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Comment by LocalPCGuy | Hacker News Reader

I agree that ADHD is a serious condition for many people, and that it's overly romanticized and that isn't good when it comes to getting help for those that do need it.

To that point, I'm going push back on this language just a bit:

> you end up addicted and pretty much permanently require drugs to function well

That is negatively framing medication, which if taken properly as prescribed is no different than any other medication someone might take to help with a chronic health condition. It slightly encourages and leans into the idea that ADHD is "fixable" without medication and so taking medication is a problem (or due to a weakness, etc).

I'm not discounting the value of other forms of non-medical treatment, but in many case medication IS appropriate as part of the overall treatment that a person requires to manage their ADHD. We should not use language that stigmatizes treatment that should be between a person and their doctor.

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Agree with original commenter but +1 to reframing the language. I was very afraid to begin medication because I would always hear about how addicting this medication can be. But like you say, you wouldn't tell someone with diabetes that they're addicted to insulin.

fully agreed with this. it's the same stigma that I see get applied to SSRIs - that you become 'dependent' on medication, it's not 'natural', etc

in reality, if the side effects are minimal and you function better on it, it's a sip of water and a pill a day and that's largely it for health outcomes. most drug interventions are generally extremely well-studied with very large sample sizes. there's a reason why clinical research is considered gold-standard - the regulatory requirements to even get a drug to market is monumental and some of the most rigorously audited and vetted processes in the world

the ironic thing is that most of the big pharma detractors are also ingesting dozens of supplements, the vast majority of which have little to no good empirical evidence backing them (and very small effect sizes to boot) along with even less regulatory oversight for issues like contamination, formulation, or if it even contains the active ingredient. which isn't to say that 'big pharma' doesn't often pursue avenues for profitability reasons instead of the public good but that's not the typical critique that an anti-empiricist brings most times

I'm addicted to several things. Like eyeglasses, and breathing.

The difference the medication makes is similarly revelatory to putting on eyeglasses. Of course you never want to take them off.

There's no withdrawal symptoms, per se, for most people, the addiction is purely psychological from "trying to drive with only 3 tires sucks"

That's not really an "addiction" by any reasonable meaning besides "something I do often".

The actual meaning is more complex, involving inability to stop, negative effects on your life, etc. - none of which apply to wearing your glasses or breathing.

You... don't think there are negative effects to stopping breathing?

If you can be behaviorally addicted to gambling, or even more aptly eating, you can be behaviorally addicted to medication that doesn't give you any physiological dependency.

> The DSM-5 has re-classified the condition [ed: gambling addiction] as an addictive disorder, with those affected exhibiting many similarities to those with substance use disorder. They both activate a reward mechanism in the brain, causing dopamine release to reinforce repetitive behavior. Both often lead to loss of control.

Edit: to engage more substantively, imagine if your glasses gave you, say, mild skin irritation that progressively got worse with wear, but you chose to mitigate that and wear them anyway. I would rate it at that level.

it's not good to flame people for things they can't control. I also think it's not fair to compare insulin (life saving non synthesizable hormone) vs amphetamine (hard drug that helps people better cope with a society expressly designed to beat them down), because then we forget that dosing amphetamines daily comes with its own price of damage to the body. drugs prescribed for adhd are also very much addicting - if one lets an amphetamine script run out, symptoms of withdrawal will take place, regardless as to how the condition is verbally labelled (which while horrible is also to me not fair to compare with a diabetic dying without insulin)

I've never heard of anyone with ADHD on prescription amphetamines experiencing withdrawal when stopping. At least, not with any symptoms worse than just having ADHD and being unmedicated.

People with ADHD are often amused by referring to amphetamines as a "hard drug" since it has practically none of the typical hard drug effects on them.

To your point about life saving - untreated ADHD folks have a 2-3x mortality rate, generally due to accidental cause or risky behaviors. Studies have shown that medication can have a significant statistical decrease in the overall mortality rate. So while it's not a cut/dry as insulin, it is still "life saving" for many.

The reasons you cite are why it is a controlled substance, and why it should be taken under supervision of a doctor. But they aren't arguments against the drug itself or that it is in a different "category" of drug. It is a treatment, and like any treatment, the pros/cons should be discussed with medical professionals and appropriate decisions made for each individual.

And yes, sadly our society fails people who are different and our medical system fails people with regards to their medication all the time - that can happen with any medication though. And yes, consequences vary greatly depending on the medication.

I think it is also worth reframing what "functioning well" means. Society expects certain things of us and our brains function in a way that those things are more difficult. Is that our fault, or society, or some mix? Isn't it possible that society itself could adjust in such a way that people who naturally struggle to sit in a cubicle doing the same thing all day every day could be offered other options? Seems like our capitalistic system that requires "productive" work as measured by those who already control the capital is maybe also a problem here.

I'm on stimulants and I agree that the post you responded to needed reframing. But I think we do ourselves and anyone else who isn't "normal" in body or mind a huge disservice just focusing on acceptance of treatment when there are larger societal changes that could be made.

I can't fix society. I can, however, take a pill that lets me hold down a job long enough to not fall into crippling debt.

I agree and it would be great if we could do that and ideally there would be roles for people that are not able to maintain the strict structure and their contributions were valued even if different.

That said, I think we agree that accepting the treatment folks need to function in society as it exists is a step in the right direction.

Oh yes, absolutely. Meds are extremely useful and given the choice between "fight myself AND the system" or just "fight the system" I'll choose to stop fighting myself every time.

This Doctor's videos reframed the clinical work and actual research for me, very informative and helpful to me personally. https://www.youtube.com/channel/UC0tLWu7ljYVFPiZQfHjTMsA

Dr. Barkley does a great job presenting research and factual information in a way that is easy to understand and I've also found it very helpful personally. Was diagnosed in adulthood, so resources like this were great finds during my hyperfocus dive into gaining some measure of understanding of ADHD.

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