Attention Disorder or Not, Pills to Help in School
nytimes.com
nytimes.com
Clearly ADHD medications work, which is wonderful. But why do we need to label people with a "disorder" in order to give them the meds?
Why is psychiatry so dead set on binary yes/no diagnoses, and labeling everything as a disorder? Is that the consequence of having to code records for insurance? Something related to prescription laws? Or is it an underlying mistake in psychiatry to think there is one right way to be, and other states are wrong?
My understanding is that it is pretty straightforward; most meds (particularly psychological meds) have potential for abuse and are generally destructive for people who don't really need them.
It might be cool if we could identify exactly how ADHD every person on the planet is, and prescribe precisely the right amount of Adderall, but this has 3 problems:
- We have no way of identifying this!
- Prescriptions are in units of pills, not nanograms of active substance
- What is the ideal level of focused vs. unfocused, anyway?
While that level of precision would be nice, pills are delineated by dosage so you can simply give 100mg of substance to one patient, and 200mg to another.
Well, anyway, my point was that if dosage units are standardized (I thought they were, but maybe I'm wrong), e.g. 50mg capsules, the doctor cannot well prescribe a patient 5mg.
Take a look at the medical warnings for Adderall. There are other mental disorders (e.g. bipolar disorder and schizophrenia, among others) that Adderall can easily make worse. It's nowhere near as simple as "these pills help you focus so take them if you want".
Make people aware of possible side effects and what to be vigilant about and that's all. Doctor as a hoop you have to jump through to get your poison doesn't help much. You'll end up in the doctors office if side effects show up anyways.
The drug war paranoia makes it necessary. So does the bureaucratic system that allows only people with an official diagnosis to obtain any kind of medication, even mood modifiers that are inherently subtle and personal.
Well, it doesn't prohibit all kinds of medication. Lots of people who are using adderall (also known as amphetamines, benzedrine, or dexedrine -- a popular self-administered medicine until the 1970s) and the like would be using truly dangerous tobacco and liquor if amphetamines were not available.
It's not about insurance. The pills themselves are very cheap to make and most formulations are not under patent.
As long as we need to put people in jail for using these substances, we're going to need a way to mark whose use is legitimate and whose isn't. Measuring who has health insurance and a good stable relationship with a doctor is a good way to tell whom to imprison and whom not to.
Methamphetamine incidentally is different from adderall only by a single methyl moiety and has almost indistinguishable clinical effect in matched doses, though meth has longer lasting side effects due to the hydrophobic methyl group allowing the medicine to persist longer in fatty tissues.
Dexedrine is the brand name for dextroamphetamine, the dextrorotatory stereo-isomer of amphetamine.
About 75% of Adderall is dextroamphetamine. The other 25% is composed of three other amphetamine salts.
The main reason methampetamine is smokeable is because it is sold on the street in fairly racemic crystal form (i.e. it contains both the active dextrotatory and levorotatory forms). If adderall, dexedrine and other prescription amphetamine salts were sold in the same form, free of the inert binders, they'd be smokeable too.
Risperdal is mentioned in the same breath as the standard ADHD precriptions. This is an anti psychotic which is meant to be prescribed to help manage recurrent aggressive / violent behavior and has a huge slew of side effects.
In contrast, most prescription stimulants used to treat (actual) ADHD have no side effects that persist after the cessation of taking the medication.
Likewise, it is well established fact that ADHD medications such as Adderall and Concerta are only effective when coupled with behavior therapy of some sort.
The larger picture behind this is that these adhd medications when taken at their recommended dosages help to make it easier to enter a focused state (as in the metaphorical sense of reducing the activation energy for a chemical reaction), and so direct efforts to develop the habits/ behaviors that are difficult with unmanaged ADHD are needed to attain any long term value out of ADHD medication.
point being: nothing new in this article, just lots of anecdote and a story built out of a single families mental health issues. Like wise the statistic that relevant diagnoses are increasing + a handy quote from a single doctor does not establish a systematic trend that should call to question the validity of a health condition.
this is also separate from the question of whether a school system designed around the time of the industrial revolution is still appropriate today
Trying to solve a social problem with technology misses the point. I highlight these two quotes:
From the article: “I don’t have a whole lot of choice,” said Dr. Anderson, a pediatrician for many poor families in Cherokee County, north of Atlanta. “We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid.”
We have to modify the kid???
Also from the article: “We are effectively forcing local community psychiatrists to use the only tool at their disposal, which is psychotropic medications.”
the only tool???
Modifying human beings because we have no alternative? If you ask me, the side effects of this approach are not just the potential side effects of the drug on the individual, but complacency in not addressing the problems' causes, creating dependency of a social class on a drug, teaching children to take drugs to solve problems, creating a belief we have no alternatives, perpetuating a system that bores children and punishing them for their boredom, and so on.
Does nobody else wonder what other unintended consequences such a policy might create, independent of the drugs' safety or not?
Our interactions are clustered -after- we are deamed unhealthy. Only once the need is most urgent do try to become 'healthy' again. This predictably leads to a culture that favours drugs and surgery as solutions. This is so engrained that health care practically IS synonymous with drugs and surgery. This bias exists in everyone, from the health care professionals, to those who are sick, to those to who are healthy, to those who would lead us. We all have it.
The 'unintended consequences' of such a policy are the problems facing nearly all 1st world health care systems. Surging costs, potentially unsustainable growth, constant doubts of effectiveness (and actual questionable effectiveness in some areas), and in general, a culture that more or less treats staying healthy as a bang-bang control system.
"Nobody can bring any medicine containing Methamphetamine or Amphetamine (Adderall and so on) into Japan. If you are found with any medicine containing Methamphetamine or Amphetamine illegally in Japan, you can be arrested as a criminal on the spot, immediately, without a warrant in principle."
"War on drugs" seems dubious at best since according to official statistics my sub-division of Moscow has 7 times more alchoholics than it has drug addicsts (20000 vs 3000 if you're wondering, taken from a newspaper, don't think the number is any accurate but tend to believe the ballpark)
Efforts are made to make alchohol harder to buy with mixed result (but "mixed result" is one step better than "no result" we see from the worldwide war on drugs)
A typical adult in Russia has so ruined, that he needs very small dosage and it affect him so heavy, transforms to almost an animal state. Young also have less tendency to abandon everything and just drink for weeks - they has much deeper social ties.
Drugs, on the other hand, creates fast and much stronger addiction, they also changes the mind, the attitude towards the world and life itself much deeper.
Another important factor is that dopers die very quickly, and you cannot see them suffering on the streets as you could see drunks whenever you happen to look. Usually, only close relatives have involved in a tragedy and it doesn't last too long - a year, on average, while drunkards could survive for decades..
So, problem is here. "War on drugs", is, of course, way to steal more money, not to offer any help with causes.
Government is involved because it affects their interests. A totalitarian state needs a cheap, unskilled workforce to build an assets and create wealth for the top-tier, but it need them sane and healthy. They cannot recruit sick slaves to serve in Army or to work on a construction sites. That is why there is a this "war on drugs" posters on the every wall.
And of course no body cares what older population does. If they going to die from alcoholism - that good for the government - less pension spending.
This is just a very rough outlook.)
It still seems the main reason for war on drugs is mining government money and political leverage.
It's the same in the USA without special permits. Methamphetamine and adderall are both classified under the same Schedule 2 criminal rubric. The investigation and prosecution of doctors who prescribe adderall, knowingly or not, to patients who then resell it to people without insurance or access to health care employs thousands -- probably tens of thousands -- of DEA and local police.
If so, where's my option to get these meds? Oh wait, I can't because I'm not ADHD, and because I wasn't "diagnosed" as a kid, it won't happen now.
I really hope the older programmers in our industry won't have to compete with people-on-drugs in the future... but it'll happen won't it?
http://scholar.google.com/scholar?q=piracetam
You might want to filter the research by time to get more recent studies, but there's a vast body of knowledge built over decades.
Of course we'll have to compete, and of course we'll use medicine, brain implants, gene therapy, you name it, because it's either that or irrelevancy. Lets be grateful for our profession, because it has a chance to become irrelevant last.
And 18 hour work days take a toll on you regardless of whether you are taking pills or not. It is more dangerous if you are taking pills because then you do not notice the effect on your body.
Regardless, on your point about being diagnosed as an adult: I was diagnosed as having ADHD as an adult. It's not unheard of. The only reason I wasn't diagnosed as a teenager was that I wasn't hyperactive — just incredibly distractible — and I was smart enough that I performed "acceptably" in school. I've wondered, though, what I could have leveled-up to if I hadn't been fighting my distractibility.
Anyway, I was diagnosed at around age 30, was on meds (Wellbutrin) for about two years, and developed good skills and organizational techniques, so that I don't need the medication any longer. Ultimately, it wasn't the medication that taught me the skills; they just cleared my head and allowed me to develop them on the side.
If you genuinely think that you might have ADHD (specifically, ADHD-inattentive-type, like me), you'd do well to talk to a psychiatrist.
If you are not hyperactive as a child, I feel it's very rare that you will get diagnosed. People forgot these days there is just the attention-deficit-disorder without the hyper-activity.
Call your general physician.
On the downside, I dread to think of the code speed-freaks would churn out after 18 hours jazzed up, ten years into their addiction.
“We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid." - To me that is the gist of the article. We failed to provide an enjoyable learning experience for kids, so we have to make them enjoy it.
Cognitive-behavior therapy is the way to re-train, re-program, unlearn a wrong habit.
There are sub-conscious habits, of course, which we cannot "see" without a training.
One might have some genetic predisposition, say, a sensitive Amigdala or whatever it is, but even then it is possible to behave in such way that you will keep the level of arousal very low.
It doesn't mean you will not get aroused quickly, it means you will not stay in a permanent overload of stress hormones, but return to a calm and relaxed state very quickly.
Unless you have any organic damages or trauma or infection, your mental states and habitual emotional patterns could be successfully altered.
I'd love to see some peer-reviewed citations on this because, honestly, it sounds like New Age wishful bullshit.
Is there any peer-review of Tibetan medicine?)
But if I encounter anyone who has the "everyone has trouble focusing" crab mentality that I've had told to me, even by psychiatrists themselves, I'll punch them square in the jaw.
Since 1999, the name of the drug was changed but the debate seems exactly the same.
Drugs for children seem to breed conformists. And conformism is bad because it ignores problems until they overhelm and crush the society.