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

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.

There may be other indications (I haven't checked), but that statement doesn't sound even remotely libertarian. The moral requirement to provide affordable health care is a positive right (something that obliges action). Contrast this to a negative right, something that obliges inaction, such as free speech or private property. Libertarians generally don't acknowledge positive rights (unless by contract, but then we're talking about something else).

"we also have to consider the observable phenomenon of decision fatigue"

Are we just talking about random things now?

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...

To me it's very much like speed or cocaine, just longer lasting and more consistent with less of a let down.

1) any child who takes it certainly has an advantage

2) I couldn't fathom taking something that strong every single day for months on end (if not years). Regardless of your neurological makeup, just the stress on your heart seems insane

Would love to hear alternative opinions, mainly I'm skeptical it's effect is that different for ADHD sufferers and non afflicted people. I mean we all have issues concentrating and it's probably more of a sliding scale across the population.

This is where you go off the rails. Neurology makes a huge difference in the effect of many drugs, and there has been a tremendous amount of research backing that up. Just because you personally can't believe it doesn't mean it's not true.

> Regardless of your neurological makeup, just the stress on your heart seems insane

He said, whatever your neurological makeup might be, Adderall is going to be unhealthy on your heart.

Adderall works primarily by switching your norepinephrine and dopamine in the brain, in all brains. From Wikipedia, norepinephrine:

"The general function of norepinephrine is to mobilize the brain and body for action. Norepinephrine release is lowest during sleep, rises during wakefulness, and reaches much higher levels during situations of stress or danger, in the so-called fight-or-flight response. In the brain, norepinephrine increases arousal and alertness, promotes vigilance, enhances formation and retrieval of memory, and focuses attention; it also increases restlessness and anxiety. In the rest of the body, norepinephrine increases heart rate and blood pressure, triggers the release of glucose from energy stores, increases blood flow to skeletal muscle, reduces blood flow to the gastrointestinal system, and inhibits voiding of the bladder and gastrointestinal motility."

Anecdotally my doctors switched me from Adderall to Armodafinil for this explicit reason. My blood pressure was pre hypertensive after taking Adderall for only a short time.

again the amount of ignorance to drugs displayed in this thread is frightening. people who have only used amphetamines for less than 10 years, or drugs at all, telling us all about them. facepalm.

In an ideal world, yes, we would all function optimally in our environment. But, unfortunately environmental changes have outpaced Human adaptation. And, while I'm pretty sure my biology would've been better suited to running around a plain chasing wild game, I didn't get to choose.

Most medications have side effects and trade offs. What's important is whether the medication improves a person's quality of life overall.

I started taking them about 14 years ago, when I was in early 30s. Being raised by my great depression era grandparents, I was extremely anti-medication. In general, I still am, for myself. It's not right to impose that view on others. You'll see why in a couple of paragraphs.

I've been technically focused, on a daily basis, since I was a kid, starting in the late 1970s, and that translated into a very successful career, even before I started taking the meds.

But I definitely have ADHD, and I always have.

What does that mean specifically, in my case? It means that it takes an enormous amount of energy to focus. Indeed, in the decade I was getting paid before taking the meds, I created many things, big, small, alone, in groups, terrible and awesome, in a variety of environments and backgrounds.

But after a long day of work, where I'd used all of my mental energy to focus, I would end up having to take an hour nap. Note, I wasn't sleep deprived. Via my grandparents, I've always valued getting enough sleep.

But the mental drain was enormous, doing software/technology for 8 or so hours every day.

My new wife at the time, who has a mental health background, suggested I get evaluated for ADHD. I resisted for a long time, but finally I did and brought home some adderall.

Me being me, I wanted to approach this very carefully and rigorously.

Despite a good diet, plenty of sleep and exercise, my pulse rate was always a bit high, as was my blood pressure. Subclinical, but notably elevated.

Something interesting happened after I took adderall the first time: my BP and pulse rate were lower. And please note that this has been clinically noted and recorded on my medical record over the years as I've gotten my vitals checked from time to time. The meta-data before each check was when I last took the med.

When I take adderall, concentrating isn't a struggle, it just happens when I want it to. This has the effect of lowering my vitals, even though adderall is, as stated elsewhere, a very smooth version of speed.

Over the years, I've alternated between adderall and ritalin at first and now concerta, which is, of course, 'ritalin extended release'.

I don't take the meds every day, and I've had the two prescribing doctors over the years give me high dosing flexibility. In other words, lots of small dosage tablets, giving me the ability to dose as I see fit.

Here are my general rules for dosing, in order of precedence: 1. work days 2. dose strongly biased toward the AM 3. lower or zero dose on work days where I need to be 'scattered' and do a lot of shallow things 4. rarely non-work days, usually with a lesser dose, where I need to do some deeper focus

I feel absolutely no 'pull' from these meds. I have gone months not taking them, and they have improved my life notably. They are a tool, and I use them as such.

The other person is my son. I must be briefer here because my day must begin shortly.

He is now a teenager, and started showing signs of clinical autism before his 2nd birthday. Further, he is even more ADHD than I am.

We were told he would never speak. Further, we resisted giving him any meds, for years. This was a mistake.

We finally started him on Concerta when he was six years old. The difference is profound.

ADHD and autism together in a single mind is quite a curious combination.

Briefly: without the meds, his mind races in so many directions, in so many deep 'autistic rabbit holes', that he can hardly string together a clear sentence, even today. Only after he started taking the meds was he able to start learning in a relatively normal way.

He is effectively dependent on the meds to function in a relatively normal way. And, with his mom's amazing, devoted and miraculous effort and attention these past 14 years, he is at mainstream class levels (but one year behind) in every subject except math.

ramblerman, I am the one who has rambled this morning (my time). I am well known for creating walls of text, so please accept my apology for that.

As you say, adderall isn't magically different. It is in fact speed.

But our brains and bodies are amazing, and amazingly variant.

I suspect that most of the people who take adderall and concerta don't need it as my son needs it. And perhaps we need more rigorous clinical protocols, but who knows. It's all pretty complicated.

PS: I have to leave this message unedited, so please pardon the roughness of it. I have to get ready for work, and the train waits on nobody.

Thanks for giving your two-cents and personal experience. Most of my friends, myself included, use amphetamines for recreational purposes. There's been a vague understanding that it works differently for people with ADHD, though I've never personally heard such a detailed testimony.

It sounds like your son is lucky to have you and your wife as parents. Bless you and your family!

No, I had not taken anything when I wrote that rambling epistle. What you're seeing is a first draft, and since I had to get moving, I had to leave it as such.

Recall that I knew how to concentrate before the meds, it just took a lot more energy. I am naturally at my highest mental energy level in the morning.

Also, those who know me will attest that my default writing style is pretty long-winded and uh..dubiously organized.

If I had gone back to edit it this morning, the wall o' text would have gotten about 1/3 shorter.

Regarding recreational use: I cast neither dispersions or judgments on anyone. Speaking for myself, I can't imagine adderall being a recreational drug. For me, it's not a particularly fun feeling, though it helps me accomplish high-focus tasks, and that feels good.

And just to be clear: our son gives our lives purpose and meaning. Truly he is the purest blessing to us.

I'm curious as well. I've come to use long (but informative) rambles as an ad-hoc indicator of the kind of executive function deficit typical of ADHD. Folks who can write short, crystal-clear, on-point emails are unlikely to be (untreated) ADHD.

I still need to put in the effort to do something difficult or boring (like just about anyone) and I do still feel a mild coffee-like perk up when I take my Adderall and it kicks in. But otherwise, it's a relatively mild tweak that I personally find to offer more benefits than drawbacks for the time being.

I don't think so. I'm in one of those environments where long hours are common and it definitely does happen. There are also people using a mix of uppers & downers (need the uppers to be wide awake but then can't sleep when at home hence downers). Hell I'm doing a vaguely similar thing (just with coffee and melatonin). Add a bit of anti-depressants and I don't think "cracked out of their minds" is that far fetched.

I would say its definitely a small minority though (in my workplace)...places like New York & London...not so sure.

>But I'd hardly call myself cracked out on drugs.

Well I'm sure your case is perfectly legitimate, but you've got to admit that self-assessment in this type of situation is rather unreliable.

I am not sure that the time it takes to have an effect is a good metric for whether or not something has potential for abuse. Sure SSRIs take a few weeks to have a noticeably effect but they also takes weeks to tail off. The area under the curve is not necessarily different.

https://www.quora.com/Why-are-SSRIs-typically-prescribed-bef...

"This last item makes SSRI's abuse-safe: contrary to benzodiazepines or opiate-based painkillers, there's no risk of abusing them for pleasure, as they're, once again not "happy pills" and there's no high. They even worsen symptoms for most people at first. That has to do with their mechanism and is their major flaw but serendipitously it strongly protects against recreational use."

Also, I do believe personality comes into play. When I was taking the max dose of Tramadol for over a year, I stopped dead three weeks post-op. The only noticeable side-effect was a runny-nose for a few days, hardly a big deal.

However, after taking it for several years on most days, I developed heart palpitations and other strange sensations. They disappeared a few weeks after I stopped taking it.

Everybody has a different reaction to sleep medicine. You might also consider environmental changes (blackout curtains, earplugs, or meditation before going to sleep - seriously) to address other possible sleep problems.

The cost difference makes it silly for me to buy a bottle of 90 1mg tablets for $10 instead of the bottle of 90 5mg tablets for $13 so I get the higher dosage and just snap bits off of them to swallow. I've seen bottles at our local Rite Aid with 10mg tablets recently! That's just crazy IMO.

From what I understand, after a certain point, there's not much benefit to higher dose and it can screw up your sleep patterns more than it helps.

Yeah I'm aware that its not ideal. Come to think of it I actually told myself I'd stop once peak season is over so I guess thats now. First need to get rid of the coffee though then the falling asleep will be fine.

>take it ~3 hours before going to bed

I thought 1 hour?

If you have ever gone on an extended camping trip, think about the time between sundown and the time you naturally start wanting to fall asleep.

Some intense exercise (7+ mile runs) will wipe you out. I'd recommend you keep the coffee, and get your body moving. Allocate 1 hour of your day, to 120+ bpm workouts.

Just TRY not to sleep.

Not a huge amount. Probably like 2-3 good strength cups.

>Some intense exercise (7+ mile runs) will wipe you out.

Yeah been getting some exercise, but I find it keeps me awake if its too close to bedtime.

http://drsircus.com/medicine/magnesium/magnesium-the-ultimat...

I've found that simple sleep hygiene habits (no blue light exposure 30 mins before, taking a shower, etc) facilitates better sleep than melatonin.

If you can find one, I'd recommend* an S+ by ResMed. It uses radar to track your sleep and can discern what phase of sleep you're in. It tracks how long it takes you to go to sleep and can offer specific hints to address issues you might be having. The app hasn't been kept up to date, but if you've got an older iOS 8.x device you're not going to upgrade that would pair well with it.

*Disclaimer: I worked at ResMed on the S+. I no longer work at ResMed but I still like my S+.

There may also be dangers of mixing adderall and alcohol, but it does everyone a disservice to casually reference such a different situation.

There's a recurring theme with drugs that mixing X and alcohol is dangerous.

Don't get me wrong, I like good wine, craft beer, and liquor. But the common link is generally the "and alcohol" part. It seems pretty clear alcohol is a remarkably dangerous drug, just normalized by social use.

Instead of writing myself off with shots until I can handle the social side, I am able to carry conversations, am not overwhelmed by the stimulus (imagine trying to have a conversation, while playing pinball and reading a book in a loud room).

It was a huge factor in breaking a drinking problem, which was actually masking many of my ADHD symptoms. It's a highly personal anecdote, but does show the other side of the coin.

(for the record, I don't generally drink anymore, never on my meds. when I do plan a night out, its usually with close friends so many of the issues just aren't there.)

You sound similar to me. I'd like to know what to ask my doctor about.

I take 2x5mg Dexamphetamine tablets in the morning (8am) and another 1x5mg around lunch (1pm).

I started (switching from Concerta) on 2 and 2, but asked to drop the later dose as it seems to top me up enough to finish the work day and handle the bulk of my evening (cooking, etc...)

The Dex works far better for me than Ritalin / Concerta, but I've heard good and bad for both. Keep your doctor in the loop for everything, and listen to what they say (eg. I brought up and planned my lower dosage, rather than just doing it), and bring up any issues as early as possible.

Don't try to fix side effects with other medications, keep the chemical intake as simple as possible. I had to spend more time on diet and sleeping habbits than anything else, but it was worth the effort and discipline.

If my diet and sleep are in check, I can manage a day without medication (relying on a detailed plan/schedule) here and there, or keep momentum up to make progress into the night.

If I burn myself out for a couple days, no amount of medication could help.

Hope that was some sort of help, good luck mastering your "mental skillness" :)

My dosage is pretty low (see my other reply), and I'll usually only take another 1x5mg which seems to 'top up' the previous dose for around 6 hours. EDIT: I believe they are considered 'quick release', described as active for 4 hours, though I seem to wind down after 5. (then I get a bit fuzzy for an hour, cant hold a conversation easily, focus gets locked on tasks I'm working on, etc...)

The general effect definitely makes me more alert, but doesn't keep me awake. On weekends, I'll often have a nap after my second dose, its like my mind clears enough to settle and without purposefully taking in new stimulus, it relaxes and I drift off. Some people describe the same with Caffeine.

As a side note, I drink coffee if I want to wake up / stay up late. Caffeine seems to turn off the part of my brain that says "fall asleep", increases my heart rate a little, but thats about it. My dex on the other hand, seems to raise everything a lot more evenly. It doesn't affect any one thing more than the others.

I'd describe Caffeine as a "dirty" feeling stimulant, and Dex as very "clean", as an anecdotal, personal comparison.

Interestingly a pretty prolific mathematician, Paul Erdős used amphetamines [1]. Not sure which one(s) though. I don't think he had a prescription but I think it worked out OK.

[1] https://en.wikipedia.org/wiki/Paul_Erd%C5%91s

So when I was at school I was on something like 20mg of Ritalin (0.02g) twice a day via a pill that was digested by my stomach. Even that lead to issues with diet and sleep and anxiety.

Whereas if we're at a rave we'll happily share 1g+ (say between 2 of us which is 12x the amount) of amphetamine between a few of us and put that shit right up our noses so it's absorbed super quick.

The comedown from that is more just a feeling of absolute terror (AKA speed comedown psychosis. I try to mostly avoid it now because it can't be doing me or my mind much good).

I'm far more interested in nootropics over stimulants. E: Just ordered some Noopept so I'll get back to you.

As far as sleep goes I find that it is about the same with or without it since I tend to self medicate with caffeine but I generally go to sleep at as semi-regular time of the night (I say this as I write this from bed). The biggest blocker for sleep for me is getting excited about stupid programming things right before bed and that tends to happen with or without stimulants.

Without Ritalin I seem to be more anxious but its hard to really evaluate that objectively.

You are correct about the comedown from an amphetamine binge being awful. Thankfully, most business professionals and working people aren't dosing like they're at TomorrowLand.

There's only one "amphetamines". There is a specific molecule (and its enantiomer) called " amphetamine". There are some other amphetamine-class drugs like methamphetamine (crystal meth) and MDMA (ecstasy). Methylphenidate (Ritalin) isn't even an amphetamine-class drug.

As you pointed out the problem with the article is that it makes no distinction between therapeutic low-dose usage and abuse level usage.

From "Prescription stimulants in individuals with and without attention deficit hyperactivity disorder: misuse, cognitive impact, and adverse effects", published in Brain and Behaviour (2012):

"In sum, the evidence concerning stimulant effects on working memory is mixed, with some findings of enhancement and some null results, although no findings of overall performance impairment (Smith and Farah 2011). However, the small effects were mainly evident in subjects who had low cognitive performance to start with, showing that the drug is more effective at correcting deficits than “enhancing performance.”"

Full text:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3489818/

Secondly, that study is flawed because it fails to acknowledge what is known as the 30%-30%-30% jump. The difference in intelligence between a retard and a normal person is the same difference of intelligence between a normal person and a genius. Different boosts account for different corrections in deficits depending on the IQ range that is being operated on. This is a known quirk of intellect. Being why Einstein sent a letter to his son telling him that intelligence was not the reason he was successful, "working hard" was, and urging him to do the same.

Amphetamines are performance enhancing drugs. They give the same "cracked out" superman effect to anyone who takes them. They are amazing. And we should not discount them by giving credence to the bullshit that is ADD and the epidemic which is giving dumb kids speed so they can live up to their parents' standards.

ADD is overdiagnosed, and adderall/speed is overprescribed in doses that hit high enough that their grandma can feel it. It's fucked up to be giving hard drugs to kids just because the kids are dumb. Let them be dumb. Let's not make them drug addicts at the cost of their mental freedom.

Just google for it, the stories on forums and other places. There are millions of kids who grew up and regret the drug issues they have now. The dependencies. Because they've been on speed their whole lives, because of a giddy parent and a giddy psychiatrist long long ago. The stories show that treating "ADD" with speed in children, is a really shitty thing to do.

Known by who? Did you just respond to a peer-reviewed study with made-up pseudo-science? Also, I should point out that the psychiatric term is ADHD, not ADD.

I didn't say the study is bunk. I said that looking at performance differences as significant without reference to the 30/30/30 effect is extremely misinformed. What I should have said is that the study's "interpretation" is flawed. That would have sounded more rigorous.

While that's partly true, in this case it's a systematic review of the literature on this exact topic. That's not nanny-picking some random study.

Over time you will develop more of a tolerance to these stimulating effects, at least to a degree, but the therapeutic benefits will continue for as long as you take them.

I don't take it in the morning for that reason. Because it has zero stimulation / awakeness effect on me, I wait to use it in the afternoon, when sleep inertia has fully dissipated.

EDIT: calm down wrt physical movement, symptoms on the cognitive side are still very present of course. It's just that adults tend to be better equipped to cope with some of them.

Anecdotally, I knew some people who took adderall in college that were not prescribed it and it seemed to cause them to have different behavior than myself. A similar situation, I would imagine, is how alcohol affects people differently. Maybe not physically, but you definitely see a wide range of actions and behaviors elicited among different individuals.

There are people who can take what are considered high therapeutic doses and feel very little effects because of the way their body metabolizes the chemical, which of course has nothing to do with whether they have ADHD or not.

7.5mg (15mg in half) is my usual dosage, but it's strong enough to fill me with the energy you'd expect someone on a high dosage to have. When I talk a full pill, it completely screws me over. Others can take 30mg and be completely fine.

I feel like a narrative is being constructed that will eventually lead to it being extremely difficult treat conditions which benefit from stimulant medications.

The orthodontist I worked for put in serious hours well beyond many of the "crunch time" horror stories we hear in tech, typically arriving at her practice at 5:30am and leaving at 8pm (prepping the office, working on orthodontic appliances, case studies, paperwork), and working Saturdays as a part time Dean at the local dental school.

There were also state mandated continuing education requirements, the occasional emergency call, lawsuit, delinquent payments, marketing and sales for her practice, the occasional sales call from a vendor rolling out "Smart Brackets", and the need to manage 10+ employees and maintain professional relationships with other dental medicine practitioners for referrals and covering sick days.

She was incredibly driven and competitive, probably an outlier, but was also certainly a multimillionaire and an accomplished dentist.

This is hardly any less sensationalist than the 1914 NYT article they mock.