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My experience working with folks who claim ADD and treat it with Adderall is more akin to working with someone who has a drug problem. Sleeplessness, suddenly missing work, constantly forgetting to eat day after day, breakdowns, MIA in meetings, really poor code, and more. This has happened > 3 times in the past handful of years.

My totally uninformed take is that these individuals emphatically do not suffer from ADD, but are victims of the "ADD software engineer industrial complex" that basically preys on folks who need a lot of focus to do their job. They get on powerful amphetamines, like it, go deeper, and then suddenly there's a _real_ health problem. It is a fact that these drugs are over-prescribed; it's basically a crisis. And there isn't nearly enough awareness of the dangers or the long-term impact on mental health.

*Writing this as someone who has been down the addiction rabbit hole in the past, and knows the ropes.

My issue with the matter is that I have ADHD, and I didn't seek treatment because of wanting to perform better a my job. It's literally the difference between me keeping my job or not, not crashing my car into another person's vehicle, etc..

I still vastly under-perform compared to my peers despite being medicated. Any person that was taking stimulant medications without ADHD would absolutely blow me out of the water -- it's the main issue I have in regards to stimulants. It's be like a professional athlete taking steroids or other PEDs when competing against a high school aged sports team.

When other people use stimulant medication for non-medical purposes then it causes me to be measured against an echelon of performance that is basically unobtainable i.e. the best I can function at is no longer "good enough."

I mean, sure, there are probably a few other factors that also contribute to my issues other than just medication (lack of organization skills, past traumas, etc.), but it has been something I noticed even back when I was in college a decade ago. I knew plenty of people that faked symptoms to get a prescription. Meanwhile, I had to go through all kinds of testing, interviews, etc. to get legitimately diagnosed.

However, I do not fault the individuals who take any substance medicinally or otherwise. We are all trying to make in this world, and I think a lot of our culture has created a demand that leaves many with no other options -- sink or swim.

Just to be clear, ADHD is certainly a real thing, and I have a lot of compassion for those who suffer it. My anecdotal story is all about being able to clearly identify when someone is suffering from addiction or drug abuse, having been there myself. Such outcomes are a natural side-effect of a culture that overprescribes addictive (and often very enjoyable) chemical stimulants.

I'm sure you are well aware of the connection between ADHD and addiction to begin with.

I am prescribed stimulants for ADHD. Just because you need something doesn't mean it can't be addictive (I know you didn't say otherwise). With that being said, I am without a doubt dependent on the medication (that's kind of the point), but am I addicted? Well, I ask myself that everyday. I would argue to some degree, I probably am too.

Chances are, if you’re worried about it that way, you aren’t.

As someone who has been through the addiction loop, I can say a) it's a good thing that he's thinking that way, it is good to be conscious of these things; b) that even the slightest question about addiction points to something significant, something to watch very closely; and c) consciousness about these things can never be used as an excuse to ignore it.

Good points. However, it’s also an extremely common reason people with ADHD use to go off their meds, when looking in from the outside they clearly weren’t addicted by literally any definition of the word.

It would be like if someone who suffered from chronic dehydration worried they were addicted to water because they were drinking the amount prescribed for them after having a medical diagnosis related to it, so they stopped. Then, of course, went back to the prior state which was ‘normal’ to them.

Which is why it’s all best done under the supervision of a qualified professional who hopefully isn’t a fuckup.

If you don't mind me asking, what were the signs you were addicted to something vs. dependent on something? I understand both are not mutually exclusive like in alcohol, for example.

While I have been addicted to tobacco, I fail to see how a people who are addicted to tobacco/nicotine are different than me (a stimulant is a stimulant). Is the difference sheerly due to the harm tobacco causes?

I do not feel like if I lost access to medication I would go and start pawning off stolen car radios to get my fix, but I feel like I would absolutely "hot-swap" to something else like caffeine (it's what I used prior to medication).

I do not think I abuse the medication or anything -- no all nighters, no running out before my next prescription, etc.. I try to take one day a week off them, but that one day is sometimes uncomfortable.

I would say my relationship to the medication is very "Flowers for Algernon" in a sense. I've almost lost access to medication due to all kinds of non-behavioral reasons like prescription issues, medication shortages, etc.. That always sends me into a spiral of anxiety and stress, but mainly because I feel like my life will fall apart quite quickly without the medication.

However, at the same time, I wonder if I am being delusional because it's not like the medication makes me some kind of FAANG developer or anything. I'm still just your lowly below-average developer working at an undervalued and dead-end job for my local government. It's about as easy as it gets in terms of jobs, and I feel like I can barely keep my head above water.

[https://nida.nih.gov/publications/drugs-brains-behavior-scie...]

Did/do you compulsively seek caffeine despite significant adverse consequences to yourself and/or others?

If someone really like having coffee, but can afford it and it doesn’t hurt their health - they aren’t addicted.

If someone can’t hold down a job because they constantly drink coffee to the point they can’t work, then they’re addicted.

Or, if they suffer from heart issues or whatever (I’m reaching, I know) due to all the coffee they drink, but can’t stop. Same.

So the question is - does the Adderall or whatever help you function, actually?

And in totality improve your life?

If so, then you aren’t addicted. It’s rational. Seeking it, as long as it isn’t compulsive (aka it is based on a reasonable need and in proportion to the benefits/circumstances) is a reasonable thing to do. Like looking for Tylenol is if you sprained an ankle.

The challenge is, Addicts (of all kinds!) are often incredibly delusional on this front, and Adderall et al IS addictive for folks without ADHD brain chemistry/ADHD dosage. It isn’t as bad as meth, but same issues.

So someone who is an addict will often say yes, everything is fine to all those questions (and often mean it), but anyone looking in from the outside who knew them would often go whoa buddy that’s fucked, and they will have noticeable issues with functioning at some point.

Others may be non-addictive personalities and be able to use the meds (and get high) but will not be addicts. They can take it or leave it.

Many (well, early stage) addicts often tend to think they are these people. It’s part of the problem that makes them addicts. Some substances are very, very addictive and only a small portion of the population will not be a problem.

Others, it requires a really special person to get addicted (in real terms) to it. Like coffee.

Where interestingly, ADHD folks will often wonder constantly if they’re addicts while their life (and symptoms) noticeably improve - inside and out, and while they actively try to cut themselves off from the meds.

Weird huh?

If you’re really wondering, writing down in a daily journal can help if you do it consistently and review it after awhile.

If your life circumstance is such it’s safe, taking a pause for a week or two on the meds while doing this can be very informative - but I wouldn’t recommend it without discussing with your Dr. first as it can be a real problem if there are real issues you need the medicine to help you address.

I had a cousin who ended up homeless every time he went off his meds, for instance.

ADHD memory is the worst.

I have yet to meet someone with ADHD who enjoys the medication. In fact, most folks I know with ADHD are often trying to avoid taking them.

It’s a pretty meaningful, objective difference actually between ‘normals’ and folks with ADHD.

The neurochemistry is different for them, objectively and visibly so.

The thing is, enjoy isn't even the issue. I have ADHD and I decided against taking medication for it because I found it addictive, and any time I changed the medication I had long periods of ups and downs that I intensely disliked.

I've had a lot of people tell me I'm brilliant etc when working with me (not a humblebrag), and that's fine. Internally I absolutely know I'm operating at like 15/100 and I could be operating at 100% with medication. The issue isn't being smart or not, its about impulse control, the ability to focus and put in long hours, etc. I get so much less done than I could get done because I can't focus on the task as much as a normal person can, even if my decision making/research is good.

so enjoy or not enjoy, if you want to be operating at the same level as your peers in high performance workplaces what you enjoy doesn't really enter into it. I just found for me the medication was too habit forming, and I'd rather be me at 15% forever and figure out what I can do with that than be at 100% and addicted to amphetamines. I completely understand the other decision, though.

What do you mean by habit forming, exactly? Taking them should be a habit, no?

Makes me glad to hear that I'm not the only one, who feels like this.

I often think that I'm simply screwed for life: Without medication my life goes off the rails within days, with medication I'm at least barely able to hold it together, but I hate the nausea, hate the rebound (disorientation after the effect wears off), and the fact that I still don't remember to eat and rehydrate properly. I think I would need a life coach for a while, but as I'm surviving on a subsistence level, that's not an option.

Meds help, but it takes more than meds if you have bad circumstances (ADHD unfriendly environment, bad self care routines, stressful circumstances, untreated co-morbidities, learned unhelpful thought patterns, etc.).

If possible, using them to help get started tackling the other issues may be worthwhile. CBT and Mindfulness/Meditation have evidence supporting their efficacy.

Unfortunately, many prescribing Dr’s just do the one button (meds), and never mention or provide useful refs to anything else.

Also notably, talk therapy is not recommended (it tends to encourage rumination, instead of using different, more useful thought patterns which CBT helps with).

It might be worth investigating.

‘How to ADHD’ on YouTube seems useful to a number of people I know, and is pretty ADHD friendly - unlike a great many other resources.

I have adhd. I enjoy the medication. I don't enjoy the crash.

> I have yet to meet someone with ADHD who enjoys the medication. In fact, most folks I know with ADHD are often trying to avoid taking them.

I love my ADHD medication, but it probably has to do with the fact that I'm taking pure dextroamphetamine directly instead of Adderall (which also contains levoamphetamine). When I did Adderall, it did nothing for weeks until I raised the dose all the way to 20mg and then it suddenly made my ADHD way worse.

Switching to dexedrine fixed everything and zapped my ADHD completely for a while. I don't really have any side effects besides urinary retention, which is very tolerable in return for what I get, honestly.

Everyone's mileage varies, but here I am, someone who enjoys their medication~

Interesting, thanks!

I do not love them, but I hate the feeling of the withdraw so much that I love taking them in a Stockholm syndrome kind of way.

It is an ADA-recognized disability. You’d expect some trouble at work without reasonable accommodations. The treatment isn’t 100%, as you’ve identified.

The problem with this anecdote is that you don't know who is taking Adderall and isn't talking to you about it. That is, they're taking it regularly and successfully, and it's working for them. They're leading productive lives, but wouldn't be off their medication. There are people with terrible self-care habits (sleeping; eating), and sprinkling powerful stimulants on top of those bad habits is a recipe for disaster.

The way I read this comment (in contrast to your followup to hirvi74), it sounds like, extrapolating from the 3+ people you know, that everyone who has ADD (an antiquated term) takes Adderall, are drug addicts, bad employees, and poor coders to boot.

There's a reason why some people with ADHD don't talk about it at work and judgements based off an uncareful reading of anecdoes like yours are why.

Adderall treats people who have ADHD, but for those who don't have the disorder, it does what you'd expect a cocktail of amphetamines to do.

Tough for the kids who get misdiagnosed, huh?

Amphetamines have a calming and focus-enhancing effect on nearly everyone. The idea that those who have ADHD have a unique experience in becoming calmer and more focused after taking amphetamines is an internet-born bro-science myth.

The side effects tell a different story.

Common side effects of Adderall may include:

stomach pain; loss of appetite; weight loss; mood changes; feeling nervous; fast heart rate; headache; dizziness; sleep problems (insomnia);

https://www.drugs.com/adderall.html

Just as they do not uniquely benefit from amphetamines, people diagnosed with ADHD are also not uniquely resilient to the side effects.

Right, so your statement “no, everyone who takes amphetamines experiences a state of calmness” is incorrect.

not OP. but he did say "nearly everyone".

long lists of side effects are common even for the most benign and common drugs. that's standard.

for example i could say that the common side effects of tylenol[0] tell a different story:

nausea, vomiting, anemia, rash, dyspnea, abnormal breath sounds, pulmonary edema, hypoxia, pleural effusion, stridor, wheezing, coughing, peripheral edema, hypertension, hypotension, tachycardia, chest pain, muscle spasms, insomnia

[0] https://www.drugs.com/sfx/tylenol-side-effects.html

I used the word "nearly" in my sentence, which is not the one you put in quotes. Also, that a given person may experience side effects at a given dose, does not mean that they will experience those same side effects at all doses. Any given person who benefits from amphetamines, would also begin to experience some side effects if given too large a dose. Given this, my original comment could have been more clearly stated as: amphetamines have a calming and focus-enhancing effect on nearly everyone, given a tolerated dose.

As someone with ADHD, if you think that's bad, you should see what they're probably like off the stimulants. They likely wouldn't have a job in the first place and would probably be MIA somewhere under a pile of laundry beneath an avalanche of unpaid bills and birthday presents they forgot to give people.

Amphetamines are "medication" in the loosest sense. The pathophysiology of the underlying condition is ill-defined, and most users of amphetamine-like drugs get the same focus-enhancing effects regardless of "condition". These drugs are dangerous, of questionable therapeutic benefit, and are schedule 2 (or banned in many countries) for a reason.

They are over prescribed, especially to below average performers who want a boost. Everyone wants to believe they are actually really really smart but have a "condition" which makes them underperform. Don't worry this little pill will "fix" your brain.

“ Sleeplessness, suddenly missing work, constantly forgetting to eat day after day, breakdowns, MIA in meetings, really poor code, and more. This has happened > 3 times in the past handful of years.” everything you’ve wrote here is typical ADHD. Being medicated for a chronic disorder is hard and while the medication is hard, It can signal the opposite - not addiction but someone who doesn’t want to take the medication to feel or act normal.

I also don’t feel that it is over prescribed. In fact there is a huge lapse and stigma would being signaled out as neurodiverse.

I would suggest to look into what is ADHD and typical symptoms and see how it overlays to a normal drug user non stimulant user. You’d find that it is 1:1 in what you described but does not correlate to drug user.

Most of what you described is symptomatic of ADHD without medication, so I think you’re confusing cause and effect here, aside from sleeplessness.

> The sheer number of software engineers who face burnout and/or have to take long multi-month sabbaticals to recover is shocking when compared to other industries where it's largely unheard of.

According to studies, there's tons of burnout in most industries - we're just the ones who can actually afford to take the sabbaticals.

Yep this. The rest of us have to take sick leave

... or just suffer for years then eventually have your your life fall apart, because you've only got five sick days a year and you already used four of those taking care of sick kids who had to stay home from school, and it's only May. You could take your annual ten days of vacation, but you'll have trouble scheduling it as two full weeks in a row, and also that's not nearly enough to make much difference even if you could.

Yup. Lawyers and finance folks cried themselves to sleep at the parent comment.

> The sheer number of software engineers who face burnout and/or have to take long multi-month sabbaticals to recover is shocking when compared to other industries where it's largely unheard of.

Is there data to back this up? Also, if engineers do take sabbaticals at a significantly above-average rate, is that because others don't need them as much or because they don't have the financial resources and relatively easy ability to get a job post-sabbatical (speaking more historically than for the current hiring environment) that software engineers do?

For context, I'm a PM who sometimes uses substances to help with work and has also taken a couple of sabbaticals, though I would not say the two are related. My sabbaticals aren't out of a deep need to recover from burnout, but because I'm very employable with plenty of savings. It's really nice to have a few months off, and interviewing is much more pleasant when it's your only job.

This is largely the same argument for why performance enhancing drugs are banned in sports.

I don’t think this is unique to programmers and is a “secret” to successful professionals for as long as drugs have been around.

I was really surprised in business school how many students, guest lecturers, and pretty much everyone was on adderral, beta blockers (without medical necessity), or even cocaine and illegal stimulants. And part of many peoples “stacks” involved visits to specific doctors who would write scripts with combinations that let them focus and work very long hours.

I agree with you on taking care of yourself but it was really illuminating the habits that people sustained for 30-50 years without any spectacular blowouts. Of course not everyone is so lucky, but I never imagined that people would sustain pharmaceutical benefits for so many decades as just part of their routine.

Makes me wonder how many people maintaining 4am daily workouts are doing so without chemical assistance. Although I’ve known many people with really rigorous daily routines (running 8-12 miles) that claimed to abstain from everything, even caffeine and headphones.

PMs and other management may feel like this is a win in the short term, but it isn't sustainable long term.

You're saying they were aware of the Adderall abuse as it was happening?

Or just that they saw all these stellar high performers around them and thought, "What's not to like?"

I think it's more like... employee is put on a Performance Improvement Plan (PIP), employee goes to doctor and gets an Adderall script, employee is taken off PIP and management considers this a job well done.

> employee is taken off PIP

Waittasec. That happens?

I was also under the impression that PIP was a way to slow-roast firing someone, not something that would be temporary.

It is basically, and you're supposed to get the "hint".

But the way it's structured - at least on paper, there's supposed to be some way in which you can pass the "test" and endure an extra run of gaslighting and ostracization until they figure out another way to get rid of you.

50%ish of employees get off PIPs successfully (or used to anyways).

I got off one at Google but ended up burning out and quitting anyways so not really a success.

Actually it is, and very substantially so -- in the sense that you left on your own terms rather than getting fired or laid off.

Except for the burning out part. Which unfortunately seems to be the natural cost of spending any amount of time in this industry.

Surely the bosses in the finance world are totally unaware of the massive cocaine use, right?

> but it isn't sustainable long term

Why would they care?

Long gone are the times where the majority of workers stayed at a company for a lifetime, so getting the most out of them for the few years that they will anyway stay is worth it in the eyes of their manager.

Interesting. I had always though that Adderall might at a cost, I did not think it would be burnout. Was more curious how that would affect your sense of judgement etc. I am not primarily a coding person, and it always seemed more important to me to have well thought out ideas than how many lines I can write in an hour. So an environment where Adderall use is rampant, what does that even look like?

Most code is boilerplate and adderall makes churning that out a breeze. It also allows you to quickly redo large amounts of code etc. I went through this myself at a former place and I moved so fast that I was managements favorite person- even though looking back a lot of the design decisions were short sighted.

I eventually got better, so I have no idea how long a person can last before failing completely but it’s at least a year or two.

Thanks for the insight, that's really interesting, not just because it feeds into my bias. Those short-sighted design decisions are what I was vaguely thinking of, It is what often happens to me when I knock out a lot of work in a short period of time.

I don't think it affects sense of judgement, it just allows you to stay on task and grind where you might otherwise give up / spin your wheels. The downside I see in the people around me is that the drug makes you feel physically fine even without proper eating or sleep, as long as you keep doing the drug. But of course eventually it catches up with you and I see people getting increasingly unreasonable, but its from not sleeping, not from the drug itself.

amphetamines definitely affect both impulse control and judgement

You're mostly correct. The detrimental effects come primarily from not sleeping but the problem is that the drug radically decreases your sleep quality and makes it more difficult to fall asleep

Some people do it so that you can do a reasonable amount of work in 8 hours then sign out and enjoy their lives

Adderall doesn’t cause burnout, that happens just fine on its own.

Shitty environments and lack of reasonable workloads cause burnout.

Adderall can help someone keep going in a shitty environment with an unreasonable workload longer than they otherwise would though.

It can also help them escape successfully when they’d otherwise be unable.

"Moloch"