhere, or there's other things, smaller, other kinds of indicators that I just kind of note in my own mind. And I also take a picture so that I know if it's a new area, I don't want to get lost. I take a picture where we parked our car, which.
- [14:55]
A
Yeah.
- [14:56]
B
And you know, in, in the world that we live in today, where there is overstimulation of every sense that this is not unusual, this in itself I would not say is a disorder. And I don't want people to. A lot of these, like people think they're quirks and they are, you know, they're just part of kind of how we learn and how our brain processes things. But when it happens a little bit too much. And I have had people, patients with NVLD who, you know, really could not drive and would have a lot of accidents or some of the ADHD problems interfering with driving. Like I always have to assess safety. So that's when it kind of becomes something that needs to be looked at in treatment. Otherwise like, you know, a lot of times now that I've accepted the diagnosis, I do laugh it off a lot of times.
- [15:48]
A
Autism is more social awkwardness. Not understanding the social rules versus NVLD is the visual spatial challenges, but it also involves reading facial expressions or body language too. Right. So can you talk about that a little bit? So it's not that there's no lack of social interest, you just miss the non verbal cues. So if there is any kind of social component, it's because you don't really understand. Right. Because you're not getting those cues.
- [16:18]
B
Exactly. Yeah. Because I think the problem is with visual integration and so. Because the overall overarching problem is putting things into context. Right. So I'm looking at you, there's a background behind you and my brain has to look at you and at the background, but choose to focus on you, but also put you in that context that you're probably in an office space, there's books behind you, there's like some plans. And so probably it's. My brain would think it's this kind of a place probably. Right. And so it helps us to identify and get context of where we are in space. So facial expressions are similar. If you think about it, when you are talking to someone and you're trying to understand or you know, read their non verbal cues, which a lot of times you do like not consciously, it just happens, it becomes automatic. You would have to look at the lips, you would have to look at if they're smiling. Right. You would have to look at how the cheeks are going, how the eyes are going and putting all of that information together to build one narrative. And these are the smaller steps that happen, which we take for granted because it happens so fast. And it appears to happen so automatically. So that can be difficult for someone with nvld, like I myself do feel sometimes it's hard for me to recognize people who look similar or really differentiate, find small differences and the social deficits can be linked to that one. You're not picking up all the cues. Even if you're picking up, then you're not really able to put it in the overall context that what is the context of this social situation? What is this interaction about? Because what I'm reading in another person's face is depending on what conversation we are having and why I would be thinking in a certain way, why they would be thinking in a certain way. So it's putting all of that information into context, context which is the problem. And that can then relate to social deficits. But I do think that other social deficits, or let's not call them deficits, but differences that NVLD shares with the autism spectrum is feeling overstimulated, feeling anxious and crowded. Places like grocery stores are not just overstimulating because of adhd, but it could be like all the, an aisle full of chips and like looking for your brand, right? And so too much, too much. But small things like this, which in your everyday life, when you're busy, when you're not busy, like when I was single, I had my own timeline of doing things. It doesn't matter, like you don't even notice. You think it's a quirk. But the women I was working with, who have small babies, who have young kids, and me myself, when I'm now busier in my life and you don't have as much time, then it wastes time and it gets frustrating sometimes, especially now that I'm more self aware that these things are happening then you know, it, it can be frustrating at times and waste time where you know, something could have been very quick.
- [19:42]
A
So I've noticed with women, specifically ADHD now, that some of us really struggle in the structure of school and others of us thrive there. So I'm thinking of my son really struggled in school, but then once he got into the workforce he just blew up. Versus others really do well in school and then they get out into the workforce where there is less structure and, and they really struggle there. Has that been your experience as well?
- [20:15]
B
In my personal experience, I think the structure and the strictness of the culture in India and a strict hierarchy of things in India throughout medical school as well, in my case was helpful to me because I think it contained my restlessness and gave me A sense of direction, to be able to put things in context gave me some context against I was against which I was striving towards certain goals. And so I think, for me, it was really helpful. And I think part of the reason I chose medicine is because, like, I'm very familiar with hospitals. I grew up around hospitals, like accompanying my parents or my uncles and aunts. So I'm very familiar with the smells, with what this means and what that means and what this corner is and who can be there. And so all these things that we constantly are detecting. So it's not surprising that I wanted to work in a hospital setting. I feel safe enough hospital setting, you know, so for me, that because I chose a profession where all those things line up right, my abilities line up with these differences. I'm great. But if I had chosen, like, if I had chosen a surgical branch, I was very bad at. Even during internship, I was terrible at surgical things because it's a lot of visuospatial. If you're doing sutures or you're doing very intricate work, the other thing in NVILD could be the fine motor activities. And so you really have to be very good at those things. And I used to think maybe it's my vision, but really it's like visual integration of all these different things and putting them into context. And so if I chose to be a surgeon, I would be miserable because I would think I'm a bad doctor because I could never do it. My abilities won't have aligned with the differences. But I think I've been lucky that I've ended up in a profession where these traits can be used as positives and not negatives.
- [22:13]
A
Absolutely. So I'm curious what you were like as a child. Were you this little driven child that was wearing doctor's coats and stethoscopes? You know how there were kids like that?
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B
Yeah. No, I was actually the complete opposite of this. Not just during childhood, but until like, my third year of medical school. And so it was interesting. You know, when I was younger, I think I was definitely more on the inattentive side. And so I was. I was never hyperactive. Like, that's at least not externalizing behaviors. It was always inner restlessness and inability to sit still and racing thoughts. So mind is unable to be still. So as a child, I was an introvert. I'm still an introvert, but I was more kind of just within my own world. And I could be like the kid, like on the last bench just staring out the window the daydreamer total daydreamer. And I would feel, like, drowsy in class sometimes. And because, like, if it was a topic that was not interactive, the teacher's style was not interactive, and they didn't actively involve me. It was just a lecture, a didactic. And it was also in a subject I didn't like, then I would not get anything. But even in subjects I did like, I was very bad at taking notes because, you know, I would. I could do only one thing at a time. I could either listen and watch, or I could, like, take notes. But once I realized that as a kid, I was always very good at making friends with kids in the class who were very good at taking notes. So one of my very close friends throughout medical school was this. She's like a radiologist now in India. She took the best notes ever. And her diagrams were perfect. And I, for five years, I studied using her notes. So I think I found these workarounds and. And that was helpful. I wasn't a very popular kid. I didn't have a lot of friends, although, I mean, that's kind of still the case. I had a small circle of really close friends, but I didn't have a big social circle because I was shy and kind of introverted. And now that I think about it, kind of confused as to how one should act in that culture and things like that. And I wasn't very driven. So, I mean, you know, I don't know if this is true in other cultures, but in India, especially when I was a kid, like, you know, you would be compared to all your siblings in terms of your academic achievements. And my older brother is brilliant and did very well in school and would win all the prize. He was the driven one, absolutely. And he was always first in class and this and that. And I think one of my coping mechanisms was to just be different from that and to just kind of withdraw and see. Like, I was content with being mediocre. And I think that that was a defense at that time. And so, like, you know, psychologically, it didn't really consciously register that, oh, I'm. I have to achieve xyz. And so for a long time I was like that. And. And I was way less anxious than I am now. So I kind of miss that sometimes because I was, like, much more carefree. But then, you know, in. In medical school, by the third year is when you start seeing patients. Before that, everything is theoretical. So until that point, I was a little bit of. And I think I was, as is common for kids, with untreated adhd, there's a lot of bullying and things like that. So, you know, there was some bullying. And I think the way I coped with it, unfortunately, I'm not proud to admit it, but I kind of became a bully myself for some time. It's not an excuse that I was bullied, but I know that it was kind of a defense for that, and I've worked on that now. But I kind of was reckless in college, so I would just go out with friends a lot. We would skip classes, we would do this, do that. I played sports, we would do that.
- [26:44]
A
Was this here in the US or was this in India?
- [26:48]
B
Med school was in India. And so. But, you know, I would always do enough that I would not get in trouble. So I. I kind of figured out that point. And so I. But I was not going to do anything beyond that point. But in my third year, I had a professor who really became a mentor for my first mentor for me. And he had interactive classes and so I won't zone out as much. And he was actually a surgeon. His way of thinking about medicine and his way of thinking about people was more than just mechanical and just surgical and like that. He could think out of the box. So I think when I came in contact with him, I felt, okay, you know, like, there is room in this profession to be like that as well. And when I started seeing patients and I was like, oh, like, now I have to know my stuff. Like, now I can't sit in front of a patient and look something up. At that time, we didn't have, like, such access to Internet. We didn't have smartphones. So I'm not going to open up like a book in front of a patient to look up something. And you know, in my medicine rotations, it was a very busy hospital in India and very, very sick people, a lot of sick people. And I realized that, you know, you have to know your stuff. Like, now there is, you know, like, I have to get serious. I cannot just be, like, blissfully ignorant anymore. And I think that's when I got super duper focused. And then from there on until now, that focus hasn't really. That drive hasn't gone away. But like I said, you know, there's pluses and minuses of everything. I think I was much happier as a kid, as carefree. But now, you know, once you kind of. Once I started to pay attention to it, then all the perfectionist, perfectionism, cognitive distortions, which are very common in adhd, all of that was there under the surface. And all of it kind of came to a head and I had to cope with that.
- [28:53]
A
I suspect that you, however, are very good with patience. You're just very real. And I don't know if you would do this with patients, but I'm assuming if you do it on a podcast, you would. You're also, you share about yourself, which puts people at ease. So where does the anxiety come from? Because it almost seems like that would be just your natural spot of living, you know, is around patients and people.
- [29:22]
B
Right. So anxiety is. My anxiety is never around patients. Like, I think when I'm sitting with, it's never around my clinical work. That is the one thing I. And you know, both with autism and adhd, it's common to have like a narrow range of interests. And so when I'm in with the patient, I'm hyper focused almost. And like nothing else, everything else goes away. My own diagnosis helps me to connect with them definitely on a deeper level where when I say I understand, I usually never say I understand because, you know, you don't really understand. But like, in some cases, when I treat this population, I do understand how frustrating it is. So even if I don't disclose my diagnosis, I think they can tell that what is coming out of my mouth is empathic and maybe even from experience. And, you know, in some patients, yes, I have disclosed. So anxiety has never been. I love my clinical work and I'm never anxious during my clinical work. The anxiety is perfectionism related in, you know, like, progressing in my career. Right. I. I just took on like a new leadership position at Brown and so just constantly thinking, am I doing the right thing? Okay. Checking my emails. Okay, how am I sounding? What am I saying? Am I a good leader or not? And working on that, not just ruminating about that, because ruminating sometimes just wastes time, but, you know, really kind of honing in on leadership podcasts or different kinds of trainings. So I think that's how I cope with it. But in terms of patient care, yeah, I mean, I really love. One of the reasons I love psychiatry is because even two people with the same diagnoses have completely different stories sometimes. And it is just fascinating. Sometimes I work with a lot of trauma people who've gone through trauma and underserved populations, especially with substance use. Like, they don't have anything in life, they're homeless, they don't have anything or anyone. They've like burnt all kinds of bridges, but somehow they end up in my office asking for help. And that's What I tell them the fact that you are alive right now and sitting here in front of me is like the hardest step that you already took. Like, you obviously have a lot of resilience. You might have made bad choices, but also you went through a lot. But if you could muster up strength to come in today and sit in front of me, I think there is some resilience that we can start there and work to build on it.
- [32:11]
A
So what changed for you once you were diagnosed?
- [32:16]
B
So the first thing that changed was I realized that people who work, people in psychiatry and psychology, clinicians who work with only adults, because that's, that's kind of, that's. I've never really, as part of training, worked with kids. And that's when you get a little bit of training in neurodevelopment, but not really. It's like a two month rotation in your residency. And when you're primarily working with adults, a lot of times they present with anxiety, depression and other things that, you know, if you don't really screen for neurodevelopmental stuff, it's very easy to miss it. And so I think one thing that changed was that I knew that now I have to screen further for certain things and I have to keep that as a possibility in the back of my mind. And so it also led to then me learning much more about all the latest data about ADHD in adults and autism in adults and especially in women. It led to one year of just voracious reading and podcast listening and books and all of that. That was one thing that clinically changed. I think the way at that time I used to teach residents, the way I taught changed. And part of the reason I wrote my book was because I felt we used to get residents every month and I would repeat the same thing every month. And I thought I'm just going to write it as like a book or a manual. You know, that happened so clinically. It definitely made me a better, better psychiatrist and a better clinician for sure, more empathic in my personal life. It again, I think initially there was, there's always like a grieving process when a person is diagnosed as an adult, right? Where you kind of think about, oh my God, like I could have done this, this, this, or if I what if I got help before, maybe I could have become a surgeon, things like that. And so once I was through that grieving process, which took a few months and of course some therapy, then I was able to play, reach a place of acceptance where, which is where I want my Patients to be like. I often tell my patients that it's kind of like, you know, in superhero movies, like in the Superman movie, when Superman is a kid and he doesn't know he's Superman, he's just like overstimulated, overwhelmed with the superpowers. He's an outcast. But then once he learns how to channel his powers towards something, then he's Superman. And so it's kind of like that where I feel that whatever treatment I've had so far and all the extra, extra work that I did helped me both in my personal and professional life and really hone in and what I'm good at and not feel bad about it or not feel like, oh, I'm weird, or the other thing was social acceptance. Like, once I understood that, okay, like, it makes sense that, you know, if I'm on the spectrum somewhere because I do have some difficulties, social difficulties or differences. And so accepting that has really taken off that pressure to fit in. Like, I think when I was younger, I used to feel a lot of pressure to fit in. But now that I understand and accept that this is who I am, I think I'm able to gauge the degree of social contact I want for. For me to feel fulfilled. And so if it's too close friends, like, that's fine with me. Like, I don't have to have a big circle of friends because, like, you know, we, we do feel, feel like peer pressure. Like, my husband is the opposite of me. He is very social and extrovert. He loves talking to people, has a lot of friends. So, you know, it could be easily. Like one can compare themselves and feel like, oh, what is wrong with me? Why am I not Now I think I know there is nothing wrong with me, that this is just how my brain works. My goal is to give my brain the optimal conditions to be at its best. And, And I'm able to do that without a lot of self criticism now. And I think that's. That definitely came from listening to a lot of people share their own stories. Me being more open about my diagnoses with patients. Like, I think it depends on the therapeutic context, if it's. If self disclosure is going to be therapeutic for them. But in general, like, I spoke with some family members that I didn't know they were struggling in the same way. So I think it helped me connect with some people on a deeper level, even within my family. And so, you know, both at a personal and professional level, it changed a lot of things.
- [37:08]
A
You made the comment that you are always Trying to fit in or wondering why don't I fit in before then you got diagnosed. And what I always say is we're not meant to fit in. And so the diagnoses, if we're in the right area, right. Our zone of genius, it allows us to. To lead and stand out. Do you feel that?
- [37:29]
B
Absolutely, absolutely.
- [37:32]
A
I once heard a therapist. Actually, it's a therapist I hold in high regard. She told me she often sees trauma without addiction, but she's never seen addiction without trauma. Does that line up with your beliefs and what you see?
- [37:52]
B
I think there is definitely something about addiction that can be understood as an attachment disorder. If we think about secure attachments and insecure attachments, which is very much related to trauma exposure in early childhood, basically when we are a baby and then later on when we are growing up, those experiences with our primary caregivers solidify how we think of relationships, how we perceive ourselves in the context of a relationship and how we perceive others. And we are social animals. We need social attachments to want to be alive for survival. There's strength in numbers. When we are sick, we always seek proximity to people so that they can take care of us. So that's one of few of the functions of attachment, but one of the major function is regulating emotions. So let's say I have a bad day, I come home and I talk to my husband and all that emotion kind of comes down. So regulating yourself. And I think people who've gone through a lot of trauma, and especially if they had untreated neurodevelopmental stuff, then you're already beginning with a brain that had some problems with affect regulation, mood regulation, and tolerate ability to tolerate distress. Right. Or conflict. And then on top of that trauma, be it physical, like traumatic brain injuries or something, or be it psychological, it interferes further with that part of development. And so they don't develop secure attachments and relationships a lot of times. And then if we introduce a substance which is highly reinforcing, which means that the brain remembers that experience, basically things are addictive because the high that you're going to get with cocaine is way higher and faster than what you would get with normal stimuli, like food or sex, like day to day, like there's always dopamine hikes, but the highest one and the fastest one, the brain remembers. And so once we introduce that, the person starts to use substances for emotional regulation. And so the more they attach to the substance, the more they detach further from people. And so this is one way that I understand addiction and do some attachment based work with my patients where, you know, if you want them to stop using, you can use some medications. We do have some medications. You, you could do counseling. There's a lot of different ways to treat addiction, but if we don't build, help them to build healthier social attachments, they are almost always going to relapse. And so that's where I kind of see the intersection of trauma and addiction.
- [41:01]
A
When you're talking about substance use adhd, it sounds like it's really just an attempt to manage an overwhelmed brain. Right. Rather than, oh, that, you know, the moral failing. Oh, that's just a reckless brain. You're making those decisions. No, it's because you don't have the skills to manage this overwhelmed brain.
- [41:25]
B
I mean your brain is overwhelmed to begin with. Like, right, your brain is. Then you know, trauma is also intergenerational. So you know, if, if your mother or your family, you're coming from a very chaotic family system, then you know, there are things that happen on a genetic level in utero that basically you get primed to, to cope stress in a different way than someone who's not gone through those experience. So you're more likely to get overwhelmed. So you're already in a dysregulated state. And then we are introducing a substance which will work in the moment. Like, you know, marijuana or alcohol are downers. A lot of women with trauma exposure, they go for downers because they're trying to self regulate the hyperarousal that they feel. Right. So that's definitely part of it. And then of course the other, other reason is self medicating. And so I have a lot of patients with ADHD where they were using a lot of cocaine all those years when they were not diagnosed or treated properly. And once I stabilize them and keep them stable and they want to start working again, that's when the ADHD now becomes very apparent. And so that's when I might have to use medications along with some coaching and psychotherapy to help them get to, to a level of functioning that they wanted. And the goal is not just to stop the substance use, but to make them a productive member of society if that's their goal. And so that's when then staying off of the substance along with doing other things and treating their distress becomes important. But yeah, I think addiction can happen physiologically there are like, opioids are highly, highly addictive because even if someone doesn't have any trauma or like did not misuse them, even if they were prescribed short acting Opioids, like for a course of five days after a dental procedure or a surgery, the tolerance, the dependence physiologically develops very quickly, much quicker than a lot of the other substances. And once that happens, then they are going to withdraw even from that. So those people are then not addicts. They don't even understand what's happening, but they're withdrawing from the oxycodone that they were given in the hospital after the surgery. So opioids, the problem is it does it very, very fast. So there's definitely a component of the substance, the nature of the substance, that some substances are way more addictive than others and way more harmful, way more difficult to stop using than others.
- [44:20]
A
There is also so much fear around treating ADHD when substance use is in the picture. And I hear from so many women who've told me that because they have a history of substance abuse, stimulant medication just off the table. And I'd love to hear your perspective on that. I think it's A lot is changing but where do you come down on that?
- [44:42]
B
Yes. So I really believe that those patients are struggling like anyone else and sometimes even in greater ways and we need to find ways to help them. And I understand where the clinicians come from, where, you know, we just came out of an opioid MIT epidemic which was because of over prescribing and irresponsible prescribing. A lot of people died. Stimulants don't cause those kinds of effects but can cause other harm if they are over prescribed and they can be misused. So you know, I understand the hesitation and the degree of like vigilance but I think it's hypervigilance, it's kind of gone to this, this kind of almost phobia that oh my God, if I, if, if I prescribe this person Ritalin or Adderall, they are definitely going to misuse it. Whereas that is not the case. That is definitely not the case. I come from a standpoint of realistic risk assessment at every stage in treatment. When they first come in and they're newly sober or not even sober, they're still using actively. Of course that's not when I'm going to put them on stimulant. First they have to stop using. I'm going to stabilize any underlying mood disorder or severe anxiety disorder that they were probably self medicating with the substances. So once you stabilize that then, you know, once they physically feel better socially, their situation improves. Then comes, okay, let's, then we reassess for the Severity of the ADHD related deficits. And a lot of times that is the point where I might send them for some neuropsychological testing where I want to know specific deficits in their executive functioning that I have to work with. Because the thing is, not everything gets better with the stimulant. There's a lot of work that you have to do along with it. If you do all of that, then you are not likely to misuse the stimulant. We can teach people how to use stimulant. And so I think where I differ from a lot of clinicians and part of the reason I wrote the book was that I really want the next generation of doctors, psychiatrists to not be so scared of controlled substances, to do a realistic risk assessment. But also you have to like the person has been sober for like five years. Like your risk assessment is different now. Like you have to update it. And you know, very often, unfortunately, what used to happen, and I've seen this, people who've been in recovery for a long time, you know, initially they have rehab, then they have some kind of transitional housing. As they get better, society then expects more of them. Right now you have to start working. I'm not going to put you on disability anymore. Now you need to earn money. Now you need to find an apartment. Now you need to live independently and you need to keep up with your treatment. It's a lot. It's a lot. And this is when, even in the case of mothers, you know, when substance use involved, mothers are often separated from their babies. And so once you get them sober and stable, they're reunited with their kids, which is the outcome you wanted and they want. But now if you're a person with ADHD who is unmedicated, who has active symptoms and no help, now you have three small kids around you and now you have to figure out how to manage that along with everything else. So that's the stage in treatment where you have to reassess the severity of the symptoms and you have to build a treatment plan both in terms of medications. See where the non stimulants can be helpful, like for example, things like clonidine and guanfacine. They are more helpful with sensory overload, actually and they are more helpful with irritability and the intensity of the anger. They are actually also helpful for, because these symptoms overlap with ptsd, the hyperarousal from ptsd. So one medication can help both. I believe that we have to be creative and we have to kind of look for multiple solutions. And people who have substance use disorders and psychiatric diagnosis, which is called dual diagnoses, usually need a team of people helping them. Usually a prescriber alone is not enough. And so that's why if you want to do this work as a psychiatrist, you should do it in, like, a program, a treatment program where, you know, you can also have the person see a counselor. You know, some of our counselors are trained in, specifically in CBT for adhd. And so, you know, if I'm going to start you on a stimulant, usually what I do is, you know, see them every week and have them see the therapist every week. So, you know, the level of care, the amount of treatment initially has to fit the severity of their symptoms. And if you do that, I have seen a lot of them get better. A lot of them get better. They stop smoking cigarettes because nicotine is a stimulant. They didn't even realize that they were smoking, chain smoking, because they were trying to get some dopamine. So they don't just stop the cocaine. Then they get a job. They're able to maintain the job time and again. Yes, there might be relapses, but they get it finally and they're able to do something about it. And so it's really very rewarding to see. It takes a few years. So I would say to clinicians, don't be scared. Do a realistic risk assessment. Keep doing that at different stages in treatment. And if it takes a few years, that's okay. Okay, it is going to take a few years. I mean, psychiatry, that's how psychiatry is different. We can't just, like, take out the appendix. Like, there's no part of the brain that you can just take out and everything's fine. So that's, that's how I look at it. And it, It's. It's difficult. I know why most people don't want to take that risk, especially people in private practice. If you're by yourself, you feel extra anxious about things like that, but then you should not do that kind of work. Then you should stick to more simple psychology. And. And most people don't. But then there are so many people who need help that there's always a need. And we need more psychiatrists, more clinicians who are comfortable with this and help these people, you know, reach. Reach a point where they can serve society, they can serve their families, they can serve themselves. And addressing neurodevelopment is a huge part of it. We can't just ignore it.
- [51:55]
A
So in your work with pregnant and postpartum women, I'm sure you see that there's something about that season of life that seems to blow everything up for so many women mentally. Can you talk about that?
- [52:14]
B
Absolutely. For women, one of the major differences in manifestation of ADHD symptoms or even some of the autism symptoms, like sensory stimulation, for women, it is very much related to hormonal changes. Not just pregnancy and postpartum, but premenstrual symptoms. ADHD symptoms are often worse in the premenstrual week. And sometimes then you have to adjust medications. And then I actually also work with patients with cancers which are like older women, so they've hit menopause. And so after menopause, again, there is a time. So, you know, like, women never really catch a break. They have all these hormonal changes. And estrogen, estrogen, progesterone, are closely related to dopamine and serotonin. And so there is a correlation of symptoms. Definitely. So in pregnancy, what happens is during pregnancy there's hormonal changes. And, you know, a lot of women stop their stimulant if they were on a stimulant or stop any medication, even if they were on. Not on stimulants, but just bupropion or a non stimulant. Like most women don't want to take medications during pregnancy because they're worried about. About the fetus. They also stop using substances when they're pregnant. That is the time to help them. But pregnancy is different because one, it is a high, like super high motivator for treatment. That is when these people can really engage in treatment because every mother wants the best for their baby. So they will. They are very good about following treatment recommendations, keeping their appointments.
- [54:08]
A
Do you also think, though, that it might be the high level of hormones, like, you know, estrogen? I mean, it's just.
- [54:15]
B
Yes.
- [54:16]
A
And so that allow, you know, we have more dopamine. And so everything's easier.
- [54:20]
B
It's a little bit more complicated because it's not, it's not clear. If you look at the graph of the hormonal levels, it's not as clear. Like some hormones go up, some hormones go down. Then there's also the role of cortisol, the stress hormone. So pregnancy in itself activates the stress system. So there's multiple factors going on. There's also sleep deprivation that happens, especially postpartum. Right. And so that is why the perinatal time is a very challenging time for the woman. And if, if she was ever to feel worse, the worst she has felt because of Untreated symptoms, it's going to be in the postpartum time. So two weeks after delivery, the hormone levels drop very suddenly, very quickly. And that is what often precipitates postpartum depression. Even that hormonal dip that happens. But also around that time is when she's not getting any sleep. Sleep, Right. And this prolonged period, it's not one night, it's months or years, which precipitates.
- [55:28]
A
All mental health challenges. Right. Like no sleep.
- [55:32]
B
No sleep. No sleep. Yeah. And then the third challenge is, like, her environment changes. Like, often people who, you know, have had adhd, even if they didn't know it, they have built compensatory systems to get stuff done. Right. They have a workaround. But now the same things are not going to work because you don't have enough time. You have a baby, you have more people to pay attention to. There is more stimuli. You haven't slept. And so the combination of sleep deprivation, hormonal changes, and the change in environment and change in expectations from her, all of that cumulatively increases the presentation of the manifestation of the ADHD symptoms for mothers. It's very extremely important for us to address that because the first year of life of the infant is extremely important for the infant, psychological development, attachment, but also for the mother. Right. Mothers go through a lot of changes psychologically in the first year and later on. But building of maternal identity and the bonding experience with the baby, like, those things are highly important even for the woman moving forwards. And so really what we need is a healthy mother baby dyad. And that's why it's so important to help these women at that time. That's why it's so crucial, because we definitely want to do it within the first year postpartum.
- [57:13]
A
Fascinating. Okay, so I have a question I've been dying to ask you. Just compare myself to my friends. They were pregnant and oh, my gosh, they were so tired. Everything hurt. Couldn't get anything done. Their brain was all foggy. I have never been so on fire as when I was pregnant. Literally, I remember thinking I hadn't been diagnosed with adhd, but I remember thinking, oh, my gosh, I can't believe how much I can get done and how quick I could solve any math problem. I mean, my brain was firing on all cylinders. And so I've always wondered about that, but I didn't really connect it to ADHD or really even pregnancy. And then I read. So there was some research that was done about ADHD medication, primarily stimulant medication in pregnancy. And there was one line, and it said, for some, the high estrogen of pregnancy may ameliorate certain ADHD symptoms.
- [58:17]
B
Yes, yes. So what happens is it's also based on the trimester. So the hormonal changes in the first trimester, once someone conceives, then certain hormones go high. Right. But they're also unstable. So in the first trimester, unstable hormones, rising levels, but instability, along with some nausea and physical symptoms, like a lot of discomfort. In the first trimester, women might not do very well, but also there's the added psychological motivation of caring for themselves and their infant. Then in the second trimester, usually the high hormone levels, like, they stabilize. And that's when probably, you know, for. For some women who are physically, like, medically stable, so they're not having any physical discomfort, because if you're also physically sick, then it's harder to enjoy the pregnancy, of course. But, like, if everything else is stable and they have a good, like, support system around them, Right. They. They have a job that allows certain accommodations or, you know, their family, they have a huge extended family that helps them with a lot of other things, then, yes, that's where she can optimize her functioning in that time. Because also, of course, there is more attention on the baby, but until she's carrying the baby, there's a lot of care and attention for her as well. That also changes. So the family dynamics change, and then towards the end of pregnancy, the hormones reach a peak. And then, like I said, after delivery, two weeks after that, it's a very steep, quick fall. And if you think about it, regardless of diagnosis, that would destabilize anyone.
- [60:07]
A
And then nursing.
- [60:09]
B
And then nursing. Yeah, yeah, yeah, definitely. And so definitely there's. Hormones play a huge, huge role. And it is true that. And that's what is so interesting, that everyone's experiences can be very, very different. And there are some women who actually are absolutely stable with stopping some of their medications and just having a lot of support through therapy and their family's help, and that works for them, and that's great. Some are not so fortunate. And then we have to take the help of medication.
- [60:48]
A
I think it's fascinating your comment about how during pregnancy is often, when you're dealing with addiction is often such a good time to be able to come in there and really make changes. I mean, it all makes so much sense how you're, you know, you're piecing it all together. So my next question, though, is how much of what we call ADHD symptoms getting worse after kids is really about biology and how much is about gender roles suddenly becoming unavoidable.
- [61:22]
B
It's definitely. It's a combination. And so I haven't read any data on exactly how much, but I know it because the social factors and the gender roles depend a lot on the family system and the nature of the job. The woman is going to go back to, like, you know, women who are going back to work after a few months, they have a whole different level of stress and adjustment that they're going to have to do. And in ADHD particularly, switching from one mode to another is not very easy. Right. And so, like, if you're really engrossed in something, I'm really reading something, and then suddenly now I have to do something else, the context is completely going to change. It's dysregulating. And when you're sleep deprived and your hormones are all over the place, it's harder to cope with those things. And so your body, regardless of whatever diagnosis you have, anyone would be in a dysregulated state in that time. If someone has a diagnosed psychiatric disorder or someone has diagnosed neurodevelopmental issue, then the areas that they usually struggled with but were able to cope, now it's likely that they're not going to be able to cope because all their coping strategies, which were based on the system that they were a part of, everything changed. So now, you know, it's not that suddenly they got adhd, it's that now their compensatory mechanisms are not working and there is high demand on them and their body is not the same. So. So I think it's a combination of both. And a lot of what I tell women is when they feel very guilty about it. So, I mean, we know that women with ADHD tend to ruminate more and internalize more. There's a lot of lot more of shame, guilt. Like, I work with families all the time. If a man in a family is not able to clean or doesn't make the bed, he doesn't think that he's a bad father, or if the kid is not very groomed or the kid is behaving badly, you don't turn to the guy and say, hey, what kind of father you are?
- [63:51]
A
You kind of expect it, right? You expect that they're going to look a mess because it's the father.
- [63:56]
B
Exactly. But like, you know, women internalize that. It affects their sense of motherhood. And part of that is gender roles and how expectations are set. Part of it is, you know, also a person's own psychological structure. Like, I did interview some couples where, you know, they were not necessarily identifying as a certain, certain gender or like same gender relationships, like different, all different kinds of relationships. And I asked them, like, I, because I was curious, like, is there, is your division of labor at home any different with your partner than it is in a heterosexual couple? And what I, what I basically found was, and this is not a study, but like just my talking to a lot of anecdotal. Anecdotal, total anecdotal. But what the majority of them said was that regardless of gender in a relationship, who is trying to take two people who are trying to take care of a kid, one person is going to have to take on certain roles and the other person is going to have like, it's always teamwork. Like one person cannot do everything. So whoever takes on the roles which are heavy on executive functions functioning, whoever is more sleep deprived, whoever is working as well as taking care of the baby, they are going to have more difficulty. So, you know, of course there is a hormonal aspect, but then there is a huge social aspect and an environmental aspect that goes into it. And now we have, you know, all different kinds of families and you know, we should really. I didn't find a lot of data about that. And so I think there should be more research in that and we should look at how people process their roles when it's in these different families.
- [66:00]
A
Absolutely. I mean, parenting was one of the easiest things I've ever done, but it was because I was able to do the part that I was good at and really enjoyed and I had so much support, not only from my husband, but also outside help. And I'm going to tell you, if I had been a single mom managing all this by myself, oh my God, the wheels would have come off the cart. So, so much of this, this is also privilege, right?
- [66:27]
B
Yes, yes, yes. I mean, the environment that you grew up in, pre pregnancy and your own psychological structure and attachments and then the environment now you're in and the family system you're in, a lot of it depends on that. But women especially, I feel like even the women, the women that I worked with, the mothers who could afford getting help, they would feel very guilty. Like if they hired a cleaner, they would feel so guilty about it. Like, I haven't met any man who's felt guilty about that.
- [67:01]
A
Again, you'd expect he would have someone to help him.
- [67:06]
B
You know, that's why the perfectionism, cognitive distortions and the internalization and the rumination I find, is definitely more something to address, more so in women.
- [67:18]
A
So, Dr. Gogne, I love that you're a psychiatrist who's open about your own diagnosis and that you also advocate for multimodal treatment beyond medication. So in real life terms, if a mom is listening and thinking, something is wrong with me, you know, she just had a baby, you know, feels awful, does not feel like herself, what do you want her to hear instead?
- [67:49]
B
I want her to know that nothing is wrong with her. That, you know, her body just went through a lot of stress. Even if it was a wanted pregnancy and everything went well, even if she was medically stable, everyone is healthy. Even then, it's a state of physiological stress. She, she has to be patient with herself. That, you know, we have to respect the body's needs. We have to get as much sleep as we can, we have to eat when we can, we have to stay hydrated when we can. And, you know, you have to have to be mindful of how you're doing as well, and not just all the focus on the baby, because really the best outcomes both for the child and the mom are a healthy mother baby dyad. So I would tell her to focus on the dyad, to ask for help without feeling bad about it. Like, really it does not. Like it does not reflect on her motherhood if she, she asks for help for something, like, she should ask for help, and anyone in that situation would have asked for help. And if you don't and you keep on taking everything on yourself, you're going to burn out. It's not a sustainable way to function. And then if there is a diagnosis that you know of, then I think any emotional problems can be heightened in that time because of the reasons we discussed. So, you know, talk to your doctor. And, you know, it doesn't mean that if you, most people think, oh, if I go to a psychiatrist, I'm 100% going to be put on meds and I don't want meds. That is actually not true. Like, I do have some patients where the majority of treatment is psychotherapy. And so we can do combined treatment and so, or I can refer them to someone who can do therapy. And so there are psychiatrists who don't just believe that you have to be put on a medication. At least you can go for an evaluation and get a sense of things. And it's really about, for me, it's not really about treating a diagnosis. It's about understanding the areas of difficulty and the treating symptoms of basically the manifestation of whatever diagnosis that was. And so which manifests in her behavior, which manifests in her day to day life. And our job is to support that. And then I would also like her to remember that when she feels frustrated with herself, she should remind herself that it's the same brain that also makes her very good at certain things. She can think out of the box easily. She can be very, very creative. And so in treatment, one of the things we used to do is, you know, have patients have these moms think about what their strengths are and then use that to problem solve themselves, to come up with creative ways. And mostly they do. And so, you know, they have a lot of strengths and it is, they are super women, they are superheroes. They just require the right settings, the right people around them. And in some cases they do need medications for some time. It really depends on, on the severity of certain things. But even if they do, it's not anything bad. Like if they had high blood pressure, if they had preeclampsia, they would have taken an antihypertensive. It is the same thing. It doesn't feel like the same thing. There is a lot of stigma, but really chemically it's the same thing. And we can always minimize the doses of medications by combining medications with psychotherapy and other things. And then stimulant is not the only medication. There are many other medications that can be there. And so I would encourage her to, I tell women, use it as an opportunity. If it's your first time, time in psychiatric treatment. Really what I'm trying to do is figure out who you are as a person, how you cope with stress, what your challenges are. It's a chance for you to really explore who you are and how your brain functions best. And then we work towards creating those conditions. And I think the challenge with mothers is that it keeps changing. Like, you know, after the first two years, then there's. The child has completely different requirements, then maybe more children are added to the mix. And so the pro. One of the problems is that they can never like the moment they feel comfortable, now everything changes again. And so they have to reset. Right? And so, you know, I wanted to know that it's hard for a reason, that it feels like this because it feels out of control, because it is out of control. And, you know, no one can get through that without help and without support and without sleep.
- [73:00]
A
I always say, I have two kids now, they're both, I'm in California and they're in New York City. And My youngest is 23, my oldest is 27. And I always say I would give anything for my worst day when they were little. So it passes and then you discover that, oh, I actually missed that. You know, them, you know, falling apart and whatever. I miss it, you know, so I'm sure.
- [73:31]
B
Yeah.
- [73:31]
A
What is your number one ADHD workaround? Do you have one?
- [73:37]
B
For me, what has been really helpful is so this actually was the positive side of getting a dog. He wakes up at like 4 o' clock every morning. 4 or 5 o'.
- [73:47]
A
Clock.
- [73:47]
B
Oh my heavens.
- [73:48]
A
Still.
- [73:51]
B
But now that's kind of become our cycle. Because what I've realized is that the morning time, if I wake up early and then I have an hour to myself where I can practice some mindfulness while drinking my coffee and just take a few minutes to look at my to do list for the day and strategize a little bit as to what I'm going to do, then my day goes a lot smoother. I'm not late to places I'm not missing anything. On days I'm not able to do that, it's definitely harder to keep up in those things. But doing it once a week doesn't really cut it. You have to do some kind of self care and you have to take out some quiet time where your brain can actually strategize and do those things. So I think waking up early and making that time for myself has, has been super helpful.
- [74:43]
A
So do you get up at 4 with the dog and you stay up, that's when you get up. Now is four between four and five?
- [74:51]
B
Yeah, yeah, I get up between four and five.
- [74:55]
A
Does that mean you go to bed earlier?
- [74:58]
B
Yes. Yeah. Yeah. And I, and I don't feel bad about it anymore. Like I don't feel like I'm boring or something. Like I go to bed around 8, 8:30.
- [75:09]
A
But when you think about the amount of time that is usually wasted late at night. Right. Versus I completely agree. I am certainly not you. One day I'm gonna be you. But if I were to go to bed, okay, there's no way I could go to bed at 8 or 8:30, but maybe 10. And then I would get up at 5 in the morning. Oh my gosh. Your day would start out so much better than, you know, what I often do.
- [75:39]
B
Right. I think because your circadian rhythms line up, but also like, it has to align with your work schedule. Fortunately, my job is such outpatient clinical practice. Our clinics are open from 8 to 5. But really if I start at 7, then I can end a little bit early. Which gives me some time before dinner to plan and things like that. And so it just aligns with my schedule. So it really depends on what the person is doing. And this is part of our treatment where and part of coaching where, you know, we people have different kinds of work schedules. And so, you know, you have to kind of adapt the medication dosing with that. You have to adapt when they are going to practice, what skill, according to that, what their schedule is going to be. It's going to differ weekday versus weekend. And so all of this, like if people don't know, they should know that it's not just treatment, is not just a stimulant, that even as a psychiatrist, like all of this extra work goes into it and people can do it in healthy ways.
- [76:49]
A
Unfortunately, in my experience, most psychiatrists are not like you. You know, they don't have the time. I don't know the HMOs, they just write the script and you're out the door. If they were all like you, I think we'd be so much farther along with adhd. So in that vein, are you working on something that you want to tell us about? How do people find you?
- [77:14]
B
How do they work with you for clinical work? So my practice is part of Brown University Health. So if they are in Rhode island, they can definitely come and see me at one of our clinics. I work at the Recovery center in Providence, Rhode Island. So that's mostly where my clinical work is. And mostly I'm a clinician, I'm not a researcher, but oftentimes I'll write case reports and things like that and books. Right. I recently authored the book you mentioned. And so yeah, I mean, I think people can look me up if they want to read my book. I would say the book is a textbook and it was meant for trainees, but I tried to make it useful for anyone, for non medical personnel. Like I have some friends who are teachers and I had them read it before I submitted the manuscript and they were able to get something out of it. And it has a lot of vignettes from things I've heard from patients from other ladies, which may be helpful to them. And so, you know, the book can be helpful in practical firstly, understanding ADHD and trauma and substance use in the way that we've discussed. But hopefully in an interesting way where there's, you know, things people have said. Patients, this is what people say. And you know, hopefully then people can feel like there's nothing wrong with being a patient or there's nothing wrong with being getting help like it's just a. Like they have the same experiences and then I present how those things changed after treatment. So hopefully that it gives people hope that, you know, there is a light at the end of the tunnel. For sure.
- [79:04]
A
I would buy the book and bring it to my clinician.
- [79:10]
B
I hope so.
- [79:12]
A
I think you're amazing. So thank you so much for spending time with us here today. I can't tell you how much I appreciated this conversation.
- [79:21]
B
Thank you for the opportunity. It was really fun.
- [79:23]
A
So that's what I have for you for this week. If you like this episode with Dr. Gogne, please let us know by leaving a review. Our goal is to change the conversation around adhd, helping as many women as we possibly can learn how their ADHD brains work so that they too may discover their amazing strengths. Thank you so much for listening and I'll see you here next week. You've been listening to the ADHD for Smartass Women podcast. I'm your host, Tracy Otsuka. Join us at adhdforsmartwomen.com where you can find more information on my new book, ADHD for Smartass Women and my patented you'd ADHD Brain is a okay system to help you get unstuck and fall in love with your brilliant brain. Let's pause here. Have you spent your whole life being told your way is the wrong way? If you try to use systems designed for a neurotypical brain, of course you'll feel like you're failing. But here's the truth. You were never the problem. You just have a different brain, which means you need different systems. That is exactly why I created the A OK Academy. It's my six step patented framework designed to help you reconnect with your intuition and build systems based on your unique strengths. Let me help you reconnect with your intuition, trust yourself again, and build a life that actually works for you. You've had the answers all along. I'll help you see them. Look, it's time to stop second guessing and start trusting yourself again. Find the link in the show notes to sign up or book a free discovery call. Now let's get back to it.