Hacker News Reader

Comment by jauer | Hacker News Reader

Maybe addictive to people without ADHD…

They are so unaddictive to people with ADHD that remembering to take them can be challenging.

I think it has a lot to do with the dose and delivery method... if you take massive doses or inject/snort the medications like people trying to get high on stimulants, the rate at which the drug takes effect causes euphoria, which is addicting. There is no euphoria with properly taken low dose stimulant medications for ADHD- they aren't "enjoyable."

Partly, but the main effect is simply the different neurology. Neurotypical people actually get a kind of high from amphetamines, whereas ADHD people just get balanced. The drug just has a fundamentally different effect on people with ADHD.

I'm pretty sure that is a myth, and it only appears that way because the circumstances are different:

People with ADHD are treated on a very low dose, and slowly titrated up which makes you much less likely to feel high. People without ADHD that are illegally using stimulants aren't getting treated by a doctor, and aren't going to slowly titrate up the dose, or take it consistently in low doses over a long period of time. People with ADHD sometimes do feel a small high or euphoria for a short time when they first start a new medication.

People without ADHD but using adderall illegally, e.g. as a "study drug" are not getting a high or euphoria if they consistently use a low dose like an ADHD person.

I have clinically diagnosed ADHD, but even the lowest possible dose of adderall makes me extremely high in an uncomfortable way and unable to sleep for days. Most likely, I also have a liver enzyme mutation that causes me to not metabolize amphetamines properly. Ritalin I metabolize quickly, and don't feel a high at all.

You can't diagnose ADHD by giving a medication and seeing how people respond. Even people with ADHD respond very differently to the same medications.

There is also the fact that medication with ADHD can give people executive control over hyperactive physical movement, so they may seem to be "slowing down," which kind-of looks like the opposite of a stimulant effect, especially to adults watching hyperactive kids calm down. But that is basically the opposite of what is actually happening- the increased stimulation allows the brain to regain executive control of behavior.

Here is a journal article reviewing the evidence and debunking this idea: https://www.nature.com/articles/1301164

I'm normally on a very minimal dose. I have, prior to getting timer tops and forgetting that I'd already taken med, taken >100mg of dextroamphetamine without feeling high and without titrating up. Instead, I got very focused and methodical to an uncomfortable degree, but there's absolutely zero high or euphoria.

Across ~4 doctors (1 PCP, 3 pysch), none have titrated up. They've ballparked and said things like "let me know and we'll reduce if you can't sleep and increase if it doesn't work. If you want, try doubling up or cut it in half (for non-XR)".

Given the variation in dosage visible in the literature (such as this case report of megadosing: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3407707/ ) I'd suggest that there are multiple underlying physical causes for the condition described as ADHD to the extent that sweeping statements like that aren't accurate. E.g. my (very different) experience and your experience being different indicates that we probably have different underlying causes, not that one is a myth or misperception and the other is the real take.

Although I agree that is possible, the extreme variations in dosage between individuals could be explained simply by variations in the liver enzymes that metabolize stimulants, and don't necessarily point to different underlying causes of ADHD itself. However- I think the fact that entirely different classes of drugs, including non-stimulant medications, seem to work better for different people with ADHD does point to what you are saying.

In my case I can't tolerate even 2.5mg of adderall, and I also have hypersensitivity to several other non-psychiatric medications that happen to be metabolized by the same enzymes as adderall/amphetamine, so I am nearly certain it is a liver enzyme issue. I do tolerate a reasonably high dose of methylphenidate (ritalin) without any euphoria or insomnia.

>Neurotypical people actually get a kind of high from amphetamines This is intellectual dishonesty to the point of nausea. Amphetamine is very well understood as far as drugs go and affects those with and without ADHD in the same way. Neurotypicals also experience increased focus at therapeutic doses, just ask anyone who's taken it as a study aid, and ADHD-sufferers also experience a high from the flood of dopamine. The most damning evidence for me is the absolutely obsessive relationship many ADHD patients have with their medication. It's immediately obvious and unlike any I know of.

Society (American society in particular) has just decided that the medical benefits of amphetamine outweigh the risks for people with ADHD vice versa for those without.

Isn't there evidence for neurotypicals only _thinking_ they are focussing better and actually not? Also note that this 'high' you are talking about would likely only apply at higher doses than ADHDers actually get.

I think you are generally correct- but just because someone disagrees with you, or hasn't seen the same information you've seen, doesn't mean it is intellectual dishonesty.

There are good reasons why this seems to be true even if it isn't... you take a hyperactive person with ADHD, because they have poor executive control of motor function, and give them a therapeutic dose of a stimulant, suddenly they can control motor function. It appears on the surface to be almost exactly the opposite of giving someone a high stimulant dose. They appear to be opposite responses, but in fact are the same type of response... it's just that the ADHD person is regaining a level of executive control that the non-ADHD person already had anyways.

Reply on news.ycombinator.com