Last week I was interviewed on TV for my thoughts on the Adderall “shortage”. You’ll soon be able to watch the interview, but perhaps my thoughts on the issue are best summarized by my putting the word “shortage” in quotation marks.
The Adderall supply issue serves a purpose – shining a light on how widespread Adderall use has become. Now in short supply (in relative terms), those who became used to it (or dependent) are struggling from its withdrawal. The shortage exposes stimulant meds as the physically and psychologically addictive drugs they really are. Once reserved for seriously impaired children diagnosed with “minimal brain dysfunction”, stimulants are now prescribed to roughly 10% of everyone in the U.S.
As I’ve said before, the increase in the diagnosis of ADHD has various causes, including pharmaceutical marketing, and changes in attitudes towards discipline by both parents and teachers. But perhaps the greatest factors propelling demand for performance-enhancing drugs are societal pressures, their rapid and intense effect, and their easy availability.
In our society, we tend to judge each other based on perceptions of success – first academic, and then financial. Children are judged by their grades and the schools they attend, which in turn determine careers. Adults with a long history of professional success are still described by the schools they attended, making academic success in youth pivotal to their lifelong perception. The pressure to succeed has never been greater – enter stimulant medication.
The movie “Take Your Pills” on Netflix describes the result of this pressure to succeed, whether it’s in academics or the sports field. The simple truth is that stimulant medication enhances performance for everyone – which is why students sell their Adderall to each other.
So, while there’s a shortage of Adderall, the bigger question is: Are too many people taking it – and what are the consequences?
The answer to the first part of the question is a simple yes. Stimulant medication is massively over-prescribed in the U.S. Powerful medications to enhance performance, combat fatigue or fight the natural changes of aging have become common weapons in society’s arms race. If other students, athletes, or professionals are taking stimulants to gain an edge, then you must too.
The consequences of stimulant over-use are significant. These are not mild drugs – they deliver a fast neurochemical boost that enhances cognition, mood and physical performance. There’s a reason why polypharmacy often starts with ADHD medications – they cause profound changes to mood, appetite and sleep patterns. These changes are often mistaken for separate disorders, requiring additional medications, when they are really just the consequences of the first.
The impact of drugs like Adderall on the cardiac system are significant, increasing the heart rate and representing a significant risk for the elderly. (At Gray Matters, we still get people calling who’ve “just been diagnosed with ADHD”, in their 70’s!)
The solution? Better diagnosis would reduce over-medication, as would a more cautious approach to prescription. Informing parents, in particular, of the power of these medications would help push back against those who promote them as a solution. qEEG remains the best way to know if someone’s brain would be normalized by stimulant meds, but access to quality brain mapping is difficult.
In short, if there’s a shortage of stimulants, it’s a function of over-medication, not a reflection of need. Stimulant medication use is a symptom of our society – our need to compete and succeed – and our fear of failure. These forces are fanned by a pharmaceutical industry that has an unfortunate history of creating needs, as well as cures.