Concerns About A.D.H.D. Practices and Amphetamine Addiction | Hacker News Reader

Concerns About A.D.H.D. Practices and Amphetamine Addiction

nytimes.com

43 pointswglb50 comments

    > “...when he was in elementary school he fidgeted, 
    > daydreamed and got A’s. he has been an A-B student 
    > until mid college when he became scattered and he 
    > wandered while reading He never had to study. Presently
    > without medication, his mind thinks most of the time, 
    > he procrastinated, he multitasks not finishing in a 
    > timely manner.”

    > His father reacted with surprise. Richard had never
    > shown any A.D.H.D. symptoms his entire life, from 
    > nursery school through high school,

This is precisely how my parents reacted when they found out I was taking amphetamine to control some sort of abject ADHD specter in university.

"But Dan, you never had problems with focus and performance. You're a smart kid! You always made A's in school!"

There's a jarring problem with this analysis. The truth is I've struggled with focus my entire life. It just so happened that university is the first time school surmounted my lack of focus or, more precisely, my willpower.

Thankfully I arrived at a low dose of amphetamine which is the only reason I've been able to work towards my life ambitions.

Addiction is always serious. And the cases in this article involve classic stimulant abuse. There are certainly conversations to be had. Not just about amphetamines, but also about the structures of our society that make amphetamine so sought after. Why was I psychoanalyzed in grade school when I didn't want to sit in a chair for 8 hours? Why do people only see "drug problem" when they hear about amphetamine availability across campuses instead of "systemic education system failure"?

But what I'm concerned about is an encroaching universal condemnation of ADHD medication where people may eventually roll their eyes at you when you seek help for a problem that inhibits your ambitions and squares your life away at a fraction of your full potential.

I don't think the article dismisses the fact that people can have trouble focusing in their lives, but how making these powerful drugs so easily available to prescribe to doctors and so easily available to patients who don't need them has created a new drug sub-culture of people who get high on prescription drugs.

There are many alternatives to taking drugs to solve focus problems in life and I personally wouldn't want to be taking drugs that have so many side effects and black warning labels from the FDA...

That great for you if you would not want to take them but why should you be able to make that decision for other people?

It's been so overly diagnosed that right now the opposite is started to happen. There's a lot of doctors and people diminishing it, and even saying it's no real sickness.

I was a straight A student until I finished high school. Not because I focused and studied but because the level was shitty and it was enough for me to be sitting in class to known enough about the subjects. I started failing when classes became so boring and I became old enough to be skipping class.

I was diagnosed at 22-23 and took medication for almost a year. My productivity was better on those months and it helped me gain some structure and organization I lacked. I stopped taking medication because I moved to a different part of the country and I didn't want to waste time seeing doctors (I needed to change meds as the ones I was taking were making me angry all the time).

I'm good enough now. Sure, I'm still more or less a mess and I do procrastinate a lot, but those months gave me enough willpower and organizative skills to be able to get things done.

I needed to change meds as the ones I was taking were making me angry all the time

It's worth pointing out that this is most likely a sign that you don't have ADHD, and possibly have some other disorder that looks a lot like it.

Believe it or not, it's not all that uncommon for Bipolar people to be diagnosed with ADHD. During the depressive stage, Bipolar people tend to be unfocused and lacking in motivation. During the Manic phase, they tend to be impulsive and hyperactive.

Same with anxiety disorders (like OCD). Those kinds of people tend to be so worried that they have difficulty paying attention.

Hell, even thyroid disorders can look like ADHD.

Either way, you're probably not taking medication right now because you don't need it.

Thank you. I dropped out of college 3 times. It took me 10 years to earn a 4 year undergrad degree (with 10 years of student loans to go along with it). I started taking Vyvanse in year 8. Now my loans are paid off, in only 3 years since graduation, and I am earning enough to start saving for my 9 month old son's college expenses.

My medication literally changed my life, and in every single way it was for the better. People who attack ADHD medication with blanket statements are incredibly misguided. It would be like keeping calorie-dense food from Anorexia sufferers so that they don't become obese.

The truth is I've struggled with focus my entire life. It just so happened that university is the first time school surmounted my lack of focus or, more precisely, my willpower.

What a wonderful way of putting it. Going by educational success, I'm by many measures in the upper percentile of my age group. But I still catch myself thinking how easy it would be to just flood your brain with dopamine. It's a very attractive option to the engineer-science-me.

I am taking Methyphenidat/Amphetamine for nearly 10 years now and it totally changed my life in a positive way. I wasn't able to read anything longer than a few sentences (which means no newspaper, no books etc). School was horror for me. I nearly failed in the lower secondary education. Then I was diagnosed with ADHD by a German mental research institute and they began to treat ADHD with medications and my situation improved very quickly.

I am very skeptical when I am confronted with overly critical statements about the current ADHD treatment. These statements come up every two weeks or so. Maybe they are correct - maybe they are wrong. The only thing I know is that the medication helped me like nothing else in my life. Maybe I am living in a dream world where my sense of reality is somehow disturbed. The good things a proper ADHD treatment can do are more or less always never mentioned - at least that is my perception.

As with all drugs, this is not a simple, binary matter. For some people, there is a very real risk that stimulants and antidepressants will cause serious psychological problems; that risk increases with dose, and even a person who is fine with low doses will probably have a psychotic episode at very high doses. Just look at the doses being discussed in the article -- this kid was blowing through a month's prescription in two weeks time, and his prescription was for 60mg/day (sometimes higher). He was past the point of therapeutic doses and that he had psychotic delusions is not terribly surprising.

I have heard of people succumbing to stimulant psychosis after drinking too much coffee for too many days. This happens with cocaine, amphetamines, cathinones, etc. Moderation is essential for using these drugs safely, though that statement is equally true for any drug.

I think the challenge is that they are prescribed so casually with so little monitoring.

I guess we could just say that he's an adult, and can OD if he wants to. But I cringe at the damage that can do.

I'm a college student, and while I've never seen first-hand a situation like this, I can attest to the widespread casual use and sale of adderall on campus. During finals last December, I was offered a pill more times than I can remember, just $5 or $10 bucks a pop.

I don't think I knew anyone that was actually diagnosed with ADHD that was taking the pill to study. Some of my close friends joked about how easy it was to lie to the doctor about your symptoms. Most of them got a prescription on their first visit.

Looking at LinaLauneBaer's comment shows that there's always two sides to a story, that sometimes these drugs can be a godsend. But I'm going to side with the NY Times on this - adderall is really, really easy to get ahold of on a college campus. It's a casual use study-enhancer that dictates sleeping, eating and reading habits for kids during that final crunch week of each semester.

I'm thankful nobody I know has endured anything worse than temporary dependence.

I would guess that nobody you know who takes drugs for ADHD -- and actually needs it -- feels like talking about it. When drugs are a game, people talk about them. When drugs are quietly taken to keep one's life stable, they keep quiet.

ADHD is a real disease with real (and severe) symptoms.

That said, I personally believe that responsible use of these stimulants by people without ADHD can be of net benefit to individuals and society. Prominent bioethicists have agreed [1,2]. Just because something can be addictive or is abusable by some (c.f., TV, food, video games) doesn't mean it should be banned.

The real crime here, in my opinion, is not that people are faking symptoms to get medication, but that they should have to. Also, as others have mentioned, the kid in the story very likely had other problems beyond his Adderall addiction.

[1] http://repository.upenn.edu/cgi/viewcontent.cgi?article=1039...

[2] http://www.nature.com/news/2008/080409/full/452674a.html

Mathematician Paul Erdos heavily consumed amphetamines, and they did not consume him.

This guy most likely had some psychological issues to begin with. You'd have to be a medical student, end up in a psychiatric hospital and not see that as a big red warning sign.

Sadly, policy is made around these incidents.

  > Sadly, policy is made around these incidents.

You're offering equally fallacious reasoning: that Erdos managed to handle his amphetamine consumption tells us nothing at all. Policy should be made around solid data, not carefully chosen data points that confirm our respective biases in the matter.

It does, it shows that not all cases are similar and that there is potentially a large variance in outcomes and thus calls for collecting more data. It's a proof by existence.

He ended up in the psychiatric hospital after the abuse had already gone on for a while. Why do you say that he most likely had "psychological issues to begin with"?

I didn't say he probably had psychological issues because he ended up in the psychiatric hospital, I'm saying he had these issues because it did not trigger a wake up call.

You don't get to reference the Erdős story and not tell it, it's too good:

> His colleague Alfréd Rényi said, "a mathematician is a machine for turning coffee into theorems",[31] and Erdős drank copious quantities. (This quotation is often attributed incorrectly to Erdős,[32] but Erdős himself ascribed it to Rényi.[33]) After 1971 he also took amphetamines, despite the concern of his friends, one of whom (Ron Graham) bet him $500 that he could not stop taking the drug for a month.[34] Erdős won the bet, but complained that during his abstinence mathematics had been set back by a month: "Before, when I looked at a piece of blank paper my mind was filled with ideas. Now all I see is a blank piece of paper." After he won the bet, he promptly resumed his amphetamine use.

(From wikipedia)

We're debating the semantics of ADHD diagnosis and ignoring the real story:

It was where, after becoming violently delusional and spending a week in a psychiatric hospital in 2011, Richard met with his doctor and received prescriptions for 90 more days of Adderall.

No legitimate doctor would prescribe amphetamines to a patient with a history of psychosis, ever, under any circumstances. It is an egregious failure of care, resulting from either indifference of incompetence.

America is beset with an epidemic of physician-facilitated drug abuse. The back pages of local newspapers all over America are full of advertisements for "pain clinics" prescribing opiates to all comers. 20,000 Americans are dying each year from overdoses of prescribed painkillers. 80% of all the world's opiates and stimulants are prescribed in the US.

It's a situation akin to patent medicines and prohibition - booze was officially banned, but you could buy "medicinal" tonics that just happen to be 80 proof.

I find it difficult to feel anything other than contempt for Fee's parents.

It seems to be accepted without question that ADHD is overdiagnosed, but I don't think that's true. I think it's more accurate to say that ADHD is misdiagnosed. That is, ADHD frequently isn't diagnosed when it should be, and is also frequently diagnosed when it shouldn't be.

I think it's the primarily-hyperactive variant that's overdiagnosed, and that's so for very adult-serving reasons. Children who are primarily hyperactive are the ones that will tend to "act out". They're constantly causing trouble, disrupting the classroom, and generally creating havoc. Of course, teachers/parents/adults tend to be very quick to want a diagnosis of ADHD for hyperactive kids: they make their jobs tough.

Primarily-inattentive ADHD (which Fee was diagnosed with) is different. They tend to lack the motivation to get into any serious trouble. Thus, they tend to be experienced as good, smart children who just need a bit more motivation and focus. The incentives here are a bit more perverse. These children tend to make the adults in their lives not want an ADHD diagnosis, because these children tend to make adults' lives easier. They don't have to discipline their kids for acting out. Of course, that leaves out the question of whether a diagnosis is best for the child. Sure they don't cause trouble, but they're also not really living and having a healthy childhood.

This is why I have contempt for Fee's parents. More than likely, Fee needed to be diagnosed with ADHD sooner. Had he been diagnosed sooner, he could have been put on medication by a doctor who could control his dosage. He probably would have started causing some amount of trouble, and that would have been more work for his parents. But he would also have been more capable of succeeding in life.

Instead, Fee (like lots of undiagnosed people with ADHD) self-medicated, and got himself addicted.

And our discourse is further complicated when we try to describe ADHD and our vocabulary sounds like it was torn from the thesaurus page for the word "lazy". Work-shy, lethargic, idle.

We spurn each other for lack of self-control and the audacity to seek treatment for something that's ostensibly ameliorated with a little bit of elbow grease.

Then we medicate each other with the same family of platitudes that tell the poor to work harder and the depressed to just smile.

When you finally venture out to confront the competitive credentialization colossus that entangles your identity with performance marks on entrance exams that will dictate the rest of your life, you find yourself reaching for your Kokiri sword and shield that everyone said you had within.

But instead you realize you were only given the Sword of Banality, etched into it the fine print: "Does no damage but can be given to others".

I have been prescribed Ritalin or Concerta since I was a child. It helps me, immensely. Where I once attended special ed schools, now am a college graduate living successfully in NYC. Since I became an adult, once a month I must go to my doctor's office to pick up a physical prescription then take that form to a pharmacy to fill. I can not call it in. I can not get refills. All because Ritalin is a controlled substance. I wish the government would keep its laws off of my body.

I think those laws are there for a reason, and that Ritalin has a high probability of abuse or "resale".

Some doctors will e-prescribe Class II prescription renewals, if they know/trust the patient, without physically seeing them. Most require at least a ~5 minute consult, sometimes with a Nurse Practitioner. I personally think the laws are there to avoid fatally tragic stupidity, like this article describes.

My shortest consult was 30 seconds in the hall with a NP, but yes, I take prescribed C II stimulants.

> It was there that her son, Richard, visited a doctor and received prescriptions for Adderall, an amphetamine-based medication for attention deficit hyperactivity disorder.

Adderall is not "an amphetamine-based medication". It is simply mixed amphetamine salts and nothing else. Amphetamines are the only active ingredients.

This makes it sound as if it's in some way only related to amphetamine.

Edit: This is equivalent to saying: "rain, a water-based type of precipitation". Rain isn't simply "water-based" — it IS water.

It's four main active ingredients are all types of Amphetamines, therefore it is an Amphetamine based drug by definition.

That's like saying: it's four main active ingredients are all types of drugs, therefore it is an drug based drug by definition.

I think the point of GP is that basically Adderall IS Amphetamine, rather than some kind of special derivative.

2nd paragraph on the Wikipedia page for Amphetamine:

Brand names of medications that contain, or metabolize into, amphetamine, include Adderall, Dexedrine, Dextroamphet, Dextrostat,[2] Didrex, ProCentra, and Vyvanse, as well as Benzedrine or Psychedrine in the past.

https://en.wikipedia.org/wiki/Amphetamine

The DEA classifies it as a Schedule II amphetamine with high potential for abuse: http://www.deadiversion.usdoj.gov/pubs/manuals/pract/section...

The main active ingredients are amphetamines, so yes, it's an amphetamine-based medication, hence its high potential for people abusing it, and many doctors have gone to jail for doling it out carelessly to people.

Isn't there a difference between street amphetamine sulphate and adderall?

I'm about to horribly mangle some chemistry. Sorry. Doesn't the amphetamine molecule have a methyl group; and that can be on the left or right side, and that makes a huge difference how your body copes with the substance? (Is this chirality?)

And so it seems reasonable to make a distinction between something that is classically abusable and adderall.

I agree it's a lazy description though - they could have explained the difference.

The FDA themselves warn Adderrall has a high potential for abuse, not to mention the risks of sudden death or cardiovascular incidents that must be checked for before prescribing it. It doesn't sound like any doctor did the proper diagnosing and checking on this kid before this tragedy happened, and those doctors should be held accountable for his death.

Not to mention the other potential side effects like Psychosis, Aggression, Seizures... I don't understand why anyone would ever take a drug like this, the list of side effects sounds worse than the problem it's trying to cure... http://www.accessdata.fda.gov/drugsatfda_docs/label/2007/011...

I think the scariest thing in the article though is the way he got the prescription: by answering a questionnaire given by a nurse. All the kid had to do to "get his fix" was lie on the form and bam, diagnosed, pills in hand, he walks out and wrecks his life.

This for me highlights the bigger issue with mental health care today, that the science is bogus, it's all based on opinion (just like the DSM where disorders are "voted into existence" by a few psychiatrists every year at the American Psych association convention) and not actual science.

If I go to a doctor complaining of chest pain, I can get a cholesterol test, and he can prescribe me a powerful blood thinner fully knowing it will save me from having a stroke. If I go to a psychiatrist, he will ask me a few questions and prescribe a powerful psychotropic that could make me go insane and hang myself. Sad but true.

I can't vote this up high enough.

I'm fairly ADHD (though I realized I was not an extreme case when I met some ADHD people who require hospitalization/safety measures simply as a result of their ADHD) , and I was on ritalin well before it was popular, (IE early-mid 80's). From there I moved to other stimulant variations over the course of 20+ years as they stopped working due to me building up a resistance.

Over the years i've seen quite a number psychiatrists for medication management/etc. Every single one i've seen since the age of 7 has required me to do more frequent GP visits to make sure heart rate/blood pressure/etc stayed normal.

Nowadays, there are actually non-stimulants like Straterra that can be used (though it depends on your exact symptons,etc). There were definitely blood pressure differences for me after being on stimulants for a very long time, and then moving off them.

Yet most doctors try stimulants first (some i've met who claim to specialize in ADHD didn't even know straterra existed).

It's clear that ADHD is over-diagnosed, and like you, i'm surprised how easily you can get stimulants. I would have expected you'd at least have to have gotten various learning disability testing done (which an actually quantify your level of detriment). Instead, as you say, you can just walk into an office, and walk out with adderall. The sad truth is that all this seems to end up doing is making it harder for those of us who need treatment to be taken seriously.

> Not to mention the other potential side effects like Psychosis, Aggression, Seizures... I don't understand why anyone would ever take a drug like this, the list of side effects sounds worse than the problem it's trying to cure... http://www.accessdata.fda.gov/drugsatfda_docs/label/2007/011....

Most people don't encounter the bad side-effects. The common ones are sweating and restlessness.

The malady that it treats is truly, truly debilitating.

I'm not a physician, but I will note that it involves lack of sleep. Sleep is important, and most of these type events involve chronic lack of sleep, and/or doubling up on prescriptions.

Note: The medical judgement of multiple providers in this case seems troubling and lacking.

While I admit I have a problem with focus, I have been able to control it with self-discipline. Others may not be so lucky.

There's a marked difference between actual ADHD and just normal fidgetiness or lack of focus. For years, psychologists prescribed children who may not have had ADHD with medication. There have been so many misdiagnoses and ADHD has received so much press attention that physicians are now much more wary of diagnosing it in an attempt to please the family of the suspected patient. Since that has happened, people with true ADHD are now not getting the help they need.

There's a simple way to test for ADHD. Give a person a deadline, and give them an hour until that deadline to complete an essay. Tell them the essay will count on one of their formal records (even though it won't). If they buckle down and finish the essay, the person most likely has a lack of discipline. If the person continues to have a lack of focus up until the last minute, you can be safely sure that that person has ADHD.

(Note that this is personal anecdote and should not be used as a substitute for proper medical attention. If you suspect you have trouble with focus, seek psychiatric help. The above is ONLY a topic for discussion.)

You've made a strong statement concerning how one should diagnose a disorder. What evidence do you have that this is an effective diagnostic tool? Or is this based on your experience as a physician or therapist in a clinical context?

My father was a psychologist for 7 years and he has seen many patients with attention deficit problems. One of his methods to see if a person would have problems with focus is the one written above. It is by no means a clinical diagnostic method or a replacement for professional help, it merely exists as a point for discussion and food for thought. (See added disclaimer above.)

When I was in fourth grade, my teacher pulled my father aside and told him, "I think your son may have ADD or ADHD." His response: "No."

While I understand his desire to believe I was okay, I wasn't. I've had extreme difficulty focusing since I was very young -- it's impacted my school work, my career, my relationships, everything.

After dropping out of college, I began to try to understand my problem better. I bought books for behaviorally challenged kids, came up with strategies to help me focus -- but nothing really worked. After over a year of trying to avoid medication, I went to my doctor and asked for a prescription for Adderall.

It worked flawlessly.

I'm a 6' 2", 180lb male, and I take a maximum of 10mg a day, up to three days of every seven. I know it's not good for me -- for all intents and purposes, it's speed -- but it's actually helped me function "normally." I'm not addicted to it. My prescription will run out, and I'll usually wait a month or two before renewing it -- but it's nice to have it there when I need to focus.

ADHD is hard to diagnose properly, and people can get addicted to Adderall, but that's why good doctors only prescribe it as a last resort to people that have the self-control necessary to properly use it.

This article (the one I've linked) outlines some great points surrounding the issue of ADHD and the use of medications. In general, North America loves to throw medication at every problem. Big Pharma plays a huge role in this. Big Pharma loves to medicalize simple facts of life, or take a real issue and broaden the definition so that more people fit within that definition. There is very little money in curing the sick, but there is some great profit in treating the living and healthy. ADHD, Social Anxiety (which isn't even the name of it, it's Social Phobia in the DSM), and PMDD just to name of a few examples.

My point is this: Be a skeptic, be overly critical of diagnosis, and look for other forms of treatments outside of medicine where appropriate. You would be amazed at what you can accomplish with therapy, but where it makes sense take medicine as a treatment.

http://www.psychologytoday.com/blog/suffer-the-children/2012...

Whenever I see comments about ADHD over diagnosis and abuse, I look at http://www.cdc.gov/ncbddd/adhd/prevalence.html and remind myself that over diagnosis is a regional problem. If you're from North Carolina and claim to have ADHD, I'm frankly going to doubt you. California, not so much. (Disclaimer of bias, my son has ADHD, diagnosed in California. I've seen the process by which that diagnosis is arrived at here, and I don't think it will create a lot of false positives.)

As for college, according to the medical literature about 1/3 of ADHD cases disappear when your brain finishes developing. Maybe there really are a lot of low-level cases that only show up in adulthood. I haven't looked into the topic. It is not impossible - after all a lot of teenagers use their parents as external organizers, which can really help. But the reported numbers and frequency are too high for a mental disease which is believed to be in the 5-7% range.

I took Ritalin all through grammer and high school. Obviously it helped me concentrate, but when I got to college, all I could think was "I'm not me, I am this drug."

So I stopped taking it. I flunked out of college, I moved back home, I failed out of community college. Then I moved west, joined the dot com boom, got a great job, a wife, a spectacular career, and I've founded a non-profit.

I am fairly certain that I don't have ADHD. Instead, I think that the real problem is that school is fucking boring as shit! I always loved working for money, since I was 13 and mowed lawns, but I always hated school because it was boring and I was ostracized.

Today, I don't take anything for my so-called ADD. Frankly, I think it's all a buncha bullshit, and ADD is an excuse for teachers who hate their students.

At the end of the day, ADD is just another personality quirk you have to learn how to manage. Drugging it into submission creates weakness in the sufferer.

You know what cured my ADHD? Working from home.

ADHD may be over-diagnosed. That does not mean it doesn't exist.

If you could actually focus an function properly, yes, you probably don't have ADHD.

So you were on a medicine and when you stopped taking it you failed out of school but its all just a bunch of bullshit?

Don't forget "buncha" and "grammer"

What is the problem with that reasoning? Not liking and failing out of school is not a medical problem.

I never claimed ADHD/ADD didn't exist. I'm just saying I was called a prime example of ADD, and I was able to eventually control myself. I'm sure there are people out there that can't, but I'd personally wager that most folks who have ADD ADHD just need to find out where they fit in life, not take a drug that allows them to do something they otherwise couldn't.

If it works for you, fine, more power to you. My real point is that calling someone broken because they are diagnosed with ADHD ADD is wrong, in my opinion. It's a character trait or flaw that can be useful if you find the right place for you.

The right place for an ADHD ADD person might just not be in an office sitting at a chair all day. Maybe it's out running a trade show, or a frantic diner or store, or maybe it's being a professional gamer. Who knows? ADD ADHD doesn't mean yer broken and only fixable with drugs. You can find your own way in life, is what I am saying, and drugs are not the only option.

Dropping out of school is the best decision I ever made, frankly.

I don't think it's fair to conclude "some people just don't like school" => "ADD doesn't exist".

I'm a graduate student working on my PhD in physics. Physics and astronomy are my lifelong passions, and is now my career. Nevertheless, my attention issues have prevented me from reading even a few pages of a textbook in a sitting. Isn't it just silly to not be able to sit and read about my favorite things.

After dropping out of undergrad, and then eventually graduating by with pretty sub-par grades, I was diagnosed with ADD and started taking medication. At my current academic level, I can't squeeze by on just wit alone; it requires a lot of focus.

What you're suggesting is that I should just drop my lifelong passion and head out Californee-way for some internet jobs.

This is why learning how to be good at doing drugs is easily the best thing you can do for your health in terms of ROI. Drug use kills or contributes to the deaths of something like 1 in 3 Americans, meaning that if you want to live a long and health life then being good at doing drugs is just as important as eating healthy and exercising. Except for that unlikely eating healthy and exercising, which you have to do every day, when it comes to learning how to be good at doing drugs you just spending a couple months reading a handful of books and then you're done, that's it.

I recently wrote a short paper that involved reviewing some recent literature on ADHD diagnosis, faking, treatment options, and abuse. I've created a pastebin with my references for those interested in these topics.

http://pastebin.com/Kf6W2vUA

I'm also happy to discuss the topic with anyone without access to these journals. I'm not an expert, but it's something I'm learning about.

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