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This is Part Two of a three part series on ADD and ADHD. A disclaimer: I do not have ADD or ADHD, nor does anyone in my household. I cannot hope to know exactly what it is to live with these conditions, but can only use my writing platform to objectively look at the full issue.
BEFORE WE BEGIN: A Definition of Stimulants
Stimulants are a class of drugs used to treat ADD and ADHD, as they can help improve focus. The medications used for treatment are called amphetamines. In the same class (as specified by the DEA) are other drugs such as Cocaine, Khat, and Methamphetamine. The DEA says that many stimulants “are legally prescribed and used to treat … ADHD” and ADD. Some, however, are abused (through swallowing, snorting, or injection, and have “effects … similar to Cocaine.”
Treating ADD
In today’s world, online question-and-answer forums have become a resource for anyone looking for facts, responses, agreements, or solace. The Attention Deficit Disorder forum site, ADDForums.com, which boasts over 75,000 members, is no exception. In one post from July 2004, a website member, whose nine-year-old son had reportedly been taking the ADD/ADHD medication Adderall, a stimulant, for three-and-a-half years, wrote something rather startling.
“Occasionally,” writes the member of her son, “he tells me that he just ‘doesn’t feel like himself’, yet he can’t quite explain what he means.” At times, she writes in another post to the same thread, “he just starts crying, but he doesn’t know why he’s crying.”
“Some days,” continues the first post, “he seems to do fine on [Adderall], and others he gets depressed and edgy. He’s usually very playful, but there are days he just snaps and wants to be alone.” In curiosity, or perhaps in despair, the mother concludes: “Is this common?”
According to a New York Times article of October 2012, her son’s problem may not only be common, but a mild case at that. Alan Schwarz writes in the article that a then-eleven-year-old boy, who had been on the same drug as the poster’s son for five years, began “seeing people and hearing voices that were not there, a rare but recognized side effect of Adderall.”
These side effects, specifically the phenomenon of not feeling like oneself while on the medication, is the first major hurdle towards acceptance that the stimulants face when taken under medical supervision.
Dr. Ned Hallowell, a nationally-renowned expert in ADD and ADHD, says that, in his practice, these problems would not be tolerated in the slightest. “I want zero side-effects, and that means: … if you lose your sense of humor, you stop it. If you feel like you’re not yourself you stop it.” Like Adderall, similar drugs Ritalin, Concerta, and Vyvanse, are “not supposed to be a personality-ectomy. [They're] not supposed to take away your special sauce,” he says.
“If you’re a jovial, funny, Robin Williams-type off the medicine, you shouldn’t, when you take the medicine, become as boring as a haddock.” Dr. Hallowell, who, at least through our phone conversation, seemed a jovial, funny, Robin Williams-type himself, is one of the nation’s leading ADD/ADHD psychiatrists.
He feels that, though the stimulant drug approach to treatment is the most common, it is one of many options, and in some cases the least helpful.
“Medication doesn’t always work!” he says. “I’m a huge advocate of what’s called a comprehensive approach.” In the first place, education about the disorder is very important. So is coaching: “helping a student develop … these skills that allow for them to hand in a paper on time, [or to use] a study schedule.” Furthermore, physical exercise “is very important for ADD treatment,” says Dr. Hallowell, along with nutrition and meditation.
“People with ADD can treat themselves just fine if they put in the work, with exercise, nutrition, and meditation only, and not use medication whatsoever,” says Dr. Hallowell.
And those families that choose to include medication in their child’s treatment? This, says Dr. Hallowell, is just fine with him, as long as it’s part of a “multi-modal approach.” The reason, he maintains, that ADD/ADHD are “not well treated around the country is that people think, ‘Well, medication is the only thing you need,’ and that’s simply not true.”
Some doctors even prescribe the stimulants when the patient does not even show signs of ADD or ADHD. In the family from that aforementioned Times article, the family’s two other children – neither of whom have diagnosed ADD or ADHD – take Adderall daily, “merely to help their grades, and because [the daughter] was, in her father’s words, ‘a little blah’” according to Aaron Schwarz’s article.
The Study Drug
Taking stimulants for grade boosts comes from two specific places. The first problem, experts say, is society. In places where schools lack the funding or ability to perform at a high level, students may take Adderall, without diagnosed ADD, to excel. They use the drugs as a way to make their grades more competitive on the national scale. This is a deep problem; as one Letter To The Editor of that Times article puts it, this phenomenon is the fault of a world “trying to ‘solve’ social policy with medication.” In these cases, the drug is being used under medical supervision, but still dangerous, in that the long term effects of stimulants are, according to Forbes, dangerous. “The effect of long-term stimulant use on people’s cardiovascular health remains an issue of pretty heated debate,” writes Matthew Herper in an article of June 2012.
The other misuse of stimulant drugs in education – as a so-called “study drug,” (either gained as a prescription through faking symptoms, bought on the black market, or shared amongst friends) – is much more illicit, and much more dangerous.
Another Times piece, this a front page article also by Alan Schwarz from June 2012, begins with an actual episode of a male high school student snorting Adderall before the SAT. The article says that some students that boy knew “routinely shared [Adderall] to study late into the night,[to] focus during tests, and, ultimately, [to] get the grades worthy of their prestigious high school.” The stimulant drugs, writes Schwarz, “gave them a tunnel focus tailor-made for the marathon of tests long known to make or break college applications.”
Dr. Hallowell concedes that “stimulants can be a dangerous drug if you take them in mega-doses or if you grind them up and snort them,” as in the Times article, however, these are not the fault of the drug, but of the user, or whoever has the prescription. “The problems that arise,” says Dr. Hallowell, “come from the black market. I’m sure that at [Name Withheld] High School, someone can buy Adderall on the black market if they want to, to study for exams, and that’s a bad idea. That causes problems.”
This misuse, according to a very recent article in the Times, also by Sabrina Tavernise, is becoming even more dangerous. According to a study by the Department of Health and Human Services referenced in the article, “the number of young adults who end up in the emergency room after taking Adderall, Ritalin, or other such stimulants has quadrupled” from 2005 until 2011. That number, says the study, is even higher when alcohol is added to the mix, a sad reality with teenagers abusing these drugs.
Misuse of the drugs, says the article, “has been linked to heart and blood vessel problems, as well as to drug abuse or dependence.” The bigger problem, says Dr. Elinore F. McCance-Katz (whose department released the study), is “easy access” to the drugs, through – as the article states – “a friend or relative.” The study found that “more than half” of misusers either received or bought the drugs from someone close or related to them.
A 2002 survey referenced in the Washington Post in 2006 shows that seven million people in the U.S. report misusing stimulants. According to ABC News, a college junior in 2009 committed suicide after contracting “psychosis caused by Adderall abuse.” A New York Times piece from earlier this year told of a college student who became addicted to and eventually overdosed on Adderall after he began using is as a study drug.
This potential for misuse is what truly acts as a thorn in the heel for many psychologists and even parents who would otherwise gladly advise or accept a prescription for stimulants.
Because of these striking numbers, some professionals advocate stopping the use of stimulants as a treatment, but Dr. Hallowell disagrees. “If you take the medication as prescribed,” he says, “it’s not addictive at all. If you take it under medical supervision, it’s not addictive in the slightest.”
“We don’t want to throw the baby out with the bathwater for people who have ADHD and who need these meds in order to get the most out of their brains,” he says. In these cases, stimulants “are very helpful and appropriate.”
Yes, abuse and side effects are problems, but so too are they with almost any drug. If a child with diagnosed ADD or ADHD (remember Part One) and needs these medications to unlock their full potential – to, as Dr. Hallowell says, “unwrap their gifts” – then, maintain experts like Dr. Hallowell and others in the field, they ought to have these drugs prescribed.
Tune in for part three soon.
The post Attention to Detail, Part Two: Treating ADD appeared first on TeenLife.