That many people misuse Adderall hoping to enhance work performance should not be news. But apparently it still is. The New York Times just published an article about workers in finance, tech, business, the arts and the professions misusing stimulant medications like Adderall, Ritalin and Concerta so as to gain a competitive advantage, or just keep up. As I’ve learned in my clinical practice, many are headed for a fall, even when they believe they have it all under control. Luckily, there are lots of warning signs along the way before it’s too late that the time has come to get some help.
No one should be surprised that so many at work use stimulant medications designed to treat ADHD. We have known for years that many students routinely turn to stimulant medications. The best current estimate from a 2015 meta-analysis (a study of the available studies) is that one in six college students misuse ADHD stimulant medication for purposes of enhancing performance. Continued use at work makes a kind of sense; why change successful work habits just because of graduation? That’s why no one should be at all surprised so many in competitive fields turn to stimulants. People started using them in school. They worked. Good grades achieved. Jobs secured. Why change?
Well, one reason to change is that life is not finals week. Life never stops. When you work for a living, especially a competitive good living, you don’t get extended semester breaks for rest and recovery, and then a clean slate with the next new semester. Instead, the question “what have you done for me lately” rules the day. Perfection becomes impossible. Even someone talented and privileged enough to do anything they want to do still can’t do everything. Choices need to be made. Taking speed does not change that. The fact is that in comparison to college, life dramatically escalates the risks that occasional as-needed amphetamine-use will degrade into dependence and addiction. Plus, there are also significant risks even for those who successfully limit use to an occasional as-needed basis, like never fully developing the grounded self-confidence one’s achievements would otherwise allow.
No one wakes up one day suddenly addicted to amphetamines like Adderall. It’s not a “poof!” It’s a process. It’s a long way from not saying no to not being able to say anything other than “more!” Along the way, statements about the horrors of addiction, as well as moral posturing, do little to support the self-reflective reappraisals of behavior that can change the process. It’s too easy for someone to say “that’s not me” or “I got it under control.” And when misuse becomes addiction and dependence? Then denial is just too powerful for reason to prevail. The best time to get a (mis)user’s attention is before it’s too late.
But how, how to get their attention? One of the lessons from clinical practice is that if you want to be heard you have to stay as close as possible to the other’s experience. You have to speak their language as well as your own. Addiction horror stories, moral injunctions, even begging and pleading, rarely if ever spark the self-reflection that can lead to behavior change. However, what people do sometimes hear are experience-near comments that support moments of self-reflection, little “ahas” that bring additional conscious thought to choices previously made mindlessly.
The following warning signs are intended in that spirit. If you’re trying to get ahead by relying on those little orange pills and you see yourself in any of what follows then, well, it might be time for a rethink about what you are doing, it might be time to reach out for some help getting back on track. Remember: someone who sprints the third mile of the career marathon may have the thrill of temporarily leading the race, but they are unlikely to be among the top finishers.
7 Warning Signs Your Adderall Use Is Out-of-Control
1. You’re using it socially
A conclusion emerging from research is that these ADHD stimulant medications are not smart drugs, despite their name and reputation. They are drive drugs. They focus attention and help extend time awake. They boost motivation to do the boring. Therefore, there is no healthy explanation for using them for a social event. None. If you’re too tired to make it to that opening take a nap, not a pill. If the event seems insufferably boring then don’t go; stop accumulating soporific social obligations. Go read a book or talk a walk or visit with someone you actually do want to see. But taking speed so you can participate in a social event, whether it’s crystal meth or Adderall, is a warning sign of a serious problem developing.
2. You use it routinely
Stimulant drugs are not the “new coffee.” They are potentially dangerous addictive drugs. You are on your way to a potentially serious problem when use becomes routine practice rather than the result of a conscious decision because of special circumstances. If you no longer go through a conscious risk/reward calculation about whether or not to pop a pill then it’s time for a re-think. I’ll frequently ask patients how did they decide to use Adderall for this project or deadline. When the only answer is that it’s because that’s how they always get work done, we know there’s a problem.
3. You have pleasurable rituals of (mis)use
I have a thing for my morning cup of coffee. It’s not just a hot beverage. It’s a ritual, from buying the coffee to grinding beans to filling the french press to that first sip. Sometimes stimulant meds include similar rituals. Instead of being an infrequent tool to marshall attention or stay awake when one’s back is against the wall, Adderall becomes a pleasurable ritual in one’s life. I once had a patient talk lovingly about his special Adderall pill case. He had rituals for the different dosages in his special container, including rituals for mixing and matching so he would be able to take the exact right amount for the task at hand.
4. You believe your success depends on use
Everyone has a story they tell themselves about who they are. These autobiographical narratives help define our identitues, how our life feels. Sometimes, Adderall-users explain success not with the alchemy of hard-work, talent, and circumstance. Instead, success stories are all about how many milligrams, sometimes including which manufacturer. Success comes from the right drug. In addition to warping the development of one’s professional identity, this is also a warning sign that it is time to re-think one’s relationship to these drugs.
5. You’re afraid not to use it
A big red flag of trouble ahead is when the thought of a grant application, a weekly progress report, or a morning on the trading desk without Adderall on board, or at least at the ready, generates anxiety.
6. You believe everyone else is using it and you need it to compete
Research shows that people who use amphetamines for performance enhancement over-estimate the frequency of use. An extreme version of this is the health-tech entrepreneur in the recent New York Times article who believed all her competitors also used speed and she needed to do it to keep up. This is false. True, a significant minority of people do (mis)use, but not everyone. Sometimes it helps just to ask someone, “are you sure everyone is doing it?” It even helps to encourage them to ask others about their Adderall use and whether others believe everyone is doing it. Anything to spark a moment of self-reflection about the drug is a positive.
7. You keep it private from non-users
Shame can be a huge problem, except when its not, when it helps someone think about what they are doing in a new way. I find that asking people why they don’t talk about their Adderall use with friends they know to be non-users often yields a useful spark of shame. I’ll often ask, “why do you want to do something you don’t feel good about doing?” Sometimes that’s enough to also spark the self-reflection from which behavior change emerges.
Did any of this ring a bell? If so, it’s time to re-think your relationship with stimulant medications, especially if you started chasing pharmaco-based performance enhancement in school and now find yourself out in the world still relying on those old work habits. Don’t ever forget you are now in a decades long career marathon. You’ve left behind the semester sprints of school days.