
Amphetamine use in America's workforce - rinze
http://daily.jstor.org/americas-workforce-narcotic-stimulants/
======
Vraxx
I think this is a little bit sensationalized at the very least. This excerpt
in particular caught me off guard.

"Abuse by young professionals is distressingly common—Wall Street traders,
software engineers, dentists, nurses, and lawyers, all cracked out of their
minds trying to keep up with the competition."

Yes, I was diagnosed with ADHD as a child, and yes I have an Adderall
prescription. But I'd hardly call myself cracked out on drugs. I think the
biggest issue is when people self-diagnose and self-medicate because they are
more likely to take dosages that aren't suited for themselves, but that issue
exists for many prescription drugs. This piece seems heavily biased towards
scare tactics, so I am not inclined to take it terribly seriously.

~~~
md224
Agreed. I was struck by the same line, "cracked out of their minds"... very
biased. I don't know if "abuse" used to have a coherent meaning, but these
days it boils down to "used in a way I don't like".

Drug use is certainly a mixed bag but it deserves a balanced treatment, not
scare tactics.

The article even goes on to list great accomplishments that were made possible
(or at least supported) by drug use. Talk about cognitive dissonance...

EDIT: For a wonderfully contrarian take on drug policy, check out Jessica
Flanigan's "Three arguments against prescription requirements":
[http://www.ncbi.nlm.nih.gov/pubmed/22844026](http://www.ncbi.nlm.nih.gov/pubmed/22844026)

~~~
HarryHirsch
Wonderfully contrarian? I'd disagree, in fact I'd maintain that what the lady
does is not science. How can you argue medical ethics, a subject firmly rooted
in observable, shared reality, from first principles and then disregard
outcomes? If you intend to do science uou can't omit to check dogma against
reality, perhaps those dogmata are no good at all to describe the world.

Very telling is another publication of hers, about Obamacare. From the
abstract: "Though states are morally required to provide citizens with access
to affordable health care, states must also take care not to violate important
economic liberties .. ." Where do the "economic liberties" even come from?
Everyone knows that US healthcare costs are an outlier in the civilized world,
and the ostensible goal of Obamacare was to fix that. And if we have to talk
about the principle of economic liberty we also have to consider the
observable phenomenon of decision fatigue.

This is not science, this is libertarian apologetics. There is a purpose for
that but it needs to be clearly distinguished as such.

~~~
programmarchy
Economic liberties means choice and competition in a market without state-
enforced monopolies. US healthcare costs are an outlier because the state
enforces insurance cartelization. Obamacare was a gift to insurance
corporations, forcing everyone to buy their product. It's inelastic demand at
gunpoint, so of course prices are going up.

Look back at the history of healthcare to see economic liberty in action when
we had a workers' self-organized healthcare. People formed friendly societies,
worker cooperatives, and lodges creating a welfare system that was organized
from the bottom up. It was well-organized, affordable, and voluntary.

That all started to change as progressive legislation was introduced in the
guise of social reform, which built up the state capitalist bureaucracy and
slowly eroded people's rights to self-organize and provide each other with
mutal aid. Instead people were forced to depend on the centralized
state/corporate welfare system. And here we are today, and things are only
getting worse.

The healthcare crisis is a problem of artificial scarcity, enforced by the
state regulatory regime which upholds the insurance monopoly and suppresses
people's rights to self-organize.

> The large corporation and centralized government agency do not exist just as
> discrete individual organizations. Beyond a certain level of proliferation,
> such large organizations crystalize into an interlocking system. Even the
> small and medium-sized firm, the cooperative, the non-profit, must function
> within an overall structure defined by large organizations. [1]

[1] [https://c4ss.org/wp-content/uploads/2010/03/C4SS-The-
Healthc...](https://c4ss.org/wp-content/uploads/2010/03/C4SS-The-Healthcare-
Crisis-A-Crisis-of-Artificial-Scarcity-by-Kevin-A.-Carson.pdf)

~~~
HarryHirsch
They sold us the healthcare-for-fee model back in the 1970s and 1980s, and
that failed to contain healthcare costs. They are trying HMOs now in
Switzerland, and it doesn't work to contain costs. Universities with large
medical schools should be in a position to serve as integrated providers, yet
you see rarely see them offer such plans to their employees. These are
observations from reality.

------
_acme
Why does this article describe these stimulants as "narcotics"? They are
neither opioids nor illegal when prescribed, so it seems like a needlessly
provocative, and factually incorrect, description.

~~~
chillingeffect
Because the authoritarian state uses an in-language to signal virtue,
overstepping denotations. These are the same people who call non-cops
"civilians."

~~~
drjesusphd
My favorite is when they have the nerve to call vets "civilians".

~~~
mnw21cam
I'm not sure my cat would appreciate having his annual check-up and booster
with a non-civilian vet.

------
fixermark
I can't help but ask myself whether we should be wondering why Americans can't
make it without drug-modified behavior, or whether this is better or worse
than alternatives such as cigarettes, alcohol, caffeine, etc.

Humans in societies have been chemically altering their moods since we
discovered mood-altering chemicals. Stress occurs inside and outside civilized
workforces, and people take measures to mitigate stress. The real question is:
what are the side-effects and how do we mitigate them?

(Not to imply that we shouldn't also look into options for de-stressing the
American worker, since benefit there can scale significantly. But we do
ourselves a disservice by imagining we're the first generation to have an
entire culture habitually consuming a physiology-tweaking chemical cocktail)

~~~
nemo44x
Anecdotally I think Europeans are more likely to self medicate with alcohol
and cigarettes rather than prescription pills which are more common in the
USA.

In my experience the culture around having a few drinks after work and even
having the occasional cigarette is far more relaxed in the European countries
I've been to than just about anywhere in the USA.

But as I've said, I have zero evidence that any of this is even true - just my
observations however well travelled I am.

~~~
duggan
In any of the companies I've worked with or visited in my times in the US (SF,
specifically), _lunchtime drinking_ was pretty common, and practically unheard
of in my European experience.

Like yourself, I wouldn't want to extrapolate a broader trend from that, just
providing a counter-anecdote.

Think on smoking we've probably had a similar experience though. I don't think
I even know an American that smokes (cigarettes), let alone seen it at a
workplace. In Europe, it'd be weird if there weren't a couple of people in any
office that didn't have an obvious habit.

------
marssaxman
It is difficult to take this article seriously given the author's repeated
references to "narcotic stimulants," a contradiction in terms. It shows that
they are getting their whole perspective from law enforcement, which routinely
(and quite misleadingly) refers to all drugs as "narcotics" regardless of
their effect. The law enforcement establishment has been spewing bullshit for
decades, to a degree that has now become embarrassingly obvious, whenever it
discusses drugs; if the author of the piece is still taking anything they say
seriously, they are either painfully incurious or they are actively
participating in the promotion of War on Drugs propaganda.

------
Houshalter
Yet sadly these drugs are still heavily regulated. You need to renew your
prescription every month, which is expensive. Doctors look at you skeptically.
In some countries they don't prescribe them at all, or only prescribe less
effective versions to prevent abuse.

And then there are articles like this that appear every so often, telling us
that we aren't really sick. Or that people who take these drugs are abusing
them like they are just trying to get high or whatever.

~~~
ta_339393
Very good points.

They really make us jump through a lot of hoops just to get the medicine we
need to live a somewhat normal life, all in the name of preventing drug abuse.
I don't believe it actually does anything significant to prevent abuse, those
who want to abuse drugs will always find a way.

There's so much of a stigma associated with low dose amphetamines and it's
completely unfounded. I really noticed this when I switched from
dextroamphetamine to methamphetamine (Desoxyn). Since my insurance wouldn't
cover the brand name drug, I get the Mylan generic that says "METHAMPHETAMINE"
on the label and I could really notice a difference in the way I was treated
at the pharmacy. It was like they immediately assumed I was some dangerous
drug addict. I'd try to be friendly with them and all I would get is really
robotic responses.

It's ridiculous that they assume methamphetamine is this much more dangerous
or addictive of a drug, it's not. In fact it's the best stimulant I have ever
used. Way more effective than dextroamphetamine with fewer side effects.

Luckily I have a good psychiatrist that is setup to handle the monthly refills
in a sane manor and doesn't treat me like a drug addict when I'm just looking
to improve my life.

~~~
llamataboot
Stigma works the other way as well though. There's plenty of people prescribed
strong stimulants that would be just aghast at the thought of someone doing
some meth to get a particularly important painting done or something.

------
ta_339393
As one who takes methamphetamine (generic Desoxyn) for ADHD, I can't help but
take issue with the sensationalism in this article.

If someone takes the same low dose I do but doesn't actually have ADHD, how
could they be considered "cracked out?" simply because they are faking a
diagnosis?

We know that low-dose amphetamines improve cognition in healthy individuals
regardless of whether or not you have ADHD. We also know that amphetamines are
very safe at therapeutic level doses and that you can take them your entire
life without any problems. We also know that stimulant therapy actually
reduces the chances of someone abusing drugs, even stimulants.

Why shouldn't all healthy people have a chance to reap the benefits from them?
Why should you have to have a disability in order to be able to access the
benefits from these drugs?

There's just no logic to the way society currently views stimulants. It's safe
for me to use amphetamines to help with my ADHD symptoms but if someone
without ADHD uses them in the same manor, then it's dangerous.

~~~
MichaelGG
Wow, how did you get an rx for that? Did they try tons of amphetamines and
finally go for Desoxyn?

I agree: It's incredibly something (classist?) that only certain people can
legally get amphetamines. I'm sure if you have lots of money, it's far easier
to convince a doctor to RX. Whereas if you don't, you can even afford the
doctor to diagnose, let alone RX (plus the risk of being labelled a "seeker").

Having essential medications behind professional, for-profit gatekeepers is a
violation of human rights. It's reprehensible and an affront to personal
liberties.

~~~
ta_339393
I asked my psychiatrist about it after doing a lot of research on my own.

I have tried all the other ADHD stimulants and formulations but it wasn't that
none of them worked for me or that I required a high dose (I take what is
considered an average therapeutic dose).

If you think meth is way more potent than dextroamphetamine, you'd be in for a
big surprise. Meth is a very subtle and gentle stimulant, so subtle I often
forget I even took a stimulant. This is probably because of the lack of PNS
stimulation at these low doses. It's also a little bit more effective than dex
because of slightly higher CNS stimulation but the lack of side effects is
probably the best feature of meth. It just feels really natural, hard to
describe completely.

It is considered a second line medicine because it's thought to be more
addictive but I can assure you this is completely unfounded and has to be due
to the stigma created by illicit meth abuse. IMO, it is a superior medicine
and should be a first line treatment for ADHD.

------
nibs
ADHD basically means the behavioral symptoms of dopamine dysregulation. A
similar thing is happening with serotonin, where people complain of
subclinical (or clinical) symptoms of depression and anxiety. Why are our
bodies finding homeostatis of neurotransmitters so difficult? Diet? Culture?
Sleep? Constant overstimulating media? Drugs? All of them?

~~~
WalterSear
All of them, and also it's more complicated than depression === serotonin
dysregulation.

~~~
nibs
Indeed. Anxiety pretty much == serotonin dysregulation. Depression could be
inflammation, mindset, low brain serotonin, low noradrenaline, low dopamine,
all of the above, or something else. Low brain serotonin would be _a_ cause.

~~~
llamataboot
or any and all of those things could be correlates and not causes. correlation
and causation get murky in the realm of consciousness and neuroscience.

------
kome
International comparisons would really help a lot to understand the
phenomena... I find that there is a tendency by many North Americans to find
pseudo-biological justification about everything.

In other words: trying to find individual solutions ("my dopamine is so messed
up!") to social problems.

~~~
drzaiusapelord
The largest users of anti-depressants are socialist style nations like
Iceland, Australia, and Portugal. These countries are run almost the opposite
of the US. So there's more than the usual liberal criticisms of how the US is
too competitive/not competitive enough or has too easy access to drugs/not
enough or whatever applies here.

>North Americans to find pseudo-biological justification about everything.

Yet the above nations are nowhere near N America. Perhaps this issue is a lot
complex than you care to understand. I guess if you want ad-impresions then
you must cater to people's ignorance and biases and leave any facts, science,
or statistics out of it.

~~~
kome
Regarding the use antidepressants, the USA beats everybody, according to OECD
data:
[http://static5.techinsider.io/image/56b363792e526551008b4c1d...](http://static5.techinsider.io/image/56b363792e526551008b4c1d-1200-1183/ti_graphics_antidepressants-
chart.png)

Also: Iceland, Australia, and Portugal cannot be called socialist by any
stretch of the imagination.

~~~
drzaiusapelord
[http://indy100.independent.co.uk/article/these-are-the-
count...](http://indy100.independent.co.uk/article/these-are-the-countries-
that-consume-the-most-antidepressants--
WJvJPf5WFx?utm_source=indy&utm_medium=top5&utm_campaign=i100)

source:

[http://www.keepeek.com/Digital-Asset-
Management/oecd/social-...](http://www.keepeek.com/Digital-Asset-
Management/oecd/social-issues-migration-health/health-at-a-
glance-2015_health_glance-2015-en#page187)

This is 2005 data btw.

------
api_or_ipa
I think this quote sums up the article's heavy handed, decidedly outdated view
on mental health.

> ADHD drug abuse had become so commonplace on college campuses that Wesleyan
> University, among other prominent institutions, has tried to ban it
> altogether.

ADHD is a diagnosed medical disorder that affects millions of people in
America. Why do we still stigmatize it in the modern age?

~~~
taxicabjesus
> ADHD is a diagnosed medical disorder that affects millions of people in
> America. Why do we still stigmatize it in the modern age?

ADHD is a meaningless psychiatric diagnostic [1] of symptoms, not cause. The
diagnosis is used to put millions of people in America on maintenance doses of
addictive psychotropic drugs. Routine use of amphetamines almost always causes
people's mental conditions to worsen, eventually.

Tonight one of my regular taxi passengers txt-messaged to ask if I was
working. I was exhausted one night, when he was going home from the gay strip
club, so I stopped at the coffee shop that was half-way between the strip club
and his mother's house. I was like, "so... what's your story?"

When the passenger was in high school, he was diagnosed with ADHD. The doctor
got him addicted to Ritalin, or one of the other legal prescription
amphetamines. At first the amphetamine was great, but then side effects
developed. Then he developed some legal troubles, which led to living in a
halfway house, with hostile housemates...

Anyways... He's a bit of a mess... probably early or mid-30's... his mother
pays his taxi fares. He had a job at the baseball stadium, but then he got
fired. Last I saw him, he was collecting unemployment insurance.

People... people are interesting. This passenger didn't use "ridesharing"
because he can't manage his money well enough, iirc.

[1] [https://www.commentarymagazine.com/articles/the-doctor-
isnt-...](https://www.commentarymagazine.com/articles/the-doctor-isnt-in/) and
[https://www.commentarymagazine.com/articles/how-
psychiatry-l...](https://www.commentarymagazine.com/articles/how-psychiatry-
lost-its-way/)

~~~
Throwaway23412
First of all, ADHD is hardly the only disease or disorder with an unclear
cause. Alzheimer's, autism, and fibromyalgia come to mind.

Second of all, here is a comprehensive list of peer-reviewed studies defending
the existence of ADHD and the efficacy of amphetamines for ADHD (much better
than some random anecdote of an improperly diagnosed taxi passenger):

[https://www.reddit.com/r/ADHD/comments/3at2u2/psa_the_existe...](https://www.reddit.com/r/ADHD/comments/3at2u2/psa_the_existence_of_adhd_has_been_shown_by)

Admittedly, psychologists seem to have a problem properly diagnosing it, but
let's not diminish a disorder suffered by millions every day.

~~~
taxicabjesus
Robert Whitaker makes the case in _Anatomy of an Epidemic_ [1] that
psychiatric medications amplify the problems they supposedly treat.

[1]
[http://www.madinamerica.com/product/62043/](http://www.madinamerica.com/product/62043/)

------
6stringmerc
So glad that as I was growing up, my ADHD tendencies were seen more as just an
individual issue I'd have to learn to control myself rather than a
physiological condition in need of medication. Granted, in my street-wise
years I've found stimulants and I get along really, really well, but there's a
nagging feeling that I simply don't want to be on amphetamines daily. It might
turn my writing into delusional drivel like Ayn Rand, a noted speed addict for
decades.

~~~
eridius
People with ADHD react to amphetamines differently than people without it (at
the correct dosages at least; I've never read anything about what happens to
people with ADHD that take more than the correct dosage).

~~~
ta_339393
This is false and a common myth. If this was true then we would have the
perfect test for ADHD, just give someone some stimulants and see how they
react.

~~~
eridius
Speaking as someone who's wrestled with ADHD all my life, as has my spouse,
this is definitely not false. And your claimed test makes no sense; if you
haven't exhibited symptoms of ADHD, how can those symptoms be erased?

~~~
ta_339393
Perhaps I misunderstood your comment, you said that people with ADHD react
differently and I was assuming you meant they do not respond in the same manor
as someone else who just took a stimulant.

Often you hear this saying that people with ADHD feel relaxed when they take a
stimulant and don't feel any increased energy or mood lift, which of course is
false. That's what I was referring to.

~~~
eridius
People who are already energetic may not notice increased energy at
therapeutic doses, though I certainly noticed. I don't think anybody feels
relaxed, but it does quiet the hyperactive impulses and behaviors, which can
easily be mistaken for being relaxed.

------
hosh
A lot of people are taking issue with what's called sensationalism in the
article.

I think that's ignoring the elephant in the room. Before amphetamines, it was
other drugs. The major point is that practice of capitalism in America is
founded on a pattern of use and abuse of drugs. This is an elephant in the
room because the dearly-held narrative in America is the idea of work hard,
get rewarded. What's called a good work ethic here is seen as insane working
hours outside of the US. And this ethos is reinforced by the dominance of US
interest in the world.

Now you add in the Chinese startups working even more insane hours.

Is this really what we want our human civilization to move towards? This
blind, tunnel-vision obsession over technological progress without actually
reflecting on where it is that we are going?

Well, at least when you're using drugs that help you focus, these inconvenient
ideas can be easily dismissed. Back to work now, y'all.

------
aznpwnzor
The comments in this thread seem to suggest a reasonable subset of people here
partake. Is there any reason you feel the need to?

I went to a pretty rough college where I had standard 24 hour straight
homework sessions once or twice a week. And I used caffeine maybe once a week
at most. I work at a startup where the work culture isn't as competitive as
what I feel is the norm, but even listening to friends at there does not seem
to be such a ridiculous need for overclocking yourself.

I just seem to have never done work that was hard enough to push me to require
drugs, and it's not because I haven't done hard work. Most work seems to be
either you just put in the 40 hours it takes to solve it or it hasn't been
solved.

~~~
MichaelGG
But have you tried using amphetamines while working? Perhaps you don't know
what you're really capable of. I know people that are fine, happy, productive.
But on speed, they are amazed at how much _more_ capable they are.

Apart from psychosis or heart issues, why should anyone settle for being less
powerful?

~~~
drjesusphd
For me, dependency and increased expectations. If I have to take drugs to
succeed, then I'm stuck taking drugs throughout my career.

The earlier in a career, the worse of a problem this is. Which is why I think
doing this as a student to enhance academic performance is a particularly bad
idea. You're in school to prove to yourself and others what you're capable of.
Doing so with drugs that you're not willing to take for the rest of your life
is only lying to yourself.

------
bluedino
Articles are either "We should be helping people with problems by giving them
these medications", or "Doctors are over-medicating everyone. It has to stop!"

~~~
HillaryBriss
Yeah. Sometimes it seems like there's a standard cycle:

1\. Drug X works wonders for millions who suffer with Syndrome Z. But these
evil politicians and FDA bureaucrats won't let people use it. Call your
congressional rep and demand support for HR ABC123 today. Stop the suffering!

2\. (2-5 years later) Is Drug X Causing Millions to get Disease Y? Look at
this new study released by the highly respected "Famous University". Mortality
went up, and, even worse, Drug X is no better than a placebo!

3\. Greedy Big Pharma has been pushing pseudo-cure Drug X and it's destroying
people's lives. Call your congressional rep and demand support for HR XYZ789
today!

------
inDigiNeous
I can't be the only one thinking that this can not be good in the long run. I
still remember my friend who had a prescription for ADHD -medication, and they
cut off this medication, and he couldn't do nothing but sleep for 3 weeks
almost.

What kind of state does prolonged use of amphetamines put the user ?
Constantly being pushed to focus on one task, what kind of thought patterns
does that create in the long run ?

I feel the biggest issue with this is that it's considered okay, like is
coffee use, and still coffee and amphetamines are really strong stimulants,
but it's so commonplace that we don't even think about it anymore.

Are we being just taught by the culture around us to work, work, work .. when
we could be taking it more easy, having our thinking be more open, and not so
closed and focused on the tasks ahead of us?

~~~
JohnBooty
I was prescribed approximately 25mg daily Adderall for 7 or 8 years, so here's
my anecdotal answer to your questions...

    
    
        > I still remember my friend who had a prescription for ADHD -medication, 
        > and they cut off this medication, and he couldn't do nothing but sleep 
        > for 3 weeks almost.
    

Wow. That is really irresponsible of them to cut him off so suddenly. I
wouldn't wish that on anybody.

I definitely had a "crash" if I suddenly stopped taking it for a day, cold
turkey. Would pretty much be stuck in bed.

However, if I slowly weaned myself off over a couple of days
(25mg-->15mg-->5mg-->0mg) or something like that, it was no problem. Currently
I haven't used any in six months.

    
    
        > What kind of state does prolonged use of amphetamines put the user ? 
        > Constantly being pushed to focus on one task, what kind of thought
        > patterns does that create in the long run ?
    

Now that it's been six months past, I feel no long-term changes whatsoever.
Mentally, I'm back to how I used to be before Adderall.

There's no denying, though, that Adderall often made me a bit more prone to
anger while I took it regularly.

I also have to say that Adderall didn't really "push me to focus on one task."
It helped my focus and energy somewhat, but I definitely didn't become some
kind of extreme monotasker.

    
    
        > Are we being just taught by the culture around us to work, work, work .. 
        > when we could be taking it more easy, having our thinking be more open, 
        > and not so closed and focused on the tasks ahead of us?
    

Absolutely, yes.

I think what bothers me about America's workaholic mentality is that _it 's
not even effective._ In the long run I firmly believe that we get _less_ work
done if we constantly push ourselves to exhaustion. We try to treat our entire
work careers like we're university students trying to power our way through an
all-nighter. It just doesn't work. I continually remind myself of this... the
hard way.

~~~
inDigiNeous
Thank you for your well put answer. I have no experience with amphetamines,
but have been thinking about this subject, but it's not something that is
exactly being talked about in public.

Sometimes I even felt it a little bit unfair as a programmer, that I am
competing with people who are medicated. But I don't think like this anymore.

And yes, I agree on the doing less is more, with highly intelligent tasks you
just start banging your head against the wall at some point, and anything
beyond this point can be time just wasted, when we could be just relaxing and
resting, to be more in tune again the next day.

~~~
JohnBooty
I'd feel the same way in your shoes - it would feel a bit unfair.

But now that I've been on both sides of the fence I can safely say that it's
not a big advantage. If programming was a footrace... on a _long term_ basis
I'd say that Adderall is more like a knee brace than a pair of roller skates.

On a short-term basis it can be different. The first time you take it, you
might be able to pull a very effective all-nighter. But you will have to catch
up on sleep eventually. Much like caffeine, a person's body adapts to Adderall
_very_ quickly. There's no free gains with this stuff.

The ideal usage pattern for Adderall might actually be closer to "take it
sparingly 2 or 3 times a month" rather than "take it every single day."

------
chm
A word of caution to those readers who might want to try self-medicating:

I have used pharmaceutical grade methylphenidate and amphetamines. The former
inevitably led to suicidal thoughts and feelings or worthlessness at the end
of the day (i.e. once the dose is gone). This happened to all of my peers who
tried it. The effects were mild, but still quite noticeable. And we were
healthy (both mentally and physically) young men.

My advice is you just get a prescription from a doctor. They are unfortunately
quite easy to come by. At least your dosage will be supervised, and you will
have someone to talk to about possible side-effects without fear of reprisal.

~~~
lfowles
What kind of doses were those? I'm honestly curious what kind of doses are
used "recreationally", since I was titrated over months until the APRN and I
found a dose that fit and didn't have alarming side effects.

~~~
chm
They were Concerta (extended release) 36mg. We also had 54mg capsules once or
twice. We all weighed around 140 pounds at the time.

------
yarou
This article is pretty poorly written. First off, methylphenidate is a
phenethylamine - not an amphetamine. Its chemical structure doesn't resemble
amphetamine. Secondly, Adderall is not simply dextroamphetamine, it is a
racemic mixture of both amphetamine salts.

There have been studies showing that amphetamine leads to definitive cognitive
improvement in the general population. Why restrict it? Human beings have a
special relationship with psychostimulants.

~~~
tcj_phx
> There have been studies showing that amphetamine leads to definitive
> cognitive improvement in the general population.

Stimulants cause people to become psychotic. Some are more vulnerable to this
effect than others.

[https://en.wikipedia.org/wiki/Substance-
induced_psychosis#Su...](https://en.wikipedia.org/wiki/Substance-
induced_psychosis#Substances)

There are better, safer ways to cause a "cognitive improvement in the general
population".

~~~
mthoms
Based on your citation - I could also say "alcohol, marijuana, cough medicine,
antihistamines and (possibly) caffeine cause people to become psychotic".

While technically true, it's a bit disingenuous to make blanket statements
like this without qualifying the risk don't you think?

~~~
tcj_phx
From my position as an observer of someone who has struggled with substances
for a long time, Amphetamines are the worst of that list. My friend recovers
from Alcohol and cocaine fairly quickly once she stops taking them. Cannabis
(CBD, specifically) calms her down - it would be a great help if she could get
it regularly.

Cough medicine is bad, but it's not nearly as potent of an addicting substance
as the others on the list. She's used antihistamines as a hallucinogen before,
but is not really tempted by them.

------
jrapdx3
This is an important topic, not only from the perspective of drug dependency
and substance use disorders (SUDs) research, but also re: potentially
misleading statements which may discourage use among people who could benefit
from stimulant-class medication.

I have treated several hundred individuals with amphetamine, methylphenidate
and related compounds, primarily for ADHD in adults and adolescents. Everyone
should know that ADHD is a very _common_ disorder, affecting >=4% of all
adults. It is a disabling condition in many, perhaps the majority, of those
who manifest its symptoms.

A troubling aspect is that only about 1/5 of sufferers seek treatment, and
often treatment is suboptimal for a variety of reasons. Staying on topic, the
most effective medication strategies remain the "stimulant" drugs.

The article contains errors re: drug effects and history. First of all
amphetamine was synthesized well before 1929. What we now call amphetamine was
created by a Romanian chemistry Ph.D. candidate, Lazăr Edeleanu, in Berlin, in
1887. It was rediscovered in 1927 by Gordon Alles who was unable to patent the
compound because of Edeleanu's work 40 years earlier.

Amphetamine was initially marketed in the 1930's as Benzedrine. Significantly
the remarkable efficacy of amphetamine in what's now call ADHD was described
in _1937_ , and to this day no other class of drug has been demonstrated to be
as effective as the stimulants.

As commented here, stimulant class medications have different effects in those
who need them. At the optimal dose, ADHD patients are _not_ "amped up", in
fact typically feel calmer, thoughts and actions more controlled and
deliberate. In people who _don 't_ have ADHD may indeed experience
"stimulating" effects.

Furthermore, ADHD adults perform much better with appropriate treatment,
whereas unaffected users experience a boost only with simple tasks. Stimulant
use will cause _decreased_ performance on cognitively demanding tasks. While
college students are known to seek out amphetamines in order to "study better"
for their final exams, in fact it's much more likely to decrement their
results, myths notwithstanding.

Not to say that drug abuse is not a serious matter. Ethical practitioners
prescribe stimulant class medications with great care to assure correct
diagnoses and appropriate prescribing practices. No question that not everyone
with a license is ethical. I firmly support taking steps to put those
deliberately contributing to drug abuse out of business, and into jail.

It's imperative to avoid throwing babies out with the bathwater. Stimulant
medications are an extremely useful tool when used along with due vigilance
for misuse. Patients in my practice were carefully monitored, and were
informed drug misuse could not be taken lightly. Over the years there were a
few who were deemed too irresponsible to continue treatment with the
medication.

~~~
ap22213
Thanks for your comments.

A few years ago, in my late 30s, I was diagnosed with bipolar, ADHD, and
anxiety disorder (all three have high comorbidity, interestingly). When I got
the diagnosis, I was a little bothered. In my family and culture, it's
considered a weakness to have mental illness or even talk about it. One is
just supposed to 'tough it out'. And, I did tough it out up until then. But, I
had finally reached my breaking point and sought out help.

One of the first things the doctor asked me was to describe my family history.
My family is largely comprised of highly-intelligent underachievers. Although
my parents and siblings are all in the 3 standard deviation IQ club, I was
only the first to be able to hold down a regular job and finish college.

When I described my parents' behavior and history to the doctor, he was able
to quickly see the patterns and inherited traits. We were all suffering from
something similar that had held us back from success (and having general life
satisfaction). In fact, after seeing how much easier life has become since I
began treatment, I felt terrible for my parents. For most of their life they
suffered and ended up self-medicating with much worse things.

I find the backlash against ADHD treatment and all mental illnesses to be
extremely classist. There are likely large portions of the population who
could have achieved much more happiness and success if they only had had
treatment. There seems to be a movement to keep these people untreated for
dubious reasons.

And, the downsides of ADHD treatment are quite minor in comparison. In fact,
having experimented with different substances over the years, I find Adderall
to be almost insignificant. I occasionally miss weeks at a time and feel no
noticeable withdrawal. In comparison, alcohol, nicotine, and caffeine are all
extremely difficult to quit both physically and psychologically.

~~~
jrapdx3
Your story is one that's familiar to me and I appreciate the courage it takes
to face the realities you describe. In my experience you have really nailed
the important elements of dealing with these seriously disabling conditions,
and comments like yours are enormously helpful to informing people about the
nature of the problems.

The comorbidities and family history are often similar to your situation. I
often said "comorbidity is the rule not the exception", and ADHD and bipolar
D/O are known to be highly heritable conditions.

Tolerability of stimulant medications is usually quite good. Can't say the
same for agents available for bipolar D/O, it's especially devilish to manage
when ADHD and mood D/O are both present.

I glean that you've responded pretty well to treatment and that's great. One
thing I learned is that treatment can help patients improve tremendously,
essentially functioning in the "normal" range. In the treatment field we
consider "normalization" to be the "gold standard" of success. It takes time,
years in most cases, but the benefit of persistent treatment is in my view
extremely clear.

The key advice I always offered was "keep up the good work".

------
snarfy
At your work you may not get free food or a lot of breaks, but I bet you get
unlimited free coffee.

I'm not sure why one stimulant is socially taboo and the other acceptable,
even encouraged.

------
bumbledraven
No mention of modafinil/armodafinil (provigil/nuvigil)?

~~~
iamchmod
This is a fun article about provigil -
[http://www.thedailybeast.com/articles/2015/05/27/silicon-
val...](http://www.thedailybeast.com/articles/2015/05/27/silicon-valley-s-
eating-up-super-ritalin-i-got-the-best-of-it.html)

------
thisguy666
There sure are a lot of people with very little experience with drugs sounding
off here. Downplaying the power of amphetamines. hrm.

------
iamleppert
Does anyone have any adderall or vyvanse for sale?

------
dsabanin
Comments on this thread are insightful, people on amphetamine defending their
way of life.

~~~
thisguy666
+1

~~~
thisguy666
awesome how one can get voted down on hacker news like this. there is nothing
incorrect or even mean stated here. you just don't like what is being said
about you. the moderators on this site are so screwed up.

------
notliketherest
As an aside, I'd be willing to bet there's a direct correlation between
Hackernews karma and amphetamine use.

~~~
llamataboot
I'd be really interested in an anonymous hackernews drug survey...maybe I'll
make one...

------
JustUhThought
This attitude, painting cognitive enhancers with a broad and critical brush,
is not helping things. Cognitive enhancers have the ability to improve persona
lives and and society on the whole. But, there is a double standard with all
things in healthcare. If you want to fix something, then by all means, take as
many pills as you want and don't worry about changing lifestyle choices. Take
insulin, for example. Or blood pressure medicine. Society may be harsh on
folks that need these medicines, but these folks will have no problem getting
the medicine. But, if we want to be better than "fixed", if we want to improve
our cognitive performance, to do that in a safe physician guided manner, and
have that translate to a better emotional, psychological, and economic future
for themselves and their family. The economic benefits are real and shouldn't
be limited to those in higher socioeconomic strata.

This article shows sleep deprived surgeons benefit from modafinil:
[http://www.ncbi.nlm.nih.gov/pubmed/21997802](http://www.ncbi.nlm.nih.gov/pubmed/21997802)

Modafinil Does Not Serve as a Reinforcer in Cocaine:
[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2842996/](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2842996/)

... Ok, I won't make it one of those posts. But, do some research. We will all
be better off if we can drop the FUD rhetoric and treat cognitive enhancers
like we treat other drugs, something that can help and hurt. And we need to
stop thinking of health care as something we do when something is broken, and
start thinking about it as another tool in the toolbox that we can use to
_improve_ our lives.

~~~
nommm-nommm
This article is about amphetamine use. Modafinil is not an amphetamine nor is
it amphetamine-like.

