
Concerns About A.D.H.D. Practices and Amphetamine Addiction  - wglb
http://www.nytimes.com/2013/02/03/us/concerns-about-adhd-practices-and-amphetamine-addiction.html?hp
======
danneu

        > “...when he was in elementary school he fidgeted, 
        > daydreamed and got A’s. he has been an A-B student 
        > until mid college when he became scattered and he 
        > wandered while reading He never had to study. Presently
        > without medication, his mind thinks most of the time, 
        > he procrastinated, he multitasks not finishing in a 
        > timely manner.”
    
        > His father reacted with surprise. Richard had never
        > shown any A.D.H.D. symptoms his entire life, from 
        > nursery school through high school, 
    

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

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

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

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

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

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

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

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

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

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

~~~
j_baker
_I needed to change meds as the ones I was taking were making me angry all the
time_

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

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

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

Hell, even thyroid disorders can look like ADHD.

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

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

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

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

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

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

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

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

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

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

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

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

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

[1]
[http://repository.upenn.edu/cgi/viewcontent.cgi?article=1039...](http://repository.upenn.edu/cgi/viewcontent.cgi?article=1039&context=neuroethics_pubs)

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

------
murbard2
Mathematician Paul Erdos heavily consumed amphetamines, and they did not
consume him.

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

Sadly, policy is made around these incidents.

~~~
apl

      > Sadly, policy is made around these incidents.
    

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

~~~
murbard2
It does, it shows that not all cases are similar and that there is potentially
a large variance in outcomes and thus calls for collecting more data. It's a
proof by existence.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

~~~
neurotech1
I think those laws are there for a reason, and that Ritalin has a high
probability of abuse or "resale".

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

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

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

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

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

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

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

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

------
imperio59
The FDA themselves warn Adderrall has a high potential for abuse, not to
mention the risks of sudden death or cardiovascular incidents that must be
checked for before prescribing it. It doesn't sound like any doctor did the
proper diagnosing and checking on this kid before this tragedy happened, and
those doctors should be held accountable for his death.

Not to mention the other potential side effects like Psychosis, Aggression,
Seizures... I don't understand why anyone would ever take a drug like this,
the list of side effects sounds worse than the problem it's trying to cure...
[http://www.accessdata.fda.gov/drugsatfda_docs/label/2007/011...](http://www.accessdata.fda.gov/drugsatfda_docs/label/2007/011522s040lbl.pdf)

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

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

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

~~~
DannyBee
I can't vote this up high enough.

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

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

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

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

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

------
neurotech1
I'm not a physician, but I will note that it involves lack of sleep. Sleep is
important, and most of these type events involve chronic lack of sleep, and/or
doubling up on prescriptions.

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

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

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

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

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

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

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

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

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

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

It worked flawlessly.

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

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

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

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

[http://www.psychologytoday.com/blog/suffer-the-
children/2012...](http://www.psychologytoday.com/blog/suffer-the-
children/201203/why-french-kids-dont-have-adhd)

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

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

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

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

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

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

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

You know what cured my ADHD? Working from home.

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

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

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

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

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

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

------
Alex3917
This is why learning how to be good at doing drugs is easily the best thing
you can do for your health in terms of ROI. Drug use kills or contributes to
the deaths of something like 1 in 3 Americans, meaning that if you want to
live a long and health life then being good at doing drugs is just as
important as eating healthy and exercising. Except for that unlikely eating
healthy and exercising, which you have to do every day, when it comes to
learning how to be good at doing drugs you just spending a couple months
reading a handful of books and then you're done, that's it.

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

<http://pastebin.com/Kf6W2vUA>

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

