Stopping the False Epidemic of Adult ADHD

I always find it funny how people overblow the side effects from amphetamines and other performance enhancing drugs. Somehow these are "bad" because they are illegal. Just like how marajuana was "bad" but now its suddenly "okay" because it's legal.

I have ADD - and an adderall prescription helped me get through alot of the bullshit for my bachelors degree. I can concentrate on things that interest me, but universities make you take a ton of unrelated courses and I just lost interest almost instantly on work.

So for one year (my senior year) I had a prescription ranging from 15-30mg XR (30 was too high so I dropped down).

In retrospect, I was able to quit cold turkey with minimal sides after graduating - got my heart scanned out of curiosity and its fine, cholesterol is fine, etc. etc.

I think most drugs are safe if:

1. Used in the right doses for the right duration .

2. Only used on otherwise healthy individuals (this is an important one in the world of "everyone is equal") - I would not take adderall if I was obese since it is a stimulant and does increase BP / HR.

First off any medical advice from Huffpost is bullshit. Second the author here and the doc cited are pompous idiots. ADHD is real in children and adults and evidence of it can be seen with brain imaging (https://www.sciencedaily.com/releases/2017/02/170216105919.h...). Maybe they should conduct their work with some hard science/evidence instead of a checklist based on opinion? Ooooh.... and cry me a river, some big pharma company paid for a vacation for you and then took something you said and bent it to sell some drugs. Wake up! They sell drugs and so do you doc! I have ADHD and meds are the difference between total personal ruin and successfully running a company for me... and many other people. Every one of these clickbait bullshit articles that descend into moral arguments about ADHD do real harm to actual people with a quantifiable disability. Rule 1 of being kind that you teach a child is not to pick on people for things they can't change. I can't change that I have ADHD, other people with it cannot change that. We live in a world made by people with what the book "Delivered from Distraction" called "Attention Surplus Disorder." Supposedly the people who aren't sick are the ones who can sit still at a desk and then a cubicle their whole life doing what they are told. If that's being well I'm so glad I'm "sick."

All of my post is anecdotal, but it sucks that some people abuse the system just for drugs. With that disclaimer out of the way lets begin:

From what I gather it (Adult ADHD) is also very hard to distinguish from bipolar disorder. It took 18 months of moving around with anti-psychotics and other drugs to treat my "bipolar disorder" before my doctor realized that it was ADHD and we found almost immediate results from the treatment.

It sucks that the diagnosis seems to be so easy to get for some people and they're doing it for the adderall. In my case it helped me significantly, moving up in my career and ultimately bringing me out of an almost decade long depression with myself. I hope that people who actually need help get it, and to put it simply, screw the others who make it hard for people to be properly diagnosed. My diagnosis took so long because of the known abuse to get the drugs, from what I gathered in conversations with my doctor, and she was reluctant to consider that diagnosis until she was absolutely sure of it.

I suspect that this person has never encountered someone who actually has ADHD, with meds and without. I was lucky enough to be diagnosed early on. Right around Kindergarten I was taking Dexadrine which helped until Adderall came along.

For me there's a huge difference between the two. Without the meds, my concentration drifts. If I'm at home, I may be aware of an issue that needs attention, but lack the energy and focus to carry it out. I'll start watching a video, get distracted, and drift off there, then over there, and so forth.

Out in public it manifests as an occasional intense craving for sugar, though it's possible that's just me. At the peak it can be intense uncontrollable energy (the H part), as well as frequent "why did I come in here" or "I forgot to do this". It comes in getting distracted from a task and forgetting to ever come back to it.

With the meds, it's much different. I have a sharp focus. I can throw on a whole music cd and let the tracks all play out without feeling the need to jump around or to switch to a different album. Just me and the code that I need to do, or solving any other problem tasks.

In public I'm able to control myself better. I don't have to think of doing something before doing it as much, resulting in a better flow.

This isn't a matter of a diet either. I don't snack on fatty foods, and I don't have soda to drink at home. My current doctor has me take an EKG every year to make sure that it's not playing poorly with my heart.

There's a huge difference between "I get distracted from time to time" and having a constant difficulty getting tasks accomplished and lacking the motivation to complete small tasks from start to finish (getting interrupted and forgetting to go back at all).

I suspect this person has never encountered someone with actual adult ADHD. Consider also that in the past, many of these people would have just been called crazy and left at that.

Another anecdote from someone on HN, which probably biases pretty hard for people who have had success medicating ADHD. I dropped out of a bottom tier state school at 19 studying CS with essentially a 0.0. In my mid 20s I was diagnosed with ADHD by a GP and a psychiatrist and got a second opinion from a second psychiatrist who said the first two were wrong. I stopped medication because of sentiment like that expressed in the article. A year or two later I decided I didn't like what I was doing, and wanted to return to school. I saw a second GP and got rediagnosed and prescribed. I'm now studying CS at a top 5 university with a 4.0.

My personal opinion is that there is more harm from the negative stigma associated w/ ADHD prescription than good, but you can imagine I would be biased given my narrative.

I think of ADD as Amphetamine Deficit Disorder. In a practical sense, "ADD" is the disorder that afflicts people who function better when given amphetamines. Personally, I feel that anyone who wants to take amphetamines should be allowed to.

I think that inability to concentrate is a common pathway for essentially all diseases that afflict man. Anything a disease does to draw your attention to itself is affecting concentration, because you are not able to concentrate on whatever you want to concentrate on. In some cases, this is insidious and you are not aware of the disease as such; it affects your concentration and you don't understand why. In some cases, you might only know that you can't concentrate. Amphetamines will tend to help, because they allow you to concentrate harder on what you want to concentrate on, regardless of the actual etiology of whatever is distracting you.

I know this looks like junk but https://en.wikipedia.org/wiki/Allen_Frances was the lead editor of DSM-IV.

One thing that's missing from this narrative - recreational Adderal users tend to use dosages which are in the 40-60 mg range per hit.

ADHD users tend to be in the 5-30 mg range, often in extended release form. Most neuraltypical people won't even notice any difference in concentration or energy from such small dosages.

I am at the 15mg end, and the energy hit is not even enough to affect my sleep if I make a mistake and take one at night (it's happened). A single coffee, on the other hand, is enough to keep me up for a few extra hours.

"ADHD drugs have become the campus recreational drug of choice at parties"

Is there any well documented evidence for this? It certainly contradicts my personal observations.

I'm someone who has struggled with concentration issues my entire life. I used to bemoan that I grew up in the time before medication existed to treat the condition, since my inability to concentrate has caused some particularly negative consequences in my life. But recently I had a profound realization about my concentration issues. I attended a 10-day meditation training course where, in addition to meditating most of the days, all my distractions (cell phone, computer, books, etc) were taken away from me. The first few days were extremely rough. I went through withdrawal symptoms that were really an extreme version of my concentration issues since my mind felt the need for distraction and there was nothing to sate that desire. But at the end of those 10 days, I had a brief period where I had absolutely no difficulty concentrating. It was such a stark contrast to my life before then, that it was particularly notable.

But addiction to distraction isn't like addiction to alcohol or drugs. Short of a radical "into the woods" plan, you can't go cold turkey on modern life. And since I've reintroduced my modern devices into my life, my concentration issues have returned. But it's been important for me to have realized the true cause of those issues because dialing back on TV, computing devices and everything else I use to divert my attention can cause short-term relief when things get really bad. Turning my cell phone off and spending the entire day hiking outdoors can really help.

Based on my own experience, I wonder whether our practice of medicating attention deficit issues is really just a horribly misguided attempt to treat the symptoms rather than the underlying cause. Life has changed so rapidly within the course of the past couple of generations and I don't think there's been enough attention paid to the effect that it has on our bodies, minds and health. I firmly believe that, in time, we'll look back at this period and our computing devices and other modern distractions and view them in the same way that we view asbestos insulation or lead paint...incredibly effective at accomplishing their immediate goal but with devastating health consequences that we only recognized years after they were introduced.

I'm curious whether this rings true with others, especially those who've had concentration issues. Have others tried a "digital detox" and has it helped? Or is ADHD something different from what I've experienced and that medication really is the only way to treat it?

cough Awfully quiet in here.

It doesn't matter if people are abusing drugs, it matters whether it is immoral or poor for them or not, it depends on what drugs are being abused and if they're bad, since adderall is a general performance enhancer and humans see significant benefits then such activities should be considered permissable, people cannot be held back in their lives because their doctors disagreed on their behalf, people cannot be held to the tyranny of underqualified 'professionals'.

short version: ADHD 7-8x less chance of graduating college with a degree, 10% of dropping out of high school, 30% of repeating a grade(8-12 or maybe k-12), E.F. deficits overpower High I.Q. very easily. As economy of time > economy of information.

Talking about about “overdiagnosis” without addressing underdiagnosis is, frankly, scientific and clinical malpractice. Untreated ADHD, which is underdiagnosed in adults (especially in women) can be a debilitating condition and there's ample evidence about this from peer-reviewed medical journals (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195639/, among others). Self-medication with effective medication isn’t even really possible because amphetamines aren't regular prescription drugs -- they're controlled substances, so diagnosis tends to be a necessary condition to get access to effective meds.

The “overdiagnosis” moral panic leads to parents not being OK with the idea of their children being diagnosed with ADHD or shudder be on effective medication like adderall or ritalin, or people (of all ages) thinking/internalizing the idea that they can’t ~~really~~ have ADHD and that they’re just “lazy” or “flaky” or “apathetic” or whatever other shitty terms are used for people with executive dysfunction. It also makes doctors more suspicious of people seeking treatment ("if it’s overdiagnosed it must be rare, so some of the people I see as a doctor have to be be faking it, by pigeonhole principle"), which actually causes harm to people who need access to medical care -- finding a doctor who’s OK prescribing is such a pain when you’re ADHD and have run out of meds.

I've had enough bad experiences with psychiatrists for a lifetime and I've absolutely no inclination to defend psychiatrists, their clinical practice, or their DSM. There indeed are people who are diagnosed with ADHD who don’t have it / don’t benefit from medication. However, the “overdiagnosis” meme (https://www.ncbi.nlm.nih.gov/labs/articles/17709814/) and other forms of ADHD denialism cause real harm to people who actually end up needing critical access to controlled substances which are impossible to legally get without the appropriate diagnosis. Regardless of how psychiatrists draw the lines of diagnosis, there's plenty of evidence that there actually do exist plenty of people with chronic and debilitating attention / executive function dysfunction that do experience amelioration when they take a regular dose of stimulants.

Furthermore, this isn't a straightforward discussion about the effectiveness of some given pharmaceutical -- this is a moral panic that explicitly seeks to use the criminal law to curtail access to medication, regardless if it has been shown safe and effective:

> The Drug Enforcement Agency is doing its best to contain the epidemic

ADHD-er here. I have a 2-sigma attention span in the shitty direction. It's a massive impairment. I've titrated my dose, and I've stayed at 45mg Adderall/day for the past 3-4 years, which is quite high for someone who has been careful not to develop a tolerance.

Every month, I have to spend a day (or five) dealing with the nightmare that is filling my prescription so that I can function like a normal human being.

THE RULES: 0. For ADHD people such as myself, being forced to go a day without meds is like being forced to go a day without your favorite text editor. It's not fun. In addition, I don't feel safe driving then. If I want to go someplace without meds, I'm taking a cab.

1. Adderall is classified by the DEA as a schedule II stimulant. Some other schedule II drugs: cocaine, opium, morphine. If you opt for a paper prescription, it usually has security features like microprinting, watermarks, or holograms. You're going to be asked for an id (or three) when you fill the prescription. After all, you might as well be getting a prescription for cocaine.

2. There are no refills on your prescription, ever. You have to get a new prescription every month, which means calling in to your clinic and reciting all of the details. Nurses are not allowed to copy-paste these details, so you can bet your ass that I've dealt with a number of typos over the years. Sorting out typos usually takes a few business days.

3. A doctor must sign each prescription.

4. Some doctors flat-out refuse to sign prescriptions that they didn't prescribe. That's totally reasonable, except it means that you need to call in for a new prescription on a day when your prescribing physician is in the office. That means that you need to either learn their work schedule, or call in at least 3-5 business days before you need to fill your meds.

5. Most insurance companies will not allow you to fill your medication even one day early -- if you want to do that, you're paying the sticker price yourself. For my dose, the sticker price is $500-600.

6. In some states... - if you send a prescription to a pharmacy, then it MUST be filled there, and may not be transferred.

- pharmacies may not answer questions over the phone about whether medication is in stock. They might be able to answer in person.

- pharmacists may not call other pharmacists or access any sort of database to find out whether there is any pharmacy in the area with medication

- if there is not enough medication in stock, then the pharmacy may partially fill your medication with the available stock, but you void the unfilled portion of your prescription. Your insurance will probably not allow you to fill your meds early, even if the pharmacy is out of stock and you choose to fill a partial prescription.

Remember that you can't bring your prescription somewhere else, or call in advance to inquire about stock. So you have to remember to ask the pharmacist about their stock before you hand the prescription over, in case they don't have enough stock. That gives you the opportunity to blindly search the neighborhood for a pharmacy that has them in stock. Remember, you can't call about any of this, so you're going to be doing quite a bit of travelling.

7. Some pharmacists are antsy about filling a prescription for drugs in the same category as cocaine. I've met pharmacists who will insist upon verifying the prescription with your prescribing clinic. If you try to fill your meds when your prescribing clinic is not open, tough luck. Come back tomorrow.

8. Because of the effects that large-ish daily doses of amphetamines may have on one's heart, most doctors that I've met will insist on meeting with patients every few months to check your blood pressure, heartrate, etc. That is, your prescription is not getting filled unless you make a clinic visit every few months. Because I actually have ADHD, the conversation usually goes something like this: "Are you having trouble sleeping?" Nope. "Have you been fidgeting?" Nope. "Has your heart been racing?" Nope. "Have you noticed a change in eating habits?" Nope. "Do you want to lower your dosage?" Nope.

On one hand, I understand why it's smart to keep tabs on my cardiovascular system. On the other hand, it's obnoxious to force me to get a checkup every 3 months just to fill the same prescription that I've had for the past decade.

COMMENTARY ON THE RULES: Because it's relatively easy to acquire an Adderall prescription, the DEA makes it a pain in the ass to fill it, as a way to restrict the supply for the illegal Adderall market. These rules make it as obnoxious as possible to fill an Adderall prescription.

The thing is, a drug dealer with a bogus prescription isn't going to be too bothered if they're forced to wait a week to get an Addy refill. Sure, it's a loss of income, but it's not going to temporarily ruin their life.

I think the solution here is to make it easier to refill an existing prescription, but make it harder to get one in the first place.

ADHD TESTING: In particular, I think that people should be required to get formally tested for ADHD in order to get a prescription for amphetamines. Usually, you can obtain a prescription just by telling your doctor that you think you might have ADHD, describing your experience, and then answering some basic screening questions.

But there is a more formal test. At the behest of my parents (who were skeptical about ADHD), I got formally tested. It was a 12-hour test, split up into three 4-hour chunks. I was not allowed to take any stimulant meds (not even coffee) during -or in the 24-hour period before- the test.

The test measured my IQ, short-term memory, and ability to deal with monotonous or distracting tasks.

For instance, one of the tasks was to transcribe a page of symbols using a substitution table. The problem was that the substitution table was printed on the inside front cover of a stapled booklet, and I was transcribing pages inside the booklet. I was not allowed to remove the staples, so I had to flip back and forth a ton. To make matters worse, I had to transcribe each blob of symbols onto the back of the same page. More flipping back and forth.

Another task was to listen to a list of numbers, and recite them back in order, or recite them in reverse order, or recite them in sorted order. The number of numbers that you could recite correctly in the latter two situations was used as a proxy measure for attention span, and for immediate short-term memory in the former situation.

These are exactly the sorts of tasks with which I have severe difficulty.

The test did screen for mental health issues by asking some standard, but nonetheless subjective questions about anxiety/depression/well-being etc.). But on the whole, I thought that the test was largely scientific, and did a good job of measuring my cognitive impairment in a fairly objective manner. Admittedly, the test did not involve any brain scans, so it might not be the best thing available.

But in any case, it would make my life a hell of a lot easier if the inconvenience of obtaining and filling an Adderall prescription could just be front-ended!

People have loved amphetamines for decades, and this is a legal way to obtain them. End of story.

Much of the time, ADHD is a medical term that simply means: "I don't like to pay attention to things that I find boring."

Sleep deprivation, not eating a breakfast, etc... can affect your concentration. Prior to start treating ADD-like symptoms with medication just try improving those things and see if that works for you.

Psychiatry is such an embarrassment, in the US and UK at least. So many otherwise reasonably intelligent people believe in the concrete reality of "diagnoses" that are merely descriptive at best, and delusional at worst. The number of parents who are led to believe that their child "has" "dyslexia" or "ADHD" is astonishing; and the ramifications in terms of extra time in exams, free laptops etc are absurd. One form of evidence for these assertions is the lack of cultural replication: I don't have citations, but I understand that many of these concepts do not have parallels in other languages/cultures where one would would expect replication if these really were biological phenomena. I guess people will always see shapes in clouds, but when it comes to serious matters like education, the rational, scientific side of our society needs to be kind but firm in stamping this stuff out. But when will it finally happen -- perhaps not until we've also got over the idiocy of religion, and the idiocy of the "postmodernism"-influenced humanities?