Adderall Addiction: The Last All-Nighter | Hacker News Reader

Adderall Addiction: The Last All-Nighter

opinionator.blogs.nytimes.com

225 pointsjedwhite216 comments

The comments to this article mainly focus on the medical benefits and side effects of Adderall.

I don't want a larger truth to get lost here...

While I've been prescribed Adderall for part of my adult life, and feel Adderall has benefited me, I'd like to say that there's far more to successful ADHD treatment than medication:

  - Proper environment
  - Getting enough exercise
  - Getting enough sleep
  - Support and understanding from loved ones 
  - Strategies/systems that allow frictionless organization

While nobody here is explicitly characterizing it as such, please... nobody fall into the common trap of thinking that successful ADHD treatment is just a bunch of pill-popping.

(Unfortunately, many psychiatrists do treat ADHD treatment as nothing but pill-popping. Mine does. There's a good chance yours will. If you're seeking ADHD treatment I'd urge you to do your own homework and read up on ADHD life strategies and consider seeing a therapist in addition to a psychiatrist. Whether or not you decide to go the medication route, those strategies will really benefit you. Good luck!)

I would highly recommend people interested in learning more about ADHD itself to read Delivered from Distraction: http://www.amazon.com/Delivered-Distraction-Getting-Attentio...

It's a fantastic book that explains the condition extremely well and has tons of useful information on not only how to cope with the condition, but for how family members and relatives of somebody with ADHD to best support them.

You're absolutely right.

John Ratey (http://en.wikipedia.org/wiki/John_Ratey), the professor of psychiatry at Harvard Medical School who wrote Driven to Distration, recently published a book called Spark: The Revolutionary New Science of Exercise and the Brain (http://www.amazon.com/Spark-Revolutionary-Science-Exercise-B...).

Spark details how high-intensity cardio (like sprints or interval training) put your brain chemicals in balance in part by generating BDNF (http://en.wikipedia.org/wiki/Brain-derived_neurotrophic_fact...), which as Ratey describes, it's like "Miracle-gro" for the brain.

Last year my stress levels were getting out of control from working too much. At the time I was running at least two miles every day so it's not like I wasn't exercising. But then one day I changed from running a couple miles to running 50-yard sprints, as fast and as hard as I could push myself. The first day I only ran four sprints, but I felt euphoric the rest of the day -- the best I had felt in years. So I tried it again a couple days later, and sure enough it worked again -- I felt amazing.

So then I had to find out why this worked -- why a few sprints were so much more effective than running several miles. I started Googling and eventually found Ratey's book -- it explains the entire biochemical process of what's going on and why sprinting works.

It's an eye-opening read. Each chapter covers how high-intensity cardio affects things like stress, anxiety, depression, ADHD. I have ADHD but haven't taken anything for it in years (since I was in college), and I can attest that sprints not only fixed by stress levels, but my ADHD symptoms were almost non existent.

Here's a key point that Ratey makes throughout the book that completely changed my perspective on things -- he says that instead of thinking of exercise as something you should do to look good and build a healthy body, you should instead think of exercise as the key to building a healthy brain:

"We all know that exercise makes us feel better, but most of us have no idea why. We assume it’s because we’re burning off stress or reducing muscle tension or boosting endorphins, and we leave it at that. But the real reason we feel so good when we get our blood pumping is that it makes the brain function at its best" (http://www.sparkinglife.org).

In the book's introduction he goes on to say, "Building muscles and conditioning the heart and lungs are essentially side effects. I often tell my patients that the point of exercise is to build and condition the brain."

In fact the brain exercise routine he recommends is similar to a weight workout routine, in that you have to push yourself hard one day, and then take a day off to let your brain recover, just like in weight training. Another key is when you sprint, always put everything you have into it. Run as fast and as hard as you can so you are constantly pushing your body and your brain past their limitations -- this is the key to growth.

Nitpick: "high intensity cardio" is kind of an oxymoron. "Cardio" is used to mean training which mainly uses the aerobic system. That is, longer term, lower intensity, training that you can sustain over a long period of time because you are going at a pace that your body can turn carbohydrates into all the energy you need.

Sprinting is anaerobic training, as is most strength training. It's high intensity, you can't sustain it over a long period of time, and it makes different energy demands on your body than aerobic training does.

http://en.wikipedia.org/wiki/Aerobic_exercise#Aerobic_versus...

With that said, I much prefer anaerobic training. It's more fun, for me. And if you do intervals over a long enough time, you're also increasing your aerobic capacity.

It won't increase your aerobic capacity... It will raise your lactate threshold. The only way to increase your aerobic capacity is to spend a large amount of time exercising at an aerobic heart rate.

It depends on how much rest you're getting inbetween your intervals. If the rest is short enough that your heart rate never goes back down to normal, then you're also working your aerobic capacity.

When I train jiu-jitsu, I do several rounds of live rolling. Usually something like 4 6-minute rounds with a minute rest inbetween. The hard part of live rolling is the anaerobic part: quick spurts of high intensity. How fast you can recover from them, and how often you can sustain doing them over time determines how well, athletically, you will do. But this is also a 30 minute period with an elevated heart-rate, and you never are fully rested inbetween your anaerobic bursts. So, it is also an aerobic workout.

Despite not doing much explicit cardio training, I still have the cardio capacity to run decent distances with decent times, on the rare occasions I do. That's because I am training my aerobic system even though most of the exercises are anaerobic. (I once went on a 9 mile run having not gone on a run in over 6 months, having only done jiu-jitsu training and conditioning during that time. My lungs were fine. My legs were not.)

You can run easily because your placate threshold has been significantly increased... doing sprints won't improve your aerobic capacity to any great degree... just ask Usain Bolt

My point is that I am training both, even though my anaerobic capacity is the real determinant of the outcome. But inbetween bursts, I am still active, just at low to moderate levels, and this occurs over a long period of time.

If your sprint workouts involve sprints with very light jogging inbetween then you will work both.

Many people will tell you that when you go in to "sugar burning" (approx 140bpm+) mode then you are doing very little to improve your aerobic capacity... Regardless of your heart rate being lower at certain points. Read about Mark Allen's (Ironman champion) experiences with this. To train your aerobic system you need to start in the aerobic zone and stay there religiously. IMHO

I have for many years realised the benefits of high intensity (hit) exercise and it does work... but like anything it has it's downside... illness and injury can become very common if diet and rest aren't factored in. I find the problem is that most people exercise in what I call the grey zone - not easy and long enough... or not hard and short enough. Most recreational runners fall into this category.... if you can balance easy and long (<140bpm) workouts with short and hard (20 minutes) you will gain many benefits. But you can't build an aerobic base without long easy workouts imho.

what I find interesting is that when I use the ADD medication, I'm far more likely to go to bed and get up at a semi-reasonable time. Unsurprisingly, (as it's a stimulant) it also makes it far more likely that I'll work out.

But yeah. Frictionless organization. and don't hesitate to hire things out. I mean, think about what you want to do yourself and what you want to hire out, but don't think about it from a cultural acceptability standpoint. Think about it from the perspective of "how do I get a reasonable return for my time?"

A whole lot of my coping consists of changing my lifestyle to fit how I act (which is shockingly easy compared to changing how I act.)

When I'm not medicated, I simply have to plan my life so that what needs to get done gets done in fewer hours of effort. I'm going to screw off some of the time; medication aside, I haven't figured out how to change that. So, do I clean out the office? or do I pay someone else to do that? cleaning out the office will take just as much effort on my part (well, really, rather more effort) than configuring the routing and scheduling downtime for the move to the new datacenter.)

The other thing I've found is that I'm way better at context switches and unexpected emergencies than most people. I mean, it's not so much that I do well during those situations as that I don't do any worse than I normally do in those situations. I mean, I'm distracted as-is, right? so the pager going off isn't really that big of a deal. (and, well, the 'emergency rush' is one way to get non-medicated me off my ass.)

So yeah; I mean, if I was in a McDonalds kind of situation, where peak performance didn't matter... where I just had to perform at a minimal level, but show up on time and always meet that minimal standard? I would really, really struggle, no matter what tricks or drugs I used. So I spend a lot of effort trying to construct a lifestyle and a workstyle where my weak points don't hurt me so much, and where my strong points really help.

The hardest jobs I've had in my life are the ones that are generally least respected by our society.

I tried really hard to do well, but I would tend to get fired in a few months. I was terrible at them.

I do really well as a professional developer though, something that took me a while to get used to. It's funny how these things work. Like you I have ways of coping with my weaknesses, and those 'easy' jobs didn't provide much allowance for doing it. It definitely affects my politics, because I consider myself very fortunate that a career exists for me where I can leverage technology and intellect to do things quickly enough that I can 'waste time' freely. Not everyone is so fortunate.

  So yeah; I mean, if I was in a McDonalds kind of 
  situation, where peak performance didn't matter... 
  where I just had to perform at a minimal level, but 
  show up on time and always meet that minimal standard? 
  I would really, really struggle, no matter what 
  tricks or drugs I used.

Haha. In high school and college, I struggled at some hilariously menial jobs before I became a professional developer!

At one job, all I had to do was make toast on Sundays at a busy diner... the owner and I still laugh about the fact that I still sometimes managed to screw it up!

There is a smart way to do this and not be a complete moron like the author. I take adderall a few times a year and have been doing so since my senior year (2003) in high school and have never come close to this trainwreck. It's a simple approach: know exactly what you have to do before taking it, eat a meal before (since you will have no appetite), take them in the early morning (so you can sleep by night), and finally...don't use them again for at least a few months. Also have water nearby the entire time since it dehydrates you.

Good luck getting that published.

I should also rephrase. It was not nice of me to call the author a "moron" as addiction is difficult. She was/is just ignorant of the power of drugs. I always knew from a young age I would never become addicted to a drug. I'd never allow it to ruin my life which is why I've been able to try many drugs a few times w/o developing a dependence. Except for coffee, I'm total addicted to that stuff.

Yehhh, but... that's exactly what people say to themselves when they start. It won't happen to me because I (insert whatever here). Your brain may start to say different things without you really noticing, or if you do notice, it may seem to make a different sense later. You might want to have more safeguards than just this. An example of one is tell someone you trust what you are doing, talk to them about it, and write down somewhere, that if they tell you to stop you will stop. Even if they have changed. Even if they are a stupid idiot who doesn't understand anything and you don't even know why you were friends with them before etc. etc. etc. Slippery slope is slippery.

I'm pleased that you don't sound like you're having substance addiction issues.

However, I'd recommend revisiting your entire thought process about this stuff the very first time you break one of your rules (like when you take them twice in a month for that one "really exceptional" situation).

It's called a slippery slope rather than a precipitous drop for a reason and people don't get addicted to drugs because they're "not smart".

I actually haven't taken them in over a year. Not too worried about any slippery slope.

abusing unprescribed drugs makes you a "complete moron", but abusing unprescribed drugs in moderation makes you well informed. note taken.

Is it abuse if you use them for performance reasons and moderate it properly? Just because the distributors of the drug say it is abuse doesn't mean it is - they do not get to decide these things.

this is to my point. who then is the arbiter of abuse? OP?

x pills is fine, y pills is fine, z pills makes you a "complete moron".

Well, when your life starts to fall apart at the seams and you start exhibiting any one of the behaviours mentioned in OP's article, that's a pretty good indicator you've reached "complete moron" status.

However I think you're over simplifying the question. Not everyone has the same response to drugs/substances. Some people can do what systematical does without any long term side effects because they simply have the willpower, self awareness, and personality type that allows them to avoid becoming dependent.

Conversely other people would become dependent and turn into complete wrecks almost over night. Similar things can be said for alcohol, or any other "altered stated". It doesn't necessarily mean that the substance itself is the problem, or that all use is "abuse".

It really comes down to knowing yourself, knowing your own limits, and being as well informed as you can be.

Disbelief is correct here. On the other hand we have a developer at work (with a prescription) that takes this stuff almost daily. I couldn't live like that, I enjoy my lunch too much and feeling "normal."

i'm getting abstract here but i think the point i am trying to make is that addiction in any capacity is not enough to qualify someone as a "complete moron".

i considered that this might be overly semantic. but if not definitively incorrect, it is at the very least profoundly tactless.

He never said if they were prescribed or not. He could be prescribed them and simply not taking them for a while. If they were prescribed, you can only have one prescription of 30 day supply filled every 30 days for them (in the United States).

W.H.O. defines S/A as "Substance abuse refers to the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs. Psychoactive substance use can lead to dependence syndrome - a cluster of behavioural, cognitive, and physiological phenomena that develop after repeated substance use and that typically include a strong desire to take the drug, difficulties in controlling its use, persisting in its use despite harmful consequences, a higher priority given to drug use than to other activities and obligations, increased tolerance, and sometimes a physical withdrawal state."

How much are you taking at once that you space it by several months?

1-2 pills at 10mg each. Try and just do one. Usually able to get a solid 8-12 hours of straight work out of them. It's hell on my back and I don't like the side-effects so thats why I limit it like that only taking them when I feel my workload necessitates it.

IR?

What kind of things do you on adderal?

Programming and if I get side tracked a little house cleaning. The trick is not to get side tracked and "crack" out on something that it isn't vital to the task at hand so I can maximize the "high".

IR or ER? How much?

"Romantically I became schizophrenic, smashing hearts on purpose or falling head over heels with a one-night stand, exhibiting neediness that disgusted me — yet I rationalized that becoming a self-loathing depressive could be filed neatly into my persona as a tortured New York artist, material for stories I would surely write someday. The problem was, it stopped being a persona, and became who I was as a person: uninspired, unproductive and miserable."

This sounds like it could just as well be a symptom of New York rather than Adderall. Or being a lawyer in New York rather than Adderall.

As a college student that is constantly surrounded by Adderall and Vyvanse misuse, this hits close to home. I've had a prescription to similar drugs my entire life, and it was in 8th Grade that I realized that I didn't actually need them to function.

The drugs made me unhealthily underweight, constantly antisocial, and easily aggravated. Nowadays when I look at my peers, I see the same things happening to them. Some people take two at one time the night before a big test and don't sleep for days. The worst part is, everybody sees it as normal. Popping an adderall before a test is as common, easy, and normal as opening a beer to relax on a weekend.

People don't realize that the 60mg Vyvanse they are taking casually is an extremely hard drug to take for somebody not fully diagnosed with ADHD.

> People don't realize that the 60mg Vyvanse they are taking casually is an extremely hard drug to take for somebody not fully diagnosed with ADHD.

Are controlled stimulants less harmful to those diagnosed with AD(H)D?

I'm sincerely curious. Anecdotal accounts abound on this particular subject, but I can't recall seeing any specific literature supporting the claim.

The adverse side-effects do not magically go away; however, the benefits are (supposedly) much greater for a person diagnosed with AD(H)D than recreational users. Thus the net gain (benefits - costs) is positive for some people.

This is how I'd put it. I've been diagnosed with adult ADHD and take a moderate to low dose of Adderall under the direction of my doctor. I can easily forgo taking it for weeks, and do so. These "vacations" without it were advised by my doctor to prevent tolerance buildup, and I suspect to diminish the potential for addiction. My dosage has remained constant and I don't feel a "need" for it, so I guess they work. For many of those with ADHD the drug makes a world of difference, and pushes focus and tendency to move around into the "normal" range. For certain activities the (benefits - costs) equation works out, while for others it does not (which is to say certain activities don't appreciably benefit from the quiet mind--the costs are long term and are more difficult to discern). It's about planning to take it for days where it does help, and being mindful of the health ramifications (staying hydrated, eating normal and healthy meals, monitoring cardiac health with support from a doctor, continuing to consult the doctor, etc.).

My biggest fear beyond addiction is that it will be detrimental to my memory and learning in the long term. It's difficult to know if that is true.

The author clearly abused it. Taking it "to socialize" seems weird to me. I suspect the author did not need it in the first place, and was already in the "normal" range. My mentally disorganized self is much more outgoing that the focused version of me. If it is impacting sleep, the dosage is probably too high or too extended (though many MDs prescribe the XR version since ostensibly it has less potential for abuse).

Some of the alternative pharmaceuticals may work about as well, but Adderall has been around for so long that its risks are fairly well understood--though less so with long term use.

Vyvanse is a means to extract more money from patients via patent protection. It's essentially dexedrine with a lysine attached (new side group=new patent). The lysine gets cleaved in vivo, and it becomes dextroamphetamine. Adderall is a mixture of dextro- and levo- handed salts, so it's a bit more nuanced.

Taking it without doctor supervision is a major risk, and taking more than is prescribed or mixing it with other drugs as the author did compounds the risk. The potential for abuse is real.

This is a great question, and I'd love to know the answer as well.

It's an extremely hard drug for anybody, ADHD or no. Adderall / Vyvanse is prescription meth[0] (something I've heard from several of my AD(H)D friends). If the pros outweigh the cons for an individual, great; I wish them the best. But while I can't find the research I remember to back this up, it's looking like long-term medication with amphetamines may be ineffective or harmful.

EDIT [0]: Yes, I know that that prescription meth literally exists under the name Desoxyn, that is not what I mean. See https://news.ycombinator.com/item?id=5321949 and https://news.ycombinator.com/item?id=5321935 .

A few years ago, my doctor encouraged me to stop taking Adderall based on the conventional wisdom that it was likely to cause heart disease. I'll always remember what he said, I only prescribe Adderall for depression in my terminal cancer patients, because I'm not worried as much about their long-term heart health

OK, Doc. Let's not refill that prescription, then.

This conventional wisdom has recently been challenged, but I think there is no great consensus on this issue yet.

http://www.dailyrx.com/adhd-medicines-were-not-linked-seriou...

Oh, the possible negatives I had in mind were brain-related: "diminishing returns" due to tolerance or other factors after long-term use, and adverse side-effects of the drug flooding your brain with seratonin and dopamine over long periods of time (obviously similar to that observed in long-term methamphetamine use).

I see. I wasn't a long-term user and was always extremely conservative with my dosage, so I didn't encounter any of those brain-related issues.

Even with the fact that they are in the same family of drugs, comparisons to long-term meth abusers doesn't seem quite right.

Every person is different, and meth is definitely abused in higher proportions more than prescription adderall — I am not contesting that, or attempting to compare adderall users to meth users.

I am trying to highlight the similarities between the drugs themselves.

Prescription "meth" is just that: meth. Methamphetamine is legal in the US and available under prescription (brand name: Desoxyn). It's scheduled just the same as Adderall -- not that scheduling means much; most of it's science-free political posturing.

Adderall/Vyvanse are amphetamines but not methamphetamine.

It's figurative, not literal. I am very much aware of desoxyn and that adderall is actually composed of four amphetamine salts, none of them literally meth. However, the amphetamine family of drugs have very similar effects — meth is very similar to adderall is very similar to vyvanse.

I don't understand the figurative part. Is that like folks who call oxycodone "legal heroin" or "synthetic heroin"? Is it supposed to sound edgy or provide some sort of shock effect against ignorant people? I don't get it.

I don't describe it like that to "sound edgy" or provide "shock effect." It's just pointing out that these drugs are very similar chemically and biologically, and that people should examine their own biases that divorce adderall (medicine!) from meth (evil drug!) in their minds — they are not so different substances.

However small the chemical difference, there is an enormous practical difference.

Meth can produce an intense high. Adderall, not so much.

I don't have any experience with meth so I can't compare Adderall and meth directly. However, I'd compare the extremely limited "high" from Adderall with... what a person with no caffeine tolerance feels when drinking a medium latte from Starbucks. And, like caffeine, you quickly grow accustomed to Adderall and no longer feel a high from it.

So while it's true that they're chemically similar, and that we shouldn't be demonizing anybody in my opinion, I don't think Adderall and meth are very similar in a practical sense.

While Adderall is obviously misused by some, it is seldom abused in the catastrophic ways that meth is.

I think you're naïve.

Experienced amphetamine users are not able to distinguish the effects of amphetamine (Adderall) and methamphetamine (Desoxyn) in double-blind "taste tests". The main difference is that the effective dosage is different.

It's easy to abuse amphetamine in the catastrophic ways that methamphetamine is abused: you crunch it up and snort it instead of taking a slower-releasing pill, and you take higher dosages than you'd take to focus on your homework.

> However small the chemical difference, there is an enormous practical difference. Meth can produce an intense high. Adderall, not so much.

This just isn't true. Adderall is several amphetamines and the drug definitely produces a high. The medical application of the drug is this rush of dopamine and seratonin allows users to focus and ignore distractions.

The high is an amphetamine high, much like meth, actually. You've noticed that tolerance diminishes these effects; so have many meth users.

There's no rush of serotonin. Amphetamines primarily affect the norepinephrine and dopamine transporters. They can affect serotonin transporters, but only in very high doses. (MDMA, or "pure" Ecstasy, affects primarily serotonin transporters, and has very different effects.)

The ratio of affinity for the dopamine transporter vs. norepinephrine transporter is substantially different between methamphetamine and dextroamphetamine (the principal component of Adderall). While both bind to both, methamphetamine has a stronger relative effect on the dopamine transporter as compared to dextroamphetamine.

The "classic" picture is that the norepinephrine transporter affects dopamine levels in prefrontal cortex and norepinephrine levels throughout the brain, and the dopamine transporter affects dopamine levels in the striatum. Striatal dopamine release is probably important for both the reinforcing effects of the drugs and their effects on motivation. Prefrontal dopamine release is probably important in improving focus. Because dextroamphetamine has a stronger relative effect on the norepinephrine transporter, it causes greater prefrontal dopamine release relative to striatial dopamine release, although both drugs still cause both.

So, the drugs aren't quite the same, and there's a reason Adderall and not methamphetamine is prescribed for ADHD, but you're right that a high enough dose will produce a high in either case. However, the action of the drug that produces the high isn't necessarily the (only) action that has therapeutic actions on ADHD. Atomoxetine (Strattera®), which only affects norepinephrine transporters and is comparatively non-addictive, is also effective against ADHD.

(While I am a neuroscientist, I'm not entirely up to date on the literature here, so take this all with a grain of salt.)

Thanks for going into more depth here. You understand it much more thoroughly than me =).

Your body acclimates itself to just about anything - the weather, sugar, MSG, even frequent shampooing or Chap-Stick usage. That doesn't mean those things are comparable to meth.

Nobody I know feels that Adderall provides much of a high. Anecdotal, sure, but it seems like a heck of a statistical anomaly.

Then again, I don't know anybody that's experimented with unsafe doses of Adderall. I'm sure that at dangerously high doses, the effect isn't unlike meth.

Then again, that's true of just about anything even remotely psychoactive when you talk about large doses. Heck, 500-1000mg of pure caffeine will probably get you meth-like results.

No, large doses of different drugs have very different effects. Massive doses of caffeine will make you anxious, shaky, and give you heart palpitations, but it won't make you have sex all night long or hyperfocus like amphetamine.

The reason large doses of methamphetamine have very similar effects to large doses of amphetamine is not that in large doses, all drugs are similar; it's that methamphetamine is very similar to amphetamine.

> Your body acclimates itself to just about anything - the weather, sugar, MSG, even frequent shampooing or Chap-Stick usage. That doesn't mean those things are comparable to meth.

Yes, of course, tolerance isn't indicative of meth.

> Nobody I know feels that Adderall provides much of a high. Anecdotal, sure, but it seems like a heck of a statistical anomaly.

I would respectively disagree. Yes, typical therapeutic doses of adderall are smaller than typical recreational doses of meth. But that is comparing small apples with bigger apples ;-).

> Then again, I don't know anybody that's experimented with unsafe doses of Adderall. I'm sure that at dangerously high doses, the effect isn't unlike meth.

Or even just at non-dangerously high doses ("normal" meth doses). In other words, if the doses are similar, the effects are similar. You seem to be arguing that because meth is typically consumed at higher doses, it is different.

I agree that typical meth use is very different from typical medical adderall use.

Haha. I'm afraid to look like I'm asking for my own recreational purposes, but what doses would that be?

Again, this is anecdotal and doesn't prove anything, but when I've taken too much Adderall at once I haven't found it very pleasant at all. It wasn't fun and nothing about those dosages made me want to repeat the experience, much less experiment with even higher dosages.

(For me, "too much" would be taking 15mg in a single dose. I know that's not a huge amount in the scheme of things.)

  > I agree that typical meth use is 
  > very different from typical medical adderall use.

I don't mean this rhetorically at all... what do you feel is the reason (or reasons) for this?

  > Haha. I'm afraid to look like I'm asking for my own
  > recreational purposes, but what doses would that be?

GP here (separate work/home accounts). Anecdotally, I get a mild high from 10 mg of dextroamphetamine or adderall, and have experimentally taken as much as 30 mg. But I have zero tolerance; I've taken amphetamines less than ten times in my life.

  > Again, this is anecdotal and doesn't prove anything,
  > but when I've taken too much Adderall at once I haven't
  > found it very pleasant at all. It wasn't fun and nothing 
  > about those dosages made me want to repeat the 
  > experience, much less experiment with even higher 
  > dosages.
  > (For me, "too much" would be taking 15mg in a single 
  > dose. I know that's not a huge amount in the scheme of 
  > things.)

Yeah, at 20-30 mg there are definitely negative side effects; I wouldn't want to do anything social, like the article's author describes, at those doses.

  > > I agree that typical meth use is 
  > > very different from typical medical adderall use.
  >
  > I don't mean this rhetorically at all... what do you 
  > feel is the reason (or reasons) for this?

I think they are introduced to people differently, on average. I think adderall is primarily introduced to people as medicine by some authority figure the person respects (doctor), and they're likely to stick to their prescribed doses. Vs, I think meth is more frequently introduced as a fun energy drug (or advertised as MDMA), with vague dosages, unknown quality and purity, etc. Maybe meth users titrate until they feel good, which means escalating dosages quickly due to tolerance. (I can't speak from personal experience here.)

I think some minority of both adderall and meth users (ab)use the stimulants to try and overcome drowsiness and focus more on their work, like some college students (including article author). I think a fair number of people do this without any bad outcomes (myself included). But a fair number also escalate in response to tolerance, and this kind of use is problematic. Maybe awareness of tolerance, neurobiology, etc, would help? I read a lot of erowid before I ever consumed any drugs, but I also have pretty strong self-control, so I don't know that it would work for everyone.

Anecdotally, I don't even try to use amphetamines for productivity anymore because they don't clear from my system fast enough to avoid interfering with my sleep. I'm more productive for one day (if that), but less productive over a two-day period.

> I don't even try to use amphetamines for productivity anymore because they don't clear from my system fast enough to avoid interfering with my sleep.

Some people have told me that they prefer cocaine to amphetamine specifically for this reason: its metabolic half-life is something like two hours, if I recall. Have you tried using cocaine instead? I'm not sure if the toxic side effects are more or less severe; maybe you know.

(Myself, I stay far, far away from the entire family of stimulants. The most I take is caffeine, and then only in the traditional drink forms, not in pill form.)

I wouldn't want to try and use cocaine to focus. While I've tried it once, I don't like the typical routes of administration, the lack of quality control, and financially, supporting the drug cartels.

The only drug I use regularly is caffeine, also (coffee) =).

Hmm, I think most people who take cocaine just chew coca leaf, which eliminates all three of your concerns. There may not be any people taking cocaine by that route anywhere near you, though.

Yeah, I live in the PNW of the US, not South America. Coca leaves are basically unavailable.

From a former tweaker I know: smoked meth (or even hotrails) is in an entirely different class, but swallowing methamphetamine powder (capped or in a paper "parachute") isn't noticeably different in peak intensity from the 30mg IR adderall pills, but the meth lasts much longer.

Insufflated meth is higher peak than comparable by weight adderall powder (crushed up pills), but just increasing the adderall quantity makes up for that.

> Adderall / Vyvanse is prescription meth (something I've heard from several of my AD(H)D friends).

No, that's Desoxyn[0].

What you may be referring to is that Adderall, methamphetamine, and MDMA have remarkably similar effects, which is true - the active ingredients in all three are metabolized in a similar manner, and the main differences are the means of ingestion, the bioavailability, and set/setting. In methamphetamine, for example, the extra methyl group simply ensures that it can cross the blood-brain barrier more easily, but it doesn't change the actual effect of the drug in itself.

[0]http://www.rxlist.com/desoxyn-drug.htm

> What you may be referring to is that Adderall, methamphetamine, and MDMA have remarkably similar effects, which is true - the active ingredients in all three are metabolized in a similar manner, and the main differences are the means of ingestion, the bioavailability, and set/setting.

Precisely. I'll add a clarifying edit now that two people have interpreted my statement differently than intended..

https://news.ycombinator.com/item?id=5321935

Someone close to me has severe ADD and stopped taking Adderall recently. This person is more productive and organized and even coherent on it. But this has turned out not to be worth A) the way if affects their mood/social interactions, and B) the inevitable Flowers For Algernon "mush-brain" feeling when it wears off in the evening.

I used to take lots of L-Tyrosine and Magnesium supplements to help restore the toll Adderall takes on your body. I was on 30 MG of XR daily and would indeed do the work of 2 or 3 of myself ... but you do pay for it at the end of the day.

Ever wish you could clone yourself? You can. It's called Adderall. I miss it dearly. Moving to Sweden has meant that I can't get it any longer. Heading back to the US in a week to pick up a 5 month supply.

I tried to quit, but to be honest the benefits are simply too great. I often wonder the number of successful people that are on Adderall or similar drugs ... because I genuinely think some of the amazing things people are doing these days are impossible as a "baseline human" ... or I am a severely broken one.

This is a nice post that sums up my thoughts nicely: http://backreaction.blogspot.se/2012/08/erdos-and-amphetamin...

I'm surprised she didn't get Xanax or another benzo to help come off of the stimulants. Using alcohol for that effect seems like a strange choice.

How do people who've taken it for most of their adult life cope with adderall usage? I mean, how necessary of a drug does it seem to be -- or, to put it another way, how bad are the withdrawals, compared to antipsychotics, painkillers, etc?

And if you've lived with adderall usage, do you chronically feel like you have a reduced appetite and all the other kinds of symptoms? I've heard that happens for people who take the drug on an occasional/recreational basis, but I wonder how the side-effects feel for people who are more "on" Adderall than off of it in their normal lives.

You need to qualify your question a bit more. People with ADHD experience it differently than people without ADHD generally.

For me, withdrawals after long term use (continuously taking it for 2-3 weeks or more) are generally over a three day period. The end of the first day you really start feeling it. The second day you will be dragging, all day. The third day is similar to the first. After that, you're back to yourself, more or less.

Short term (day to day) withdrawals are a bit different. The "zombie" effect doesn't really occur until later in the day. It goes down with long term use. Often times, the zombie effect is actually due to a bad sleep schedule versus the drug, at least in my experience. Short term withdrawals are more pronounced in the first 2-3 weeks of taking it.

The apetite thing is true and false. Long term, it goes away a bit. I lost weight the first 5 months, gained it back slowly. It took about a year and a bit of consciousness to normalize.

Withdrawal symptoms are similar if using Adderall XR, except they are over a longer period of time. Adderall XR is much harder to dose right, and leads to much worse sleeping habits IMO.

For it to be effective with my ADHD, I had to take large doses. 40mg/day (instant release) was the minimum, 60 mg the usual. I've taken over 160mg in a two day period more than a few times.

Adderrall gave me headaches though at useful dosages. At first, I realized part of this was because of a decreased apetite, but even after mitigation of that (remembering to eat), I still had them.

I took Adderall over a 4 year period. Experiments with purely non-stimulant medicinces was over about 6 months. The latest combination I've been using for about a year.

"People with ADHD experience it differently than people without ADHD generally."

I generally disagree with this statement. I don't think that the subjective experience of low-dose stimulants is terribly different between people with and without ADHD. I think that those with ADHD are unable or unlikely to reach a similar state of concentration without low-dose stimulants, however.

Yes...I know the "do you really have ADHD?" question is not an easy or clear one. I was more interested in the side effects of continual use of the drug...Nearly all of the media mentions of the drug deal with people who use it periodically or who are prescribed the drug during a significant volatile period in their life (i.e. college).

Of course, selection bias would also indicate that media mentions of Adderall would come from people who've faced drastic side effects. But I've rarely read from people who've taken the drug 20+ years. And I'm interested in not just what happens if you decide to quit...but if you haven't ever quit, what side effects you tolerate day-to-day?

I have taken Adderall now for about a year, and while I have reduced appetite it is not all that bad, I still eat the necessary amount of food, in reality it has been helping me lose weight healthily since I stopped eating while bored ... since I am bored less and can focus on the task at hand. I take 10 mg twice daily.

I can go on and off Adderall with minor issues. The only issue when I go off Adderall for a day or two (they call them holidays, doctor recommended) is that I lose the effects it gives me (ability to focus) and it makes me feel slightly depressed (it helps regulate dopamine). Besides that no ill-effects, and I am aware after going off the Adderall that I will feel slightly depressed.

I've also gone entire weeks to a month without, when I am not required to focus then I can choose not to take it.

Although I do understand where the addictiveness comes in, that feeling of slight depression after going off it can be enough for most people to want to continue taking more, but I don't have an addictive personality (I've been able to start/quit smoking/drinking/soda (sugar/caffeine)/gambling/gaming (WoW) without issues). There are definitely people I know that do have addictive personalities that wouldn't be able to stop themselves.

Without it I simply wouldn't be able to function as well as I do now and I am pretty sure that I would have lost my job. It has given me a way out of the brain fog, a clarity of mind. I feel free from my mind at the end of the day and no longer have trouble falling asleep. I sleep better, much better. I worry less, and am able to prioritize and put less important things to the back of my head to process or deal with another time. With my ADHD that would always be problematic, I wouldn't be able to pay attention in meetings or conversations because I'd be working on two or three other things. I'm more aware when I am not paying attention or elsewhere and am able to voice it, something my friends/colleagues appreciate since it means they don't have to repeat the same thing over and over to me =).

Yes, Adderall gives me an energy boost as well, but it is actually less of an energy boost than from all the coffee and soda I used to drink while I was in college.

I am not saying Adderall is the end all be all drug, I wouldn't even recommend it for most people, I won't sell or give away the drugs I have, not only for the penalties it carries, but also because I know how drugs can be addictive and how those can destroy a person. If I could function properly in society without it, I would drop it in a heartbeat.

Is that 10mg IR or 10mg ER?

10mg b.i.d. isn't a very high dose, which is probably why side effects are relatively low. It certainly sounds like it's helping you.

10 mg instant release.

The extended release (XR) formula would help me for the first half of the day, but after about noon all effects would have worn off. Asked my doctor to change from 20 mg XR to 10 mg twice daily.

And no, it is not a whole lot, and I am trying to keep it that way. As mentioned before, if I could do without it, I would.

If you need to take Adderall daily in order to keep your job, then the job is not for your or your employer is pushing you too much.

(However, I can understand why Adderall is necessary occasionally to meet certain deadlines.)

Why do you presume to know what is/isn't good for me, my ADHD, and my employer with only that what I have written above.

Adderall occasionally wouldn't help me complete the tasks I have to complete. I take it as the doctor has prescribed it to me. I make sure to take breaks from it (and I schedule those with work, so they know that during that week/two weeks I am going to be distracted, have trouble concentrating and it is best to let me be and bite into a hard problem and figure it all out). I have been taking the same dose for a year now, I know its effects, I know how it affects me.

I don't use Adderall as a pick-me-up, or to cram for an exam, I use it as a daily medicine because it helps me do my work. Please don't tell me what I should or shouldn't do, or that my job is not for me. I love the work I do, I enjoy working with the people I work with and learn more than I could have ever imagined. Adderall helps me through the non-exciting parts, it helps me keep focused in design meetings, it helps me keep focused on finishing the last part of the project where there is no challenge left, it helps me be able to think clearly and reason without being distracted by other projects and things I enjoy.

The only reason I think that without Adderall I would have lost my job is that it allowed me to do all those other tasks that were not interesting that still need doing. A worker that can do the hard tasks but leaves projects unfinished is useless. When a worker can't even stay focused long enough on work to be a participant in a meeting regarding new features/design that is a problem, especially when writing new software. I can learn new technologies and pick things up almost instantly, I can see my code, see how things fit together, but once the hard part is done and the rest is just rote coding, my mind goes onto new and better things. Adderall lets me focus on writing good API documentation, it lets me focus on designing the last 10% of a library to be excellent.

I don't know how to explain it to you. You have your notions of Adderall and how it should be used, and I doubt a comment from a fairly faceless person will persuade you one way or another. What I do know is that Adderall has helped me tremendously, and has helped me accomplish things I didn't think I was capable of before.

...or you have moderate to severe ADHD?

I may not be quite who you're looking for, but I think I'm in the ballpark.

I've been taking methylphenidate (ritalin) since I was about 10 years old, though I've recently switched to Vyvanse. This is what I can say about my experience.

I took methylphenidate in two forms, a short acting tablet that lasted for a ~4 hours and a proprietary time release capsule called Concerta that lasted for ~9 hours. As a kid, for the first few years taking it there was a massive difference between me under it's effects and me without it. I totally remember feeling like I could focus on anything I wanted and completely block out everything else. Also, I remember my appetite being hugely affected, where I could ignore eating for quite a while and not really feel affected.

However, as time passed, I noticed two things:

1. The medication didn't affect me as much as it used to.

2. When off the medication, I wasn't as distracted.

In fact, by the time senior year rolled around, I could tell when I was under the effects of the medication, but not by a huge amount.

This August, after a recommendation from my doctor, I switched to Vyvanse instead of Concerta as my long-acting medication. For me, this has actually been very good. It's a much "gentler" effect than what I remember Concerta being like, in that I don't feel like the guy in "Limitless". I feel much more like my "normal" self but with my mind just slightly more organized. I feel like it's the right balance for me.

On the downsides: for me, it's totally impossible to sleep under the effect of any of the medications I've mentioned above. I can't sleep a wink. The author's description of "mind and heart racing" seems pretty accurate, though that only seems to be the case when I actually try to go to sleep. Also, now that I've switched to Vyvanse I am back to having less of an appetite than I used to. Not quite like when I first started on Concerta, but also not "normal."

I took adderall (under the direction of my doctor, naturally) as an adult for around two years. Getting off it had zero side effects or withdrawal symptoms for me, other than the fact that extraordinary focus and concentration were suddenly difficult again.

Same here. I've had ADHD for my entire life, but I seem to be able to just go on and off of it whenever I want and the only side effects is that I no longer have the benefits. In fact, I regularly do just stop taking it for time to time when I need to be more creative rather than more focused.

Myself as well. The only difference is that I have a greater appetite when I'm off it. Considering that I am overweight by just about any metric, that isn't a totally bad side effect, because I don't stop eating, I just don't eat as much when on it.

Same here to a small extent. I find that I am not hungry for lunch when on it. My breakfast / dinner appetite remains the same.

Someone very close to me had been on it since she was 12. She's 23 now and stopped last fall.

Due to her tolerance, she'd been on very high doses for basically a decade.

After stopping, sleeping for 16-18 hours a day was the norm for about a month- but just getting to that point, first she had to cope with a weeklong psychotic break.

It causes some serious dopamine desensitization after extended use. Depression is common among withdrawl symptoms.

Wow. Did she stop taking Adderall abruptly, or did she gradually taper down her dosage?

I find I can easily stop taking it if I taper my dosage. Going "cold turkey," however, is kind of hard to imagine.

It sounds like that person was on a much higher dose than most ADHD patients are prescribed to take.

Did she quit cold turkey, or taper off?

What was her dosage?

Hi, I've taken Adderall responsibly (low-dose instant release, once a day, regularly, under GP direction) for about 5 years. I usually don't take it on the weekend. The 5 years before that, I did the same, except with recreational abuse of much higher doses, and lots of late-night binges. (Hey, I had a lot of college/MMORPG playing/hobby game programing to do.)

I have zero withdrawal symptoms when I stop taking it (as I often do when going out of town, going on vacation, long weekend, etc.) and only have a temporarily reduced appetite (i.e. uninterested in lunch). I don't feel that it currently has any negative impact on my life, whatsoever.

The years where I would stay up for 30 hours programming were a lot of fun, and I definitely don't regret them -- but I do feel that they took a bit of a mental and physical toll. Also, in hindsight, it's easy to see that Adderall benders really sap your creativity. It's nothing to rewrite the same code over and over for 30 hours -- if you'd just gotten some sleep like a normal human you would have quintupled your productivity.

Just another anecdote for you.

Dose: 10 mg each workday morning.

Side effects: Appetite was severely reduced for the first few weeks, but now I eat normally at meal times (though I don't snack the way I did before). Sleep is fine, no head aches. A slightly elevated blood pressure from before, but not worrisome. However, I am starting to watch sodium intake to combat this. My doctor sees no reason for me not to take Adderall long term.

General experience: Much less anxious and stressed than before, when I was always scared of losing my job. The effects described in the article are much exaggerated from my experience, probably due to the quantity she was consuming. More focus has made work much more fascinating, and led to several small side projects. Social life is better, mostly due to better defined work hours and less anxiety.

The author of the article was fairly stupid- the side effects of Adderall are well known and easily searchable, and she clearly abused her (already high dosage) prescription. Some common sense and restraint would have saved her worlds of pain.

I've taken adderall on and off for 7 years, and I'm 27. In my opinion, ADHD is often a fuzzy diagnosis, but I would say that I'm legitimately classified as someone with mild ADHD. Many of my closest friends have also been people with ADHD, and we've talked a lot amongst ourselves over the years about the effects of the drug. I've noticed a lot of patterns, and determined my own set of best practices:

- Take your adderall in the morning. If you take adderall later in the day, it can affect your sleep schedule. If you don't sleep well, you may find yourself wanting to take more adderall to compensate for your lack of sleep the next day, and so begins a snowball effect that inevitably ends with a crash, and a net a loss of productivity.

- Extended release works better for me, and it has much less addictive potential than "instant release."

- Determine your personal minimum effective dose. Don't trust what the doctor happens to prescribe you to be the precisely perfect dose for you. There is most certainly a point of diminishing returns for net productivity gains. Higher doses have higher side effects.

- There are social consequences. If you'll allow me a moment of hippie speak, I'd say that adderall makes your mind resonate at a different frequency than that of regular humans. It's not so easy to establish rapport when you're not even operating on the same frequency.

- Long-term productivity gains for what I'll call production tasks is questionable. For boring work that just needs to get done, suck it up and just do it. Learn the Pomodoro technique, and improve your general capacity to focus by practicing meditation (if you have mild ADHD like me - I can't speak for people who have moderate or severe ADHD).

- Adderall works for me as an excellent tool for expanding production capability. If you have a repetitive business task that you can potentially automate, adderall works very well to help you think through automating it.

Due to the social side effects and my dislike for the inevitable down cycles (end of the day or off days) associated with regular use, I currently limit myself to use once a week. I use it ONLY to organize my week ahead of time, and to increase my production capability (learned this phrasing from Stephen Covey) by automating repetitive tasks. This is the system I've settled on after 7 years of trying different routines.

I could really say a lot more my experience with this drug, but alas I'm not on it right now :) If anyone has more questions I'm happy to follow up.

"How do people who've taken it for most of their adult life cope with adderall usage? I mean, how necessary of a drug does it seem to be -- or, to put it another way, how bad are the withdrawals, compared to antipsychotics, painkillers, etc?"

I'm 36 and I've been taking Adderall approximately since I was 32. So I've lived most of my life without it.

I've never smoked and I've never been on antidepressants or any other psychiatric drugs so I have a limited number of reference points as far as addiction/withdrawal goes. I have had an off-again, on-again caffeine addiction. In my experience, Adderall is significantly less addictive than caffeine.

Quitting Adderall is easy in my experience. I take less on the weekends, and on several occasions I've had no problems tapering my Adderall dosage down to zero over the course of 3-4 days just so I could do a little "reality check" and see for myself if I'm truly better off while taking it.

Adderall is not a medication that really lends itself to abuse in the sense that you want to cram mouthfuls of it into your body or anything.

In some ways, Adderall is very comparable to caffeine -- the first few times you take it, you feel a bit of a rush, but your body acclimates to it rather quickly and you stop feeling it. Unlike caffeine, you don't typically get the same sort of "crash" an hour later.

Though I have pretty poor impulse control at times, I've had no problem moderating Adderall usage. My psychiatrist, after a year or two of developing trust in me, actually prescribes me twice the dosage I need (30mg daily instead of 15mg daily) because he knows it will last me twice as long and therefore I can save myself some insurance co-pays for office visits. :)

I've never been on antidepressants but I've watched friends struggle with getting off of antidepressants, and I've also seen what they're like after missing a few doses. They have found themselves in really rough shape unless they carefully taper their dosages down over the course of weeks or even months. From those secondhand observations, I feel Adderall is not even close to being in that league when it comes to withdrawal.

"And if you've lived with Adderall usage, do you chronically feel like you have a reduced appetite and all the other kinds of symptoms?"

It hasn't affected my appetite much. (I kind of wish it had!) The main negative side effect is that Adderall makes me more high-strung. However, falling behind on one's obligations due to untreated ADHD can also negatively one's mood, to say the very least.

edit: grammar/spelling/formatting

When you take amphetamine every day, you incur a debt that can only be repaid by taking a break. If you don't pay back the debt, you enter the risky business of increasing your dose and dancing with the loan shark that always collects.

So I imagine most chronic amphetamine users like myself have a healthy relationship with it or we'd burn out like the girl in the article which is a rather familiar tale of classic abuse.

Amphetamine side-effects never go away. If you're tolerant of the side-effects, you're tolerant of the very effect you're taking it for. In fact, the side-effects are a good indicator of where you are in a dose. The onset of cotton mouth is what reminds you that it's working.

Even after a month or two of constant amphetamine use, withdrawal for me is at most a week of some scatterbrained lethargy (paying back that debt). The demons of amphetamine are the side-effects and psychological dependency, not the weak withdrawal. Unfortunately you're susceptible to those demons no matter how long you've been prescribed.

Hi Kate,

If you're reading this (and I'd like to think so because Hacker News is no longer a stepchild), 2 things:

1. It sounds like you've turned the corner on this thing. If so, congratulations and best wishes.

Oddly, I just posted my feelings regarding drugs and work earlier today.

http://news.ycombinator.com/item?id=5318320

2. You write very well! I look forward to more. Let us know how to follow you. And keep 'em coming (naturally, of course).

I have the power to conjure energy, intense concentration, motivation, all-nighters, etc all on my own. I call it: stress+goals+pride+enjoyment+intelligence. Sometimes it's a great asset and sometimes it runs me into the ground. In my experience a lot of people are like this (programmers, parents, executives, creatives, lawyers, etc) and we all find our own ways to cope. For me it was a realization of my own body and mind (and that I'm normal) and not buying into someone's diagnosis or someone else's coping strategy.

One of the most reassuring pieces of advice I had during sleepless nights in high school was from an adult who told me he can't sleep a lot and instead of tossing and turning he seizes the moment and works, since that's what he's thinking about anyway. I'm not saying this is healthy advice, I'm saying that he helped me feel normal by letting me in on his coping strategy. Others will tell you they drink tea, or workout, or avoid sugar or caffeine. They all work--for them--and we should take everyone's advice with a grain of salt because we all have very different minds/bodies/lives. I guess the author here found a coping strategy that happened not to work for her, so thank you for sharing.

I'll share my strategy: I take trazodone occasionally as needed to sleep. I let myself get all worked up and be very productive for as long as I think it's healthy for me. Eventually I get on a weird cycle and this corrects it for me. There are all sorts of other things I do but there are so many variables in life, and this is the only one I view as relevant. And who knows, in a few years I might have to try a new strategy.

Everyone's weird and bizarre and has problems. We should stop stigmatizing illness, eccentricities, addiction, medication and start realizing that we're all different and have the potential to be healthy if we find what works for us. Also don't always try to find the root cause and be pragmatic more often.

Also, I should add that I share these details sort of like people do when they admit they're gay. It's not without risk, but I hope someone reading this is helped. And if you think I'm being overly dramatic, this does not apply to you then, because I'm being way underly dramatic.

I remember when I was younger, I could stay up a full 30 hours consistently.

Years later I wondered where that energy went. I thought for a moment that it was a result of aging or some such, until I remembered that at the time I was taking medication for ADD.

It's really not healthy to sit and watch TV that long anyway.

A large part of the blame lays on her.

IMO adderall's mechanism is much more severe on neurons than methylphenidate. It's very well proven that amphetamine/methamphetamine increases the level of free dopamine in the cytosol which are prone to auto-oxidation to quinones. This wreaks all sort of havoc over the long-term.

Methylphenidate(ritalin) and its stereoisomer stay cleanly outside the presynaptic neurons and only blocks NET and DAT from pumping NE and DA back inside the cell. Unlike amphetamine, it doesnt disrupt the pH gradient of the vesicle membrane and cause an abnormal amount of dopamine to leak and accumulate in the cytosol.

Personally, I would never take adderall/vyvanse/dexedrine.

As a counterexample, let me give you my experience. After being prescribed focalin, my gpa shot through the roof. This stuff actually improved my health.

How?

Instead of pulling all nighters and procrastinating like I used to, this stuff allows me to get work done weeks early and go to sleep on time.

I learned calculus in 1 week, bought a piano and taught myself how to play moonlight sonata 1st mvt and kiss the rain in 3 weeks (working on bach air in d major at the moment).

Oh yea, I also read the entire lehninger biochem book and bernard milller's advanced organic chemistry for fun in my own time. Then a whole world of research papers were discovered through the uni library subscription :>

This stuff allows you to learn at an alarming rate if used properly.

I don't drink alcohol on days of studying because it prevents LTM formation, you're basically wasting your time studying if you do this. Also I never waste my time with people while medicated. This stuff can make you socially awkward and kill your sense of humor. Take it only for the singular purpose of learning and getting work done.

I took extra care with my health, ate blueberries, avocado, eggs, brocoli, meat, etc., lots of lycopene, astaxanthin, R-lipoic acid, melatonin and 8 hours of sleep.

Tolerance will go up very slowly with frequent breaks and essentially goes back to zero with a month break. For adderall, this will take much longer, some people will even develop permanent tolerance that will never go away.

On days when I dont take focalin, I sit around, sip on a beer and browse HN ;)

> A large part of the blame lays on her.

I'd say all the blame lays on her.

When you know your gaming a system by either buying a drug from a dealer, using a crooked doctor to write your prescriptions, taking more than your prescribed dosage, and not reading the warning label on the bottle every time you take a dose out of it, its hard to believe that you didn't understand the consequences of what you were doing.

I'm prescribed adderall and your comment dissuades me from taking it 100x more than this article does, even more than the warning label does.

Even if you were exaggerating anything, I found more keywords to research from just the first paragraph than I would get out of 10 of these types of NY Times articles.

Check out Dr.Sulzer's research. A lot of these studies are very hard to understand without some organic chem and biochem background.

Reading the abstract is simply not enough feel the significance of these research.

The other problem is access to these articles through journal subscription is quite expensive.

I always figure that methamphetamine does some long-term damage, but when they found melanin accumulation in the neurons by examining brain slices, it was pretty alarming.

The mechanism of action between amphetamine and methamphetamine is too similar to rule out the possibility of long-term damage.

It just doesn't make sense to take adderall when dexmethylphenidate (focalin) gives most of the benefit without ritalin's side effects.

In the long-term, I'm still quite leery of dexmethylphenidate, particularly how it acts as a releaser at high concentration.

I haven't come across any papers that describe its mechanism of action as a releasing agent.

This is another reason why I only use it to study and practice piano. As long as you're learning, it's easy to justify that the benefit outweigh the cost.

I noticed my tolerance to adderall going up. I did a 4 day juice fast and now I'm a lightweight again.

It's unfortunate the author was not able to manage the drug properly. Adderall is a potent substance that, when used in the correct fashion, can be an effective aid for those who need it. It's also highly addictive so must be combined with a healthy lifestyle and coupled to good habits in order to be kept in check. I would highly recommend that anyone who feels themselves falling into a routine similar to that described seek a therapist as well as focus hard on improving their sleep, diet, and exercise routine.

It's unfortunate the author was not able to manage the drug properly. Adderall is a potent substance that, when used in the correct fashion, can be an effective aid for those who need it.

Uh, I would claim that drug reactions vary considerably from person. To claim Adderall is always bad for someone seems to be untrue but to attack someone for not being able to control their reaction to it or any given drug seems really problematic. You can't tell what ability person X has to control their reaction to substance Y, I'm not arguing this just based on the tautology that you aren't them but on the fairly well demonstrated point that human psycho-physiological reactions have been shown to have considerable variation.

It is a question of who or what is in-control and pretending there's a pat answer to this is evil.

Exactly.

The tone of the article made it seem like the Author was a victim here, when in reality I think this comment sums it up:

>The writer tells us she was "23" when all this happened, as if to say, "Really, I was just a kid." But, really, she wasn't a kid. The brain is quite mature at age 23, but she didn't explore, evidently, the possibility that she was making a mistake.

Denial is a principal aspect of drug addiction. Even if she quits using, it will likely take a long-time for her to fully accept that it was all her fault. Drug addicts will blame every single person but themselves.

Nobody older than thirty looks back and sees themselves as anything but a 'kid' at 23. Brain development or not.

To be honest I think most people consider the change that happens in the latter 20's/early 30's to be 'reaching adulthood'

Ive been taking adderall for a bit over 2 years now, and the important part about taking adderall is that you are supposed to do things like sleep every night, eat food during the day, and drink plenty of water, otherwise your tolerance takes over. This is true for people with adhd as well.

The thing is, if you are taking adderall because it "super charges" you, you are taking it for the wrong reasons. People with adhd (like myself) have to take adderall so that we can compete on a level playing field. There is nothing we can really do to self motivate and study. Without my meds I can not retain the information that I read. Without my meds I cant motivate myself to sit down and program because I cant concentrate and conceptualize the model im trying to write in code.

Adderall can be an invaluable tool for somebody who doesnt stand a chance without it, but it can take control of somebody who doesnt have a good enough reason to maintain self control and moderate their usage. The adhd mindset is a very awkward and uncomfortable feeling. Abusing our medication means we have to go back into that mindset and it sucks, therefore its easier to not let it become a craving addiction.

Also the zombie feeling the kid was talking about, is due to the fact that he is taking too high of a dose. Either that or he would be better off on ritalin or strattera. Each specific case of adhd is somewhat different and the underlying cause may be served by a different treatment due to the difference reactions the drugs have in the brain. (Adderall increases dopamine and prevents it reuptake. Ritalin, just prevents the reuptake, etc).

You can boost productivity for a year or two with Adderall, but over a 10 year period most people will find that they perform better by staying off Adderall and other stimulants.

And we are all in it for the long run, I think.

After taking Adderall (or any stimulant) for long enough, you need the drug just to get to your baseline performance level.

Add onto that the unproductive evenings, crashing on days off the pill, mood swings, likely health repercussions, and the general malaise caused by intentionally inducing your body into flight-or-fight mode.. It adds up to a not-so-pretty picture.

If you want to feel like superman for a while, go for it. As for me, I'll trade short term productivity for low cortisol levels and inner peace.

Any data to back that 10 year claim?

Equating any and all stimulant usage with unproductive evenings, crashing, mood swings, and malaise is pretty exaggerated.

I don't have data, just personal experience and observations of people around me who have used stimulants for prolonged periods of time. Adderall starts off with 10mgs/day, 20, 30, then 40 to get the same productivity.

I was mostly equating adderall use with that list of effects, not less stimulants.

I took adderall for almost a year (under the direction of my GP), for what I thought might be ADD. It actually did almost nothing for me... Except each time we upped the dose, I got really dizzy for a day. Other than that, I felt no better able to concentrate, no better memory. I finally just stopped taking it because it was a pain in the assignment to get it each month, and it wasn't doing anything. The only effects of going off it was that my wife said I was kind of a jerk for a few days.

Going cold turkey off 40 mg of adderall a day and calling it addiction is a slap in the face to people who have dealt with real addiction. As someone who has used Adderall at this level and stopped cold turkey and someone who has also been a heroin addict, stopping adderall cold turkey is a fucking joke compared to heroin addiction. Alcohol addiction also has the potential to be unbearably uncomfortable, not to mention deadly.

The author is a poseur, and doesn't realize how lucky she is.

Has anyone tried Yoga and/or meditation for ADD? I think it might be helpful...I am distracted easily and often. However, I find breathing exercises help me focus.

Yoga and meditation may benefit anyone. There is considerable interest in mindfulness techniques for ADD treatment. Search for 'mindfulness ADHD'.

Yeah, I do these things on my "vacation" days. It helps, but it's hard for me to do it for a long time. Usually I end up walking around after a few minutes.

I never took any amphetamines but I find myself much more focused on weeks I spend at least 10m meditating.

The amount of comments here claiming being diagnosed with ADD and taking pills for it made my head explode. ADD can't be a real condition if suddenly everybody is diagnosed with it, can it? Because if it is, we have an epidemy going on.

"ADD can't be a real condition if suddenly everybody is diagnosed with it, can it?"

Sure it can be a real condition, one that is superficially easier to treat by giving everyone meds rather than admit that the modern "American" society we've created is full of all manner of unnatural stressors that we haven't evolved to deal with.

Yeah, that's what I'm talking about. The amount of people being prescribed meds made me scared. I'm from Brazil, and I almost never hear about ADD, let alone about Adderal.

Bias. Many of those who discuss in this thread do because they actually know something.

(Thid is still HN)

It might help to think of it like a spectrum.

Naturally, everybody struggles with focus at times. Some more than others. One one end of the spectrum you have people who rarely struggle with focus, and on the other end you have people that struggle with it so much that it begins to cause them problems.

So it's less an sudden epidemic than a growing recognition that this is an issue that many people struggle with, and that people struggling with it can really benefit from treatment.

That treatment can include medication, though it doesn't have to. My personal experience is that proper sleep, diet, exercise, and environment are super-important as well.

Yes, it's perhaps over-diagnosed/mis-diagnosed. Yes, some people probably use an ADHD diagnosis as a crutch or excuse.

However, surely you can agree that focus is an issue that many people clearly struggle with, can't you?

They also have far more to say about the issue than people without ADD.

Its a good article and I am glad she feels better however what do expect when you abuse a powerful medication and drink every night.

"The mix of whiskey rocks and a pocket of pills was a potent one. I was now getting high seven nights a week, every night a delicate balancing act".

Since she kicked the "pills" she now should kick the whiskey before that gets out of control. The title should probably read "Substance Addiction:The Last All-Nighter".

I would bet that without all the energy that Adderall gave her, she no longer has the energy to go drinking with friends 7 nights a week.

I have dealt Adderall addiction although in a way most likely different than most. In my college years I was on tons of medications ranging from mood stabilizers to anti-psychotics, all in all, I was on 8 different medications to treat psychological issues I was having. Now those 8 medicines combined to deliver a mighty powerful punch which made me sleepy all of the time and made it very hard for me to wake up. The psychiatrist's solution was Adderall.

In the beginning, it was great. I would set my alarm for 4 hours before I had to wake up and take an Adderall that I had next to my bed and I'd be awake. It was amazing being able to get to my classes on time. At the same time, if I got 4 hours of sleep I felt refreshed as if I had 8 to 12 hours.

Things started slipping once I was taken off my medications. All of a sudden I didn't need the Adderall but I was addicted to being able stay up late. I never used it recreationally or to be more productive, I was just hooked on not needing sleep and it was great. I took a few months of re-adjusting but I was finally able to get back to sleeping normally but it was still hard for awhile. Why sleep for 6 hours and be tired when I could sleep for 2 less and pop an Adderall and not be tired at all.

There are many reports here of people who've taken Adderal without significant issues, suggesting the key is "active medical supervision" (ie, much more than the passive doc just handing Kate Miller pills).

In fact, once we have monitoring in place, you might even argue "intelligence doping" could provide such benefits to society that we should even encourage it (though only for those who face minimal side effects):

http://www.becker-posner-blog.com/2008/03/intelligence-dopin...

These kinds of articles are often used to delegitimize ADHD as a genuine condition: it actually can be. People can take Adderall for genuine conditions and see improvement.

When it comes to the actual diagnosis of ADHD...that's where it gets interesting. Is everyone on an attention spectrum, and ADHD individuals are simply at one extreme? Or is there something completely different about these individuals that can be a single defining marker?

The general understanding is that ADHD is characterized by a spectrum of attention deficit to an extreme.

The process of diagnosis usually involves a self-questionnaire. In my case I somehow managed to fail the questionnaire and the psychologist performed an IQ test.

The IQ test is analyzed to see if you have a processing speed subscore that is significantly lower than your other subscores (all subscores should be roughly equal).

I've never met someone who was diagnosed with ADHD since their early years. It's always people like the one in this article. I have a few questions to ask people who have used amphetamines while exercising (cross training, cardio), having sex, meditating, or anything that raises your heart rate. How does it feel? Does it feel like running on an empty stomach on a Monday morning after having slept only 3 hours?

Methylphenidate (Ritalin) and the amphetamines do wonders for physical work. You feel fantastic and capable. Amphetamines in particular provide a bit of a euphoric boost. In general, amphetamines are going to make you feel pretty damn good, although coming down might be unpleasant sometimes.

I have to caution people to not do exert themselves, as they figure out that they can go workout at the gym like mad. I'm not sure it's healthy to work out while on stimulants.

Ugh, I have hated Methylphenidate, it was really close to ruining my life. It made me feel angry and depressed. I hated the world and every single moment after taking it for some time. Even off of it I felt it semi-permanently affected my brain.

I gave Adderral a shot, but again it is quite an unstable drug. Mostly because of it's a Dopamine Uptake Inhibitor. And that usually causes unstable Dopamine levels, meaning less stable mood and thinking.

I fortunately found a Doctor that prescribed new age of ADHD medication. Although it is not for the weary. Atomoxetine(Strattera) is much more stable, and much more powerful drug. It doesn't have tolerance issues like typical drugs. It is a norepinephrine reuptake inhibitor, meaning it enhances the neurotransmitter that's a precursor to all other neurotransmitters including Dopamine. This means all your neurotransmitters become enhanced.

Now I say it's a drug not for weary minded, because it's actually very hard to adjust to it. For the first month you have to take 20mg increments every week to get your body to adjust to it. At first it makes your incredibly sleepy(can't even stay awake at any time), but that quickly fades and your realize that sleep is much easier to schedule when you can get the brain to feel sleepy(Needed for someone with ADHD).

It also is tough on your liver, unless you eat a decent sized meal you will most definitely vomit bile from your Liver(I know I have seen it enough). It gives your incredible nausea and will eliminate your appetite to the point where it hurts to eat.

I have found that combining it with Marijuanna to be advantageous. Both drugs complement each other(one to counteract nausea and trigger hunger, the other to enhance the high you get.

It's one of those drugs that doesn't make your ADHD disappear, but let you take control of it. But it really is miles ahead of anything, and has changed my life completely. I have been using it for a year, and the flood gates are off. Unfortunately I still struggle with a lot of things, but now I have the ability to correct those learning weakness because I can concentrate.

I tried switching to Strattera and ended up with some serious sexual dysfunctions and nearly lost my job (at a company I founded!) because I had to wait two months before I could say for certain that it didn't work for me. So buyer beware.

From what you said atomoxetine is a new age sleeping drug. Not a focusing ADHD drug.

Atomoxetine has different effects in different parts of the brain. In the motivational centers it promotes a sense of tiredness, which tends to wear off after several weeks. In the frontal lobes it increases the action of dopamine, promoting focus and persistence.

The proficiency exchange isn't worth it with those side effects.

I've associated Ritalin with a negative connotation until a few weeks ago when I saw what it can do. I haven't tried adderral yet but I'm guessing it makes you feel synthetic. Like a robot who just learned how to use it's reserved cores. It's not natural but I feel like someone should measure their heart rate when doing the activities I said while high on amphetamines. How would one feel?

I was told monitoring heart rate and blood pressure is standard for a patient newly prescribed it.

That sounds like a drag for the patient to update their statistics. Did they tell you if they have to drive to the doctor's weekly? I doubt it though because people don't get into the specifics on stuff like this. I can't imagine someone normally saying, yeah um, I was prescribed adderral the other day and they gave me this device that measures my heart rate-- so far I'm doing fine. Etc. Now I'm interested if it's done online or not, what device is it. Taking adderral means you don't have much time on things like reporting back to your doctor. So I'm curious, has anybody been given a device after being prescribed adderral, anybody?

If there is a euphoric boost it sounds like the dose is much higher than would be indicated for ADHD. Slight modulation of mood maybe, but euphoria speaks of abuse.

On the days that I workout in the morning I skip the first dosage.

You need to be very consciously aware of yourself, because it can be easy to forget about yourself. Buy a sphygmomanometer if you don't already have one so that you can regularly keep an eye on your blood pressure. Make certain that you are eating and drinking regularly. Finally, make sure that you are getting enough sleep.

NEVER take more then the prescribed amount; regardless of whether the medication is working or not. Certain foods can dampen the strength of the medication; particularly foods with citrus. The common tendency that I have seen, is to take another dosage because of the perceived lack of effect. This might just be the single most significant reason why people spiral out of control. Regardless of how they feel or perform, the medication is in their system, and by adding another dosage, will cause their tolerance to rise. The rise in tolerance will only make it that much more likely that person will experience the same scenario in the near future.

Interesting article on the subject of abuse. It would be more interesting to find out who the doctor was and if this woman ever received a proper clinical evaluation or a genome sequence. It seems pretty clear that she was improperly prescribed Adderall. Though they are cracking down on it much harder these days due to misdiagnosis and parents who do go pay "expensive upper east side doctors" so their kids can ace their SAT exams.

It really is sad.

I've been taking the extended release version for over a year now and without it I would be an unproductive wreck. I went through a full clinical eval by a neuropsychologist, and had my genome sequenced to verify that I had the specific mutations that are thought to be responsible for ADHD.

For me it has been life changing to say the least. I grew up in NYC and would take the uptown train when I was supposed to take the downtown train twice a week at minimum, I wouldn't realize this had happened until I would end up in the Bronx or somewhere the train exited the tunnel and allowed light to come through the windows and bring me back to reality. I would make these errors due to my brain being off thinking about computers, robots, books, particle physics, food, girls, music, manga, etc ... rapidly shifting from one idea to the next, never completely finishing a single thought.

It was hard for me to read. To finish projects. And I never had a job and instead chose to start my own companies.

I don't quite believe the exercise hype - I was a division I athlete during my undergrad years, and worked out harder and longer than 99% of the human population during that time - and I still had difficulty.

I decided to get help after my first year of my master. I was getting frustrated, unable to complete projects to my liking/standard, and staying up far later and working far longer to complete anything than many of my peers - and having just finished designing digital products for one of the top design firms in the world (really my first true foray into corporate America), while having trouble sitting down during meetings, and only hearing every third word that came out of my colleagues mouths, was beginning to freak me out.

so i went in. And worked through the process. I was diagnosed and confirmed and my life completely changed. Although I had a difficult time with my family (asian) who looked at me differently and refuse to this day, to talk about my condition. The pluses still out-weigh the minuses.

Adderall doesn't excite me. It calms me down. I can even sleep better since my mind is not racing 10000 miles per hour. I'm doing the best work of my life these days and couldn't be happier as I finish up my master thesis. (something i cannot imagine being possible had I not talked to someone and gotten help). I have no side-effects, and just feel "normal" when I'm taking it. And I am closely monitored by my physicians, all of whom have my best interests in mind. Sadly, this sort of support and knowledgeable/honest care is not easy to find.

I think stories like these are both helpful and harmful. Helpful at exposing the blatant misuse and misdiagnosis, and also harmful because it shows people that it's still possible to find doctor's who don't give a shit about you and will just prescribe whatever you ask for. I have people who ask me for the drug, of course, I don't hand it out for $5 or whatever because it actually helps me and doesn't turn me into some sort of incredible hulk super human like the author or other abusers. Patients and doctors should be more responsible b/c if you don't really had ADHD, then this stuff will mess you up ...

and i have no idea how to end this brain dump because well, it 2am and i'm sleepy and i have ADHD, I won't take my prescribed dose until 9am, and i have to talk about the healthcare system during my preliminary thesis defense tomorrow ... so ya ... later

> I think stories like these are both helpful and harmful.

These things worry me too. For those of us that Adderall genuinely helps, what do we do if some scaremongers make it (and similar stimulants) inaccessible to us? Crap. I did the math on it once and it turns out it's cheaper to make your own meth lab than continue to buy for the rest of your life. Plus, if things go south, you always have yourself covered.

The US refuses to admit that the real drug problem are prescriptions. The effects of prolonged adderall usage have not been studied and I can't imagine how it interacts with other medications.

It's a schedule II narcotic with a high similar to cocaine. Keep your kids off of it.

I realize you're probably trolling, but just in case..

The 'high' of adderall is not even remotely similar to cocaine.

Cocaine and amphetamine result in the same flood of the same neurotransmitters. Cocaine has no surprises for anyone that's ever been cracked out on instant release speed. Except maybe making them go "...is this it?"

Lots of overlap between the two, especially when comparing pharmacophores. For instance, the peptide transcript called the "cocaine- and amphetamine-regulated transcript (CART)"[1] might be a good example.

Not to say that you personally haven't had different experiences with the substances. There's just substantial chemical/physiological overlap between the substances while there's much less demographic/prescription/intended-effect overlap.

[1]: http://en.wikipedia.org/wiki/Cocaine_and_amphetamine_regulat...

I have had substantial experience with both of them, and while the effect is similar, the feeling is not. In my experience, cocaine has a stronger euphoric component than d-amp. Adderall makes me logical and emotionally detached, while cocaine makes me feel like I'm on top of the world.

I think the reason for using the substance could be coloring my opinion of the experience, since I use adderall to get work done, and when I use cocaine (not often, maybe once or twice a year. I did a decent amount of blow when I was doing opiates heavily), it's almost always in a social setting.

I will grant that the pharmacological effects are very similar.

You haven't tried them both then. Adderall is just like cocaine, except longer lasting and smoother. I've tried both more than a few times.

This kinda reminds me of that movie, 'Limitless'.

To others in similar situation, either considering it or on it, or just taking some other stimulant like caffeine, or are just tired all the time:

* If you have ADD and it is working for you and you are happy, ignore this shit and do what you need to do.

* If you have ADD and take it, but you don't like how you feel while you are on it, talk to your doc and have him/her help wean you off of it or find a different dose or med.

* If you are fat or not but don't get enough exercise, please get exercise and stop eating fast food and drinking any kind of soda (diet is just as bad). I am overweight now and have been normal weight before when I've exercised regularly and it made a big difference both cognitively and with energy, etc. I need to do that again. I learned the hard way not to diet though. It worked but it is true what they say; you gain it back +10 lbs (or more).

* Replace soda with coffee or tea, even if you hate them. I really hated them. I feel much better not drinking diet sodas constantly. Try to eliminate caffeine if you can.

* Try eliminating/limiting aluminum (drinking from cans, using hair products with aluminum, etc.). (May be unnecessary, but lower your Alzheimer's risk.)

* Try taking daily vitamins (Centrum, etc.), Fish/cod oil pills. Consider taking a baby aspirin each day if you are 40+. Don't overdose on daily recommended intake, even when sick! Some things can be really bad. Don't overdose on ginko, etc. either!

* There is nothing wrong with wanting to be your best, but you'll be your best when you aren't cheating and hurting yourself, and that is as good as you need to be. Even if you think you will get shot or people will die if you don't take stimulants, you can stop and it will be better- for everyone.

* Talk to an ENT about sleep apnea. Losing weight is key no matter what, maybe stop drinking water and eating before bedtime, and no blue light or monitors or T.V. for a few hours before your 8-9 hours sleep. But after you do all that, if you snore or don't dream regularly and feel like crap and hate your job, get help.

If you are like me, you have done a lot of this because you think you deserve it. I feel on a regular basis like I don't deserve to have what I have and that I'm a failure. In many ways, I am a failure; but mostly because I'm doing it to myself. I eat too much. I don't exercise. I hate my job. I think I should die. I feel like I need the food so my brain won't get distracted by being hungry. I feel like I don't have time to exercise. I feel like it is my fault that I hate my job. But, all that is crap. I need to take care of myself, and so do you! Just go on a short walk tomorrow, and the next day, and the next. Eat 1/2 as much as normal if you eat too much. Drink less caffeine. Talk to your doc about changing your meds or anything at all that you're worried about. Get a hobby and get outside more. Make friends that do healthy things. Get a job where you can live healthier and work a normal workweek.

This made me sick. I don't know what's worst: the author's self-absorption, the victimization tone, or the fact that her colleagues had to do similar unhealthy shit in order to compete with her. It stinks the whole way.

Using drugs to gain an unfair advantage over other people at work has unhealthy emotional side effects? Am I to be surprised by this?

> the fact that her colleagues had to do similar unhealthy shit in order to compete with her

You are asserting that the law firm's long working hours were caused by her med use. Do you think you might have that backwards?

> the author's self-absorption, the victimization tone

She had a substance abuse problem. She's warning others that it's a slippery slope. Show some compassion.

> You are asserting that the law firm's long working hours were caused by her med use. Do you think you might have that backwards?

It probably becomes a vicious cycle / race to the bottom. You take more drugs to work longer hours and compete with your colleagues, who start taking more drugs so they can work more hours to have the edge over you...

The long working hours of many law firms existed before the widespread availability of adderall. Drugs have absolutely zero to do with it. They are merely a symptom of the underlying workaholic culture.

I had a friend whose grandfather was a hot shot lawyer at one of the largest international firms of his day in the 60s/70s/80s. She told me that he was a speed addict for close to 20 years. Long story short he got into a situation where he had to quit cold turkey and did, successfully.

Substance abuse to get ahead is nothing new. Drugs are not as new as we pretend they are, and it's been common practice to abuse them for personal gain probably as long as they've been around.

I've worked for a couple of the bigger law firms in the UK and I've never come across drug use (of this type).

Drugs may enable and perpetuate this behaviour today, at least in some countries, but I don't think there's much of a case that they caused it. At least if they did it arose in places like the UK without that assistance.

From my experience the root is far simpler - greed. They dangle the possibility of partnership with all it's attendant wealth and status in front of the bright young things and watch them scrap it out and burn out. I have a friend who made partner with one of the magic circle firms and while the rewards are amazing, I wouldn't swap his life for mine in a million years.

They dangle the possibility of partnership with all it's attendant wealth and status in front of the bright young things and watch them scrap it out and burn out.

It used to be that about 5% didn't make partner. It was like getting fired-- in the 1970s, when that itself was rare. It was harder to get an associate position, but once you were in, you were solid. Also, work hours were not at the extreme that they are now.

Now, instead of 5% not making partner, it's about 5% who make partner.

That's because some really evil, greedy fucks got in charge and realized they could replace partnerships with overworked, churn-and-burn associates.

> That's because some really evil, greedy fucks got in charge and realized they could replace partnerships with overworked, churn-and-burn associates.

Or could it be that there are way too many lawyers being produced every year and the realities of a highly competitive market have set in?

http://flustercucked.blogspot.com/2010/07/40-years-of-lawyer...

You're right that the number who make partner has shrunk massively (and the competitiveness goes further in that being a partner is no longer as secure as it was - several of the large firms have ousted partners which would previously have been almost unheard of).

The upside (at least for those competing) is that many who don't make partner will still go on to secure corporate lawyer jobs earning six figures...

This is a scale error.

The industrial revolution was a shift in the curve. You could successfully argue that automation to get ahead is nothing new, but it would miss the importance of the scale of the new changes.

Adderal and its ilk are a similar shift in the curve. People with access used to be people rich enough to afford speed.

Now almost all school kids are entering the work force and know someone or have themselves used performance enhancers.

Can you be more specific about the time frame you're thinking about? Adderall has been widely available since the 1940s.

Cocaine and speed were abused by high powered professions for decades.

Are you asserting that the main reason people work long hours is because of performance enhancing drugs? And if you're not asserting that, what are you asserting?

I'm asserting that trying to extract causation from these scenarios is often not productive. One outcome didn't lead to another; feedback was almost certainly involved.

>She had a substance abuse problem

This is true. However, a lot of people will take away the message 'stay off adderall' whereas

(1) some people apparently benefit from it, (2) some people whom doctors wouldn't prescribe to may benefit (e.g. the mathematician Paul Erdös took ritalin, a similar drug), (3) all people who abuse drugs do so because of personality problems -- thus if she hadn't taken adderall then she may well have gotten into some other drug or obsession leading to some other addiction or disorder

She isn't saying that people should stay off adderall, she is saying that people should be careful and not think of it as something totally harmless and risk-free. Obviously adderall can be very useful both on- and off-label, but that doesn't mean it can't be harmful too.

And saying that "all people who abuse drugs do so because of personality problems" is obviously quite ignorant. Genetical factors are often important of course, no doubt about it, but to suggest that everyone physically addicted to really addictive substances do it purely because of personality problems, and not the addictiveness of the drugs, is really strange.

You seem to think that being addicted is a simple choice. That might be true for psychological addictions (although I doubt it), but it is certainly not true for physical addictions.

>She isn't saying that people should stay off adderall

Indeed.

>And saying that "all people who abuse drugs do so because of personality problems" is obviously quite ignorant

Nah. The truth in this whole drugs business is far from obvious. Check out Gabor Maté on youtube, he has some interesting things to say. Apart from that, perhaps when we have a theory of consciousness we will be able to re-frame mental disorders as disorders of consciousness.

Meanwhile 'addiction' and 'abuse' are problems -- are you saying they're not to do with personality? Some people do talk about genes in this context, but they have no explanatory theory connecting genes to specific mental traits, so I think they're mistaken. And, if they did, those genes would then be part of the personality

>You seem to think that being addicted is a simple choice

No, I think addictions are a form of unconscious behaviour, so not a matter of choice, although the cure might entail making a choice

You are asserting that the law firm's long working hours were caused by her med use.

Her drug abuse, obviously not. Drug abuse by young professionals? Yes.

The cocaine boom and the increase in law firm hours (from about 40 to about 60) both happened at the same time: the 1980s.

Dude, have some compassion. It's upsetting that this is the top voted comment. Not everyone is as well-informed and knowledgeable about things like this as you are, and this first-hand account of her experience will likely help a lot of people experiencing similar issues.

>>Using drugs to gain an unfair advantage over other people at work has unhealthy emotional side effects? Am I to be suprised by this?

Your claim that this stimulant gives its users/abusers/misusers an "unfair advantage" over those who don't use it (ie you) not only contradicts your following statement (that it causes emotional side effects) but also tells me that perhaps you're angered or upset by this perceived 'unfair advantage' you see this drug giving your peers.

If you looked at the big picture, or her story, you'd see that the drug doesn't, in fact, give its abusers an unfair advantage. Whatever temporary 'gain' they are getting is unsustainable and clearly destructive both emotionally and physically.

First of all, the two are not mutually exclusive. She explicitly states that she was better able to perform at work and experienced a better social life, but also faced emotional problems.

To the second point, he probably is. This is to be expected. There is very little reason to by sympathetic to someone who abuses prescription drugs in order to achieve success in school or outlast their peers in the working world. The fact that she decried her plight makes it all the more irksome: before she was a "victim," she consciously chose to abuse these drugs, then lied to her physician and continued taking them for months...

Tone it down. This is a sober (heh) account of a young woman finding herself in a place she thought she'd never be, not a personal ad.

No, tone it up instead.

From the comments on that article:

My 3rd grade granddaughter has been put on adderall for ADD. This is really scary.

It's because of people like her and her self-absorbed, nugatory account of her experiences being featured on a high-profile news journal that we drift into a world where mention of ADHD medicine usage gets you the eye-roll 'wow you druggie' judgement. She's doing a tremendous disservice to individuals actually diagnosed with ADHD.

As an individual who was actually diagnosed with ADHD, I have an axe to grind with a medical industry that sold me amphetamines at 15. The results were ~nugatory~ at best.

As an individual who was diagnosed with ADHD, but whose parents refused to acquire medicine based on superstitious 'but isn't adderall just basically cocaine?' grounds, I assure you I've got an axe about 3,000x bigger than yours to grind at individuals like those who wrote this NYTimes article.

I'm sorry to hear that you were diagnosed by an incompetent psychiatric physician, but I would hope you don't use your misfortune as fuel for spreading superstitious, anti-science anti-ADHD-medicine hysteria, there's enough of that out there already.

While this is an op-ed being run by a web tabloid, there's no superstition or anti-science on display that I can sense.

So let's find some quieter common ground:

A class of prescription psychoactive drugs are increasingly being used by tens of millions. They substantially alter the motivation systems of the human brain, have a poorly understood method of action, are extremely easily and inexpensively sourced from the graymarket, and are being issued to children as young as five. Off-label use is increasing to the point where it's omnipresent in high-pressure social arenas.

There are no social rituals or consumption contexts that retard use of these amphetamines - they're privately consumed as "medication" (therefore perceived as "undangerous" and "acceptable") in a way that street drugs would never be considered.

But the results are the same. They're the same for ADHD folks, they're the same for non-ADHD folks, they're the same for the habitual user, and they're the same for the occasional user. Ferocious forever focus! ...for a while... with a comedown. And then: more?

The end-game for every single one of these users is potentially the same. Five years old with ADHD, 24 years old trying to make it in NYC, whatever. It's habit forming, excessive use comes with a boatload of major side effects, and it's directly monkeying with a core part of the human psyche for a sprawling number of reasons, all of them social in nature.

We're doing something new and big here as a society, and it's worth discussing.

> have a poorly understood method of action

Where did you get this from? Using psychostimulants to treat ADHD is one of the most researched treatments in psychiatry. We've been prescribing Adderall for almost 100 years now. We know it works, and it works well when prescribed correctly.

Either way, if you want drugs to get up in arms about, better choices are SSRIs and atypical antipsychotics. Those are the drugs with poorly understood mechanisms of action that are given to way too many people.

Using amphetamines to treat depression has a longer/safer history than using SSRIs for depression, too.

  > But the results are the same. They're 
  > the same for ADHD folks, they're the 
  > same for non-ADHD folks...

It's certainly worth talking about, but I'm not at all sure that's true. Our understanding of Adderall's mechanism is incomplete but our current understanding is that, in those with ADHD, appropriate doses of stimulants can boost some functions to where it would be in a non-ADHD brain.

It's kind of like saying that platform shoes make everybody taller. Yes, they do, but some people need platform shoes just to reach an "average" height.

Does it truly affect people with ADHD differently than someone without? My understand is that this is a misconception...

Drugs like Adderall tend to increase Dopamine and Norepinepherine. The idea being that people with ADHD tend to not have enough of these chemicals. When they take drugs like Adderall, they feel better. If they take too much, or someone who already has enough of these chemicals takes them, they tend to become irritable and have trouble sleeping.

There really is a huge difference.

For someone with ADHD, a single Adderall isn't going to make them stay up all night. It isn't going to cause them to stop eating. There is no "razor sharp infinite focus".

Instead, it just brings things up to normal. Rather than being unable to even have a chance to focus, the possibility now exists.

Well, it's probably safe to assume that at least some of the effects are the same for ADHD and non-ADHD users. Stimulants affect pretty much the whole brain; probably much more of the brain than merely the part(s) that differ between those with ADHD and those without ADHD.

(To be clear, I'm not a medical professional)

pretty clear you haven't the faintest idea that amphetamines are among the most well researched drugs on the planet.

>anti-science

Is debate allowed about in science anymore? It seems that everyone who disagrees with the status quo is branded as anti-science, therefore destroying all chances for a constructive discussion.

In the context of the comment, anti-science was correctly used. There was nothing scientific about it.

> Is debate allowed about in science anymore?

Of the type we are discussing? It's never been allowed. It's always been discouraged. You can see similar types of debates when people talk about teaching the controversy.

In fact, science is not about debate. It's about presenting facts in support of an argument. Merely arguing is pointless.

"In fact, science is not about debate. It's about presenting facts in support of an argument. Merely arguing is pointless."

What science "is" is a subjective opinion, and there are many different claims what science really is. In my opinion debate is important to science. In addition, 'presenting facts in support of an argument' is debating in my opinion.

Pedantic comments like this are worthless. You know what I meant. And rather than discuss that meaning, you decided to take a trip on anal train.

Anyways, I'm not about to explain why allowing holocaust denialists equal time is a silly proposition.

Huff! Puff! That's antilogic because I disagree! /s

I've always seen debate as the fundamental principle of advancing science (and have no idea what Popper may think on the subject).

So because you had a bad experience, no one else can share their bad experiences if those experiences somehow conflict with yours? You sound like a cry baby.

This woman shared her negative experiences related to abusing Adderall. Note that she was never even really diagnosed with ADHD (and she makes mention of this fact). This is clearly an essay about the dangers of addiction and substance abuse, not about the dangers of Adderall. Perhaps secondary themes might be the disturbing "performance at all costs" attitude found in many workplaces and the ease with which legal drugs can be obtained without proper diagnosis.

These are real problems for society. The fact that the illiterate take the wrong message from something doesn't mean that it shouldn't be published.

your parents did you a favor. this is a diagnosis which is politically motivated. here's an example: http://en.wikipedia.org/wiki/Drapetomania

What does this have to do with the OP and ADHD?

Many critics of institutional psychiatry hold that the construct of mental illness is often used to medicalize nonpathological behavior that doesn't meet social norms, putting a scientific stamp of approval on judgements regarding human behavior, morals, and ethics.

Given the uncertain pathophysiology of ADHD, the degree to which symptoms resemble moral judgements, the dramatic increase in diagnosis following advocacy in the psychiatric community, and questionable improvement of long-term outcomes for patients treated with medication, ADHD is seen by them as a good example of this point of view. I assume that's what he was alluding to.

very well said

meh, I am in a similar situation, and have mixed feelings. My parents were for it, but I was against it (because of the values my parents instilled in me... I'm pretty shocked they thought it was acceptable... but I think they were really scared that I was going to be a failure. I mean, I was a failure, at school.)

Anyhow, I'm only the second person in my extended family to not have gone to college. If I performed in school how I perform now (when I am medicated) I would have done very well in high school, I would have gone to college, and I probably would have done pretty okay.

But, then I would have graduated to the work force in 2001-2002 rather than in 1997.

do you see the problem here?

in 1997, I was able to get a programming job, essentially on enthusiasm. In 2001-2002? I would have spent considerable time unemployed, even with a degree.

(of course, that was just pure luck)

But yeah. I'm glad that the crutch is available to me now.

Well by your own admission and logic its essentially a fluke that things worked out for you.

If you were born 2-3 years later you would have been writing a thoroughly different comment.

As a matter of fact, there is very likely someone who made a similar choice like you, only his time line was shifted forward a few years.

His outcomes would be remarkably worse than yours. Not only would he have never gone to college, he would also have an non-competitive start in a tough environment.

>As a matter of fact, there is very likely someone who made a similar choice like you, only his time line was shifted forward a few years.

Oh yeah, that guy worked for me for a short period of time. He got a better job (first at hostgator, then at some fairly well-known generic-sounding consulting house) very shortly afterwards. He mostly just needed /something/ to put on the resume so people didn't give him shit about the empty years.

But yea, random chance is absolutely huge, and I got lucky.

>His outcomes would be remarkably worse than yours. Not only would he have never gone to college, he would also have an non-competitive start in a tough environment.

College isn't one of those 'once in a lifetime' chances; I mean, unless you have parents or something that are willing to pay for it out of high school but not willing to pay for it a few years later, you /can/ go back a few years later. I think it's pretty destructive that the choice is presented to 17 year olds as "go to college now, or suffer forever because you did not!"

Really, if I had to do my life over with what I know now? I would have spent much of the .com crash trying to go to college. I dono if I would have done very well, but I was much better equipped then than I was right out of high school. (well, that, or staying at MAPS. I don't know if I could have handled it, but if I could have, I would have been a thousand times better off than I was hiding out where I did.)

I mean, my main takaway there? even authority figures that genuinely care about and want to do right by you often give bad advice. Your life gets vastly better once you gain self-determinism.

Uh yeah,

I am seriously surprised at HN seeing the comments here.

I didn't like the article either. The whole thing struck me as melodramatic and narcissistic.

Perhaps there are intelligent commentaries to be written about this culture's abuse of Adderall, but this is not one of them.

> The whole thing struck me as melodramatic and narcissistic.

She's a young aspiring writer living in New York City, as well as a UCLA grad... shouldn't be a surprise...

"She's a young aspiring writer living"

Which makes you wonder what parts are true in the story and what parts are enhanced for dramatic effect.

http://en.wikipedia.org/wiki/James_Frey

NYT also has a similar piece weekly called "Modern Love" typically by a writer with a screwed up love life that sometimes seems stranger than fiction.

That's a bit ad hominem, no?

Before posting this I took a look at your comment history to make sure I wasn't feeding a troll. Instead, I found tons of quality contributions. You're better than this, my fellow HN'er.

I didn't get any sense of victimization from the article. I got the sense of someone who was coming clean on a bad choice they'd made, and bearing witness to the consequences of said choice. In fact, she did so in a quite self deprecating fashion.

From your comment I assume that you only respect people who have made correct and logical choices throughout their lives, and/or people who make bad choices, bear the consequences, and don't tell anyone about them (lest they appear to be self absorbed). You are certainly welcome to only respect said people, though I hope that if you ever make a bad choice that the people around you will be more compassionate.

"Using drugs to gain an unfair advantage over other people at work"

Perhaps the ABA (American Bar Association) needs to implement a ban on performance enhancing drugs similar to what MLB (Major League Baseball) mandates?

I drink coffee every day. Does that give me an advantage over those who don't drink coffee? If there is an advantage, is that advantage unfair?

Caffeine junkies like you disgust me. The use of an artificial stimulant to gain an unfair productivity gain is unethical, you CHEATER.

Unless you are drinking more of it every day, there is probably nothing more than placebo by now.

Anyway, caffeine works in vastly different ways. It blocks adenine receptors (which keeps your heart rate and blood pressure high), it does not flood the brain with neurotransmitters used in parts of the brain responsible for learning, retention and the reward system.

Good point ... I drink coffee every day too, but I'm no longer addicted (I mean that in the literal sense) like I was when I drank three to four pots.

I think you mean your addiction is no longer outside the social norm. Caffeine is addictive, regardless what you rationalise or not. The only way to not be addicted is to severely limit supply...

Actually, I mean that how my body functions is unaffected by my caffeine intake. If I don't have coffee on any given day, I continue to be functional ... in the "old days", I'd have had a killer headache within 30-45 minutes of waking up if I didn't down a large cup.

It shouldn't. At least, if you believe all the reports of geeks who've "quit" caffeine. They nearly all say they feel more energetic, sleep better, etc.

People with ADHD often self-medicate with caffeine.

I think the precedent is certainly different for use of prescription drugs that were acquired through dubious means.

Reminds me of http://xkcd.com/1173/

ok, what about (among others

- desmopressin,

- galantamine,

- Phenylpiracetam

Agreed, she's totally self-absorbed. I found 97 uses of the perpendicular pronoun, not including all the uses of 'me', 'my' and so on.

> the fact that her colleagues had to do similar unhealthy shit in order to compete with her.

This is one of the things that bothers you? The paralegals felt the need to compete with her?

Adderall IR makes me feel very energetic and motivated, a feeling I like a lot. But I always seem to use it until it becomes so detrimental to my health that I feel I have to quit.

Always, my dosage creeps up, my sleep schedule becomes chaotic, I become too thin and frail. I'm mentally quick, but also irritable. At first I take it to feel great, but at some point I'm taking it just not to feel as if I'm wearing a lead suit.

I recently quit again after using for two months. If I get my weight and health back, I may try Adderall again, but only if I'm sure I can be extremely strict with myself. People say that taking weekends off can inhibit the dependence.

I would suggest using the XR version if possible. You may need 20-30mg, but I have found it is much more stable and I don't feel the need to redose all day long. My friend has an IR script, and he ends up running out early, while I keep a stable sleep schedule and don't experience the mood swings.

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