Amphetamine use in America's workforce
daily.jstor.org
daily.jstor.org
"Abuse by young professionals is distressingly common—Wall Street traders, software engineers, dentists, nurses, and lawyers, all cracked out of their minds trying to keep up with the competition."
Yes, I was diagnosed with ADHD as a child, and yes I have an Adderall prescription. But I'd hardly call myself cracked out on drugs. I think the biggest issue is when people self-diagnose and self-medicate because they are more likely to take dosages that aren't suited for themselves, but that issue exists for many prescription drugs. This piece seems heavily biased towards scare tactics, so I am not inclined to take it terribly seriously.
Anecdotally, I knew some people who took adderall in college that were not prescribed it and it seemed to cause them to have different behavior than myself. A similar situation, I would imagine, is how alcohol affects people differently. Maybe not physically, but you definitely see a wide range of actions and behaviors elicited among different individuals.
There are people who can take what are considered high therapeutic doses and feel very little effects because of the way their body metabolizes the chemical, which of course has nothing to do with whether they have ADHD or not.
7.5mg (15mg in half) is my usual dosage, but it's strong enough to fill me with the energy you'd expect someone on a high dosage to have. When I talk a full pill, it completely screws me over. Others can take 30mg and be completely fine.
As you pointed out the problem with the article is that it makes no distinction between therapeutic low-dose usage and abuse level usage.
Over time you will develop more of a tolerance to these stimulating effects, at least to a degree, but the therapeutic benefits will continue for as long as you take them.
I don't take it in the morning for that reason. Because it has zero stimulation / awakeness effect on me, I wait to use it in the afternoon, when sleep inertia has fully dissipated.
EDIT: calm down wrt physical movement, symptoms on the cognitive side are still very present of course. It's just that adults tend to be better equipped to cope with some of them.
From "Prescription stimulants in individuals with and without attention deficit hyperactivity disorder: misuse, cognitive impact, and adverse effects", published in Brain and Behaviour (2012):
"In sum, the evidence concerning stimulant effects on working memory is mixed, with some findings of enhancement and some null results, although no findings of overall performance impairment (Smith and Farah 2011). However, the small effects were mainly evident in subjects who had low cognitive performance to start with, showing that the drug is more effective at correcting deficits than “enhancing performance.”"
Full text:
Secondly, that study is flawed because it fails to acknowledge what is known as the 30%-30%-30% jump. The difference in intelligence between a retard and a normal person is the same difference of intelligence between a normal person and a genius. Different boosts account for different corrections in deficits depending on the IQ range that is being operated on. This is a known quirk of intellect. Being why Einstein sent a letter to his son telling him that intelligence was not the reason he was successful, "working hard" was, and urging him to do the same.
Amphetamines are performance enhancing drugs. They give the same "cracked out" superman effect to anyone who takes them. They are amazing. And we should not discount them by giving credence to the bullshit that is ADD and the epidemic which is giving dumb kids speed so they can live up to their parents' standards.
ADD is overdiagnosed, and adderall/speed is overprescribed in doses that hit high enough that their grandma can feel it. It's fucked up to be giving hard drugs to kids just because the kids are dumb. Let them be dumb. Let's not make them drug addicts at the cost of their mental freedom.
Just google for it, the stories on forums and other places. There are millions of kids who grew up and regret the drug issues they have now. The dependencies. Because they've been on speed their whole lives, because of a giddy parent and a giddy psychiatrist long long ago. The stories show that treating "ADD" with speed in children, is a really shitty thing to do.
Known by who? Did you just respond to a peer-reviewed study with made-up pseudo-science? Also, I should point out that the psychiatric term is ADHD, not ADD.
I didn't say the study is bunk. I said that looking at performance differences as significant without reference to the 30/30/30 effect is extremely misinformed. What I should have said is that the study's "interpretation" is flawed. That would have sounded more rigorous.
While that's partly true, in this case it's a systematic review of the literature on this exact topic. That's not nanny-picking some random study.
I don't think so. I'm in one of those environments where long hours are common and it definitely does happen. There are also people using a mix of uppers & downers (need the uppers to be wide awake but then can't sleep when at home hence downers). Hell I'm doing a vaguely similar thing (just with coffee and melatonin). Add a bit of anti-depressants and I don't think "cracked out of their minds" is that far fetched.
I would say its definitely a small minority though (in my workplace)...places like New York & London...not so sure.
>But I'd hardly call myself cracked out on drugs.
Well I'm sure your case is perfectly legitimate, but you've got to admit that self-assessment in this type of situation is rather unreliable.
I've found that simple sleep hygiene habits (no blue light exposure 30 mins before, taking a shower, etc) facilitates better sleep than melatonin.
If you can find one, I'd recommend* an S+ by ResMed. It uses radar to track your sleep and can discern what phase of sleep you're in. It tracks how long it takes you to go to sleep and can offer specific hints to address issues you might be having. The app hasn't been kept up to date, but if you've got an older iOS 8.x device you're not going to upgrade that would pair well with it.
*Disclaimer: I worked at ResMed on the S+. I no longer work at ResMed but I still like my S+.
I am not sure that the time it takes to have an effect is a good metric for whether or not something has potential for abuse. Sure SSRIs take a few weeks to have a noticeably effect but they also takes weeks to tail off. The area under the curve is not necessarily different.
https://www.quora.com/Why-are-SSRIs-typically-prescribed-bef...
"This last item makes SSRI's abuse-safe: contrary to benzodiazepines or opiate-based painkillers, there's no risk of abusing them for pleasure, as they're, once again not "happy pills" and there's no high. They even worsen symptoms for most people at first. That has to do with their mechanism and is their major flaw but serendipitously it strongly protects against recreational use."
Also, I do believe personality comes into play. When I was taking the max dose of Tramadol for over a year, I stopped dead three weeks post-op. The only noticeable side-effect was a runny-nose for a few days, hardly a big deal.
However, after taking it for several years on most days, I developed heart palpitations and other strange sensations. They disappeared a few weeks after I stopped taking it.
Yeah I'm aware that its not ideal. Come to think of it I actually told myself I'd stop once peak season is over so I guess thats now. First need to get rid of the coffee though then the falling asleep will be fine.
>take it ~3 hours before going to bed
I thought 1 hour?
If you have ever gone on an extended camping trip, think about the time between sundown and the time you naturally start wanting to fall asleep.
Some intense exercise (7+ mile runs) will wipe you out. I'd recommend you keep the coffee, and get your body moving. Allocate 1 hour of your day, to 120+ bpm workouts.
Just TRY not to sleep.
Not a huge amount. Probably like 2-3 good strength cups.
>Some intense exercise (7+ mile runs) will wipe you out.
Yeah been getting some exercise, but I find it keeps me awake if its too close to bedtime.
Everybody has a different reaction to sleep medicine. You might also consider environmental changes (blackout curtains, earplugs, or meditation before going to sleep - seriously) to address other possible sleep problems.
The cost difference makes it silly for me to buy a bottle of 90 1mg tablets for $10 instead of the bottle of 90 5mg tablets for $13 so I get the higher dosage and just snap bits off of them to swallow. I've seen bottles at our local Rite Aid with 10mg tablets recently! That's just crazy IMO.
From what I understand, after a certain point, there's not much benefit to higher dose and it can screw up your sleep patterns more than it helps.
http://drsircus.com/medicine/magnesium/magnesium-the-ultimat...
Drug use is certainly a mixed bag but it deserves a balanced treatment, not scare tactics.
The article even goes on to list great accomplishments that were made possible (or at least supported) by drug use. Talk about cognitive dissonance...
EDIT: For a wonderfully contrarian take on drug policy, check out Jessica Flanigan's "Three arguments against prescription requirements": http://www.ncbi.nlm.nih.gov/pubmed/22844026
Very telling is another publication of hers, about Obamacare. From the abstract: "Though states are morally required to provide citizens with access to affordable health care, states must also take care not to violate important economic liberties .. ." Where do the "economic liberties" even come from? Everyone knows that US healthcare costs are an outlier in the civilized world, and the ostensible goal of Obamacare was to fix that. And if we have to talk about the principle of economic liberty we also have to consider the observable phenomenon of decision fatigue.
This is not science, this is libertarian apologetics. There is a purpose for that but it needs to be clearly distinguished as such.
There may be other indications (I haven't checked), but that statement doesn't sound even remotely libertarian. The moral requirement to provide affordable health care is a positive right (something that obliges action). Contrast this to a negative right, something that obliges inaction, such as free speech or private property. Libertarians generally don't acknowledge positive rights (unless by contract, but then we're talking about something else).
"we also have to consider the observable phenomenon of decision fatigue"
Are we just talking about random things now?
Look back at the history of healthcare to see economic liberty in action when we had a workers' self-organized healthcare. People formed friendly societies, worker cooperatives, and lodges creating a welfare system that was organized from the bottom up. It was well-organized, affordable, and voluntary.
That all started to change as progressive legislation was introduced in the guise of social reform, which built up the state capitalist bureaucracy and slowly eroded people's rights to self-organize and provide each other with mutal aid. Instead people were forced to depend on the centralized state/corporate welfare system. And here we are today, and things are only getting worse.
The healthcare crisis is a problem of artificial scarcity, enforced by the state regulatory regime which upholds the insurance monopoly and suppresses people's rights to self-organize.
> The large corporation and centralized government agency do not exist just as discrete individual organizations. Beyond a certain level of proliferation, such large organizations crystalize into an interlocking system. Even the small and medium-sized firm, the cooperative, the non-profit, must function within an overall structure defined by large organizations. [1]
[1] https://c4ss.org/wp-content/uploads/2010/03/C4SS-The-Healthc...
There may also be dangers of mixing adderall and alcohol, but it does everyone a disservice to casually reference such a different situation.
There's a recurring theme with drugs that mixing X and alcohol is dangerous.
Don't get me wrong, I like good wine, craft beer, and liquor. But the common link is generally the "and alcohol" part. It seems pretty clear alcohol is a remarkably dangerous drug, just normalized by social use.
Instead of writing myself off with shots until I can handle the social side, I am able to carry conversations, am not overwhelmed by the stimulus (imagine trying to have a conversation, while playing pinball and reading a book in a loud room).
It was a huge factor in breaking a drinking problem, which was actually masking many of my ADHD symptoms. It's a highly personal anecdote, but does show the other side of the coin.
(for the record, I don't generally drink anymore, never on my meds. when I do plan a night out, its usually with close friends so many of the issues just aren't there.)
You sound similar to me. I'd like to know what to ask my doctor about.
I take 2x5mg Dexamphetamine tablets in the morning (8am) and another 1x5mg around lunch (1pm).
I started (switching from Concerta) on 2 and 2, but asked to drop the later dose as it seems to top me up enough to finish the work day and handle the bulk of my evening (cooking, etc...)
The Dex works far better for me than Ritalin / Concerta, but I've heard good and bad for both. Keep your doctor in the loop for everything, and listen to what they say (eg. I brought up and planned my lower dosage, rather than just doing it), and bring up any issues as early as possible.
Don't try to fix side effects with other medications, keep the chemical intake as simple as possible. I had to spend more time on diet and sleeping habbits than anything else, but it was worth the effort and discipline.
If my diet and sleep are in check, I can manage a day without medication (relying on a detailed plan/schedule) here and there, or keep momentum up to make progress into the night.
If I burn myself out for a couple days, no amount of medication could help.
Hope that was some sort of help, good luck mastering your "mental skillness" :)
My dosage is pretty low (see my other reply), and I'll usually only take another 1x5mg which seems to 'top up' the previous dose for around 6 hours. EDIT: I believe they are considered 'quick release', described as active for 4 hours, though I seem to wind down after 5. (then I get a bit fuzzy for an hour, cant hold a conversation easily, focus gets locked on tasks I'm working on, etc...)
The general effect definitely makes me more alert, but doesn't keep me awake. On weekends, I'll often have a nap after my second dose, its like my mind clears enough to settle and without purposefully taking in new stimulus, it relaxes and I drift off. Some people describe the same with Caffeine.
As a side note, I drink coffee if I want to wake up / stay up late. Caffeine seems to turn off the part of my brain that says "fall asleep", increases my heart rate a little, but thats about it. My dex on the other hand, seems to raise everything a lot more evenly. It doesn't affect any one thing more than the others.
I'd describe Caffeine as a "dirty" feeling stimulant, and Dex as very "clean", as an anecdotal, personal comparison.
The orthodontist I worked for put in serious hours well beyond many of the "crunch time" horror stories we hear in tech, typically arriving at her practice at 5:30am and leaving at 8pm (prepping the office, working on orthodontic appliances, case studies, paperwork), and working Saturdays as a part time Dean at the local dental school.
There were also state mandated continuing education requirements, the occasional emergency call, lawsuit, delinquent payments, marketing and sales for her practice, the occasional sales call from a vendor rolling out "Smart Brackets", and the need to manage 10+ employees and maintain professional relationships with other dental medicine practitioners for referrals and covering sick days.
She was incredibly driven and competitive, probably an outlier, but was also certainly a multimillionaire and an accomplished dentist.
I feel like a narrative is being constructed that will eventually lead to it being extremely difficult treat conditions which benefit from stimulant medications.
This is hardly any less sensationalist than the 1914 NYT article they mock.
Interestingly a pretty prolific mathematician, Paul Erdős used amphetamines [1]. Not sure which one(s) though. I don't think he had a prescription but I think it worked out OK.
So when I was at school I was on something like 20mg of Ritalin (0.02g) twice a day via a pill that was digested by my stomach. Even that lead to issues with diet and sleep and anxiety.
Whereas if we're at a rave we'll happily share 1g+ (say between 2 of us which is 12x the amount) of amphetamine between a few of us and put that shit right up our noses so it's absorbed super quick.
The comedown from that is more just a feeling of absolute terror (AKA speed comedown psychosis. I try to mostly avoid it now because it can't be doing me or my mind much good).
I'm far more interested in nootropics over stimulants. E: Just ordered some Noopept so I'll get back to you.
You are correct about the comedown from an amphetamine binge being awful. Thankfully, most business professionals and working people aren't dosing like they're at TomorrowLand.
As far as sleep goes I find that it is about the same with or without it since I tend to self medicate with caffeine but I generally go to sleep at as semi-regular time of the night (I say this as I write this from bed). The biggest blocker for sleep for me is getting excited about stupid programming things right before bed and that tends to happen with or without stimulants.
Without Ritalin I seem to be more anxious but its hard to really evaluate that objectively.
There's only one "amphetamines". There is a specific molecule (and its enantiomer) called " amphetamine". There are some other amphetamine-class drugs like methamphetamine (crystal meth) and MDMA (ecstasy). Methylphenidate (Ritalin) isn't even an amphetamine-class drug.
To me it's very much like speed or cocaine, just longer lasting and more consistent with less of a let down.
1) any child who takes it certainly has an advantage
2) I couldn't fathom taking something that strong every single day for months on end (if not years). Regardless of your neurological makeup, just the stress on your heart seems insane
Would love to hear alternative opinions, mainly I'm skeptical it's effect is that different for ADHD sufferers and non afflicted people. I mean we all have issues concentrating and it's probably more of a sliding scale across the population.
This is where you go off the rails. Neurology makes a huge difference in the effect of many drugs, and there has been a tremendous amount of research backing that up. Just because you personally can't believe it doesn't mean it's not true.
> Regardless of your neurological makeup, just the stress on your heart seems insane
He said, whatever your neurological makeup might be, Adderall is going to be unhealthy on your heart.
Adderall works primarily by switching your norepinephrine and dopamine in the brain, in all brains. From Wikipedia, norepinephrine:
"The general function of norepinephrine is to mobilize the brain and body for action. Norepinephrine release is lowest during sleep, rises during wakefulness, and reaches much higher levels during situations of stress or danger, in the so-called fight-or-flight response. In the brain, norepinephrine increases arousal and alertness, promotes vigilance, enhances formation and retrieval of memory, and focuses attention; it also increases restlessness and anxiety. In the rest of the body, norepinephrine increases heart rate and blood pressure, triggers the release of glucose from energy stores, increases blood flow to skeletal muscle, reduces blood flow to the gastrointestinal system, and inhibits voiding of the bladder and gastrointestinal motility."
Anecdotally my doctors switched me from Adderall to Armodafinil for this explicit reason. My blood pressure was pre hypertensive after taking Adderall for only a short time.
again the amount of ignorance to drugs displayed in this thread is frightening. people who have only used amphetamines for less than 10 years, or drugs at all, telling us all about them. facepalm.
I started taking them about 14 years ago, when I was in early 30s. Being raised by my great depression era grandparents, I was extremely anti-medication. In general, I still am, for myself. It's not right to impose that view on others. You'll see why in a couple of paragraphs.
I've been technically focused, on a daily basis, since I was a kid, starting in the late 1970s, and that translated into a very successful career, even before I started taking the meds.
But I definitely have ADHD, and I always have.
What does that mean specifically, in my case? It means that it takes an enormous amount of energy to focus. Indeed, in the decade I was getting paid before taking the meds, I created many things, big, small, alone, in groups, terrible and awesome, in a variety of environments and backgrounds.
But after a long day of work, where I'd used all of my mental energy to focus, I would end up having to take an hour nap. Note, I wasn't sleep deprived. Via my grandparents, I've always valued getting enough sleep.
But the mental drain was enormous, doing software/technology for 8 or so hours every day.
My new wife at the time, who has a mental health background, suggested I get evaluated for ADHD. I resisted for a long time, but finally I did and brought home some adderall.
Me being me, I wanted to approach this very carefully and rigorously.
Despite a good diet, plenty of sleep and exercise, my pulse rate was always a bit high, as was my blood pressure. Subclinical, but notably elevated.
Something interesting happened after I took adderall the first time: my BP and pulse rate were lower. And please note that this has been clinically noted and recorded on my medical record over the years as I've gotten my vitals checked from time to time. The meta-data before each check was when I last took the med.
When I take adderall, concentrating isn't a struggle, it just happens when I want it to. This has the effect of lowering my vitals, even though adderall is, as stated elsewhere, a very smooth version of speed.
Over the years, I've alternated between adderall and ritalin at first and now concerta, which is, of course, 'ritalin extended release'.
I don't take the meds every day, and I've had the two prescribing doctors over the years give me high dosing flexibility. In other words, lots of small dosage tablets, giving me the ability to dose as I see fit.
Here are my general rules for dosing, in order of precedence: 1. work days 2. dose strongly biased toward the AM 3. lower or zero dose on work days where I need to be 'scattered' and do a lot of shallow things 4. rarely non-work days, usually with a lesser dose, where I need to do some deeper focus
I feel absolutely no 'pull' from these meds. I have gone months not taking them, and they have improved my life notably. They are a tool, and I use them as such.
The other person is my son. I must be briefer here because my day must begin shortly.
He is now a teenager, and started showing signs of clinical autism before his 2nd birthday. Further, he is even more ADHD than I am.
We were told he would never speak. Further, we resisted giving him any meds, for years. This was a mistake.
We finally started him on Concerta when he was six years old. The difference is profound.
ADHD and autism together in a single mind is quite a curious combination.
Briefly: without the meds, his mind races in so many directions, in so many deep 'autistic rabbit holes', that he can hardly string together a clear sentence, even today. Only after he started taking the meds was he able to start learning in a relatively normal way.
He is effectively dependent on the meds to function in a relatively normal way. And, with his mom's amazing, devoted and miraculous effort and attention these past 14 years, he is at mainstream class levels (but one year behind) in every subject except math.
ramblerman, I am the one who has rambled this morning (my time). I am well known for creating walls of text, so please accept my apology for that.
As you say, adderall isn't magically different. It is in fact speed.
But our brains and bodies are amazing, and amazingly variant.
I suspect that most of the people who take adderall and concerta don't need it as my son needs it. And perhaps we need more rigorous clinical protocols, but who knows. It's all pretty complicated.
PS: I have to leave this message unedited, so please pardon the roughness of it. I have to get ready for work, and the train waits on nobody.
Thanks for giving your two-cents and personal experience. Most of my friends, myself included, use amphetamines for recreational purposes. There's been a vague understanding that it works differently for people with ADHD, though I've never personally heard such a detailed testimony.
It sounds like your son is lucky to have you and your wife as parents. Bless you and your family!
I'm curious as well. I've come to use long (but informative) rambles as an ad-hoc indicator of the kind of executive function deficit typical of ADHD. Folks who can write short, crystal-clear, on-point emails are unlikely to be (untreated) ADHD.
I still need to put in the effort to do something difficult or boring (like just about anyone) and I do still feel a mild coffee-like perk up when I take my Adderall and it kicks in. But otherwise, it's a relatively mild tweak that I personally find to offer more benefits than drawbacks for the time being.
No, I had not taken anything when I wrote that rambling epistle. What you're seeing is a first draft, and since I had to get moving, I had to leave it as such.
Recall that I knew how to concentrate before the meds, it just took a lot more energy. I am naturally at my highest mental energy level in the morning.
Also, those who know me will attest that my default writing style is pretty long-winded and uh..dubiously organized.
If I had gone back to edit it this morning, the wall o' text would have gotten about 1/3 shorter.
Regarding recreational use: I cast neither dispersions or judgments on anyone. Speaking for myself, I can't imagine adderall being a recreational drug. For me, it's not a particularly fun feeling, though it helps me accomplish high-focus tasks, and that feels good.
And just to be clear: our son gives our lives purpose and meaning. Truly he is the purest blessing to us.
In an ideal world, yes, we would all function optimally in our environment. But, unfortunately environmental changes have outpaced Human adaptation. And, while I'm pretty sure my biology would've been better suited to running around a plain chasing wild game, I didn't get to choose.
Most medications have side effects and trade offs. What's important is whether the medication improves a person's quality of life overall.
Humans in societies have been chemically altering their moods since we discovered mood-altering chemicals. Stress occurs inside and outside civilized workforces, and people take measures to mitigate stress. The real question is: what are the side-effects and how do we mitigate them?
(Not to imply that we shouldn't also look into options for de-stressing the American worker, since benefit there can scale significantly. But we do ourselves a disservice by imagining we're the first generation to have an entire culture habitually consuming a physiology-tweaking chemical cocktail)
In my experience the culture around having a few drinks after work and even having the occasional cigarette is far more relaxed in the European countries I've been to than just about anywhere in the USA.
But as I've said, I have zero evidence that any of this is even true - just my observations however well travelled I am.
Like yourself, I wouldn't want to extrapolate a broader trend from that, just providing a counter-anecdote.
Think on smoking we've probably had a similar experience though. I don't think I even know an American that smokes (cigarettes), let alone seen it at a workplace. In Europe, it'd be weird if there weren't a couple of people in any office that didn't have an obvious habit.
Observations are evidence. You meant that you had no non-anecdotal evidence.
It's not so much as "why can't Americans go without" as much as it is a "why can't Americans admit Prohibition doesn't work" type of question to me. The latter is a lot easier to fix than the former, I think.
Can't or don't want to? Drugs can make things easier, at least in the short run, and the stigma against pill popping is pretty much gone.
And then there are articles like this that appear every so often, telling us that we aren't really sick. Or that people who take these drugs are abusing them like they are just trying to get high or whatever.
They really make us jump through a lot of hoops just to get the medicine we need to live a somewhat normal life, all in the name of preventing drug abuse. I don't believe it actually does anything significant to prevent abuse, those who want to abuse drugs will always find a way.
There's so much of a stigma associated with low dose amphetamines and it's completely unfounded. I really noticed this when I switched from dextroamphetamine to methamphetamine (Desoxyn). Since my insurance wouldn't cover the brand name drug, I get the Mylan generic that says "METHAMPHETAMINE" on the label and I could really notice a difference in the way I was treated at the pharmacy. It was like they immediately assumed I was some dangerous drug addict. I'd try to be friendly with them and all I would get is really robotic responses.
It's ridiculous that they assume methamphetamine is this much more dangerous or addictive of a drug, it's not. In fact it's the best stimulant I have ever used. Way more effective than dextroamphetamine with fewer side effects.
Luckily I have a good psychiatrist that is setup to handle the monthly refills in a sane manor and doesn't treat me like a drug addict when I'm just looking to improve my life.
If someone takes the same low dose I do but doesn't actually have ADHD, how could they be considered "cracked out?" simply because they are faking a diagnosis?
We know that low-dose amphetamines improve cognition in healthy individuals regardless of whether or not you have ADHD. We also know that amphetamines are very safe at therapeutic level doses and that you can take them your entire life without any problems. We also know that stimulant therapy actually reduces the chances of someone abusing drugs, even stimulants.
Why shouldn't all healthy people have a chance to reap the benefits from them? Why should you have to have a disability in order to be able to access the benefits from these drugs?
There's just no logic to the way society currently views stimulants. It's safe for me to use amphetamines to help with my ADHD symptoms but if someone without ADHD uses them in the same manor, then it's dangerous.
"Cracked out" or not isn't quite the question.
Amphetamines in low doses have measurable benefits in terms of increased ability to concentrate and work longer hours and definite drawbacks in terms of longer term health effects and risks of actual serious addiction.
When the job market creates such pressures that a significant portion of workers are working 12 hours days, not receiving particularly higher compensation, and using amphetamines to manage the situation, it seems that employers are repeating the benefits while the workers only get the drawbacks.
There is a potential for abuse but studies have shown that people on stimulant therapy are LESS likely to abuse drugs, including stimulants.
While people on both sides of the argument are guzzling coffee and tea.
In my opinion, anyone claiming that it's a "personality trait" or a made up condition is a moron. It's absolutely turned my life around. After getting my dosage lined up correctly I feel as if I'm finally living normal.
I agree: It's incredibly something (classist?) that only certain people can legally get amphetamines. I'm sure if you have lots of money, it's far easier to convince a doctor to RX. Whereas if you don't, you can even afford the doctor to diagnose, let alone RX (plus the risk of being labelled a "seeker").
Having essential medications behind professional, for-profit gatekeepers is a violation of human rights. It's reprehensible and an affront to personal liberties.
I have tried all the other ADHD stimulants and formulations but it wasn't that none of them worked for me or that I required a high dose (I take what is considered an average therapeutic dose).
If you think meth is way more potent than dextroamphetamine, you'd be in for a big surprise. Meth is a very subtle and gentle stimulant, so subtle I often forget I even took a stimulant. This is probably because of the lack of PNS stimulation at these low doses. It's also a little bit more effective than dex because of slightly higher CNS stimulation but the lack of side effects is probably the best feature of meth. It just feels really natural, hard to describe completely.
It is considered a second line medicine because it's thought to be more addictive but I can assure you this is completely unfounded and has to be due to the stigma created by illicit meth abuse. IMO, it is a superior medicine and should be a first line treatment for ADHD.
Don't forget that it's not necessarily an evolutionary disadvantage to be slightly depressed or anxious, because you tend to avoid risks. Same with low motivation and an easily distracted mind which can help to conserve energy by finding ways of avoiding tasks.
Even pre-internet, we had a rise of TV shows like "Lifestyles of the Rich and Famous" which gave viewers a daily reminder of how mediocre their lives were in comparison.
The notion that everyone's life is (or should be) full of constant excitement, joy, and amazing experiences is false. It is very one-sided. But if that's all you see of everyone else, your own troubles (which are mostly the same troubles everyone has) start to seem abnormal, something that needs to be treated. So you go see a doctor and end up medicating the problem away.
And though she's not really ill, there's a little yellow pill / She goes running for the shelter of a mother's little helper / And it helps her on her way, gets her through her busy day
In other words: trying to find individual solutions ("my dopamine is so messed up!") to social problems.
Problem is the "chemical imbalance" line is a myth, there's no evidence that depression is caused by a serotonin imbalance or an imbalance of anything else (easily) testable. It was only ever a theory and one that's not very well regarded. See [1], but there are loads more criticizing it.
[1] http://journals.plos.org/plosmedicine/article?id=10.1371/jou...
>North Americans to find pseudo-biological justification about everything.
Yet the above nations are nowhere near N America. Perhaps this issue is a lot complex than you care to understand. I guess if you want ad-impresions then you must cater to people's ignorance and biases and leave any facts, science, or statistics out of it.
Also: Iceland, Australia, and Portugal cannot be called socialist by any stretch of the imagination.
ADHD is basically the most studied and best understood psychological condition out there. People who get treatment (medical treatment! Treatment without medication is a major uphill battle) have a 60+% response rate, with something like 30% of people having almost total recovery of symptoms.
This is much better than "real" conditions like bipolar disorders and "well most people think it's real" things like depression. If you think we can diagnose and treat bipolar, then acknowledging ADHD as a real thing that does affect a lot of people is the next logical step.
A bit of a rant but I think a lot society is still in denial about ADHD mainly because the symptoms look a lot like behaviour we expect from children.
And of course that denial makes ADHD sufferers feel like shit and shuts down most paths for recourse...
> ADHD drug abuse had become so commonplace on college campuses that Wesleyan University, among other prominent institutions, has tried to ban it altogether.
ADHD is a diagnosed medical disorder that affects millions of people in America. Why do we still stigmatize it in the modern age?
ADHD is a meaningless psychiatric diagnostic [1] of symptoms, not cause. The diagnosis is used to put millions of people in America on maintenance doses of addictive psychotropic drugs. Routine use of amphetamines almost always causes people's mental conditions to worsen, eventually.
Tonight one of my regular taxi passengers txt-messaged to ask if I was working. I was exhausted one night, when he was going home from the gay strip club, so I stopped at the coffee shop that was half-way between the strip club and his mother's house. I was like, "so... what's your story?"
When the passenger was in high school, he was diagnosed with ADHD. The doctor got him addicted to Ritalin, or one of the other legal prescription amphetamines. At first the amphetamine was great, but then side effects developed. Then he developed some legal troubles, which led to living in a halfway house, with hostile housemates...
Anyways... He's a bit of a mess... probably early or mid-30's... his mother pays his taxi fares. He had a job at the baseball stadium, but then he got fired. Last I saw him, he was collecting unemployment insurance.
People... people are interesting. This passenger didn't use "ridesharing" because he can't manage his money well enough, iirc.
[1] https://www.commentarymagazine.com/articles/the-doctor-isnt-... and https://www.commentarymagazine.com/articles/how-psychiatry-l...
I've not heard this before..do you have a source? Quite interested.
Here's a random quote from a mainstream medical source:
"Mood disorders similar to hypomania and mania can be elicited during intoxication with amphetamines. Depression can occur during withdrawal, and repeated use of amphetamines can produce antidepressant-resistant amphetamine-induced depression. ..."
- "Amphetamine-Related Psychiatric Disorders" (emphasis added), http://emedicine.medscape.com/article/289973-overview
Mad in America makes the case that mental health treatment is a make-work endeavor. http://www.madinamerica.com/
[1] https://en.wikipedia.org/wiki/Methylphenidate
Adderall [2] is an amphetamine.
Ironically it's the most subtle and gentle of all the ADHD stimulants, at least at therapeutic doses. It has a bad reputation because of the abuse of illicitly manufactured meth available on the black market but it's completely unwarranted.
It's pretty irrating to support stigmatizing/banning a drug that millions of people use and get therapeutic effects from based on a few unrelated anecdotes.
My position is simply that there is underlying causes behind people's complaints. Stimulant-prescribing doctors would rather suppress the symptom than investigate.
Robert Whitaker's Anatomy of an Epidemic discusses amphetamines on pages 64, 219, 228-29,236, "See also Benzedrine; Ritalin". Ritalin is covered in more depth: case studies, as cause of juvenile bipolar disorder, hiding the evidence, risks/side-effects, and silencing dissent.
More information about this book can be found through the Mad In America link above; I directly linked to its information page in another comment.
People tend to like the stimulants. They tend to hate the sedatives. Some stimulant users end up being forcibly sedated with "anti-psychotics" (courtesy of a court-order), because they couldn't keep their stimulant use under control and became psychotic.
Second of all, here is a comprehensive list of peer-reviewed studies defending the existence of ADHD and the efficacy of amphetamines for ADHD (much better than some random anecdote of an improperly diagnosed taxi passenger):
https://www.reddit.com/r/ADHD/comments/3at2u2/psa_the_existe...
Admittedly, psychologists seem to have a problem properly diagnosing it, but let's not diminish a disorder suffered by millions every day.
Oh, most likely not R, because it doesn't cause addiction if taken according to prescription.
* Many didn't cope.
* Also there were more physical work to be done.
I could have been diagnosed as ADHD in college. This was not a biological problem, but that I didn't care about my classes. Stimulants might have helped me focus better, but ... why?
Robert Whitaker [1], author of Mad in America and Anatomy of an Epidemic, has looked into these matters, and concluded that the medications make people's conditions worse.
Sure, I agree that the school isn't making it any better but lashing out against the things that work in lessening the pain given our current theoretical overload?
Remember, we don't need to go further back than my childhood before woodworking and sewing was a school subject, as was cooking (yeap, real food: fish, meat and vegs).
One generation back and my dad grew up with a work horse, dairy cows, dairy goats and sheep. And so on and so on.
Evolution doesn't move that fast. Banning or further restricting (i.e. beyond todays standard where you need something line 7 years of medical scool) the best solutions we have doesn't sound like something I would support.
The solutions offered by the medical profession are far from the best solutions we have, they're what are profitable for the medical-industrial establishment to offer.
I'm all ears: Tell me about it because I know someone who really did try without and would be happy if there was a better way.
4.4% of Americans are supposed to have ADHD (http://www.ncbi.nlm.nih.gov/pubmed/16585449). One starts to wonder if all those people really are suffering from a medical disorder, or if it is just a character trait. I would say a disorder is something which makes it difficult or impossible to function in life. Is that the case for 4.4% of the Americans? How would their ancestors have been surviving for all those thousands of years before Ritalin had been invented?
There are more and more people who have a different view on ADHD: that it has both its bad and its good sides, and that focusing on the good sides of ADHD is the way to deal with it, rather than trying to suppress the symptoms with medicine. See for instance http://www.forbes.com/sites/dalearcher/2014/05/14/adhd-the-e...
Different demands. I was diagnosed with ADHD and started medication. At that time, I was an engineer doing the problematic, bleeding-edge R&D-ish stuff pretty much by myself with close support of a small team and needed to focus, something that never came easy to me. The company was acquired, I moved on and accepted a technical management position at a much smaller place. Being constantly interrupted annoyed me and I stopped the medication (my psychiatrist agreeing). Without it, I felt again more at ease spread over more, different tasks.
So, to answer your question, people survived by doing jobs that didn't demand the kind of focus that's difficult for people with ADHD.
Such jobs, sadly, are not abundant anymore or evenly distributed geographically.
Or maybe your writing would start to look like the work of genius Paul Erdős, a noted speed addict for decades.
ADHD is caused by a low dopamine level or uptake. This can lead to concentration problems and impulsive behavior, and those symptoms can make people look restless and overactive. Amphetamine stimulates dopamine production, and that cancels out the effect of ADHD. If given in a low enough dosis to someone with ADHD, it takes the restlessness away, so it has the effect of a downer instead of an upper.
Stimulants are useful. I would say upwards of 25% of people I know use/abuse some sort of stimulant on an irregular or regular basis. Everything from adderall to speed paste from the dark net, to the people I know that enjoy a good 3 day long meth binge every few months (yes, there are highly successful and responsible meth users).
Stimulants are also dangerous. They all have varying degrees of what people in the drug community call "more-ishness" -- the urge to redose. Because who the hell wants to come down when being up is so up? Some way more than others (Hi there, meth again!) They certainly tax your system -- I'm sure even the stuent popping two or three adderall to pull an allnighter has felt the next day blah of shitty brain chemicals (pro tip: sleep, eat a lot, exercise, and have sex). As far as long term effects of taking amphetamines every day, especially starting from childhood...well, we're running a population wide experiment on that now
In any case, to reiterate, I believe some people have a lot more trouble than others staying focused. This can help or hinder them, depending on what they are trying to do. No doubt some people find daily amphetamines super indispensable to leading a productive life. But pretending there is some bright line between "normal people" and "people with ADHD" wherein on one side of that line amphetamine use is abuse and other the other side its just a medicine that acts totally differently obscures the murky and muddy truth. And especially keeps us from having a rational discussion about harm reduction, safe stimulant use, etc etc.
And we're just getting started. New stimulants roll onto the streets from pharm labs in China and India nearly every money as research chemicals. Flourinated versions of methamphetamine and methylphenidate, etc etc etc. Some have rather unfortunate dose response curves between stimulation and psychosis for street drugs (see also: flakka) as not too many people carry their milligram scale on them.
In any case, we can keep pretending that stimulants are just good medicine for a vaguely nebulous diagnosis and poison for everyone else, or we can have rational discussions about what stimulants give with one hand, and what they take away with another. Because they do both.
Meanwhile, just out of sight, I assure you there's a lot more people crushing up half an adderall in their bedroom right now that you think.
I'm actually genuinely appreciative because while I have a testable, physiological medical condition, I think the ADHD 'testing' without a biological marker that can be seen in a petri dish (so to speak) is wishy-washy. Yes, this goes for Autism too. Yes, I understand these views probably aren't popular, and, in closing, I do feel fine holding this definition distinction in light of people wanting to argue their fuzzy feelings about "What's real" in medical science.
>well, we're running a population wide experiment on that now
I suspect I also get hositility from pointing out a lot of people think their medication is helping them but they really don't know about long term effects, but don't want to hear that they might be, you know, bad.
Except it appears as though it's actually pretty good. Long-term treatment with amphetamines appears to decrease abnormalities in brain structure and function in people with ADHD and improves function in several other parts of the brain. Wikipedia provides 3 citations for this, but only one study appears to be available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3801446/
> In any case, we can keep pretending that stimulants are just good medicine for a vaguely nebulous diagnosis and poison for everyone else
That is a gross misstatement of the position you're arguing against.
> As far as long term effects of taking amphetamines every day, especially starting from childhood...well, we're running a population wide experiment on that now
Amphetamines were discovered over 100 years ago, and have been used for therapeutic purposes since 1935. In fact, it appears that as early as 1937 amphetamines were being tested on children with severe behavioral problems (i.e. what would be finally classified as ADHD). We may be using amphetamines much more often now for therapeutic purposes, but pretending that nobody has been taking amphetamines long-term until recently is wrong.
#2) Whether ADHD is "real" or not requires a complex discussion about epistemology, etc, as do all mental health diagnoses. What do you mean, "real"? Yes, of course it is real in so far as there are people with various clusters of symptoms that seem to go together, but they are all on a spectrum. Psychiatric diagnoses are inherently unreliable[1] -- in that it can't generally be replicated sufficiently from doctor to doctor with the same patient (or even doctor to same patient at different times) even with that giant bible sitting there we call the DSM.
So yes, there are a variety of states of consciousness that vaguely cluster together that we have decided to call "depression". We know some chemicals that help some of these states -- though it's arguable that many of them are better than placebo (hello, SSRIs, but hey ketamine seems quite promising). Any therapist worth hir salt knows that depressions are different for different people -- different causes different manifestations etc. Yet thanks largely to the pharma industry, we have begun to collectively think there's this very specific thing called "depression" that's due to "brain chemistry" that can be fixed with XYZ and in fact human consciousness is much much much more complicated than that -- from both a psycho-spiritual angle and from a neuroscientific angle.
Lastly, there's no doubt amphetamine usage has been around for a long time, and probably at higher concentrations than today among some population groups (middle-aged women in the 50s for example). But I doubt you can find me any study showing that we've ever seen so many people on high-dose daily amphetamines from a young age through adulthood until the past decade or so.
#2) I agree that ADHD is a complex subject and diagnosing is hard. However, given that something like 80% of people with ADHD show improvement with amphetamines, I'm not sure what the point is of this line of argument. Even if ADHD really is a cluster of similar issues, if they all can be treated the same way, then it doesn't really matter whether it's a single issue or multiple.
I'm not sure why you're trying to draw a comparison with depression. The only real connection here is that they're both psychiatric diagnoses, but beyond that they're not the same at all.
> But I doubt you can find me any study showing that we've ever seen so many people on high-dose daily amphetamines from a young age through adulthood until the past decade or so.
That's completely irrelevant. Why would you want a study looking at the number of people being prescribed? There's nothing you can conclude from the fact that more people are taking it now than before, because the number of people taking it has no relevance to its long-term effects. All that really matters is whether a statistically significant number of people have been taking it, and that's certainly been true.
Often you hear this saying that people with ADHD feel relaxed when they take a stimulant and don't feel any increased energy or mood lift, which of course is false. That's what I was referring to.
"Correspondence (letter to the editor): Paradoxical Reaction in ADHD":
Didn't know this. Googled it:
http://www.slate.com/articles/arts/culturebox/features/2013/...
I think that's ignoring the elephant in the room. Before amphetamines, it was other drugs. The major point is that practice of capitalism in America is founded on a pattern of use and abuse of drugs. This is an elephant in the room because the dearly-held narrative in America is the idea of work hard, get rewarded. What's called a good work ethic here is seen as insane working hours outside of the US. And this ethos is reinforced by the dominance of US interest in the world.
Now you add in the Chinese startups working even more insane hours.
Is this really what we want our human civilization to move towards? This blind, tunnel-vision obsession over technological progress without actually reflecting on where it is that we are going?
Well, at least when you're using drugs that help you focus, these inconvenient ideas can be easily dismissed. Back to work now, y'all.
I went to a pretty rough college where I had standard 24 hour straight homework sessions once or twice a week. And I used caffeine maybe once a week at most. I work at a startup where the work culture isn't as competitive as what I feel is the norm, but even listening to friends at there does not seem to be such a ridiculous need for overclocking yourself.
I just seem to have never done work that was hard enough to push me to require drugs, and it's not because I haven't done hard work. Most work seems to be either you just put in the 40 hours it takes to solve it or it hasn't been solved.
One of the first reasons that sticks out to me is that it motivates you to get things done, especially things that would otherwise be boring and repetitive. For example, something like fixing formatting errors in 100,000 lines code.
As for why you never felt the need to use it, my guess is that maybe you're more secure with yourself than some other people.
There's an incredible push to become "successful" these days (partly due to social media I guess), so I can see why some people resort to Adderall to give themselves a leg up.
Of course, I’m talking about people who don’t have ADHD and are taking it simply to augment their performance.
Everyone here is a misunderstood genius with ADHD.
Apart from psychosis or heart issues, why should anyone settle for being less powerful?
The earlier in a career, the worse of a problem this is. Which is why I think doing this as a student to enhance academic performance is a particularly bad idea. You're in school to prove to yourself and others what you're capable of. Doing so with drugs that you're not willing to take for the rest of your life is only lying to yourself.
Contrary to the sentiment that these medications are just some kind of super energy drink, I find regular therapeutic use actually leads to less work hours and reduced stress for me.
I can't cope with boredom. It feels like a prolonged low intensity panic attack to me. I will do almost anything to avoid it. In a work environment that includes making bad choices merely to avoid putting myself in situations where I might have to do boring things. I think ADHD is actually under diagnosed and a lot of people would be happier if they were taking medication for it. That's probably the reason the people this article cites are trying to self medicate for it. If it wasn't a problem they wouldn't be looking for a solution.
1. Drug X works wonders for millions who suffer with Syndrome Z. But these evil politicians and FDA bureaucrats won't let people use it. Call your congressional rep and demand support for HR ABC123 today. Stop the suffering!
2. (2-5 years later) Is Drug X Causing Millions to get Disease Y? Look at this new study released by the highly respected "Famous University". Mortality went up, and, even worse, Drug X is no better than a placebo!
3. Greedy Big Pharma has been pushing pseudo-cure Drug X and it's destroying people's lives. Call your congressional rep and demand support for HR XYZ789 today!
What kind of state does prolonged use of amphetamines put the user ? Constantly being pushed to focus on one task, what kind of thought patterns does that create in the long run ?
I feel the biggest issue with this is that it's considered okay, like is coffee use, and still coffee and amphetamines are really strong stimulants, but it's so commonplace that we don't even think about it anymore.
Are we being just taught by the culture around us to work, work, work .. when we could be taking it more easy, having our thinking be more open, and not so closed and focused on the tasks ahead of us?
> I still remember my friend who had a prescription for ADHD -medication,
> and they cut off this medication, and he couldn't do nothing but sleep
> for 3 weeks almost.
I definitely had a "crash" if I suddenly stopped taking it for a day, cold turkey. Would pretty much be stuck in bed.
However, if I slowly weaned myself off over a couple of days (25mg-->15mg-->5mg-->0mg) or something like that, it was no problem. Currently I haven't used any in six months.
> What kind of state does prolonged use of amphetamines put the user ?
> Constantly being pushed to focus on one task, what kind of thought
> patterns does that create in the long run ?
There's no denying, though, that Adderall often made me a bit more prone to anger while I took it regularly.
I also have to say that Adderall didn't really "push me to focus on one task." It helped my focus and energy somewhat, but I definitely didn't become some kind of extreme monotasker.
> Are we being just taught by the culture around us to work, work, work ..
> when we could be taking it more easy, having our thinking be more open,
> and not so closed and focused on the tasks ahead of us?
I think what bothers me about America's workaholic mentality is that it's not even effective. In the long run I firmly believe that we get less work done if we constantly push ourselves to exhaustion. We try to treat our entire work careers like we're university students trying to power our way through an all-nighter. It just doesn't work. I continually remind myself of this... the hard way.
Also to be honest I found modafinil to be a lot more effective.
I don't see myself going back onto Adderall. I wouldn't rule it out, but it doesn't appeal to me right now.
Sometimes I even felt it a little bit unfair as a programmer, that I am competing with people who are medicated. But I don't think like this anymore.
And yes, I agree on the doing less is more, with highly intelligent tasks you just start banging your head against the wall at some point, and anything beyond this point can be time just wasted, when we could be just relaxing and resting, to be more in tune again the next day.
But now that I've been on both sides of the fence I can safely say that it's not a big advantage. If programming was a footrace... on a long term basis I'd say that Adderall is more like a knee brace than a pair of roller skates.
On a short-term basis it can be different. The first time you take it, you might be able to pull a very effective all-nighter. But you will have to catch up on sleep eventually. Much like caffeine, a person's body adapts to Adderall very quickly. There's no free gains with this stuff.
The ideal usage pattern for Adderall might actually be closer to "take it sparingly 2 or 3 times a month" rather than "take it every single day."
Prior to taking the meds, I could not tear myself away from some tasks (basically anything really interesting to me)[1]. One of the side effects is supposed to be reduced appetite, but I find I actually am eating more often because now I can get up from my desk when I'm hungry.
This sounds great and all, and it's actually useful when the task that catches my attention is also one I am supposed to be working on. However, interruptions don't work, and the minutia end up not happening (e.g. self assessment for performance review, answer question a customer or technical writer had about how X works, &ct.). Often times even writing down a note to do something later was not possible for me when I was in the middle of a task.
The worst, of course, is when a problem catches my attention that has zero value for my employer.
Today I had a similar interruption, I asked for a couple minutes to finish up the part I was working on, and two minutes later, I hit the stopping point I was anticipating and looked into the more urgent matter. Previous to the meds, I would have either completely forgotten about the more urgent matter, or would just have had to work for "just five more minutes" for an hour or two.
1: https://xkcd.com/356/ <-- this comic understates if anything what that's like. Though there is a 50-50 chance I don't even see the sign because I'm still thinking about whatever I was working on when I left work.
I have used pharmaceutical grade methylphenidate and amphetamines. The former inevitably led to suicidal thoughts and feelings or worthlessness at the end of the day (i.e. once the dose is gone). This happened to all of my peers who tried it. The effects were mild, but still quite noticeable. And we were healthy (both mentally and physically) young men.
My advice is you just get a prescription from a doctor. They are unfortunately quite easy to come by. At least your dosage will be supervised, and you will have someone to talk to about possible side-effects without fear of reprisal.
There have been studies showing that amphetamine leads to definitive cognitive improvement in the general population. Why restrict it? Human beings have a special relationship with psychostimulants.
Note -- I'm a staunch anti-prohibitionist and I agree that stimulants are useful tools, but they are also dangerous tools with a high potential for abuse and some pretty wicked effects if you push them too far (stimulant psychosis in the short term, pretty nasty anhedonia as well as a bunch of other health effects in the long term)
So yes, of course let's decriminalize and legalize - and let's start by acknowledging that lots of well rounded people use amphetamines mostly safely and responsibly (the occasional binge seems inevitable) - but let's also have a rational harm reduction talk about the dangers of stimulant abuse. More than any class of drugs, I think they give with one hand and take away with the other. What goes up must come down after all.
Also there have been studies that show that people on low-dose therapeutic amphetamines are less likely to abuse drugs, including stimulants.
In the past (up until the 60s or 70s I believe), there was also a racemic mixture available on the market as well.
However these days I take methamphetamine which feels more subtle and has even less side effects.
Stimulants cause people to become psychotic. Some are more vulnerable to this effect than others.
https://en.wikipedia.org/wiki/Substance-induced_psychosis#Su...
There are better, safer ways to cause a "cognitive improvement in the general population".
It really depends on the individual, but amphetamines are no more dangerous than legal drugs. Why is ephedrine easily available OTC but not levo/dextroamphetamine?
While technically true, it's a bit disingenuous to make blanket statements like this without qualifying the risk don't you think?
Cough medicine is bad, but it's not nearly as potent of an addicting substance as the others on the list. She's used antihistamines as a hallucinogen before, but is not really tempted by them.
I have treated several hundred individuals with amphetamine, methylphenidate and related compounds, primarily for ADHD in adults and adolescents. Everyone should know that ADHD is a very common disorder, affecting >=4% of all adults. It is a disabling condition in many, perhaps the majority, of those who manifest its symptoms.
A troubling aspect is that only about 1/5 of sufferers seek treatment, and often treatment is suboptimal for a variety of reasons. Staying on topic, the most effective medication strategies remain the "stimulant" drugs.
The article contains errors re: drug effects and history. First of all amphetamine was synthesized well before 1929. What we now call amphetamine was created by a Romanian chemistry Ph.D. candidate, Lazăr Edeleanu, in Berlin, in 1887. It was rediscovered in 1927 by Gordon Alles who was unable to patent the compound because of Edeleanu's work 40 years earlier.
Amphetamine was initially marketed in the 1930's as Benzedrine. Significantly the remarkable efficacy of amphetamine in what's now call ADHD was described in 1937, and to this day no other class of drug has been demonstrated to be as effective as the stimulants.
As commented here, stimulant class medications have different effects in those who need them. At the optimal dose, ADHD patients are not "amped up", in fact typically feel calmer, thoughts and actions more controlled and deliberate. In people who don't have ADHD may indeed experience "stimulating" effects.
Furthermore, ADHD adults perform much better with appropriate treatment, whereas unaffected users experience a boost only with simple tasks. Stimulant use will cause decreased performance on cognitively demanding tasks. While college students are known to seek out amphetamines in order to "study better" for their final exams, in fact it's much more likely to decrement their results, myths notwithstanding.
Not to say that drug abuse is not a serious matter. Ethical practitioners prescribe stimulant class medications with great care to assure correct diagnoses and appropriate prescribing practices. No question that not everyone with a license is ethical. I firmly support taking steps to put those deliberately contributing to drug abuse out of business, and into jail.
It's imperative to avoid throwing babies out with the bathwater. Stimulant medications are an extremely useful tool when used along with due vigilance for misuse. Patients in my practice were carefully monitored, and were informed drug misuse could not be taken lightly. Over the years there were a few who were deemed too irresponsible to continue treatment with the medication.
A few years ago, in my late 30s, I was diagnosed with bipolar, ADHD, and anxiety disorder (all three have high comorbidity, interestingly). When I got the diagnosis, I was a little bothered. In my family and culture, it's considered a weakness to have mental illness or even talk about it. One is just supposed to 'tough it out'. And, I did tough it out up until then. But, I had finally reached my breaking point and sought out help.
One of the first things the doctor asked me was to describe my family history. My family is largely comprised of highly-intelligent underachievers. Although my parents and siblings are all in the 3 standard deviation IQ club, I was only the first to be able to hold down a regular job and finish college.
When I described my parents' behavior and history to the doctor, he was able to quickly see the patterns and inherited traits. We were all suffering from something similar that had held us back from success (and having general life satisfaction). In fact, after seeing how much easier life has become since I began treatment, I felt terrible for my parents. For most of their life they suffered and ended up self-medicating with much worse things.
I find the backlash against ADHD treatment and all mental illnesses to be extremely classist. There are likely large portions of the population who could have achieved much more happiness and success if they only had had treatment. There seems to be a movement to keep these people untreated for dubious reasons.
And, the downsides of ADHD treatment are quite minor in comparison. In fact, having experimented with different substances over the years, I find Adderall to be almost insignificant. I occasionally miss weeks at a time and feel no noticeable withdrawal. In comparison, alcohol, nicotine, and caffeine are all extremely difficult to quit both physically and psychologically.
The comorbidities and family history are often similar to your situation. I often said "comorbidity is the rule not the exception", and ADHD and bipolar D/O are known to be highly heritable conditions.
Tolerability of stimulant medications is usually quite good. Can't say the same for agents available for bipolar D/O, it's especially devilish to manage when ADHD and mood D/O are both present.
I glean that you've responded pretty well to treatment and that's great. One thing I learned is that treatment can help patients improve tremendously, essentially functioning in the "normal" range. In the treatment field we consider "normalization" to be the "gold standard" of success. It takes time, years in most cases, but the benefit of persistent treatment is in my view extremely clear.
The key advice I always offered was "keep up the good work".
I'm not sure why one stimulant is socially taboo and the other acceptable, even encouraged.
This article shows sleep deprived surgeons benefit from modafinil: http://www.ncbi.nlm.nih.gov/pubmed/21997802
Modafinil Does Not Serve as a Reinforcer in Cocaine: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2842996/
... Ok, I won't make it one of those posts. But, do some research. We will all be better off if we can drop the FUD rhetoric and treat cognitive enhancers like we treat other drugs, something that can help and hurt. And we need to stop thinking of health care as something we do when something is broken, and start thinking about it as another tool in the toolbox that we can use to improve our lives.