
Workers Seeking Productivity in a Pill Are Abusing A.D.H.D. Drugs - romefort
http://www.nytimes.com/2015/04/19/us/workers-seeking-productivity-in-a-pill-are-abusing-adhd-drugs.html
======
zxcvcxz
Off topic, but I was diagnosed with ADHD about 10 years ago, been taking
methylphenidate ER ever since. Throughout the years I have had over ten
different doctors at the same location and I informed each doctor that I was a
marijuana user.

Recently my latest doctor decided to drug test me, before asking any questions
about my usage or even looking at my file he stated he would no longer
prescribe me my medicine because I use marijuana and "those two don't interact
well together". When I repeatedly asked him to back up his opinion with actual
evidence (studies), he repeatedly refused. He would not even explain the
reaction that marijuana had with ADHD medication. After less than three
minutes I was asked to leave his office. No discussion about my condition was
allowed.

I'm aware that the doctors opinion is what goes and he has all the power, but
I feel I've been wronged. I really need this medicine and it's probably does
more harm to kick me off cold turkey without even looking at my file than to
let me smoke marijuana with it, and I feel that his opinion is based more on
politics than rigorous medical study.

I have a feeling if I was an alcohol drinker he would have no problem. So it
goes.

~~~
snarfy
> I'm aware that the doctors opinion is what goes and he has all the power,
> but I feel I've been wronged.

He actually has little power. You can go to a different doctor. There are many
people that abuse this fact, e.g. keep switching doctors until they find one
that prescribes them painkillers, but in your case it sounds perfectly valid.
You have ten other opinions that think it's perfectly fine to combine your
meds.

~~~
zxcvcxz
The problem is that I go to a mental-health center and because of my financial
situation they only charge me three dollars a visit. I'm going to look for
other doctors, but I'm not sure if I'll be able to find another health center
willing to work with poor people. We'll see..

------
ryan90
This really shouldn't be a shocker. I was diagnosed with ADHD in elementary
school and have been on and off medication ever since. A large number of
friends in the professional world use these stimulants regularly.

I think that these drugs are very useful for short term sprints where one
needs to focus, or do rather mundane tasks. But it's incredibly easy to become
dependent on them. At one point, I could even begin to focus unless I had the
max dose of adderall and a strong cup of coffee.

I don't judge anyone who uses stimulants to increase performance. Just because
I was diagnosed with ADHD doesn't mean I'm not using them as a performing
enhancing drug; it's just legal for me to do so. However, I would encourage
everyone - whether you're prescribed or not - to use them in moderation. It's
very easy to build up a tolerance and become dependent, and once you're
dependent, you're no better off than where you started.

~~~
jdefr89
I have also been on psycho-stimulants for a while. People simply don't realize
the effect they are really after is the buzzed high like euphoria.
Furthermore, those effects don't last and you need to keep cranking up the
dose to achieve your desired mental state.

------
solve
Something will replace coffee eventually. I refuse to believe that technology
will never find a better productivity enhancer, with near-zero side effects
like coffee.

Adderall is not the answer as these journalists like to claim though. It's
useless for basically anything other than very rare usage and has difficult to
manage loss of productivity during withdraw. It has an incredibly fast
tolerance buildup. If your work requires steady output instead of rare bursts,
it's questionable whether it even surpasses coffee because of these downsides.

~~~
ugexe
The tolerance/withdrawal drawbacks for adderall are nearly non existent if you
don't abuse it and take weekends off. Sure, after the well known honeymoon
phase of a few weeks it's not the superman pill you might have expected would
last forever, but otherwise responsible use will keep you more productive.
People with little will power or addictive personalities (which a third party
can't possibly always know) aren't usually equipped to deal with such
moderation, so instead we let the "gotta work 7 days a week!" grinders
stigmatize an otherwise safe and useful medicine/tool.

When used responsibly I can assure you it's more effective and has less side
effects than caffeine IF you tolerate it well (not everyone can, just like not
everyone can tolerate caffeine)

~~~
inmyunix
i recently quit adderall after 10 years and experienced Zero withdrawal.

~~~
throwaway98031
Everyone is different, of course, but after 10 years it would be reasonable to
assume that your brain was well-adapted to many of the effects of the Adderall
and that you were taking a reasonable therapeutic dosage with a proper,
healthy dosing schedule.

On the other hand, those who abuse Adderall for the initial euphoric and
energetic properties with sporadic dosing schemes are likely to experience
unpleasant withdrawal as those effects disappear.

~~~
danneu
I can't imagine a withdrawal for amphetamine outside the come-down from a
multi-day binge. The come-down lasts a day or two. Maybe a week of fogginess
if you hit it fear-and-loathing hard.

If you're taking amphetamine at such a rate that you would call it a
"withdrawal", then you might want to consider the possibility that you were
abusing amphetamine.

It's common to double-dose on the weekend whether for a productivity spree or
recreation (they're usually one in the same) even if you haven't taken a pill
in months. You just have to pay a day or two penalty and you're good to go.

------
fasteo
>>> Investors in her health-technology start-up

Running a health start-up and popping Aderalls like there is no tomorrow does
not seem a good fit.

~~~
jotm
Hopefully it's a health startup promoting the legalization of stimulants and
enhancers :-)

~~~
eli_gottlieb
Legalize all you like: amphetamines are still bad for your heart and can
engender quite the headache when they wear off.

~~~
SCAQTony
That quote from Blade Runner: "The candle that burns twice as bright only
lasts half as long..."

Sparingly, it seems like an important drug as a last resort for ADDHD but for
"enhancement purposes?"

Summary: A new study conducted in rats [rats are not people] by the National
Institutes of Health (NIH) and McLean Hospital/Harvard Medical School suggests
that the misdiagnosis of attention-deficit hyperactivity disorder (ADHD)
combined with prescription drug use in children may [emphasis on the word may]
lead to a higher risk of developing depressive symptoms in adulthood.

[http://www.sciencedaily.com/releases/2004/12/041220013546.ht...](http://www.sciencedaily.com/releases/2004/12/041220013546.htm)

------
whybroke
Honestly though what percentage difference does this make in productivity and
is that percentage really going to be the difference between a startup's
success and failure? Being fired or not? Being happy or not?

If the thing makes you happy then that's one thing. If you think getting 10%
or 20% more work done is going to move you from mediocre to exceptional or is
going to make you happy, I beg to differ.

~~~
mej10
(assuming) 10-20%, compounded over as long as you can sustain it. It can make
a huge difference.

Also, they make most people feel fantastic and like they can conquer the
world. Is it really any question why people would find that appealing?

~~~
whybroke
Does labor compound? My understanding is that say a freelance carpenter who
works 20% harder for 40 years ends up about 20% richer not 1.2 ^ 40 = 1469
times richer

>Also, they make most people feel fantastic and like they can conquer the
world. Is it really any question why people would find that appealing?

Perhaps, but what is the delta increase in zeal for their project. Presumably
they were tolerably enthusiastic before taking the pill. Is the difference
significant?

Now if it makes the user feel better then that alone might be a good reason
for taking it. But let's not suppose that a bad project or feckless employee
is going to become the next google or Einstein because of a pill.

~~~
mej10
There are three areas I am aware of where labor can absolutely compound (in
terms of output): business, software, and learning.

> Perhaps, but what is the delta increase in zeal for their project.

From my personal experience, it can increase dramatically. This is across the
board. Whether it is something I am actually interested in doing or just
drudgery.

> But let's not suppose that a bad project or feckless employee is going to
> become the next google or Einstein because of a pill.

Of course not, but it can really help. People can also become
psychologically/physically dependent on them as well -- they aren't without
risks.

~~~
whybroke
>There are three areas I am aware of where labor can absolutely compound (in
terms of output): business, software, and learning.

Well this would mean that every 10 times engineer ends up 10^20 richer than
average at the end of his career. Since that far exceeds the planet's wealth,
I am somewhat skeptical.

And if there are no 10 times engineer, even a five times engineer would end up
roughly a hundred trillion times wealthier than average. So I humbly submit
there's a flaw in the idea of literal compound labor value.

~~~
mej10
If you want to be (unnecessarily) pedantic, I never said what the frequency of
the compounding was.

I didn't realize we were trying to come up with a realistic model of expected
utility in these three fields.

If you don't want to believe that work put into these can compound over a
person's life, thats fine. You're wrong, but that's ok. -- just don't pretend
to pick it apart by applying math to an informal discussion.

------
josephagoss
Interesting that there was no mention of Modafinil.

I believe that one of the most "abused" drugs for "productivity" is currently
Modafinil, far more powerful than Adderall and without all those side effects.

Of course, long term side effects are unknown.

~~~
jronald
I'd disagree with it being far more "powerful" than Adderall, having been
prescribed both at one time or another. They're effects on me are quite
different:

Adderall - I seem to focus on anything I needed to without resistance, similar
to how I would focus on something I enjoy. The side effects on me were (to me)
extreme emotional instability, which was too off putting to use regularly -
could not play well with others.

Modafinil (and Adrafinil before that) - The concentration assistance is there
for when I'm focused, but it doesn't seem to help me stay on topic - I'm still
easily distracted. The upside is I can still play well with others, and if
anything seem more energetic (I hit the gym every morning I use it). The
reduced sleep effect is real, I went from an average of 6 hours a night to <4,
and it feels like the regained time is still productive. I have no hard
numbers around this, and not really sure how to build a baseline to compare
to.

I'd like to see how I react to both together, but hesitant given my poor
reaction to Adderall. When I was younger I remember preferring Ritalin over
Adderall.

EDIT: Adding to the throwaway comment below, the long halflife of Modafinil is
true, especially when trying to sleep. For me, after months of 3-4 days on a
week, there seemed to be no long term issues with this, where days I had taken
Modafinil I only slept 3-4 hours.

I definitely had issues with alcohol and Modafinil, where at my weight
(220lbs) I could normally drink 3-4 pints to reach 'buzzed' status, this
seemed to happen at 1-2 pints. This trend stayed consistent - and proper
'drunk' came much quicker. This had the effect of limiting my drinking, to the
point where I would switch to light beers and stop drinking after 1-2. This
has been positive to me, but a bit concerning as I hadn't read of that effect
before.

~~~
throwaway98031
> I'd like to see how I react to both together, but hesitant given my poor
> reaction to Adderall. When I was younger I remember preferring Ritalin over
> Adderall.

I always advise against poly-pharmacy if possible. Particularly when dealing
with powerful stimulants for which the mechanism of action isn't fully
understood (Modafinil).

Interestingly, Modafinil might somewhat antagonize the Adderall due to an
interaction between their mechanisms of action. Modafinil's MOA is partially
due to dopamine reuptake inhibition (similar to Ritalin), but Adderall relies
largely on being taken in to the presynaptic terminals and forcing dopamine
out. By inhibiting dopamine uptake, Modafinil can (theoretically) decrease the
amount of Adderall taken in to the terminal as well as the amount of dopamine
available in the terminal for release. We've seen this in a few studies where
Modafinil can actually reduce the neurotoxic effects of Adderall, likely due
to this antagonizing of Adderall's core MOA.

The magnitude of this effect at therapeutic dosages is unknown, but it's
possible and even likely that the combination would be distinctly different
than what you might expect a combination of the two drugs to feel like.

> EDIT: Adding to the throwaway comment below, the long halflife of Modafinil
> is true, especially when trying to sleep. For me, after months of 3-4 days
> on a week, there seemed to be no long term issues with this, where days I
> had taken Modafinil I only slept 3-4 hours.

It's expected that your body would adapt somewhat to sleeping on the
medication, but that doesn't mean that you were getting quality sleep. Humans
are notoriously bad at judging sleep quality, for one, but more importantly
here: You were taking a wakefulness-promoting agent, which would have covered
any subjective feelings of poor sleep. My concerns with Modafinil stem more
from potential long-term implications of interrupting sleep, particularly when
the traditional signs of poor sleep (daily fatigue and sleepiness) are then
obscured by the drug itself, leading to a false sense of restedness.

However, we can begin to infer poor sleep quality by other, indirect markets,
such as:

> I definitely had issues with alcohol and Modafinil, where at my weight
> (220lbs) I could normally drink 3-4 pints to reach 'buzzed' status, this
> seemed to happen at 1-2 pints. This trend stayed consistent - and proper
> 'drunk' came much quicker. This had the effect of limiting my drinking, to
> the point where I would switch to light beers and stop drinking after 1-2.

Getting subjectively incapacitated from a lower number of beers could,
theoretically, be indicative of a subtle sleep-deprived state, for example.

Again, much of this is just semi-educated conjecture, but given the importance
of sleep to long-term health I'm wary of these stimulants with long half-
lives.

------
gregpilling
I have a prescription for Adderall, Modafinil and a have tried bunch of
others. Adderall was prescribed for fibromyalgia related symptoms of brain fog
and lack of memory, modafinil for chronic fatigue.

Adderall aggravated the Renaud's syndrome that I have had for 5 years, to the
point where the blood flow stopped and the fingers began to suffer from
continuos lack of blood . See
[http://imgur.com/Djy6g2A](http://imgur.com/Djy6g2A) This has been a daily
challenge for the last couple of months, and it has greatly impacted my
ability to work. I have a hard time using my hands to do anything, even
typing. I am now off Adderall (6 months), withdrawal was not too bad for me.

I miss the Adderall, since it made me feel like my brain worked again. I felt
like my old self, much sharper mentally - no focus change, still ADD as ever,
but felt restored in the brain. I felt 25 again (45 now) and was able to work
better, in the sense that 25 year old me was more energetic than 45 year old
me. I tried Strattera for a few days, but found that has nasty side effects
and also aggravated my hands.

Modafinil I don't notice any other effect, other than I don't feel as tired
all the time. I don't feel smarter, or better, only _not exhausted_. For me,
there is no stimulant feeling with Modafinil, or ability/skills change, just
an change in the tired all the time feeling.

So, if you are going to use these drugs, pay attention to the side effects. I
would recommend avoiding them unless you need them.

------
SCAQTony
Not just in the workplace NFL players are using ADHD drugs to mask concussions
too so as to keep their jobs and be "more productive."

[http://www.beyondchron.org/will-ritalin-become-the-human-
gro...](http://www.beyondchron.org/will-ritalin-become-the-human-growth-
hormone-of-sports-concussion-testing/)

~~~
ams6110
How is that not "in the workplace"?

------
afarrell
How does somebody tell if they actually have ADHD or they are just easily
distracted?

Isn't "Do they respond to ADHD medication?" our only test?

~~~
throwaway98031
> Isn't "Do they respond to ADHD medication?" our only test?

No, absolutely not. It's a common internet myth that response to ADHD
medication is indicative of ADHD. In reality, nearly anyone who takes ADHD
medication acutely will experience increased focus and productivity (again,
acutely) due to the acute (pre-tolerance build-up) effects of the drugs.
Additionally, new users experience a short-lived euphoria that convinces many
people that they need a stimulant to feel "normal," when in fact they're just
experiencing the initial euphoric effects of the drug. Be warned that the
euphoria fades and, more importantly, does not return without abusing dosing
schedules.

ADHD marketing materials combined with pop-psychiatry have stretched the
definition of ADHD to encompass nearly anyone. It's trivial to find low-grade
internet forums in which users believe that anything and everything is a
symptom of ADHD. You can even find a large number of people who believe that
something called "hyperfocus" (being able to focus very intently on one thing
for a long period of time) is a symptom of ADHD, believe it or not. Of course,
the term "hyperfocus" does not appear in ADHD medical literature or any ADHD
studies.

ADHD is a complex disorder, and the modern world can (and does) drive people
in to ADHD-like states with all of the distractions available to us. The
single best approach to dealing with this is to pursue constant discipline and
self-monitoring, in order to train yourself back to a healthier mental
process. ADHD medications can help people implement those disciplines and
healthy processes, but they don't actually substitute for proper habits. It's
not uncommon for people to pop Adderall expecting their ADHD to disappear,
only to be drawn in to extended video game or web-browsing sessions that are
in no way productive.

So my advice would be to make efforts to structure your life in ways to
minimize distractions and hold yourself accountable for your results. Realize
that _everyone_ is distracted in modern life, but that's not necessarily
indicative of a disease. Stimulant medications are not to be taken lightly,
and you're best avoiding them long-term if possible.

~~~
afarrell
To be clear: I'm getting that from a psychiatrist and a psychologist that I've
seen. Of course they would have an economic incentive to over-diagnose.

Do you happen to know what one actually does in order to "pursue constant
discipline and self-monitoring"? Mindfulness meditation is not really that
effective, but I might have been doing it wrong. Running in the morning seems
to have had some effect but I can't yet tell. The only things that have been
effective have been applying external constraints by:

\- Getting married to someone willing to yell at me for getting distracted.

\- Installing [http://selfcontrolapp.com/](http://selfcontrolapp.com/) and
putting it on before I go to bed.

\- Putting my smartphone near a co-worker's desk when I get in in the morning.

\- Making sure my monitor faces out towards the common area so someone could
look over my shoulder.

\- Keeping a lab notebook so that I can remember the state in my head if I do
get distracted.

\- During meetings, pushing people to be very clear on what problem we are
trying to solve.

It works okay. I am a fairly productive engineer as long as I am on a team
where I can succeed at that last bit. But I've never been able to get rid of
the internal urge to check my email or HN or Twitter. Or worse, to look things
up about, for example, the role that the Harlem Hellfighters and other WWI
vets played in the Civil Rights movement of the 1920's and 30's. So whenever I
have a weekend to myself to work on projects in my spare time, I don't get
anything done and I haven't known how to even make progress toward fixing
that.

~~~
ktsmith
> Of course they would have an economic incentive to over-diagnose.

Why would your Dr have an economic incentive to over-diagnose? I was diagnosed
a year ago with ADHD and I have tried every self-discipline technique you can
think of without success. The quantified self just becomes an effort in
futility and depression when you see where you are wasting time, actively try
to correct it and still fail. I saw my Dr every six weeks initially when
trying out medications. I see my Dr. every three months now instead of six
months so that I can have my prescription renewed as she can only issue three
one month non-refillable prescriptions but that's a tiny amount of additional
money my Dr. is getting. I suppose if the Dr. is diagnosing this on a large
scale the volume adds up but it just doesn't seem worth it. Especially with
the changes to schedule II drugs and their prescription/distribution in the
U.S.

I've been medicated for the last year and it's been a life changing
experience. My own day sounds similar to what you describe below as far as the
distractions go. I cut down to two monitors instead of three as I was using
the third for just email and other communication tools. I now hide those on a
virtual desktop. I do occasionally miss the third when I have a code window on
one, and an output/debugging window on the other when having all three full
screen would be easier but that's about it. I only let communication apps send
me notifications once an hour instead of in real time which helps. I also have
scheduled blocks where the notifications are blocked on my phone and computer
except for specific people which is a new feature of Android 5 that I really
like (Priority notifications). The medication has helped me build a routine
and stick with it, and I'm hoping that when I decide I'm ready to try going
off of it full time I will be better able to continue that trend. I don't
believe for a minute that I will be able to eliminate all of it completely but
I hope that I will be better prepared to handle it.

------
amelius
And these practices are in a way unfair against the rest of us workers!

> Most users who were interviewed said they got pills by feigning symptoms of
> A.D.H.D., a disorder marked by severe impulsivity and inattention, to
> physicians who casually write prescriptions without proper evaluations.

And thus these practices disturb statistics about the true prevalence of ADHD.

~~~
xamuel
>And these practices are in a way unfair against the rest of us workers!

This raises interesting philosophical questions about work in general. If work
is inherently valuable, isn't anything that enhances it a good thing (assume
lack of side effects for simplicity)? Is it "unfair" if a
doctor/scientist/programmer uses a product to be more productive? Very few of
us are formally competitive athletes, and special rules apply to those of us
who are. I think it's unfair that some people can afford secretaries,
accountants, editors, private schools, etc., those seem much less fair than
ADHD medicine.

One of my childhood heroes, the great mathematician Paul Erdos, was a famous
amphetamine user, does that mean the wonderful contributions he made to our
understanding of the universe are "unfair"?

~~~
jdefr89
The real issue is they don't improve your performance much at all. A recent
study demonstrated people simply feel as if they are performing better,
however its a false perception. Additionally the drugs won't give you that
"buzzed motivated" feeling for long. You have to keep upping the dose and
upping the dose, and people end up addicted and in a worse spot than when they
started.

~~~
danneu
Have you ever taken a therapeutic extended-release dose of amphetamine? The
idea of amphetamine only making you _feel_ like you're performing better is
hilarious to anyone that's ever taken it. Kind of like someone telling you
that marijuana is actually inert. Yeah, whatever.

The drugs will give you an effect as long as you keep your tolerance down.

You don't take them every day. You need off days. Most people I know are
prescribed 20mg Adderall XRs or 50mg Vyvanse caps and only up their dose if
they want to save money by splitting pills.

