A question and also kind of a break-up letter
I am so sorry to hear about your mental health challenges, and I admire you for your wisdom in knowing that they are a lifelong condition.
Our family’s amphetamine story concerns our son. He started taking Adderall at age 8, because his autism made it difficult for him to focus on topics that didn’t interest him in school. I was very reluctant to start him on meds, but his pediatrician said, “why would you want to risk having him hate school?” So I agreed--but my husband and I decided to do an n = 1 study to see if he really needed the medication. In both second grade and third grade, we picked a two-week period and told his teachers that during those weeks, every morning we would flip a coin, and if it was heads, he’d get the pill, and if tails he wouldn’t. We asked that they tell us every day whether they thought he had had the pill or not. Both teachers got it right 100 percent of the time, and both said that it wasn’t at all ambiguous--they could tell within minutes whether he was on the meds or not. That was good enough for me, so we kept him on. We gave him the Adderall (and later Vyvanse and Concerta) on school days only, until he graduated from high school.
He went to college in the UK, where take courses in your subject only; you don’t take general education (i.e. not math, science, or foreign languages--subjects that didn’t interest our son). He didn’t like how the meds made him feel, so he went off them. Because he was only required to study topics that interested him in college, he didn’t need the meds to help him focus and was very successful without them.
The upshot, in my opinion and based on our family’s experience, is that these meds can help make school an easier and more pleasant experience for kids who struggle with focus, and that is good. There are people with ADHD who will benefit from these meds during and after school. But perhaps we also ought to think about ways to make education more engaging and requirements more sensible, so that borderline kids like our son don’t struggle with focus in the first place.
Not sure about this. Everyone has different responses to medication, and different responses at different ages. By your own admission, the medication didn’t have much effect outside of a heightened self confidence, indicating either you never had the disorder to begin with (and admit this later in the episode), or it was so low in the scale, it barely registered.
That’s great. It means you weren’t the target for the medication, and it didn’t do much - nor should it have. Ultimately though, this whole episode comes across as “I didn’t get any benefit despite maybe/but probably not having the condition, so the medication is bad because big pharma.”
As someone diagnosed late in life, I wish I could’ve started on amphetamine based treatment far earlier. While it does assist with focus, more than anything, it helps with emotional regulation and reduction in anxiety, helps my memory, helps me to slow my brain down to take in one thing at once, and limits constant noise in my head. It also helped me build routines that wouldn’t have exist without the drug.
It has (quite literally) saved my marriage, my career, and in several ways, my life.
Adderall (and amphetamine treatment in general) have been proven to have some of the highest treatment efficacy of any psychotropic medication classifications existence. This research is widely available, and makes me wonder how many scholarly articles on the medication were actually read and considered prior to this episode, or if there was substantial cherry picking going on.
If you want to actually provide a balanced presentation on the treatment of ADHD, please look up Dr. Russel Barkley, a neuroscientist with some of the most prevalent and preeminent ADHD research over the last two decades to counterbalance the ultimate message of “it’s pharmaceutical advertising.” His impact has been tremendous, and can’t be understated.
Are the medications for everyone? Absolutely not. Even people with ADHD. Is ADHD over diagnosed? Absolutely, but that’s multiple different issues including a lack of high quality, affordable mental healthcare.
Instead of being properly diagnosed (a $2k process for myself, $3k for the pediatric versions for my son - neither covered by insurance), people are turning to online automated prescribing services, or other low quality, low cost providers who can make money off the medications (much like your second doctor).
Maybe this response is a knee jerk reaction to the podcast, but labeling amphetamine based treatments “speed” and meth throughout the episode and even in the title does little to help with the stigma, and presents the views pretty clearly.
Sitting down to listen to this right now. I didn't start taking speed until I was 35. So I guess my version of this episode would be "Why didn't I take speed for twenty years?" But the fact I need it is something I grapple with constantly.
Wrote about it within the context of attention, artificial intelligence, scarcity and the thermal time hypothesis earlier this year. I realize that context sounds bonkers, but I think bonkers is okay with you. So here's the link: https://homeculture.substack.com/p/attention-is-all-we-need
So much appreciation for this episode and the nuance you brought to it. As someone who researches substance use from a harm reduction lens, I often think about how we legitimize certain drugs and de-legitimize others, even when they are very similar, and how the (de)legitimization process interacts with racism, classism, ableism, sexism, homophobia, etc. The medicalization of certain substances is one way this seems to happen, in that taking a drug for medical purposes is viewed as OK but taking a drug for pleasure, work, socializing, etc. is not. I see this a lot with cannabis and psychedelics (i.e. drug exceptionalism).
On the one hand, I wonder how much of this comes into play with amphetamines and if medicalization detracts from the larger social determinants of health that influence attention — for example, overwork and the attention economy. On the other hand, I worry that de-legitimizing its medical use will lead to a situation similar to the one we saw with opioids, where many people were abruptly cut off and subsequently turned to heroin, which because of its unregulated/illicit nature led to the introduction of fentanyl.
Anyways, looking forward to the next episode. Also recommend reading the book Blitzed: Drugs in Nazi Germany by Norman Ohler.
I have extremely mixed feelings about this episode. I'm an adult with ADHD who didn't have a formal diagnosis or access to meds until I was in my 30s. I did well in school, but socially I struggled. And the depression and anxiety and suicidal ideation I experienced as a teen and young adult was DIRECTLY tied to my ADHD and inability to "live up to my potential". My parents didn't have me tested even tho they suspected because they "didn't want me labeled", and as such my mother intentionally helped me work on coping skills for my issues. I often forget others didnt have the same very explicit and repetitive skill building in childhood, and so I forget that the pills alone aren't a fix all. For me, the pills help me implement skills I already know/have.
So. Skill building, explicit instruction on things that "come naturally" to others, exercise and food as coping mechanisms, therapy or coaching, AND/OR pills should all be part of someone's toolbox for coping with ADHD imo. And it blows my tiny little brain when doctors don't give patients and parents the access to all those tools. Not all parents are like my mother, who had the time, education, and motivation to find evidence based interventions for her kid's struggles.
I have had a lifelong addiction to Adderall, and it's had such a major impact on my life.
Back around the year 1999, when I was 15 or 16, I was sneaking out all the time and just overall being a little delinquent punk. I forgot why I first saw a psychologist, but I told him about how I was always so sleepy. I didn't mention that I was barely home at night. He wrote me out a prescription for Adderall and said "this will perk you up a bit!" I was never formally diagnosed with ADHD, and it seems like once a doctor has written the first prescription, no one ever asks questions.
No one told me what to expect, and I started having these obsessive thoughts. My mind was racing all the time but somehow I still sucked at actually *doing* things. I was always super smart, in the gifted program and winning awards at stuff, but I could never seem to get out of my own way and actually hand in homework assignments on time, or apply that intelligence effectively. I started to abuse Adderall, and using it to help me stay up even later. It definitely gave me more confidence, and the dosage continuously increased. I was diagnosed with OCD, which I don't think I ever really had, and I was also put on Prozac for awhile.
I would stop the other prescriptions but just keep the Adderall. Eventually I was prescribed 90MG/day, which is 30MG, 3x/day. This is the instant release, not the XR. They tried the XR, but it wasn't covered by my parents insurance, and I'm also overweight and XR medications don't work that well for me.
There was a little while when I was a young adult when I wasn't on any medication because I was too poor. Maybe 5 or 6 years? But once I got a good job, I was worried that I wouldn't be able to keep up, so I went to a psychiatrist, told him that I used to be on Adderall and it worked well, and they started me up on the high doses again. Again, I've never been formally tested or diagnosed with anything.
I've been on that dosage for the last 13 years. There was one time that I lost my insurance and was paying out of pocket for it. I had to change doctors and the new doctor didn't want to continue to prescribe it. I had heard about a doctor that was very "loosey goosey" with the prescriptions, and I called them, told them that I just wanted to continue my old prescription but no one would write it, and he would write me prescriptions for cash. He ended up killing himself, and I couldn't find anyone else to prescribe it. I explained the situation to my doctor, and how it was dangerous for me to go off of 90MG daily just cold turkey. I was struggling very hard with the withdrawal. I couldn't function without it. He prescribed me enough to come off of it slowly, and also prescribed Effexor. It actually seemed to help, and I was able to get off of it, but I always craved it so much.
After ~6 months, I got a new job with insurance again, went to an "ADHD clinic" and the represcribed me at my former dose. I'm still on Effexor now, because the withdrawal for that is insane. My job was stressful, and I would abuse the Adderall a lot. I've always been very emotionally dependent on it. If I was going out somewhere, I would take an Addy before I left in order to help me socialize. I would stay out late and take one in the morning so I could function at work. If I missed a dose, I was non-functional. I would frequently end up taking more than I was supposed to, and would sometimes run out before I could get my next prescription. I would have to call out of work, because all I could do is sleep.
It's left me very disillusioned with the mental health industry. I feel like when people walk into a psychiatrist's office, they're going to leave with a prescription of some kind, no matter what. I definitely identify with a lot of ADHD "symptoms" but a this point, I feel like being on this medication for so long has changed my brain, and I don't know what life is like without it anymore, and I'm too afraid to try. It feels so helpless... like, am I going to be on this drug when I'm 80?
There are conflicting studies about whether it can have neurotoxic effects in high doses. I wish that I could get an fMRI and just see what's going on in my brain, and take whatever medication I need to supplement whatever I'm lacking. So much of psychiatry just seems like doctors taking a stab in the dark based on a really biased perception of what's going on in your brain. I know what to say to sound like I have ADHD. Depression medication seems like so much "Try this and see how it feels" and it seems crazy to me that we're giving children these brain altering chemicals without knowing what their brain is actually lacking. It's so frustrating to me that there aren't blood tests, or brain tests, or I don't know... *something* that can give a more scientific basis for prescribing things.
This is just my experience. Everyone else has different experiences, and I'm not trying to tell anyone that there experience isn't valid. But I feel hopeless, and like doctors just want to throw drugs at problems and there's nobody that's concerned about how people are going to get off of these drugs, or what the long term effects are. I don't tell any of this to my doctor, because they'll stop prescribing. It just seems so easy to abuse.
As someone who has been really helped by taking a stimulant medication, I'll be honest that I didn't love this episode. I guess I'd fall into that category of "person whose perspective wasn't represented here," so I look forward to listening to the follow up episode.
To be fair, I know I'm a lot more sensitive to this stuff than the average person because I *have* ADHD, and it's a diagnosis everyone seems to have an opinion about, and tell you about. This episode hits some of those same buttons for me, which is a bias I want to acknowledge.
A few critiques (coming from someone who really enjoys your podcast and will continue to listen):
On this substack post, I really appreciate that you acknowledge the stigma around these meds and say that people should take them if they are helpful, but I wish you'd been explicit about that in the podcast itself, or at least added it to the episode description. I don't feel like those opinions came across.
For example, I wish you'd used the term "amphetamine" or "stimulants" instead of "Speed" in the title, since your episode discusses both stimulant abuse and stimulant therapy. Referring to it as "speed" feels unnecessarily stigmatizing. As you say in the podcast, among a large swath of the population speed is known as "a street drug mainly associated with truckers and beatniks." Semantics thing, yes -- amphetamine is amphetamine either way!-- but I do think the words can contribute a lot.
Your goal in telling the story was to describe the history of stimulants in America, not to give the history of ADHD, which is fair. However, I wish you had added at least a sentence or two more of the ADHD lens to the telling of it, because the two are so so so closely linked and there's so much stigma around it. True, stimulants can have "manic" effects on people. But they have wildly different effects on people with the condition than those without it-- (stimulant naps! focus! relaxation!). Yes, prescription rates have increased, but people are just now learning more about it and that there are drugs people take that help. Not knowing stuff like that kept me from getting treatment (and therefore, relief) for a long time.
I know you are putting out a second episode, but I wish you had done them both in one so it didn't end on that note. I also wish you had included a reference to a potential third answer to your "what's going on here" question at the end of the episode: that, despite a chaotic origin story, stimulants can be a helpful tool for people managing a really tough condition.
Thanks for reading, and I look forward to the second episode. I promise I will listen in good faith.
Ps. I also was not a fan of Concerta.
Oh PJ, my heart breaks for you. Thank you so very much for speaking about your challenges. I have recently been told I may have ADHD (at 54) and, while I will go to get an assessment, I'm actually quite frightened about having to take meds for it, while also being quite excited. I want my brain to be normal. Yes, I use that word because that's how I feel. It's exhausting to think and behave so differently to others. I also have clinical depression, unipolar, which is the shit version of bipolar. I get no highs, just different levels of lows. I have taken lithium, Effexor etc, and some meds that made me suicidal. I have now found a medication that has been helpful for a few years, and that, in itself, is the big problem. It can take years to find the right solution. And the right solution must always include talk therapy which, unfortunately, is not always available to everyone. But yeah, I don't want to take meds for ADHD because I don't want to enter that hellish hall of mirrors. I'm currently reading Jesse J Anderson's Extra Focus, which talks about adult ADHD and it has been such a revelation. PJ thank you so much for your vulnerability in sharing your story with us. And as I always say, I'm so happy you're back.
PJ I loved this episode. I could identify. I was told by a friend I might have ADD senior year of high school and similar to you found a pediatrician who asked a one page questionnaire, gave a prescription and said “try it out”. Then I used and abused ridalin for 7 years. I used it to “help study” and get through college, but i also abused it to stay awake drinking longer and get through life on 5 or 6 hrs sleep. When I was 25 and quit drinking, I decided it wasn’t giving me good energy and focus that actually lead to productivity, and it was part of my personal addictions so I quit. I also got irritable from ridalin so that was a trade off, I thought I could snap and lose jobs or relationships. I did have to feel tired and drained for 2 months. Since I quit I’ve grabbed bits and pieces of knowledge - that ridalin is close to speed , and been a bit of an annoying activist against adult AdHd over prescription telling my mom and others maybe ridalin isn’t worth it and find other ways to be productive. Your reporting tells a much bigger story of the origins of the drug and what it does (the confidence bit). Combined with the info from science vs. that adhd is a real thing you can see in brain scans on actual individuals but again, probably much more rare then it is prescribed, I’ve evolved my opinions. I guess my advice to people in the margins that might not pass the full 2 day adhd test that may be considering quitting focus drugs is to take a real look at your productivity - if you still haven't tacked the major work or projects you started taking it for, think about trade offs (my being more irritable thing) and consider alternatives (8 hrs sleep, to-do lists, other life changes).
your podcast continues to impress. Your willingness to open yourself up to the audience in an authentic way (at least that is how I perceive it) really takes your story telling to a new level. Keep doing what you are doing - looking forward to seeing the next adventure you take us on.
I've been listening to your podcasts for maybe 9 years now and this has to be one of the best you've ever made. It was such a captivating story and so well framed, blending the historical context with your personal experience. Can't wait for the next episode!
I found this episode so fascinating and have to admit I didn’t know any of the history of use of amphetamines. I would love to know some of the literary references used that track this history if it’s possible?
I’m a psychologist who has worked in education much of my career and I cannot help but wonder if based on your cognitive profile you may have actually been experiencing a learning disability rather than ADHD. It’s a shame that no one suggested this as a possibility (if they indeed did not) given you had such comprehensive neuropsych assessment.
Oh god as a 24 year old with an office job who just started taking vyvanse 6 months ago I’m afraid to finish the rest of the episode...
I listen to a lot of podcasts and when there is a new episode of Search Engine, it goes to the very top of my playlist. The episodes are interesting, enlightening, and entertaining all while tackling complex subjects with a touch of humor and vulnerability. It’s a beautiful mix that is something unique in a sea of so many voices. So when the self-doubt is heavy, I hope my words will encourage you to keep going and help you build confidence in what you offer, not just as a podcaster but as a person.
Not that my opinion, or anyone else’s, really matters. If you’re making something you’re proud of, the right people will appreciate it and the rest can fuck off. That’s easy to say and hard to internalize, but that doesn’t make it any less true. Don't let the pressure to make something other people will like stop you from making something you love. (And that many of us love, too.)
I found this episode fascinating and a bit concerning. As a parent of a teenager who has been prescribed and takes this medication for ADD, I have such mixed emotion. I often struggle with the idea that she is probably going to take drugs like these for the rest of her working adult life but I KNOW and she agrees that she cannot possibly succeed in school or even think about attenin college if she is not taking them. However, she does not like taking it. And to be fair my husband is kinda against it too. So our compromise is on weekends, summer or vacation she doesn't have too. But now that she is learning to drive and we are practicing together, I feel like she needs it all the time. I'm so torn. PJ do you think that you are able to "break-up" with these drugs because you have also gained a level of maturity? Do you believe that teenage PJ would have been able to succeed and break up with these drugs?
Thanks for an interesting episode.
Quibble-I think ADHD brains are different than typical brains. I hypothesize that amphetamines (in the correct prescribed dose) calms, rather than excites an adhd brain.