Prescribing Addiction

Wednesday, April 16, 2025

Prescribing Addiction

At times one suspects it isn’t so much that drugs are invented to remedy ailments as the ailments are invented to sell the pharmaceuticals. Is it conspiracy-minded to think so, or merely cynical?

These were among the questions inspired by this investigative NYT article about the long-term research into ADHD in children and the drugs used to treat them. At one point, the article discusses how the drugmakers and the drugs’ proponents say unwilling children should be dealt with:

For [some] teenagers, the negatives of stimulants outweigh the positives, and they lobby their parents to stop taking the medication — or they just quit on their own. Statistically, most adolescents don’t stay on stimulants for more than a year. To [pioneering ADHD researcher James] Swanson, the high quit rate is further evidence that over the long term, the medications just aren’t that good. “If it’s so effective, why do people stop?” he asked. “The physicians say, ‘They stop because they don’t know what’s good for them.’ So the parents hear the message: ‘If you don’t fill this prescription, you just don’t know what’s good for your kid.’ But if you ask the kids themselves, they say, ‘It makes me feel bad.’ Or, ‘It didn’t help me.’ Or, ‘It stopped working.’ Who do you believe?”

A significant part of the A.D.H.D. establishment does, in fact, promote the message that children and adolescents who resist medication don’t know what’s good for them. You encounter this point of view often when you read ADDitude magazine, which is owned by the online publisher WebMD. The headline on one recent story read: “Half of College Kids Stop Taking Their A.D.H.D. Medication. Make Sure Your Teen Isn’t One of Them.” Another article, by Wes Crenshaw, advised parents to “problematize” their children’s A.D.H.D. in order to encourage them to take their medication. “To accept treatment, teens need to feel A.D.H.D. as problematic, as a pain in their life that limits and controls them,” Crenshaw wrote. “Too many parents normalize their children’s struggles to make them feel better.”

The reporter describes several studies in the last couple of decades that call into question whether the drugs—including Adderal and Ritalin—are beneficial at all. They may help those diagnosed with ADHD feel like they are better able to concentrate on tasks that bore them, but when tested on scholastic performance against the same students not on the drugs, there is no improvement. There are also well documented negative side effects, including stunted growth.

Apart from problems with the drugs, the six-part criteria used to diagnose ADHD according to the psychological Diagnostic and Statistical Manual of Mental Disorders are themselves disputable, since they ultimately require subjective evaluation.

And then there are alternative treatments. In one, you look for the things that are naturally interesting to individual ADHD youngsters:

Subject after subject spontaneously brought up the importance of finding their “niche,” or the right “fit,” in school or in the workplace. As adults, they had more freedom than they did as children to control the parameters of their lives — whether to go to college, what to study, what kind of career to pursue. Many of them had sensibly chosen contexts that were a better match for their personalities than what they experienced in school, and as a result, they reported that their A.D.H.D. symptoms had essentially disappeared. In fact, some of them were questioning whether they had ever had a disorder at all — or if they had just been in the wrong environment as children.

Another approach is to help them break free from a sense of boredom by giving them more responsibility in their daily lives:

Margaret Sibley’s recent fluctuations paper provided some additional clues into what might help adolescents and young adults feel better and function better. To Sibley’s surprise, patients’ symptoms tended to improve, rather than worsen, during times of higher “environmental demands” — periods of more responsibility and busier schedules. For many of the young men and women in the “niche” study, the same phenomenon held: Jobs or college courses that were demanding and interesting helped alleviate their symptoms. And as their symptoms lifted, they changed the way they thought about themselves.

Human nature is complicated, intrinsically and extrinsically. Thinking of human nature as a pathology requiring medication is greater evidence that we are culturally infatuate with the idea that there’s a pill for everything. But what makes us so certain that everything is indeed a disorder or pathology in need of prescription drug cures?