Amphetamine Deficiency Disorder

America's love affair with speed

Hey you!

Is your room messy? Can’t find your keys? Do you prefer doing something fun over finishing a boring task?

You might have amphetamine deficiency disorder!

Ask your doctor if highly addictive stimulant drugs are right for you.

Invented in the 1930s, amphetamines have come in and out of pharmaceutical fashion since. In 1937, the Journal of the American Medical Association (JAMA) touted amphetamines as a cure daily pharmaceutical treatment for “difficulty in thinking, in concentrating, and in initiating and accomplishing usual tasks.”

In 1938, scientists discovered that amphetamines were also helpful in treating the newly minted medical condition called “discouragement.” Discouraged patients exhibited apathy, pessimism, weakness and exhaustion. At the peak of the Great Depression, many Americans coincidentally suffered from this (very real, very scientific) disease “discouragement.”

Sales revenue from amphetamines reached $300,000 within a year of their market debut.

The advent of World War II ended the Depression Era and its corresponding disease of discouragement, but a new chemical imbalance arose in the population. Ask your doctor about psychogenic tiredness.

Men between 18 and 45 were drafted into the military and sent to war. With their husbands, sons, and brothers fighting overseas, women were required to continue their traditional domestic and childrearing tasks and also to enter the industrial workforce as paid laborers on assembly lines. Suddenly many Americans, most of them female, were suffering from “psychogenic tiredness—the result of overworry, of monotonous routine, or frustrating circumstances.” Amphetamines were the treatment of choice.

Non-medical use of amphetamines took off during World War II as well. German military leaders gave amphetamines to soldiers to fuel the blitzkrieg conquests. The US military supplied amphetamines to fighter pilots. The supply kits in every bomber contained a package of benzadrine tablets. Brittish and American soldiers were encouraged to take amphetamines to “boost morale” and ward off fatigue.

Recreational use of amphetamines skyrocketed in the 1960s. First the beatniks and later the hippies touted the use of speed to fuel creativity and induce euphoria. But the mainstream mood turned against these drugs. By the 1970s, American teenagers and college students received public health messaging warning that “Speed Kills.”

The 1980s saw the development of two major influences in American healthcare: a massive increase in direct to consumer marketing of pharmaceutical drugs and a simultaneous movement to destigmatize psychiatric diagnoses. Once a source of shame, mental illnesses were rebranded as physical problems to be treated with daily drugs. Drug companies began pushing for the normalization of daily use of both anti-depressants and amphetamines to treat “chemical imbalances.”

Behavioral and mood disorders became lucrative business opportunities. Big Pharma rebranded angst, melancholy, fidgeting, and not liking being told what to do as illnesses. Drug companies created propaganda advertising campaigns to sell diagnoses and drugs for these diagnoses to doctors and the American public.

Unsurprisingly (to students of economics), increase in supply of psychiatric diagnoses and drugs increased consumer demand for psychiatric diagnoses and drugs. One in every four American adults and nearly one in every two American teenagers now identitfy as mentally ill.

Before 1980, children who had a hard time sitting still were subjected to harsh discipline in school settings. They were occasionally diagnosed with “hyperkinetic disorder of childhood.” Children who could not control their impulses and were prone to disobedience received behavioral punishment. Sometimes they were taken to doctors and received the diagnosis of “abnormal defect of moral control in children.” In 1987, the science changed and these techniques and diagnoses were abandoned. Attention Deficit Hyperactivity Disorder (ADHD) became an official medical diagnosis.

ADHD was once known as “abnormal defect of moral control in children.”

Anyone who has spent time with children knows they tend to be fidgety people who move constantly and interrupt adults frequently. Most of the children I know alternate between hyper-fixation on subjects that interest them and endlessly hopping from topic to seemingly-unrelated topic during conversations. Like big dogs, kids need to be taken out for a run every day or they will destroy the house.

These childhood tendencies are mitigated by individual attention, regular schedules that promote consistency, structured creative projects, activities that promote self-discipline, and lots of outdoor physical play. In our era of working parents, split custody, sedentary lifestyles, near-constant screen time, and disappearing art and recess, fewer and fewer people are developing mental and emotional regulation skills.

In 1995 five percent of American children received a diagnosis of ADHD. That number has since tripled. Nearly all children officially diagnosed with ADHD are prescribed amphetamines to treat the condition.

By the 2000s, Big Pharma began marketing ADD and amphetamines to adults. The children whose parents and providers had told them they had ADHD and needed stimulants to treat it were entering adulthood. Many of them were now hooked on both amphetamines and the idea that their brains did not work normally. Diagnostic criteria changed and ADHD became a lifelong, rather than pediatric, condition.

Life in the internet age was getting busier and more distracting. Many adults who had not been labeled with attention problems in childhood found themselves having difficulty focusing and keeping up with the times. Parents of children with ADHD diagnoses began thinking they might also benefit from taking stimulants to help them focus.

Americans love feeling unique and special. Hyper-individuality runs through our national DNA. Unbridled capitalism is another defining trait of America. So when the biggest industry in the US sells the idea that being easily distractible, prone to messiness, and jumping from one interest to another makes someone unique and special, Americans are quick to buy it. The United States accounts for 85% of the world’s ADHD diagnoses.

Before you call me a conspiracy theorist or science denier for believing that Big Pharma is selling us ADD diagnoses so we will buy their (highly addictive) cure, consider this: The name Adderall was coined by pharmaceuitical executive Roger Griggs in 1994 as a play on the words “ADD for all.”

Nearly everyone has behaviors and tendencies symptoms that could qualify them for an ADD diagnosis. And nearly everyone focuses more easily and gets more done when they start taking speed.

The demand for ADD diagnoses and treatment (amphetamines) continues to rise. Adult ADD diagnoses increased 15% in 2020 alone. Primary health care providers are overwhelmed with patients insisting they have attention deficit disorder. Each of these individual patients insists they have difficulty sustaining focus and motivation in their lives. And they aren’t lying.

Modern life bombards us with more information and stimuli than we ever evolved to process. This has created an attention crisis. Just as many of our recent ancestors developed “discouragement” and “psychogenic tiredness” in response to the stressors of the Great Depression and World War II, we now suffer from Attention Deficit Disorder, the inability to sustain focus in the face of infinte distractions. I feel deep compassion for everyone struggling to find focus in this overwheling world. I just question whether the mass drugging of the population with amphetamines is the appropriate medical response.

I’m old enough to remember 1996. That was the year when the American medical establishment declared pain was the fifth vital sign. A patient’s subjective report of pain was considered just as vital as objective measures of pulse, blood pressure, temperature and respiratory rate.

Medical providers were being sued for not treating pain. Direct marketing campaigns to patients sold Americans on the idea that using highly addictive opiate medication was safer than leaving pain untreated. Drug manufacturers bribed doctors with fancy dinners and even Hawaiian vacations to push opiate prescriptions on their patients.

Doctors asked every patient at every visit to rate their pain on a pain scale. Patients reporting moderate to severe pain were prescribed opiate medications like Percocet or Oxycontin. Many patients became addicted to these drugs. When they were no longer able to access opiates from their doctors, they often turned to purchasing illegal prescription drugs. When they couldn’t obtain illegal prescription-grade pills, they resorted to heroin and fentanyl. The United States now faces a crisis of opiate addiction that is ravaging communities, causing over 80,000 deaths a year, and costing taxpayers trillions of dollars.

By the 2010s, the link between prescription pain medication and opiate addiction became incontrovertible. In 2016 the American Medical Association officially removed pain from the list of vital signs. The American Pain Society, the organization that had propagandized educated patients and medical providers on the importance of self-assessing and treating pain with opiates in the 1990s disbanded in 2019. Investigations revealed the organization had received massive amounts of money from the pharmaceutical companies who produced these highly addictive drugs.

Medical consensus has shifted to no longer managing chronic pain with opiate pain medication due to what we now now about the risks of these drugs. Nearly every state now polices medical providers to prevent over-prescription of opiate drugs. Far from the days when pain was a vital sign and every patient with pain received some oxy, doctors are now afraid to write for even a few days of opiates for patients recovering from severe injuries or surgery. But as the old stories about barn doors and cows and genies and bottles tell us, the opiate crisis that was created by over-prescribing rolls on despite efforts to curb the availability of prescription opiates.

Apparently we have learned nothing, or at least nothing we can apply thorugh deductive reasoning to other medical/legal/societal situations. Overtreatment of pain with addictive drugs created millions of people addicted to opiates. And we are now creating a similar Adderall to meth pipeline.

Where I live, methamphetamine addiction is a huge problem. New Mexico law enforcement representatives report the behavior of amphetamine addicts is the biggest policing problem facing the state. Psych wards are full of patients experiencing meth psychosis. A colleague who works as a nurse at an inpatient psychiatric facility recently told me, “I would love to care for some old fashioned schizophrenics. All we see now is meth.”

When I worked in a women’s health clinic at the county jail, most of the women I saw were incarcerated for meth related crimes. I asked every one of them how they started using meth. And every one of them told me some version of, “I was diagnosed with ADHD as a child. When I dropped out of school/turned 18 and could not get Adderall anymore, I had to buy it on the street. Meth was easier to find and cheaper than Adderall.”

Economic class usually determines who becomes a meth addict and who remains a legal amphetamine consumer. Prescribers are more likely to write for Adderall for college students and busy professionals than for patients who say they need help focusing at their working class jobs. People with computer access and a credit card can even obtain legally prescribed amphetamines online. If you are poor and seeking uppers you’ll probably need to buy them on the street.

Writing this, I can hear the chorus of defensive voices chanting, “But I really do have ADHD and the drugs really do help” and “you don’t understand how difficult my child is when he’s not taking ADD meds.” I truly am sympathetic.

Every time I administer an ADHD assessment in my office I think to myself, “if this really is a disorder, I definintely have it.” Like all of you who identify with ADD diagnoses, my room is a mess, my keys are usually lost, I have a stack of half-read books by my bed, and my brain jumps from topic to topic faster than you can say whatever you are saying when I’m pretending to pay attention to you.

I’m part of the “neurodivergent” tribe, or at least I would be if I were interested in such labels. And I’m sure I would get a lot more productive work done if I took amphetamines. But I’m a contrarian who is incredibly skeptical of everything Big Pharma is pushing, as well as a hypochondriac whose dad died relatively young of a heart attack. So I’ll pass on the speed, thanks.

Of course people perform better in our fast paced over-stimulating world when they take speed. I tend to think this means we should rethink the structure of our world, rather than give more and more people speed.

Maybe the tide is turning and we will soon see a reversal of the over-prescription of amphetamines.

In May 2023 the FDA finally added a two-fold black box warning to Adderall, Ritalin and other stimulant medications used in the treatment of ADHD. In 2006, an FDA panel had recommended a black box warning for the drugs but the agency chose not to follow the recommendations of the advisors. The new FDA warning concerns both the high risk of addiction and abuse as well the risk of of heart attack, high blood pressure, and death. “CNS stimulants, including amphetamine-containing products and methylphenidate, have a high potential for abuse and dependence. Amphetamines may cause sudden death and serious cardiovascular adverse events.”

If we do move out of the ADHD era, who knows what new socio-medical condition will take it’s place. I find myself experiencing discouragement and psychogenic tiredness just thinking about it.