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Comment by gwbas1c | Hacker News Reader

> could only be diagnosed with ADHD if your life was worse than "the norm"

Because ADHD is a real situation for some people, and for others it's a way to legally take class-B stimulants.

Yes, people really do try their friends' ADHD medication, enjoy it, and then shop around doctors to find someone who will prescribe it. It's called "drug seeking," and doctors do flag patients who do it.

This, BTW, is what happens with medical marijuana. There are people who really need it, there are people who think they need it, and then there are people who who tell everyone but their doctor that it's recreational.

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I'm ADHD-diagnosed, and god damn do I wish I could just go to the store and get Adderall when I feel like I need it

The fact that I have to call someone and get a prescription every month just makes it so that I go untreated for months at a time (kind of a cruel irony that ADHD treatment is gated behind the wherewithal to make a monthly phone call). And honestly I think modern life is probably such that most people could benefit from 10-20 mg of Adderall.

Have you tried a nicotine patch?

Taken for a short period each morning at a low dose (cut an 8mg patch into sections) it offers similar stimulant effects, but with fewer side-effects. Nicotine patches are reportedly less agitating, less addictive, less expensive, and more available than Adderall. It also measurably improves cognitive ability according to some studies I've read online.

I'm almost 40 years old, and I have ADHD-inattentive. For two weeks I've been using sections of nicotine patches - about 1/4 of an 8mg patch for an hour each morning, and I have never found it more easy to be focused and productive.

Just be careful to not use too much, especially if you've never been a recreational nicotine user. I've had several nights when it's been difficult to sleep -- which has been a signal that I need to decrease the morning dose.

(I'm not a doctor, this is not medical advice)

Maybe find another doctor?

The couple that referred me to my primary care doctor likes our doctor because it's very quick for them to renew their ADHD prescriptions.

BTW, I once tried 30 mg of Adderall and I felt like I would go crazy if I took it every day. I took it at 6:00 a.m. and I had heart palpitations, euphoria, and crazy insomnia past midnight. It's not really something that's as safe as coffee for the average person.

FYI, 30mg IR (immediate release) of Adderall is an absurdly high dose. If it was all-day it's merely a very high dose, much too high to start on.

It was an XR, which is 15mg immediately, and another 15mg 4 hours later.

I was euphoric off the first 15.

> Because ADHD is a real situation for some people, and for others it's a way to legally take class-B stimulants.

In some cases it's really clear, in some others it isn't. A few of my friends did better than me in school, and they had access to Ritalin. They were pretty good student while I was a problem child. I never really explored the option during school as I didn't really know how it worked and what ADHD was. I tried it later in life and it helped with work. Ritalin probably would have helped me during school. But was it because of some "real" ADHD? Was it because it's a stimulant and it helps anyone? Was my ADHD more or less real than them? I know that for them Rilatin and ADHD was a part of their identity, so maybe they convinced themselves they couldn't work without it? I don't think there's any good and objective way to measure that. Should I feel guilt when I take Ritalin now? I can function without it, but they can too. It's just far from optimal.

> Was it because it's a stimulant and it helps anyone?

ADHD meds for non-ADHD students don't really help those students perform better academically. See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3489818/

They make you feel better, but not actually perform notably better.

From the article you linked:

> These data suggest that when people are given rote-learning tasks their performance is improved by stimulants.

Rote learning was (and still is) one of my big weaknesses. Tools like Anki help but going through them is way easier when I use stimulants. So maybe it depends on the student, but I'm wary of statements like "ADHD meds for non-ADHD students don't really help", it seems more to be pushing an agenda than telling the truth.

> This, BTW, is what happens with medical marijuana. There are people who really need it, there are people who think they need it, and then there are people who who tell everyone but their doctor that it's recreational.

Well, yes, and this is how it came to be allowed; the harm from the "preventing recreational use" system was so huge (see yesterday's war on drugs post etc) that it made sense to stop trying to make this distinction. The medical system provides a "fig leaf" which allows the remaining pure-puritans to accept it while at the same time the people who need it for medical use can get it, and nobody has to get their life ruined with jail.

(By "Pure-puritans" I mean those people who are against it because it's recreational, not because of alleged harms or externalities like smoke)

I also think there's a huge grey area of people with chronic pain or unhappiness problems that don't quite reach a diagnosis bucket - or they've not yet learned to speak the words that would get them there, or don't meed the social class critera - whose "drug seeking" behavior might most easily be addressed by just letting them have the drugs. As long as they're not opiates.

Let people take whatever medicine they want.

So like, in theory, yes, but in practice, now everyone has to take Adderall just to be able to keep up with their coworkers.

Seems like the free market at work to me.

That's about the shortest, but most on-point and total, take down of the free market I've seen in some time.

Would you apply the same reasoning to caffeine and nicotine? Should we ban both? You're also seeing the world as a competition between people ("keep up with their coworkers") but I believe most people are actually trying to make a living (no need to take adderall if you are already satisfied with what you have).

Not at all, there's more work than can possibly be done. It's not a sports competition - everyone can win.

It's straightforward/trivial to excel over coworkers (even those on stimulants) at most jobs.

Regardless, this idea that one needs to "keep up", as if work were a competitive footrace, is something you have invented.

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