How To Take Ritalin Correctly
thelastpsychiatrist.com
thelastpsychiatrist.com
As a vitamin junkie, I truly believe that certain "hacks" allow me to do better on interviews: caffeine, ginko, SAMe, glutamine, etc. Maybe by a few percentage points. Nothing to write home about, but worth the investment for the job interview.
But these kids aren't going for job interviews. And they're not talking about run-of-the-mill OTC brain hacking. They're talking about using high-performance brain-targeted stimulants as part of a maximization strategy for some test in school. As if anybody gives a rat's ass about what you made on calculus finals six months from now.
Let's see: brain damage versus 10 points less on a test you're never going to talk about (unless you fail). I think this risk analysis is a no-brainer here, to use a pun.
I'm concerned that what's really going on is that some people are just wired to go screw around with their bodies using chemicals. This whole take-to-maximize-study rationale is just another in a long line of rationales going back many decades. There was drug use to combat the drudgery of life. Drug use to protest the system. Drug use to find inner peace. Drug use for religious exploration. Drug use for sports enhancement. Drug use to prolong life. Now we have drug use for educational enhancement.
I'm not saying this is wrong -- whatever that means. Perhaps there is an evolutionary competitive advantage to hacking your brain with chemicals and, if so, we're seeing a new branch of the human family tree. Or perhaps we're still four hundred years away from true brain hacking and this is just another in a long line of reasons to screw around with reality.
Timothy Leary may be dead, but he's far from gone.
Therefore, the choice isn't "brain damage vs 10 points on a test." It's more like "performing like a normal human being vs failing at life."
Because I'm talking about the first case, and you seem to be talking about the second. The article, to me, was geared toward the first scenario. If you'd like to talk about the second scenario, that's fair game, but not what I was talking about at all.
At least that's how I read it.
When it comes to taking tests, 99% of the population seems to me like they have serious brain problems. They perform far below my level, which I arbitrarily designate as normal. The kinds of "real brain problems that need some intervention" that we're talking about here are defined pretty empirically; we mostly aren't talking about things that show up on an MRI, we're talking about things that are "diagnosed" by people scoring 1½σ below the mean on an IQ test.
To take a concrete and fairly extreme example, I don't know what the fuck is wrong with people that they can see a word spelled correctly dozens or hundreds of times and still not know how to spell it. But that seems to be the case for 99% of the population.
The function of correct spelling in modern society seems to me to be essentially the same as the function of good penmanship a century ago: to demonstrate to the reader that the writer is properly educated, i.e. approximately that their parents were rich enough that they didn't have to pull them out of school in 1950 when they were 10 to work on the farm. Fundamentally, this is harmful to the social fabric. Either prejudice distracts from the quality of the writing — there are any number of Nobel-winning writers with terrible spelling and penmanship.
(I was expelled from eighth grade for picking a particularly inopportune time to explain this point of view, somewhat less articulately: coming in second in the regional spelling bee, if I remember correctly.)
It's fortunate that this particular neurological deficit doesn't happen to cause any harm, and unfortunate that we choose to stigmatize the 99% of the population who's dramatically worse at it than I am. But given that there's a relatively safe drug that allows many people to escape that stigma, it seems reasonable to let them have it until such time as we can expiate the stigma.
Since I observed that there are smart people who can't spell, I've revised spelling ability down to "weak indicator" of stupidity or poor education. I.e., if someone spells poorly and has a few other things going against them, then the spelling will help decide the matter. But I would not make any rapid judgements on someone's intelligence based purely on their spelling/grammar.
I'd like to see some medical references for the statement "amphetamines don't cause brain damage," because study of long-term neurotoxicity or neuroprotective effects of most medicines is still in very early stages. What medical journal references can you cite on that point for amphetamines?
Stimulants feel good, regardless of their other effects. People will always want to rationalize continuing to do something that feels good. Again, regardless of the other effects both positive and negative.
The difference here is that this rationale is culturally acceptable. It's become good to use these drugs for this reason. The PR submarine[1] is out in full force[2], building positive associations (Take these drugs and you'll get into Harvard!) and diminishing negatives ones ("Progress often carries risk.") That, to me, is what makes this tend unsettling, far more than the drugs themselves.
[1]:http://www.paulgraham.com/submarine.html [2]:http://www.independent.co.uk/news/science/mindenhancing-drug...
It is very important, if you do use psychoactive drugs, to have some sort of external metric. When I was undergoing various ADD treatments, I had my boss evaluate me every week. I found that what I was doing before (that is, using unusually large amounts of caffeine) was not better than baseline me.
A family friend just died from a random brain bleed, well before his time. Guess how many herbs he took? There is a strong correlation between random brain bleeds and herb use, it just isn't substantiated well enough to pull them from the market yet. I hear about them all the time. Which is a damn shame. Herbs kill.
So do yourself a favor: go get a Ritalin or Adderall prescription and cut the vitamin overdoses and herbs. You'll probably live longer ;)
I think there is an implied dichotomy that I did not mean to make: I'm perfectly happy with people hacking their brains. I'm perfectly happy with the natural state of mankind being some sort of intoxication, whether it's spoiled fruits, running, nicotine, or whatever.
I'm just amused at the rationales being used, which seem to me to have all sort of inner contradictions.
Ritalin was synthesized in 1954. In use clinically for 50 years.
How's that for data? Pretty good, I'd say. It is well known that these chemicals at high levels eat people's souls, but do not do much physical damage. At clinical doses they're harmless. Some caution in kids for heart shenanigans. They're very well characterized.
I expressed some of the same concerns you did to my doctor when he first prescribed me amphetamine. He told me about his speed freak patients, and how they returned to normal after coming off.
I would like to talk just for a moment about my problems with concentration. ADD is a very real problem for me. I don't mean this in a learned helplessness, "trust me I've been diagnosed" sort of way. I mean it in a "Everything in my entire life points to this diagnosis, 100% -- and I would challenge anyone to try and explain it in an alternative fashion."
I won't go into the details and don't really care to discuss my symptoms and issues much further. However I will say that there are many people out there who are correctly diagnosed as ADD, and whom would probably have never finish high school, let alone college, without the aid of adderall, ritalin, etc. I can tell you this with a certain level of confidence because I am one of them.
I never abused them, and avoided taking them because they make me feel like a zombie, no sense of humor, lack of appetite, irritable, etc. However, for many people out there, they're not just a brain hack, they're the only ticket they have to competing with brains that have a normal level of attention.
I think that if somebody were in a position to take the author's advice of "take a pill, and then study for 4 uninterrupted hours, keeping your attention keenly focused on the task at hand", they'd do (almost) as well skipping the pill.
That the author suggests good study habits doesn't mean people shouldn't take them.
Given the risk of addiction, it is probably especially important to recommend good usage habits.
One good reason to legalize stimulants is to let more people experiment with them. It would be great to know that taking amphetamine is actually a bad way to work in the long term.
Either way, I'm more excited about non-stimulant methods of increasing concentration. Stimulants seem zero sum, at best.
I'm not sure in what sense you mean "zero sum" but it isn't true of amphetamine in the senses that come to mind.
However, as I commented below, I am skeptical as to how concrete the amphetamine driven associations persist 3-6 months down the line.
(We've talked a lot on HN about whether it's worth it to go to college. That wouldn't be a half-bad metric to use as part of that decision; do you actually recall stuff from more than three months ago in school? If not, don't spend money on college. Obviously, this is not necessary to live a good life because most people seem to manage without it.)
As a public service announcement, don't worry too much about grades. This is America, not Germany, where success is determined by the solidity of your goal and the amount you are willing to work. I know you don't believe it now, but it's true. Go have a drink.
I went back to school too soon after having a craniotomy to remove a brain tumor and didn't have the energy to get perfect grades. I'm not sure if I was impaired as a result of the surgery, or if I just realized, in light of it, that life is too short to spend too many nights worrying about what rounding algorithm/grading scale some professor uses.
Best of luck to you!
One possible explanation that I can't shake is that I never belonged in college or grad school anyways. At least it's over now.
Nowadays I get to look forward to being judged by my colleagues. Until I retire or die.
So, no drinking, no smoking, no other drugs, just healthy food and a good rhythm in your life. And preferably a significant other of the same mindset. You'll be surprized by how well you can perform without any 'additives' when you're well rested and healthy.
General intake is a snort of half a ritalin pill when your body is beginning to tire near 12am before your early morning exam or big term paper.
It isn't just ritalin either. I've seen people snort so many wake-ups (an over the counter caffeine pill) that they are too busy zoning to even study.
Ritalin or amphetamines are much less addictive if you take them in a pill, especially a slow-release pill and/or with some food. And if your reason is to be awake for an all-nighter on a term paper, you don't get any benefit from snorting.
Since at this point, humanity will diverge into two species (those who have access to technology and those who don't), how exactly should we value those who's lineage hasn't been benefited by the presence of these drugs?
Just a hypothetical situation of this mentality being taken to an extreme, but still interesting nonetheless.
Then again, these drugs only cost pennies so they could really even the playing field. Starbucks needs to hurry up and invent the amphetamine latte.
If you are using amphetamines please see this article by Jonah Lehrer, editor of Seed Magazine: http://scienceblogs.com/cortex/2009/04/cognitive_enhancement...
Besides, when did the geeks become pill-popers?
There's serious demand for "study aids". It's really not a surprise. If you're statistically going to score higher than your peers by taking a pill, that's not too far off from hacking. Code optimization for the brain.
If amphetamine use is a mental "hack", then so is cheating or paying someone to do your work; call it crowd-sourcing, or distributed education, but that doesn't lend it any legitimacy.
(I did find it very boring and generally worthless, so I dropped out to work on something more interesting. The real world is even less competitive -- there is more work to do than there are people available to do it.)
Don't assume it's a risk. The effects of these stimulants are well known and well studied. Taken safely and in proper doses these are not risky drugs. The world is not black and white and learning and self development can be aided by these drugs. It is not cheating.
Artificially enhancing your natural cognitive abilities is a trend that is only going to continue to increase as we learn more and more about the brain and how to manipulate it. The body is a machine, and if we learn to make the machine operate better through chemicals, which is inevitable, then we're going to take advantage of that. You won't see people complaining when they're daily regiment of 20 pills lets them live healthy lives well into their 200's.
Some people realize this is already happening and are taking advantage of it.
In my experience, calling the effects "enhancing your natural cognitive abilities" is extremely inaccurate, as the state of mind created is not one you can achieve naturally. That alone would not be bad, but there is a trend toward ignoring the difference. The risk here is that we recalibrate the world of normal human functioning to the standards of people high on speed.
That doesn't matter, what matters is the affect and side effects of the drug on people is known. This isn't a roll of the dice on some newly discovered drug where the long terms effects are unknown.
> In my experience, calling the effects "enhancing your natural cognitive abilities" is extremely inaccurate, as the state of mind created is not one you can achieve naturally.
Not true, people can and do naturally achieve extreme focus and flow, the drug isn't giving you new abilities, it's giving you more of an ability you already have and allowing you to control when you have it.
> The risk here is that we recalibrate the world of normal human functioning to the standards of people high on speed.
There's nothing wrong with that as long as people are aware of what they're doing and it's reasonably safe to do so. People have always used drugs, people are always going to use drugs, and as the drugs get better and better, more and more people will use them if they find it beneficial to do so.
Yes, this is obvious, and I wasn't denying that at all. What is not obvious, and what there is no evidence for, is that these states are the same as what is achieved on stimulants. It is my own experience that they are very distintly different, and I would never refer to the effects of speed as "natural". The very fact that they are achieved in humans without use of stimulants should be a strong indication that the stimulants do not recreate the same effect. Lack of focus is not due to deficiency of Ritalin.
it's giving you more of an ability you already have and allowing you to control when you have it.
This is exactly what I am saying is not true. Taking speed does not do the same thing to your brain that your brain is ordinarily capable of doing to yourself. When you take speed, you're not making your brain function like one of a smarter person, no matter how much smarter you feel. Cognition is altered, not just enhanced, and I think it is a huge mistake to ignore that. We don't ignore it when talking about cocaine or any other illegal drugs that people report similarly positive effects from. Why are we so willing to ignore that distinction for these drugs?
There's nothing wrong with that as long as people are aware of what they're doing and it's reasonably safe to do so.
That people believe (as you do) that these drugs merely enhance existing brain function is a sign that people really aren't aware of what they are doing.
Who cares? Really? People use these drugs because they give you super focus, both the feeling, and the reality. You're too concerned about the mechanism rather than the effect.
> The very fact that they are achieved in humans without use of stimulants should be a strong indication that the stimulants do not recreate the same effect.
That makes no sense at all. Sleep is natural, it doesn't follow that any pill which also induces sleep is not doing it via the same mechanism. In fact, it's an indication of nothing, either way.
> Lack of focus is not due to deficiency of Ritalin.
No one claimed it was. You're ignoring the desire for superhuman focus. People take these when they want more focus than is natural.
> That people believe (as you do) that these drugs merely enhance existing brain function is a sign that people really aren't aware of what they are doing.
That people such as you are so strongly opposed is a sign that you're not objective about the issue and you assume others don't know the risks and if you could just educate them they'd change their behavior; you'd be wrong.
People willingly take far worse and far less safe drugs off the street just to get high. Those who use prescription drugs like Ritalin off label to enhance work or study performance are not the people you need to be concerned with. Drug use is not drug abuse.
I would hope that anybody taking "cognitive enhancers" would care. It seems entirely relevant that one should know the difference between normal brain functioning and drug-induced brain functioning. My concern is that there is a trend towards not knowing the difference, and that this is being applauded.
You're too concerned about the mechanism rather than the effect.
I am specifically talking about the effect. It is different. It is not, in your words, "enhancing your natural cognitive abilities". You cannot honestly argue that it is the same as a natural state of focus while simultaneously claiming that the point is to have unnatural kind of focus.
And yes, I regard the distinction between natural and unnatural states as important when it impacts things like (say) competition for top-tier education.
That people such as you are so strongly opposed is a sign that you're not objective about the issue
I have no idea what this means. You seem to be rejecting the validity of my opinion because it does not agree with yours. That's...deft.
People willingly take far worse and far less safe drugs off the street just to get high. Those who use prescription drugs like Ritalin off label to enhance work or study performance are not the people you need to be concerned with.
Taking Ritalin to "enhance work or study performance" is getting high. The effect of the drug is the same regardless of whether you take it to study or not. Why have we recently gotten a free pass to class it up by calling it "cognitive enhancement"?
People have historically taken all kinds of drugs for performance reasons, be they legal, illegal, or legal but illegally obtained--many to famously great effect. What changed to allow us to use such different terminiology for the same act? What is the effect on our culture of continuing to do so? And why should I not be concerned with changing social norms?
No it isn't. No more so than drinking a cup of coffee gets you high on caffeine, or eating a candy bar gets you high on sugar, or drinking a bottle of Jack gets you high on Jack.
Getting "high" is generic slang for the consumption of some mind altering substances for fun. 99% of the time getting high specifically means smoking marijuana. You do not label the taking of all substances as getting high, I'm not getting high if I take a percocet, I'm not getting high if I take a paxil, I'm not getting high if I take an abilify.
You can tweak on Ritalin by taking far more than the prescribed dose which people usually do by crushing and snorting it. This is not at all comparable to those taking the pill in the prescribed fashion in the same dose that one would take for ADD.
> What changed to allow us to use such different terminology for the same act?
What difference, you don't say an athlete is getting high on steroids, that's not what getting high means. Secondly, you'll note we're against steroids because they're known to be very damaging to the user, not because they enhance his muscles. If steroids were as safe as Ritalin they wouldn't be illegal and they'd be used by the vast majority of athletes just like every other legal substance they've found that works.
The terminology hasn't changed, you're just mistakenly thinking we use the same term for every drug and intent. We never have other than the generic "using drugs". Name a drug and there is specific lingo associated with that drug.
> And why should I not be concerned with changing social norms?
You should be aware of them, but not concerned because what other people do shouldn't concern you unless it affects you, I fail to see how it affects you. Being concerned implies that you feel the right to object to the behavior and prevent others from doing what they want with themselves, that's what I'm objecting to.
Social norms change, that's life, they've always been changing. If someone wants to take a pill - widely considered safe - to make themselves perform better, who's business is that but theirs?
The point is that you're arbitrarily defining which substances and what uses qualify as fun. If you snort a line of coke and then write a paper is that getting high or not? If you take Ritalin and play Xbox is that getting high or not? If you smoke marijuana because you feel it allows you to have better ideas is that getting high or not?
There is no heuristic here, no fact-based rule for whether we acknowledge the different states of consciousness or not. We've just taken the exact same activity that people have been doing with stimulants for decades and given it a more palatable marketing label.
This is not at all comparable to those taking the pill in the prescribed fashion in the same dose that one would take for ADD.
The drug has the same effect either way, with only slight differences between methods of delivery. The drug does not care why you take it. In any event, we are specifically not talking about anyone taking it for the treatment of an actual deficiency of functioning (controversy over ADHD aside), we're talking about people taking it for "cognitive enhancement", where the indicated dosage is none.
...they'd be used by the vast majority of athletes just like every other legal substance they've found that works.
There are plenty of legal substances frequently banned in competitive sports. For example: Ritalin, Adderal, and modafinil.
I fail to see how it affects you.
Exactly. Can you understand why that would bother me? I'm talking about broad sweeping changes in cultural norms that could potentially redefine what we expect from individuals in society to standards set by people on drugs that make them perform certain tasks at superhuman levels -- in essence doing to our civilization what we've done to professional baseball -- and all you're doing is arguing with my use of the term "getting high" to include "tweaking".
Social norms effect everyone that desires to participate in society. I want those norms to be reasonable because I happen to want to participate in society, and what I see happening with these drugs seems unreasonable, expecially when seen as a long-term trend.
In ten years, am I going to have to take drugs in order to hold a decent job? In twenty years, is my child going to have to take drugs in order to get into college? More generally: what will be the long-term large-scale effect of using drugs that alter the mesolimbic reward pathway? What reason do I have to not be concerned about these possibilities?
If someone wants to take a pill - widely considered safe - to make themselves perform better, who's business is that but theirs?
If everyone were free to take whatever drug they want for whatever purpose they want, that would be a good point. But that isn't the situation we have. A person can only take some drugs for some purposes if obtained in some ways. It is already everybody's business and we already have strict laws and rules specifying which pills you have to take, what kind of performance is acceptable, and who gets to decide if you can take them.
I don't want more constraints on what people are allowed to do with themselves than already exist, and in general my preference would be for less, but I do want less of this irrational exuberance that treats normal baseline human cognition as a disease to be medicated.
> but I do want less of this irrational exuberance that treats normal baseline human cognition as a disease to be medicated.
Ah, but it is. Some of us feel extremely limited by biology and regardless of what others feel is or isn't normal, we're going to push biology beyond what nature provided because we can. This doesn't just apply to drugs, in the next 100 years as biotechnology really takes off, people are going to be augmenting everything they can. Transhumanism is coming whether you like it or not.
If I can implant artificial memory to surpass the abilities of the brain nature provided me, I will, and so will many others, and no amount of clinging to the past or to what nature intended will prevent this from happening.
What you fear, is inevitable, the march of technology will not be stopped because people who don't want to augment cry foul when augmented people are out competing them, that's just how it's going to be.
You cannot, and I resent your attempt to do so. You're just retreating into vagueness instead of arguing pertinent points. You're also projecting opinions on me that I haven't stated, apparently because you're more comfortable with parrotable dogma than relating your own opinions. Suddenly, instead of arguing for my own specific statements, you expect me to argue against extremely general statements about technology and phrophetic claims of inevitibility. You'd might as well say "God wills it" for all the passivity and coarseness of thought you've expressed here.
You're making the worst sort of argument that a person can make about transhumanism when you pretend that everything with turn out perfectly in some distant future regardless of the actions taken by people in the meantime. That is faith, not reason, and I'll have no part of it.
Reality is not an implementation detail. We're done here.
Furthermore, arguing about the legitimacy is a completely different matter, and deserves its own thread altogether IMO. I would be with you on amphetamines being illegitimate, a subtle form of cheating. However, what is one man's cheat is simply "clever" or "brilliant" to another. You ought to be prepared to spell out exactly what you mean by "cheating", and in what context, before you try and rail against me for suggesting something as innocuous as I did.
Finally, if you think higher education is for 'self-development and learning', then you're either living in the past, or have a naively idealistic view on what the current situation is in colleges across the country. If colleges are about one thing, it's about getting a job. The school I attend is incredibly competitive, and there isn't room for self-development. If you want self-development, you're better off dropping out. 0.02c
I agree with you that that is the claim of the people taking the pills, but where are the statistics? How well controlled are studies claiming to show that the pills help normal people?
You actually see the same thing in artists. Sure, the top geniuses are prone to hard-life and drug use, but there are plenty of phonies abusing drugs and living the "life style" without producing any work of value. My gf is a musician and every time I hangout with her friends I feel like I am the dirty unhealthy one. Nearly all the musos are vegeterian yoga freaks, even the rockers, while I the computer programmer chase cigarettes with spirits like a "rockstar" :-P
I wouldn't describe Erdős's amphetamine use as "hard life". He wasn't taking the pills for euphoria, and his body survived longer than most people's; amphetamines in the doses he was presumably taking don't seem to cause much extra wear and tear on the body.
Basically, he tried stopping taking amphetamines, and was okay, but couldn't do any math without them. He was dependent on them.