Productivity in a Pill: The Lie That Kills

Diane was 29 years old, a lawyer in a major law firm, and half of her guts were dead. They died because she had a “stroke” of her blood feeding her guts as a result of taking amphetamines to improve her work performance.

Diane had been taking amphetamines, either as a prescription for ADHD (Adderall) or purchased from shady sources, since law school. She had felt they allowed her to study the tedium of the law, book more hours as a young associate, and she felt they were responsible for her being a young partner in a major firm. Now that abuse nearly killed her.

What she didn’t know, is that the “increase” in productivity and attention is an illusion.

“I heard they could cause strokes, but I thought I was young, and it wouldn’t happen to me. They were amazing at first, I could concentrate, I didn’t need sleep, I didn’t need to eat, and everything seemed brighter. I could study for hours, and felt like I got things quickly.”

Diane also didn’t realize she had become addicted to the drugs. A highly functioning addict, but this addiction nearly killed her.

The increasing use of drugs for performance is nothing new. During World War 2 they were used to “enhance” soldiers who were often sleep deprived.  In the 1960’s they were used by medical students to improve performance, but that stopped when the results showed only an illusion of performance, and severe consequences. By the 1970’s they were classified as a controlled substance because of the severe addiction potential. Medical students who had taken those drugs reported severe depression following withdrawal, and some underwent treatment for addiction.

Those lessons were forgotten, or never learned, however. These medications are easily obtained with a diagnosis of ADHD, but they are also readily obtained on the street – without having to have a note in your medical record. Diane used both, because the medication she was prescribed wasn’t enough.

The effects of amphetamines, and ‘amphetamine like’ drugs on performance is a myth. The feeling of improved performance, from the ability to concentrate on drudgery to staying up and not sleeping is less than others. But you “feel” as if you are sharper, have an edge, and it is often that illusion that pulls people in. When people were tested, those taking Adderall against those who were not, those who did not take the prescriptions had improved performance in tests, those who took the medications felt they were better than they tested.

Like many drugs, it takes more and more to get that “feeling.” Diane felt increasingly like she “needed” the drug to be sharp for meetings, to take the drudgery out of reading contracts, and to just get going in the morning. What she thought was an edge was merely an addiction.

“I started them I law school when I needed to cram, one of my classmates gave me some. I couldn’t believe how I felt, I spent the night studying and in the morning took another and felt I did great. Then when I got to the firm I knew I had to book endless hours to make partner, and so I would use them to keep working late.”

She wasn’t the first young person I saw from the emergency room with bowel death from taking those medications. Emergency room visits for problems related to prescription amphetamines have tripled, and addiction centers report a large increase of people with addictions to Adderall. Some countries have banned Adderall completely because of its potential for abuse, and poor efficacy.

Amphetamine Use In Baseball

Baseball has long had issues with amphetamine abuse among players. More players are using this for the same reason – the sensation of an “edge.” The confidence – but that is also a myth. Most who use amphetamines have shorter careers in baseball, burning out quickly, and without evidence that they have improved eye-hand coordination or concentration on the 96 mile per hour fastball. When tested – performance isn’t enhanced with the drugs, in fact, it declines with its use – but the athletes “feel” as if they are doing better.

Long Term Use of Adderall and Amphetamines 

Long-term use of Adderall or other amphetamines can lead to paranoia, depression, high blood pressure, strokes, and heart attacks. All for an illusion that isn’t true. The worst cases of long-term use (more than three years) are those we see in the emergency room: young people who have developed strokes, heart attacks, or, in Diane’s case – a stroke of the blood vessels leading to her small bowel, requiring emergency surgery.

Some have used such drugs for weight loss, but the rebound effect is clear. In our weight loss clinic there is an increasing number of people who have had the drug for its anorexic effects, only to discover when they left the drugs their weight rebounded, and even increased. Not wishing to go back to the drugs, but now facing obesity as a result of the rebound, they need another solution – and the solution isn’t a pill, the solution is a lifestyle change.

The drugs don’t improve intelligence, they don’t improve performance, they don’t lead to long-term weight loss, nor do they change the requirement for sleep.

“I wish I would have just studied,” Diane related as her two-week stay in the hospital was ending and she was going to an expensive treatment center for addiction. She was suffering from the usual depression, she still had a pressured speech pattern, and in the two-week hospital stay would have severe paranoid episodes requiring psychiatric intervention. Her guts that remained, recovered, but her brain was craving that feeling again.

“It was all a lie, like an abusive spouse, I just kept getting battered thinking it was good.”

She worried she couldn’t carry her workload, but the psychiatrist assured her that she could. “It was all a lie, it was an illusion, but you really were not smarter, you really didn’t have an edge, and your increasing combination of depression and paranoia would have cost you clients.” The psychiatrist told her that she had a scar to remind her that the price for the drug was reversible this time, “Dr. Simpson could fix your guts, but if you had a stroke, there is no one that could fix the lost brain.”

There is no job worth taking that drug for, no career worth a person’s brain, body, and no short cut to improving. It makes menial tasks a bit better for a while, but it takes its toll, and that toll is not worth it. No athlete really improves performance.

It is all a lie- an illusion, and one that can kill.