Adderall: not for all

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He was a cute guy, though not really my type: skinny, tanned, wearing a printed t-shirt that screamed “surfer dude.”

He seemed like a nice enough person, however, and it wasn’t like we were on a first date. Our meeting was practical, nothing more: it was April of 2011, I was studying in one of the Student Union Building booths near Vertigo, and he’d asked to sit across from me and share the precious outlet for his laptop. We exchanged smiles and a minimum of small talk before disappearing under headphones and burying our noses in our books. Then, about 20 minutes into our studies, he got my attention.

“Do you have any Dex?” he asked.

“I’m sorry, what?”

He grinned sheepishly. “Dex? Like, Dexedrine. Have you ever taken it?”

I opened and closed my mouth like a fish. It’s not every day that someone casually asks you for drugs. It’s rarer still that the request is for the medication you’ve been taking for over a decade.

That wasn’t the first time I had been asked to give or sell my medication to someone, but it was the only instance in which the solicitor was a stranger — someone who couldn’t have possibly known my history. I was diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) when I was 10 years old; since that time, I have discovered that there is a significant divide between the public perception of ADHD and the real-life experiences of those with the disorder.

When I’ve told others about my ADHD, I’ve received a variety of responses. Sometimes it’s a grin and a wink — an assumption that I’ve successfully scammed the system in order to ease the stress of midterms. Some people will pepper me with questions, occasionally tinged with subtle accusations. Does ADHD really exist? Isn’t it awfully convenient that the drug companies make billions off of these medications? Doesn’t it seem as though everyone has a diagnosis and a prescription for something nowadays? What did people do before they classified ADHD as a disorder? Isn’t it just an excuse for laziness or a symptom of terrible parents who would rather give their kid drugs than actually work on parenting?

Yes, it does. Sure, but that’s the pharmaceutical industry for you. It might seem that everyone has a prescription these days, but that’s not my problem. Some people are lazy, sure, but I’m just trying to get this essay done on time. I’m not an addict; I’m not lazy; I’m not a victim of Big Pharma’s scam. I have Attention Deficit Hyperactivity Disorder, and so do others. We really do.

The Forgetful Personality

ADHD is a highly prevalent neurobehavioural disorder, and one of the most common to affect children. The Diagnostic and Statistical Manual of Mental Disorders (DSM) defines it as “ a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequently displayed and is more severe than is typically observed in individuals at comparable level of development.” There are three recognized sub-categories: predominantly inattentive type, hyperactive-impulsive type and combined type. The symptoms include distractibility, poor organization, restlessness, inattentiveness and forgetfulness; the hyperactive-impulsive types also may show destructive behaviours and act immaturely compared to their peers.

In elementary school, I was never the type to scream, throw things or run around in circles. I loved school, but it didn’t seem to love me back. Despite being bright enough to skip the fourth grade, nothing ever seemed to go right. Book reports got left at home and science fair experiments were lost in my backpack for six months. Homework was never finished on time, and the process of getting a permission slip signed and returned was so frustrating that I’m sure I drove at least one teacher to drink.

Socially, I didn’t fare much better. Young girls construct a complex web of kept secrets and whispered rumours, a china shop in which I was a lumbering and desperate bull, predictably outcast. It seemed like I had another personality: an impish doppelgänger who existed specifically to cause chaos, eradicate chunks of memory and leave me to take the fall. I tried so hard, but nothing seemed to go right.

This is a common situation for people with ADHD. With no physical symptoms and a wide range of subtle, problematic behaviours, many people will spend years feeling disheartened and stupid. Allie Montoya, who is currently studying forestry at UBC, describes a similar experience growing up with ADHD symptoms. “I was always an extremely overactive child, and had an incredibly hard time concentrating in school. I did all my learning at home, reading. I could never sit still or focus long enough in a lecture,” says Montoya. “If I wasn’t interested, I wouldn’t retain any of what I was reading or listening to.”

Montoya’s real problems began at university.

“I didn’t understand what had happened and why I was doing so poorly. I was so frustrated and felt really stupid and incapable of doing four years [of a degree],” she says.

By 10 years old, I was in a similar situation and swiftly reaching a crisis point. Despite transferring to a new elementary school at the start of sixth grade, I was still struggling to pass assignments and make new friends. ADHD wasn’t unheard of at the time, and I had many of the symptoms. After a psychological assessment, my diagnosis was confirmed and I was prescribed Ritalin. My first day of medication is now a well-known family story. My parents went for a walk. Before they left, they asked me to put away the board game I was playing with once I was finished. When they came home, I told them how freaky it felt: I remembered that they’d asked me to clean up, and I saw the pieces lying around, and I did it. It was the first time I’d ever managed to accomplish that sort of delayed organizational task.

While it seemed miraculous, Ritalin never fixed me. None of the drugs I’ve taken for my ADHD have cured my symptoms permanently, and they never will. This is one of the best-kept secrets of the ADHD crowd: those magic pills aren’t an easy fix.

“I am still distracted on the medication, but I do notice a difference,” Montoya says. “My grades are higher and my mind is more focused.” The forgetful personality never goes away; however, it becomes less of a struggle to ask it to sit quietly for a while. Stimulant medications like Ritalin, Dexedrine and Adderall are a tool. So what’s the big deal?

The Controversy

Few mental disorders come with as much baggage as ADHD. Despite its prevalence, it continues to incite controversy and make headlines all over the world. It’s unthinkable that anyone would tell a diabetic that their insulin injections were doing them more harm than good; likewise, it’s in exceptionally poor taste to ask a clinically depressed person to “just cheer up.” But for those with ADHD, interactions like these can be frustratingly common, even after decades of mainstream attention.

Part of the problem is due to ADHD being the disordered end of a normal human behavioural spectrum. Everyone gets distracted, misplaces their wallet or forgets their homework. All children have hyperactive periods or have trouble paying attention in school. These emotions and experiences are universal, the same way that depression and anxiety are universal. The disorder occurs when these behaviours interfere with normal functioning and cannot be altered without help.

What is “normal functioning,” and how do you know if your misplaced keys qualify as a deficiency? Therein lies a major issue: human beings are complex creatures, and our behaviour fits into a multi-dimensional spectrum where “normal” isn’t always clear. In some cases, diagnosing ADHD is very easy; in others, a difficult judgment call must be made. We depend on psychologists and experts to know the symptoms well enough to be able to make that decision. However, the diagnostic process for ADHD is incredibly unclear; it relies on the testimony of parents and teachers, and it can be difficult to get an unbiased third-party observation. There is no biological marker to indicate ADHD, and it often coexists with depression, anxiety and conduct disorders, such as antisocial personality disorder. Finally, it’s difficult to shed the behaviourist ideology, in which parents are responsible for their child’s conduct, good or bad. Compound unclear diagnostic criteria with social pressures and a strained medical system, and it’s easy to see that diagnosing ADHD is complicated.

Nonetheless, scientists have known about ADHD for at least 100 years; it was originally called “hyperkinetic syndrome” or “minimal brain dysfunction.” Those affected by it exhibited poor impulse control, academic failure, rage issues and a lack of foresight. While they did not usually have low IQs, certain executive functioning skills simply did not develop in time with their peers. In the middle decades of the 20th century, psychologists were inclined to blame this poor behaviour on a child’s parents or environment; however, as the neurological view of psychology matured, scientists began to realize that many disorders were the result of fundamental problems in brain chemistry, development or function. Methylphenidate, the stimulant known as Ritalin, was first synthesized in 1944. It was initially marketed as a treatment for chronic fatigue and depression; in the 1960s, doctors began to prescribe it for ADHD.

The result was startling. The stimulant had a paradoxical calming effect on ADHD symptoms, decreasing hyperactivity, boosting attention span and turning unruly hellions into functioning students. While it wasn’t exactly clear why Ritalin worked, the benefits were undeniable. Soon Ritalin sales saw a dramatic rise, increasing by 500 per cent between 1991 and 1999.

But by the end of the decade, a vicious backlash had developed. Parents came forward with horror stories, claiming that their children had become robotic, depressed and even psychotic as a result of medication. Others saw their disruptive behavioural symptoms worsen rather than improve. Public opinion turned negative as people began to question the apparent spike of ADHD diagnoses and the ethics of giving stimulants to young children. Reports surfaced that thousands of high school students were abusing Ritalin and Dexedrine, either buying it from their ADHD friends or obtaining prescriptions on their own. The pills worked as both a study aid and a party drug — cheaper than cocaine and far less dangerous than speed. Several of these young adults had horror stories of their own — tales of being forced to endure an amphetamine’s horrific side effects, of being medicated against their will to satisfy indifferent teachers and parents who searched for a “quick fix.”

In 2000, class-action lawsuits were filed in five separate U.S. States against Novartis, the maker of Ritalin. The suits alleged that the drug company had conspired with the American Psychiatric Association to invent ADHD and promote Ritalin as its cure. While all suits were dismissed due to the lack of any concrete evidence, the implication was clear: there was serious doubt that ADHD actually existed and considerable suspicion about the treatment process.

ADHD then and now  

So where were all of these kids back when our parents were in school? Why does it suddenly seem that ADHD is everywhere? Russell Barkley, one of the leading experts on the disorder, addressed the question during a 2001 interview with PBS.

“These kids were there,” said Barkley. “They were the class clowns. They were the juvenile delinquents. They were the school dropouts. They were the kids who quit school at 14 or 15 because they weren’t doing well.”

The difference, said Barkley, was the lack of vocabulary for and understanding of these kids.

“Back then, we didn’t have a professional label for them. We preferred to think of them more in moral terms. They were the lazy kids, the no-good kids, the dropouts, the delinquents, the lay-about ne’er-do-wells who were doing nothing with their life. Now we know better. Now we know that it is a real disability, that it is a valid condition and that we shouldn’t be judging them so critically from a moral stance.”

While the hysteria has largely died down, university students are still living out the after-effects.  A quick Internet search can bring up thousands of news stories about students who use ADHD medications as study aids and energy boosters; the New York Times wrote about the trend in 2005 and published another in-depth examination in June of 2012. High school and college-age kids without an ADHD diagnosis buy Ritalin, Dexedrine and Adderall from friends and report superhuman levels of focus and capability. They can study for eight hours without a break; for once, they don’t feel overwhelmed by their intense workloads or commitments. A 10-page term paper suddenly becomes a mere night’s work. Unlike cocaine or caffeine, the stimulants in ADHD drugs are specifically designed to have long half-lives and slow-release mechanisms. There is not enough initial euphoria to produce a high, and the long-lasting effects do not produce nearly as harsh of a crash. It’s not tough to fake ADHD and get a prescription of one’s very own; independent studies from the University of Washington and the University of Kentucky in 2010 found that many of the neuropsychological tests for ADHD were unreliable and could not easily catch those faking the symptoms.

The American Psychiatric Association (APA) will be releasing the new edition of the DSM in 2013. Among the many revisions, the APA has reworked its diagnostic criteria for ADHD. The proposed changes raise the age of childhood ADHD symptom onset to 12, up from seven years old, and recommends using teachers as sources of information about the child’s behaviour. For adult-onset ADHD, the minimum number of symptoms for two types of ADHD will be lowered from six down to four. Diagnosis will be more stringent in children, but easier to spot in adults.

The pressure to use  

Some of the students interviewed by the New York Times felt that they had no other choice; they were entrenched in a highly competitive school environment. When one GPA point or extracurricular activity can make or break a college application, anything less than perfection is unacceptable. After a certain point, the issue becomes one of fairness rather than health; if everyone in the class is studying with Dexedrine, the abstaining student cannot level the playing field — and the kid with ADHD can’t even see the pitch. Indeed, many skeptics feel that ADHD’s prevalence in North America is proof that our society is at fault, pressuring kids to meet an impossible standard of excellence and viewing any deviation as something to be cured. Eager to please, non-ADHD students will self-medicate in an effort to avoid the humiliation of perceived failure.

While the media cries panic about students and their study drugs, a rather libertarian response has emerged from those who casually use these prescription medications. For them, popping an Adderall is no worse than smoking a joint: it’s illegal, but everyone does it, and it shouldn’t be a big deal. Many recreational users have found the drugs to be helpful. Jennifer Jones (who prefers her real name not be used), for instance, was always terrible at math; while attending high school in Florida, she found that taking Adderall helped her study and get the best grades she’d ever had. “It seemed to slow everything down so I could see the connections that I had missed, and I was able to actually understand and learn what I needed to do,” she says. She had a few friends who would share their prescriptions with her. Now working as a transcriptionist in Virginia, Jennifer doesn’t regret her choice, but she rarely talks about it. And despite feeling the useful effects of Adderall, she’s never thought that she might have ADHD herself, and no longer takes the drug.

It’s easy to assume that all people who take Dexedrine are doing it with a wink and a grin. When the subject comes up on ADHD-centric websites and comment boards I frequent, the comments have been startling. I’ve been called a drug user, no better or worse than the surfer dude who wanted to score. Despite the fact that there is a fundamental difference between our native capabilities, taking ADHD meds is still perceived as taking the easy way out, even for those who need them. Many people dismiss casual use  as a victimless crime; the sellers make a few bucks on the side for pills they won’t use anyway, and the buyers get through exam times with better grades. Everyone does well in the end, right?

The problem is, this isn’t victimless. The easy access and relative safety of ADHD drugs doesn’t change the fact that they are prescription medications that some people actually need. Furthermore, this casual approach dismisses the real struggles and triumphs of people with ADHD; when everyone around you can get six superbly focused hours out of one pill, your own success no longer feels valid. And the overwhelming attention paid to the abuse causes those with ADHD to retreat into shadows — they may deny their symptoms and delay seeking treatment.

Chloe Shilaos was diagnosed with ADHD–predominantly inattentive as an adult. Inattentive-type ADHD is often overlooked, as the symptoms are not as obvious as hyperactivity and impulsiveness in childhood. But the stigma around ADHD’s legitimacy may have been one of the reasons why it took so long to get some help.

“It was one of my hang-ups in getting the diagnosis: I didn’t want it to seem like I was trying to get pills or anything,” Shilaos says. “I’m open if people ask about it, but I don’t go around advertising it because there are quite a few people who think it’s just a lack of discipline.”

And what about those who pop a few Dex before a big exam? Like many with ADHD, Chloe finds it frustrating. “It’s not super noticeable to me that I’ve taken any Adderall unless I set out to do something that requires a lot of mental focus. I still get distracted, but it’s easier to organize and prioritize when I’ve taken my meds. That’s why I get so annoyed when people without ADD take them: it elevates them to this super-student or whatever, but when I take [the pills], I only get brought up to the level most people rest at. I can get stuff done or not. It just makes it easier.”

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  • torbs

    Thank you for writing this article! I was recently diagnosed with ADD and prescribed dexedrine, and now that I’ve finally achieved a level of normalcy I’ve previously only imagined and dreamed of while watching other students succeed with comparative ease, I am getting really frustrated by the fact that significant portions of my class are using my medication to get ahead of their peers, putting them just as far ahead of me as they were when neither of us were taking stimulants. And it’s such a relief to see an article bringing some visibility to that ridiculous debate over the validity of the ADD/ADHD diagnosis as a disorder from the point of view of someone who actually has it. It’s a shame how often our experiences and struggles are minimized by the seemingly dominant view that ADD/ADHD does not exist and is just an excuse to be lazy and not keep commitments.

    So thank you again for taking the daring step of outing yourself to bring some visibility to these issues surrounding ADD/ADHD. It’s a relief to know that I can expect some of my community to now be a bit more educated and aware of this, and it’s nice to know that I’m not alone.