sad NYT article re: faking adhd, stimulant abuse

[dwolen]

The lead article in Sunday's NYT is about a college student who faked ADHD symptoms to get stimulant prescriptions. His first prescription was written by someone from my profession, a nurse practitioner.
It's a really sad story. I really identified with the parents, thinking, "I could have done exactly what these parents did."
It made me think about how much we parents need to educate our kids about the risks of drug abuse.
It is ironic that so many college aged students with ADHD don't want to take their medicines, and how the non-ADHD affect students are banging down the doors to get stimulants. I wonder if the ones who take stimulants are more vulnerable to addiction?

www.nytimes.com/2013/02/03/us/concerns-about-adhd-practices-and-amphetamine-addiction.html?_r=0

[healthy11]

I've heard several stories similar to this lately. You're right - it does seem odd how many kids who actually have ADHD, like my son, resist taking medications, yet many students who really don't have ADHD want the stimulant meds. The article says, "Various studies have estimated that 8 percent to 35 percent of college students take stimulant pills to enhance school performance. Few students realize that giving or accepting even one Adderall pill from a friend with a prescription is a federal crime. " I'm surprised the estimated range of students is so wide (you'd think they could be more exacting, because to me there's a huge difference between 1 in 12, versus 1 in 3 abusing meds) but in any case, I'm glad my son knows NOT to share his meds with anyone, even if he's not taking them as regularly as he probably should.

[eoffg]

While we tend to think of 'performance enhancing drugs' in relation to sports?
We are entering a world of performance enhancing drugs, in relation to academics?

As an instance of this, I recently read a report of study, that claimed that a particular medication that enhanced spatial cognition, and also improved math abilities.
Where it might not be long, before students are heading off to school with various drugs for different subjects? Which are 'quick release', and just last the length of a lesson or exam?

So that it might not be long before 'drug testing' becomes a standard part of exams?
Also the development of 'black market' academic drugs, that make molecular changes, to avoid detection.

[jisp]

In my opinion the real issue this article raises is with the quality of psychiatric care and also how we cut parents out of the treatment for young adults, when in fact that is a time when it is vital to involve families.

I could not believe the way the psychiatrists in these articles prescribed medication. And how quick they were to increase dosings without spending the necessary therapeutic time with the patient. One reason that happens is the way insurance companies reimburse mental health practitioners. There is no financial incentive to take the time with patients and really do the intense psychotherapy that is needed to comfortable diagnosis and treat a person.

The other issue is that we assume that once a child turns 18 they are capable of managing their own psychiatric care. When in fact we know that most young adults who have a psychiatric issue, whether it be the result of drug abuse or something more biological such as depression or psychosis are just not capable of being 100% honest with clinicians. Families often know critical information about the young adult that can help guide treatment. If families are cut out of the process then it is possible for the patient to manipulate the caregiver into believing their own distorted reality.

EOFF-cognitive enhancing drugs have always been around (AKA Coffee and Nicotine) it is just that now we are able to improve, refine and tweak chemicals like these to be more effective. The question we will need to ask as a society is whether the risk-benefit equation is such that it makes sense to allow more widespread use. With Coffee there are risks, but we deny them. With Nicotine we have had to confront the risks but you can see how hard it is for a society to give up something that is so effective at cognitive enhancement, even when it comes with a death sentence.

[SharonF]

The story told in the article is tragic. While the reporter mentioned a few times how rare this type of suicide is, I'm concerned that fact will be lost on the general public. I'm concerned the public, already skeptical about ADHD, will now assume ADHD meds cause a high proportion of people to become suicidal.

I also wonder if our educational system is, in part, creating this monster. There is definitely ADHD. But many students who don't have true ADHD still have trouble meeting education's demands for concentration, focus and executive function.

Are these students lazy? Sometimes. But more often, they do not have the cognitive maturity that the assigned task requires. There is a difference!

As the article points out, too many students wait until the last minute to study for a test. Feeling the last-minute pressure, they borrow a roommate's stimulant meds to help them stay awake all night and cram the material into their brains. And for some, this becomes both emotionally and physically addictive.

Cramming is as old as college! But I believe the academic stakes are higher now.

I saw way too many high school teachers treat their students like college kids--under the guise that the high school teacher was preparing their students for college. But 16 year olds, in general, don't think as maturely as 21-year olds (in general.)

And 21-year olds may not have the forethought and presence of mind that a 28 year old has.

There is nothing wrong with pushing kids to the next level. But when a teacher or professor's main goal is pushing, rather than teaching and empowering mastery, I think we increase the likelihood that overwhelmed kids will cheat. The kid usually knows it is wrong but often feels they have no other choice.

As others have said, it's much like taking performance-enhancing drugs to win the home run derby or Tour de France. "Average" isn't good enough anymore. Not for professors and teachers. Not for students.

So we create an unrealistic environment where "overachieving" becomes the norm. And the only way people with average brains can keep up is by cheating or dropping out.

That's not the fault of ADHD diagnoses or ADHD drugs. It's the fault of a society that cannot accept the reality that not everyone can be above average.

[jisp]

just some more insight into this issue. We work closely with a top child adolescent psychopharmacologist. When our daughter was a freshman she went off to NYC with a known psychiatric diagnosis. Our doctor found her a young hot-shot doctor that came highly recommended by one of his colleagues. That young doctor was very sure of herself, having been the chief resident for child-adolescent psychiatry at Cornell Weill. But she refused to take input from us, the parents, our our pdoc. Instead she wanted to focus just on our daughter as an independent young adult. Our young daughter convinced the doctor that all her problems were caused by mom. She told the doctor that we were overprotective and because her younger brother had a mental health diagnosis we were fearful that she did as well. Our daughter is smart and verbally skilled and a good actress. The NYC doctor fell for our daughter's tales about our dysfunctional family and how her problems were related to her need for independence from us. Meanwhile we were watching our daughter get sicker and sicker. Our pdoc called the NYC doctor and told her that he had known our family for many years and the parents were not being overprotective and the observations they were reporting to him had him concerned given what he knew about our family's biology and our daughter. The NYC doctor ignored him.

Until finally our daughter hit rock bottom and everything fell apart. Fortunately our daughter called our doctor in addition to the NYC doctor. It took us an entire weekend, where my DH and I were coached by our psychiatrist on how to talk to our daughter, to convince our 18 year old that she needed to leave the care of the NYC doctor, come home and admit herself to the hospital. I would have loved to have been a fly on the wall when our doctor (who is very senior in the AACAP) chewed out this young up and coming psychiatrist for the mistakes she made with our daughter. But at the same time the NYC psychiatrist was doing what she had been taught to do with young adults, which is to treat them like adults and ignore their parents and provide them with a fresh start ignoring any previous clinicians. If you read the NYTimes article that is what so many of the doctors did to this family. Imagine if this family had a psychiatrist like we had onboard who could of helped them help their son to wean from the bad psychiatric care he was getting and see somebody who could actually help him. What we did was not easy. It was one of the hardest things I have ever done. But my daughter is the successful young women she is today because of that, and had we not been able to intervene the way we did I shudder to think what might of happened to her in NYC under this doctor's care.

[healthy11]

The above dialogue is just another reason why I'm proud to be a member of this forum. The comments are insightful and reflect personal experiences, that no "textbook answer" can compare to.

I feel very fortunate that my son has been able to see the same psychiatrist for over a decade. Since our son started seeing the Dr. when he was in elementary school, we (parents) were obviously in attendance at his appointments, and that has continued to be the case over the years, even though our son is now 22. The "format" of the appointments has changed, so now the Dr. starts off by asking our son what's been happening, instead of looking to us first, but if we interject or roll our eyes, etc. the Dr. perceptively rephrases things to take into account what we said.

The Dr. has directly told our son that "very often, people with conditions like ADHD have a hard time recognizing what other people see, so it's good to get your parents perspective." Where we used to stay in the room for the entire time of the appointment, now his dad and I will typically leave the last 10 minutes to our son and the Dr. alone, but it's reassuring that they both still allow our input to be heard as part of the treatment plan. (And it was so helpful that when our son experienced a couple of unusual episodes/antibiomania, the Dr. and his assistant were willing to make emergency appointments for our son based on my description of the situation, instead of refusing to do anything until talking directly to our son.)

[beth]

Yesterday I was sitting at a table having lunch and working when I overheard part of a conversation of two college students. One said something about needing some Adderall and the other agreed. They acted as though that was totally normal.

[michellea]

NPR did a follow up on this article last week. onpoint.wbur.org/2013/02/06/adderall There are so many issues that feed into this problem - starting from our "medication" culture, to the competition in our schools and society, to our health care system, to a growing trend to look for a quick fix rather than doing the work and delaying gratification. It is frightening as we look ahead to what our kids and their kids will face.

[michellea]

My dd and I were talking about this topic - she said that almost all of her friends use stimulants to study, rebound from parties to do work and to get an edge. It really sounds out of control.

[healthy11]

Michellea, I'm disappointed that your daughter is surrounded by what sounds like rampant abuse of medications. I'm forgetting...is she still involved with sports in college? Are the friends she's mentioning all in her sorority, or ? The reason I ask is because my son, who didn't get involved in many school clubs or extracurricular activities, only mentioned being approached once by someone who was interested in getting Adderall from him. I know he didn't "hide" the fact he had ADHD, but he didn't make it sound like there was widespread misuse of stimulants, although he said plenty of people still smoked pot. I can't help but wonder if it's more likely that in "familiar groups" (ie, a greek house, or sports team players) they spend more time together, and share more "intimate secrets," and they have more access to people who might share their meds, so that's why your daughter is aware of so many kids who don't actually have ADHD taking stims. (Or is she saying that the students are "faking" having ADHD themselves just to get prescriptions for ADHD, rather than getting pills from other people?)

[michellea]

She said that they are buying meds from others - basically $8/pill. She said virtually EVERYONE - girls from her sorority, on her club lacrosse team, in her dorm, in her classes. She said that the only person she knew that does not take it, is her very health conscious roommate and herself. She also said that her cousin who goes to a different, very high caliber school said the same thing. In fact, it seems that things are even worse with the binge drinking, late nights and then stimulant use as a routine.

And yes, pot use is very widespread - she said especially with guys.

[healthy11]

It's certainly encouraging that your daughter and her roommate have decided not to participate in the poor lifestyle decisions that are being chosen by people around her.

If it's any reassurance, both my son and one of his best friend from H.S. acknowledged that they drank much more BEFORE age 21 than after turning "legal." Since they can now get it anytime, they don't feel like it's anything special, and there's no reason to binge. If your daughter is resisting "overdoing it" already, then she should find even less pressure coming from her friends/classmates as they get older, and hopefully wiser.

On a side note, my son's lease on his college apartment ends Aug. 1st, and he's been trying to find an affordable place in the town where he's working...It's an older mixed-income, multi-racial city of about 150,000 people, roughly 45 min. away from where his campus is. Since he's technically still an "intern," and won't know if he's got a full-time offer until Sept. 1st, we'd been thinking it would be best to just rent a room in someone's house, and not get into a lease yet. Unfortunately, one of the first places he looked at, the owner shared that he had to kick out his former renter because the guy was a heroin user. That, and Cory Monteith's recent death, has made me wonder just how prevalent heroin use really is in our country... It sounds like it's is an even bigger problem in your New England area ( www.policymic.com/articles/55663/quaint-new-england-towns-are-now-havens-for-heroin-users ) whereas meth labs are more of an issue in the Midwest ( io9.com/5989152/a-map-of-state+by+state-meth-incidents-in-2012--what-can-we-take-away ). Since the residue from crystal meth labs can be toxic long after someone has left the property, I just bought a "drug wipe kit" to test for meth contamination hopefully before my son moves into any new apartment. ( methlabhomes.com/products/meth-test/#cid=39053 ) I know he will think I'm worrying unnecessarily, but it seems like there are plenty of causes for concern.

[empeg1]

This thread hit home. I am in the process of having my oldest dd formally diagnosed for a FASD. There is a geneticist at Stanford who is a FASD expert. I spoke to one of the Fellows of this program. When he heard my dd's age (26), this doc told me, we will be talking with just your daughter about the results of the exam and the diagnosis. Huh? No way! For one, difficulty with language processing is a major component of FASD. In my dd's words, "You know me, mom, I only hear every 3rd word". She absolutely needs a second pair of ears with her. Then too, my dd has been hurt by so many professionals. I am feeling protective. I want to know what will occur in the appointment, 2 hours, and how the team speaks to young adults who are just being diagnosed. So much is at stake here; she is already afraid to hear that she is just damaged. I will not allow her to walk into an appointment like this and have me excluded, as her only support person, nor will I allow her to walk into this appointment without an idea of what will be said and how. The question? How do I contact this specialist. Rrrgh, I wish more physicians would remember part of the Hippocratic Oath, first do no harm.

[SharonF]

michellea--

I'm glad your dd feels comfortable talking with you about what she's seeing. As you know, that's really important!

I'm afraid too many young adults who would never do street drugs like meth, cocaine or heroine see nothing wrong with illegally buying and using someone else's ADHD meds. As I said in an earlier post, I still believe that the main driver is society's intense pressure to succeed. That's made worse by two other common factors of that age group: a perception of being invincible and a desire to test the system/push limits.

Thankfully, most young adults get tired of the drink/get-drunk/use-drugs-to-recover routine. And the "brilliant and bulletproof" attitude common in late teens and early 20s also seems to diminish with time and real-life experience. But the stakes are high.

[eoffg]

Though 'academic performance enhancing drugs', present a whole new situation from recreational drug use?
Where we could be entering an age where students that don't use them, will recognize that their grades will be 5% to 10% lower without them?
So that using them could motivated by just putting them on equal footing to other students?

But another side of this, is the rapidly growing untested 'synthetic drugs' industry, where users are the guinea pigs and might end up with the brain of a guinea pig?

[michellea]

eoffg - you bring up a good point when you say, "we could be entering an age where students that don't use them (drugs/stimulants), will recognize that their grades will be 5% to 10% lower without them?
So that using them could motivated by just putting them on equal footing to other students?" The NPR report I mentioned earlier in the year examined this. They found that students like my daughter who did not use the drugs in their freshman and sophomore year, were at risk for succumbing to drug use because of the idea of the equal footing. So, while I am glad that she is not using now (and I trust her), I know that the temptation will be there and I hope she has the strength and fortitude to stay clean.

The other issue is the binge drinking. My dd believes that part of the problem are the restrictions on the drinking age. She feels it drives kids to binge and take shots in a "safe" environment prior to heading out to the parties. I know there are some college presidents and some research that supports this. But, the bottom line is the drinking age IS 18 and it IS NOT safe to binge, take shots and get totally messed up. I hope that as Healthy and Sharon say they get tired of the scene. I know I did. But I do worry about both long and short term safety and health consequences and I can't understand why drinking needs to be central to so many activities.

[SharonF]

Where we could be entering an age where students that don't use them, will recognize that their grades will be 5% to 10% lower without them?

That's been the case with some pro athletes. Some say they truly don't want to use performance-enhancing drugs. But they may not make it to the pros, stay on the team or get the stats required for a higher salary...unless they cheat (take drugs). Sports Illustrated wrote a fascinating article about two young men who were baseball teammates in college and in the minor leagues. Pro scouts said the two had very similar prospects. The one who used PEDs moved on to the major leagues. The one who refused to take drugs ended up losing his place to a "better athlete."

MLB, pro cycling and other sports are finally cracking down a bit on those who use drugs to make themselves appear to be better athletes than they really are. But the culture of cheating (using PEDs) apparently still permeates many amateur and pro sports.

I can't understand why drinking needs to be central to so many activities.

Just as prohibition only encouraged the moonshiners, making alcohol a forbidden fruit until the age of 21 is a key factor in why many young adults see alcohol as our culture's main rite of passage. In countries and cultures where there is no minimum drinking age, many studies have shown that kids are less enthralled with the concept of drinking. There is binge drinking in Europe. There are alcoholics in Europe. But US laws banning alcohol until the age of 21 are not having the desired effect. In fact, they may be having the opposite effect.

Yes, most young adults outgrow it. But as I said, the stakes are high.

[healthy11]

empeg, if your daughter signs a HIPPA form that allows info to be shared with you, I don't believe the doctor could keep you out of his meeting with her. My son has approved my husband and I still showing up for his annual meetings with the psychiatrist who does his med management, and I've gone along to many Dr. visits with elderly relatives, too. So long as your daughter doesn't object to you being with her, there shouldn't be a problem.

[empeg1]

Healthy, i know I can go with my dd with her consent. What raised my radar was that a Fellow of the program at Stanford would know so little of the disability of FASD to even suggest that the docs would want to talk to my daughter by her own. I passed by the remarks of this physician to a friend who is a long time expert in FASD and she was equally appalled at the lack of understanding. Which then raises my hackles.... what else do the docs in this genetics clinic not know about FASD? Are they going to know or have the sensitivity to speak with my daughter so that she understands, yes, this happened to me and yes, there are things I can do to make my life better? She has been so hurt so many times by professionals that I am not trusting this time. The damage that could be done to her right now, if the diagnosis of FASD is presented to her in the wrong way, is immense. And, so far the program has stuck out as this doc did not have the sensitivity to say, I know your dd probably has processing difficulties, We will ask her for her consent to have you with her when we speak to her about our findings.

[empeg1]

BTW, if you have not already surmised this, "momma bear" is now up on her hind legs, growling re my daughter. I will not let another well meaning but ill informed professional hurt my daughter. Such has been her life (and mine) with FASD. You guys have no idea what it is like to have a chid with a ghost disability- no one has read the 40 years of research, no one gets it, no one knows about it or if they do, here is the message given out, there is nothing you can do about FAS any way. I will simply descend upon a doc if he/she tells my daughter this, as was the experience of another parent, with yes, an adult son, who understood the message of the doctor.

[SharonF]

empeg--

You're right. I have no idea what it's like. LDs and ADHD are terribly misunderstood, but FASD is flat-out ignored. I've learned more about FASD from your posts than I have from any other source. Suffice it to say, few others talk about FASD or explain it.

Doctors, even those with intensive specialties, tend to be limited by their own training and their own experience. We expect them to be more knowledgeable. We even are willing to explain to them what we know. But time and again, they dismiss new information. They stick to their training and their limited experience as if it is gospel.

One frequent poster here has had her life permanently changed by side effects of antibiotics. If I remember correctly, her doctor dismissed the side effects and didn't want to believe the evidence. The FDA also continues to allow that family of meds to be sold like candy, despite thousands of cases of extremely detrimental side effects.

Medical ignorance is, in my opinion, not far from medical malpractice. Not doing the right thing can be just as bad as doing the wrong thing. But many docs don't see it that way.

You mention the pain caused when doctors say (directly or indirectly) there is nothing they can do about FASD. Doctors are trained to "heal" with the goal being a "cure." But there's a flip-side to that deeply ingrained culture. It's no secret that many physicians have big egos. If some doctors cannot "cure," they don't want to be part of the treatment.

I think many of us have run into that problem with doctors. I have. My son has. And I can only imagine it is far worse if the root issue is FASD, mental illness or something doctors perceive as illusive or untreatable.

So stand your ground. Look for doctors who bring more knowledge and a broader perspective. Stay strong. And we're here to cheer you on.

[healthy11]

Some of the problem is medical ignorance, but I wonder if a contributing factor in these situations is a fear of legal ramification by doctors, and that is outweighing their willingness to put a patient's needs ahead of their own concerns?

It's no secret that the cost of medical insurance keeps escalating. Having a claim against a Dr. would raise rates even more, and without insurance, they can't practice. If a Dr. suggests something that violates HIPPA (ie, "I'm not even supposed to be talking to you because your daughter hasn't given approval, but you should be here when I give her the results") or if they admit to possibly having contributed to a problem (ie, having prescribed an antibiotic that caused permanent damage) it opens them up to litigation.

[michellea]

A good friend and I were just lamenting about the lack of knowledge, understanding, time in the medical community regarding mental illness. I can only imagine that FASD is even worse. Empeg, it must be so frustrating and exhausting to constantly run into these barriers as you are trying to get your daughter the help she needs. You are an inspiration to all of us - stay strong, keep fighting and clawing. You are an amazing mamma bear.