I was recently quoted in a rather edgy online account of a woman’s personal experiment with Vyvanse, a stimulant similar to amphetamine, and feel it is important to clarify and reiterate my concerns in a post here.
In short, it is my opinion that amphetamines are widely overused and abused, and that there is a considerable danger both to individuals and larger society in their expanding use.
Amphetamines have been found useful for a wide variety of medical conditions since their discovery around 1929. However, it is their psychological effects which I am concerned with in my practice and which I want to discuss here.
In the psychological realm, they produce a feeling of alertness, pep, and well-being in moderate doses. They enhance the ability to maintain attention on particular tasks. They block feelings of fatigue and tiredness. On the downside, they can cause irritability and aggression, and can trigger mania and psychosis in susceptable people. They are also quite addictive psychologically.
Although initially considered a wonder-drug for psychiatrists, in the 1950’s recognition of their addictive qualities caused them to fall out of favor in the treatment of depression. However, since that time and particularly more recently, their expanding use in the treatment of Attention Deficit Disorder (ADD) has fueled their availability and acceptance for use in other ways.
In my personal opinion, the medical treatment of ADD with stimulants is dangerous, and should be considered only as a last resort after environmental and behavioral methods of addressing the issues have been exhausted. Using any medication long term in the context of a developing brain (ie.in children), may cause a change in normal brain development which may not be readilly apparent initially or rectifiable later. Also, it potentially sets up a lifetime of dependency.
My practice is located in the Financial District in Manhattan. Arguabley, one of the more high pressure work environments around, especially for young associates in the financial, legal, and accounting firms here. I often see are young professionals coming to me explaining they have to work extended hours in chaotic, noisy environments, which demand a high degree of attention to detail, and that they are unable to maintain their work performance at the level of their peers, and they feel in danger of losing their jobs because of it. Adding to the problem is social bonding behavior which encourages heavy drinking several times a week after work with their peer group.
I also have seen plenty of students: high school, college and graduate; who feel they are at a competitive disadvantage with their peers who are widely using these drugs as study aids, and to enhance performance on tests and in athletic contests.
These situations really put me into conflict. Although most of these folks come to me with histories of past treatment with stimulants, I am often of the opinion that they are “normal” people being tasked to perform at an exceptional level, in difficult environments, in the face of outsized expectations of family, peers, supervisors, and themselves. But knowing that, and explaining it to them is often not helpful. When their peers are all engaged in similar activity, it is hard to get people to accept that it is best for them to be at a short term competitive disadvantage to their peers in order to preserve their long term psychological health. This is because they (perhaps reasonably) link their short-term performance to the chance of long-term career and financial success. Nontheless, I am hoping that by reading this post some will think twice and consider other options.
Once one starts stimulant use, several things occur. In addition to the psychological benefits one feels while the drug is active, the brain is adapting to the stimulation by lowering its own production of stimulating neurochemicals, in an attempt to get back to a more “balanced” state. There are several levels of these production mechanisms, some short term and some longer term. Even with short term use, one feels immediately tired and “down” after the drug wears off. This effect can take days to wear off. With chronic use, the recovery time can be much longer, weeks to months and sometimes longer. So, once one has been using these medications for even a relatively short period, it can be difficult for someone who has a work environment which is perhaps competitive, or requires them to be “on”, to accept having to go through a recovery phase where they will almost certainly be worse off mentally than when they started. This, and the short term enhancing effects, are the powerful psychological “hooks” which keep people locked into continueing stimulant use.
Other dangers of stimulant use include increased irritablity and aggressive behavior, which can lead to violence. In addition, using stimulants while drinking will supress the normal tiredness which comes from excessive drinking and can lead to alcohol related destructive behavior, or alcohol toxicity. In addition to overt mania and psychosis leading to involuntary hospitalization, I have seen more subtle induced hypomania, which has led to rash decisions to break up stable long term relationships on what seemed to be a whim.
So, what can be done then to minimize the “need” or temptation to use stimulants in these situations? Well, for example, one can alter the environment in ways which encourage a calm, settled mind. Finding the right solution for an individual person will likely require some experimentation. For example, a quiet environment is soothing for many people, though not everyone. If it works for you, using some cotton or breathable earplugs during the day could be very useful. For others who cannot tolerate silence, playing quiet, soothing music, like some forms of classical music can work wonders. Headphones are increasingly accepted nowdays even in work environments. Another approach is to limit simultaneous stimulus to the extent you can. If possible, create discrete times during the day when one answers the phone, or responds to texts, or emails, or updates with Facebook or Twitter. Doing all this simultaneously creates chaos in the mind, which limits attention. If you have a work environment which seems to require simultaneous action, at least try to put limits on it, and when on your own time be sure to give your mind a break.
In terms of behavioral things, there are the basics of good health which should be attended to: Adequate sleep, good diet, regular exercise, and adequate “play” time are important. Alcohol and other recreational drugs are detrimental to calming the mind, and although it is reasonable to incorporate them into occasional “play” times, their habitual use should be avoided.
Finally, a regular meditation practice, such as attending to the breath, is very helpful. Perhaps I’ll write one up sometime.
For those interested in the history of amphetamine and other stimulants, I can recommend the book: On Speed: The Many Lives of Amphetamine, by Nicholas Rasmussen.
I hope this has been helpful. Let me know if there are things you disagree with or I have been unclear about, or perhaps you have your own experiences in this area you’d like to share.