by Lawrence Diller -
“Crrraackkkkk!” was the sound I heard of the arctic ice breaking in my head as I finished reading the Sunday New York Times front-page article “Drowned in a Stream Of Prescriptions.” I’m speaking metaphorically of course. But the 5,000-word Times piece on the life and death by suicide of a young man, Richard Fee, addicted to Adderall (a form of prescription amphetamine), could represent a true thawing of what some feel has been a 20-year ADHD/Adderall Ice Age.
I am behavioral/developmental pediatrician who’s been prescribing prescription stimulants like Ritalin, Adderall or Concerta to children, teens and adults for 35 years. I’ve never been against using medications in children. But I prescribe the meds only after giving effective non-drug interventions, like home/school behavioral modification and special education, a chance to work first.
I’ve never felt entirely comfortable with the non-hyperactive form of ADHD, officially called ADHD-inattentive type, but to nearly every else called simply ADD. In kids, ADD generally represents learning or processing problems that first should be addressed educationally. For older teens and adults, I’m not sure who, at various times in their lives, doesn’t qualify for the vague and broad criteria of adult ADD.
The public has come to accept biological psychiatry and the use of drugs to treat their problems. Really anyone, who by temperament or talent profile, does not fit into a desired goal (like an adult with eighth-grade reading comprehension who wants to be an attorney) becomes a candidate for the universal performance-enhancing effects of the stimulant/amphetamine drugs.
While fairly safe when used properly, these drugs have an 80-year history of misuse, abuse and addiction throughout the developed world, including the United States, Europe and Japan. Children who don’t have access to the drug and don’t like higher doses (“I feel nervous… I feel weird”) never become addicted to Adderall. History has shown though that adults who do have access to the drug and like higher doses (“I feel powerful… I feel grand”) regularly misuse, abuse and can become addicted.
American society goes through cycles of use, abuse and ultimately renewed control of prescription stimulants (read Nick Rasmussen’s fascinating history of prescription amphetamines, On Speed, The Many Lives of Amphetamine). American Psychiatry was the first to make adult ADHD legitimate, but the drug companies, by their promotion to doctors and direct-to-consumer advertising, took the proverbial football and ran with it. I and a small number of my colleagues have been concerned about the growing legal (and illegal) use of prescription stimulants since the publication of Driven to Distraction in 1994. However, our Cassandra-like worries have been drowned out by the medical/pharmaceutical industry.
That’s what I’ve been describing as the ADHD/Adderall Ice Age — about 20 years if you start from 1991, when rates of childhood ADHD diagnosis and stimulant use started to skyrocket. In 2010, America constituted 4 percent of the world’s population and produced 88 percent of the world’s legal stimulant drugs. But the Times piece suggests a thaw is coming to this medical/drug climate.
Read more at Is an ADHD/Adderall Ice Age Ending?
[Via The Huffington Post]