On Sunday, the New York Times ran a lengthy article titled “Risky Rise of the Good-Grade Pill,” and it illustrated, in vivid detail, how our society—and the medical community—may view a “drug of abuse” through one prism (as harmful) and a “prescribed drug” through another (as helpful), even though the drug in both cases is the same.
This was a story about high school students abusing stimulants in order to perform better on academic tests, and so, in this case, the article highlighted the harm these drugs can do. Here is the key paragraph: “Abuse of prescription stimulants can lead to depression and mood swings (from sleep deprivation), heart irregularities and acute exhaustion or psychosis during withdrawal, doctors say. Little is known about the long-term effects of abuse of stimulants among the young. Drug counselors say that for some teenagers, the pills eventually become an entry to the abuse of painkillers and sleep aids.”
All of this is quite true. But—and this is the key point—these happen to be the very side effects that show up in trials of stimulants prescribed for ADHD. There, in the scientific literature, you will find reports of the drugs causing mood swings (and thus leading to diagnoses of bipolar), psychotic episodes, hallucinations, depression, heart irregularities, and withdrawal symptoms. While the literature regarding whether stimulants lead to substance abuse in adulthood is mixed, there certainly are a lot of anecdotal stories about youth initially prescribed stimulants for ADHD ending up with a drug addiction problem.
However, in newspaper articles about the prescribing of stimulants for ADHD, those side effects are never featured prominently. Instead, in those instances, the drugs are presented as being effective and safe. Thus, in this story, the New York Times obviously had a dilemma: How could it reconcile those dueling images of stimulants as both helpful and bad?
The reconciliation comes in two paragraphs. First, the New York Times writes: “While these medicines tend to calm people with A.D.H.D., those without the disorders find that just one pill can jolt them with the energy and focus to push through all-night homework binges and stay awake during exams afterward.”
In other words, youth with ADHD respond differently to the drugs. Stimulants calm them but keep non-ADHD youth awake.
Then, it quotes Paul L. Hokemeyer, a family therapist at Caron Treatment Centers in Manhattan, who says: “Children have prefrontal cortexes that are not fully developed, and we’re changing the chemistry of the brain. That’s what these drugs do. It’s one thing if you have a real deficiency—the medicine is really important to those people—but not if your deficiency is not getting into Brown.”
And thus, in this quote, readers are told the reason that youth with ADHD respond differently to stimulants — such youth have a “real deficiency.” They have a “chemical imbalance” (and given that stimulants up dopamine levels, the implication here is that youth with ADHD have low dopamine levels.)
So is this true? Do youth diagnosed with ADHD respond in a fundamentally different way to the drugs than “normal kids” do? Do they suffer from a known “deficiency?”
The literature shows that they experience the same harmful side effects that non-ADHD youth do. Youth diagnosed with ADHD who take stimulants, rather than feeling “calmed,” may suffer from insomnia, just the same way that “normal” kids do. Youth diagnosed with ADHD who take stimulants may tell of being able to “focus” better on school tests, just as “normal” kids do. As for research into the “biology” of ADHD, it certainly has not been shown that such youth suffer from low dopamine levels, or that they have a “real” chemical deficiency of any kind.
This was an article intent on exploring how high school students abuse stimulants in order to get better grades. But, unwittingly, it also perfectly revealed our society’s cognitive dissonance around the prescribing of stimulants to youth diagnosed with ADHD. Indeed, we can see our societal mindset vividly on display; how we turn a blind eye to the many side effects these drugs can cause, and how, when we explain to ourselves why stimulants are good for youth so diagnosed, we tell false stories about how they respond differently to the drugs than “normal” kids do and what is known to be “wrong” with them.
Stimulants may help youth—whether diagnosed with ADHD or not—focus better on tests, and thus do better academically over the short term. But it would be helpful, I think, if the prescribing of these drugs did not rely on this sort of cognitive dissonance, but instead was done with medical eyes wide open regarding the harm they can cause too.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.