The Big ADHD Rant

Published by Adenosine Triphosphate in the blog Adenosine's Notebook. Views: 308

(Post copied from my blog)

Ah, yes. ADHD. A controversy, a fad, an uncomfortable reminder of the physical nature of our minds, and a license for the use of such evil stimulant drugs as amphetamine and methylphenidate. Common remedies include the aforementioned evil stimulant drugs, along with exercise, therapy, clonidine, Strattera, noradrenergic antidepressants, and beating your kids until they magically acquire the attributes you desire.

It's like smoking but with less cancer.

The Fifth Edition of the Diagnostic and Statistic Manual of Mental Disorders estimates that five percent of children suffer from ADHD, but rates of diagnosis in some areas run as high as eleven or thirteen percent. Proposed explanations for this epidemic include overzealous attempts at diagnosis, mislabeling of sleep deprivation or family stress as a disorder, environmental toxins, and the idea that ADHD is a natural variant of human cognition. On a technical level, the fourth point is entirely accurate, and I'd be surprised if the first two didn't hold water in a fair number of cases. ADHD is not schizophrenia. The diagnostic criteria for it are imprecise and subjective, and so is their application. This lends itself well to false positives.

Some use that knowledge to deny the disorder's entire existence, but we know by now that some people naturally have great difficulty focusing, and a moderate or even severe amount of overdiagnosis does not change that. What label we give those individuals is equally irrelevant. As the Diagnostic and Statistic Manual of Mental Disorders has gone through its various revisions, mental retardation has been renamed to intellectual disability, multiple personality disorder has been renamed to dissociative identity disorder, Asperger's syndrome has been merged under the umbrella of autism spectrum disorder, and ADD has been subsumed and reworded into ADHD as a variant with symptoms concentrated in the area of inattention. None of these textual alterations change the underlying nature of things, including that of my own mind.

I have, for whatever reason, great difficulty with focus and multitasking. My mind is a chaotic swamp of memories, self-analysis, politics, philosophy, music, writing ambitions, and a million other ideas. Any train of thought can potentially intrude on any other at any given time, no matter how unwelcome it is and no matter how badly it interferes with the task at hand. This is not a result of sleep deprivation or anger. It is a basic component of my experience, and it happens every second of every day in my natural state, regardless of my mood or energy level.

In fact, enthusiasm can actually make it worse, and so can attempting to limit my attention to one or two items. I'm smart enough to complete many individual tasks very quickly, but life is not merely a pool of individual tasks. it is a neverending chain of chores and responsibilities, and the rapid, purposeful switches in focus required to navigate much of it are beyond me.

Some have called the process I describe a side effect of high intelligence, and perhaps they may be right, but it's still a problem. It's a problem for productivity, it's a problem for organization, it's a problem for independence, and it's particularly going to be a problem if I ever start driving a car. Distraction in that context can be lethal.

The Fourth Edition of the Diagnostic and Statistic Manual of Mental Disorders did not allow ADHD to be diagnosed alongside Asperger's or any of the other autistic disorders, which I clearly suffered from. The Fifth Edition does, but it still took me until tenth grade to realize that I probably had both and until the end of eleventh to get an actual evaluation. This isn't something my parents made up because I wouldn't sit still or because they heard about it on the news. In fact, neither of them were very happy when I suggested it, and one of them was hostile enough to delay the evaluation for several months. I consider myself fortunate that it happened at all.

Some of you may currently be berating me for not working hard enough, for not taking "personal responsibility". Well, you know what? I tried. I tried exercising, I tried getting more sleep, I tried keeping a daily planner, I tried thinking positively, and I tried drinking caffeine, but none of those things solved my basic problem, and the latter sometimes made it even worse. I suppose I could have started smoking, but tobacco is a tremendously toxic drug, worse than alcohol, weed, Ritalin, Adderall, caffeine, and a whole host of others. Its yearly death toll exceeds 400,000. I prefer not to join that statistic.

Caffeine didn't work, lifestyle changes didn't work, and tobacco was out of the question. Those weak interventions were insufficient, and so I arrived at this lovely molecule.

It'll take out your soul.

Amphetamine. Speed. I have a prescription, of course—I'm not a felon—and the doses I take are fairly low, but it's still speed.

This particular form of speed is known as Vyvanse. It's a molecule of dextroamphetamine fused with a molecule of the amino acid L-lysine. Their combined form is biologically inactive, but your body separates them soon after ingestion, and then the freed dextroamphetamine molecule enters the brain. The inherently delayed nature of its release makes it somewhat harder to abuse than Adderall or Dexedrine, but in the end it produces the same effects, even if you can't make it work faster by shooting or snorting it.

In essence, it feels like a severely exaggerated version of caffeine. It gives me a moderate boost in self-confidence, speeds up my thoughts, makes them much easier to direct, and gives me so much motivation that slacking off becomes harder than working. This has led to such spectacles as cleaning up my entire room out of the blue, happily completing two math assignments in one class period, writing a 6,800 word short story in three days, and voluntarily taking on four household chores in rapid succession. This sensation is pleasant, of course, but it doesn't eliminate my normal range of emotions, and doesn't turn me into a raving megalomaniac. It merely makes me more efficient and less prone to error.

The more prominent and speedy effects fade after a few hours, but the focus increase lasts well into the evening. This is consistent with dextroamphetamine's long half-life of 10-13 hours. It is also consistent with the observation that I have to take it very early in the morning to stop it from damaging my sleep.

This substance essentially eliminates all the problems I just mentioned, but at the moment I'm only taking it three or four times a week. More frequent usage could lead to tolerance, and that could lead to dose raises. The prospect of getting a car raises some questions about this pattern, but for now I'm going to try to avoid such troubleshooting.

Notice that everything I just mentioned, from motivation to focus to insomnia, is a classic stimulant effect. A lot of them would probably go away if I took it more often, but they're still classic stimulant effects. They are not "paradoxical", and they are not categorically limited to people with ADHD. Amphetamine and methylphenidate might be better at correcting deficits than turning users into Stephen Hawking, but normal people can still use them to some effect, and that's worth remembering. It renders authorized medical use and illegal performance-enhancement more similar than our culture would like to believe. I think this is an argument for legalization, or at least against locking non-violent users in cages, but you might have a different perspective. Make of it what you will.

I've already said most of what I need to say, so I'm going to close this off by responding to a few potential questions/insults.

There are some kids and teenagers with ADHD who hate taking stimulants because they make them feel blunted and mechanical. I am not one of them. This means that different people have different reactions, not that I'm faking it.

Similarly, please don't come screaming at me about how ADHD doesn't exist and I'm just a fucking junkie. I think it probably does, but, even if its existence is someday invalidated, I still have autism, which is itself strongly correlated with focus issues. There's a reason people often meet the criteria for both. I have problems, no matter what you call them.

On that note, if you tell me that I'm just another bum who needs to "work harder" or get a sense of "personal responsibility", I am going to slap you with a tenth grade psychology textbook. We're biological machines, not demigods. The brain is a physical thing. There are limitations to our hardware, and not all of them can be overcome through Republican buzzwords. Life doesn't work that way. It just doesn't. I don't know why that's so hard for some people to understand.

And, please, please, don't go the Neal Boortz route and expect me to believe that ADHD is some kind of government conspiracy to drug up our children and make them easier to control. You don't use amphetamine or methylphenidate as tranquilizers. You don't. They're stimulants, not sleeping pills. They don't fucking work that way. A minority of users experience depression and somnolence, but, in general, they make people more aggressive, more outspoken, and, to some limited extent, smarter. The drug you're thinking of is alcohol, and it doesn't require a prescription.
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