Ask HN: Thoughts on performance-enhancing drugs?
Yesterday my older brother approached me and proposed the idea of taking performance-enhancing drugs (I forget the names, but I assume he named the more prominent drugs for attention-deficit disorder, 'confidence-heightening' and all that that you've probably heard of). Naturally, for my convictions, I ran the other way. I myself used to be the one who would vociferously debate against these drugs (on the line that if I'm unhappy, then it's for a reason - something happened to me, a certain natural chain of events... getting at the problem with chemical changes to the body sounds like a terrifically frightening idea; likewise, in school, I always thought that ADHD was ... well, nothing, that the kids were simply spoiled and just not trying hard enough). Alas, things have changed quite a bit.
I would greatly appreciate if any of you could voice your thoughts on performance-enhancing drugs.
(Lastly, I'm sorry if my asking isn't appropriate/on-topic for this place, but I thought for my own good I best ask the question to the community I esteem most highly :))
70 comments
[ 4.3 ms ] story [ 189 ms ] threadI don't consider Adderall/Ritalin/Concerta "performance-enhancing drugs" if you have ADHD. The way my son's doctor explained was great: having ADHD is sort of like having 20/60 vision. If you have 20/60 vision, you need glasses to be able to focus. Kids with ADHD need help focusing in exactly the same way and that's where the drugs come in.
Now, there are several performance-enhancing drugs that I've seen people talk about here but I can't remember them. Sorry.
Before you try performance-enhancing drugs, I think you need to examine why you're having problems studying. Are you just not interested in the material? Maybe you need to be studying something that captures your imagination. Are you depressed? In that case, if you can't find an underlying cause, you may need antidepressants or therapy or both.
How so? I don't think taking Adderall with or without ADHD has any different effect on the body. The doctor needs to monitor your heart rate and blood pressure closely either way.
edit: Down voted... for what? I'm asking for a citation. FWIW, I have first hand experience and am (legitimately/legally) on Adderall.
There are other threads here on hackers' experience with ritalin / adderal / their benefits, addiction potential, and side effects. There has also been an item in news in last couple days about a cardiac death for a teen prescribed one of these stimulants. Buyer (and patient) be ware: especially if your doc has not checked you out for contraindications.
I doubt it's that simple. ADHD isn't one disease. It's a lot of things lumped together under one name.
Here's an excerpt from wikipedia:
> DSM-IV criteria > I. Either A or B:[32] A. Six or more of the following symptoms of inattention have been present for at least 6 months to a point that is disruptive and inappropriate for developmental level: > Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities. Often has trouble keeping attention on tasks or play activities. > Often does not seem to listen when spoken to directly. Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions). > Often has trouble organizing activities. > Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework). > Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools). > Is often easily distracted. > Often forgetful in daily activities.
Note that these vague criteria don't mention physical causes, making it highly unlikely that there's one clear physical cause for ADD in different people.
That brings me to what I don't believe:
> With kids at least: it is paradoxical how "hyper" kids are calmed by the use of stimulants - unlike the effects of stimulants on the rest of us.
If there is no clear physical cause, then how likely is this?
In short, though the causes may be as varied as genetic in origin to pre-frontal cortex injury in a collision (injuries sustained in front-end crashes which significantly damage the PFC can lead to ADHD-like symptoms), they all lead to similar systemic failures. These similar failures appear to respond quite similarly to stimulant treatment. The key here is that we're treating a systemic problem rather than addressing a specific origin.
After a lifetime of facing judgment, criticism, self-doubt, anxiety, depression, and most importantly denial that our condition is even valid, many of us have learned to be sensitive about this matter. We've struggled without much societal support, and defended ourselves against wave after wave of attacks on the very existence of our condition, even since childhood.
It's hard to live a childhood with accusations of willful laziness (at best) and trouble-making (at worst) looming over your head. It's even harder to eventually mature, and see children around you suffering the same fate. So you get a little bit angry, a measure defensive, and very sensitive.
It's obvious upon rereading that this is not what you where saying though, and for that I apologize.
For example, its got a high chance of ending up poorly if you have any sleep issues, if you have depression, if you have an addictive personality, if you're an alcoholic, or if you smoke weed (generally the paranoia one experiences from weed can make amphetamines even more dangerous).
I think that's why folks are downvoting you. You might have a small point here, but its rather nitpicky. If you don't have ADD and you're using Adderall all the time, I'd bet money its going to hurt someone, which is all the OP said.
All I'm saying is there are health risks regardless of your ADHD. It isn't as if having ADHD magically makes me immune to the side effects of Adderall. I have trouble sleeping at times and other weird effects, too. I keep my doctor up to date and get regularly checked up on.
Also, you can have ADHD and be an alcoholic / smoke weed / be paranoid / depressed. As I said, I 100% agree you should go to a doctor... I'm just saying that my ADHD doesn't give me "amphetamine immunity" or anything magical.
2. Completely agreed -- if you take a lot of Adderall, it can be bad regardless of whether or not you have ADD. One of the common bad outcomes results from a lack of sleep after prolonged use, and that happens across the board.
3. I meant to say that if you're an alcoholic / smoke weed / depressed / addictive personality -- you should be screened from taking Adderall, not that you can't have ADHD. In fact, many folks self-medicate their ADD by smoking weed.
I recently got a prescription for Adderall. I've had trouble with procrastination and some other behavior typically associated with adult ADHD.
On a typical day, I'll eat a big breakfast, then take a pill. About an hour later I'll get a sense of euphoria and go into the zone. The euphoria wears off after another hour or so but for the next few hours I'm able to concentrate really well on whatever I'm doing.
The most noticeable side effect for me has been loss of appetite. It's kinda creepy for me to look at my watch, realize I haven't eaten in 8 hours, and not feel hungry at all. I also notice sometimes that I'm thirsty, but don't bother getting a drink because I'm too engrossed in whatever I'm working on.
greengirl512 is right though. I still have to force myself to start working. But once I start I don't stop. It's the same for books and video games too. In a way it's like replacing ADHD with OCD.
I think it's worth trying. If you're 21 and in college it shouldn't be hard to get a pill, but I would recommend scheduling an appointment with a doctor and telling him or her what you've told us. With most health insurance, a month's prescription will cost you what a single pill would cost you from a dealer.
Totally.
Its a rare side effect but it happens for folks who are susceptible to depression or bipolar stuff..
Seems to me that most doctors are pretty much robots with a lot of institutionalized "knowledge".
From what I've been able to tell, all drugs that act as neurotransmitter reuptake inhibitors (including amphetamines like adderall) have a strong potential to cause unpredictable and undesirable side effects. It seems wise to use such drugs only as a last resort to treat a debilitating condition. Lack of motivation suggests you might want to find something more compelling to work on.
Adderol(and some of the other drugs) were a nightmare for me. I was uber-productive on them, but I'll never use any of that crap again. I'd rather be less effective than use amphetamines.
I've considered using nootropics (sp?), but I think getting good sleep and finding a motivational visualization to focus on before getting to work is pretty effective.
And frankly, what you say happened is illegal in America. Adderall is a schedule 2 controlled substance, which means no refills at all, much less for a year.
edit: I can't reply below so I'll do it here. Agreed -- there's a scary underside to this story and its that at most universities (especially the top-tier), its much too easy to walk in and get a prescription. Also, at both universities I've attended it was known that you could buy it in certain areas in the library.
All I know is it is _way_ too easy to get a prescription for adderol (and any prescription for that matter), and my experience is _not_ an exception at all. When I was in college I never knew anyone who went to the doctor to try to get a prescription that was turned down or required to take any sort of test.
We'd probably be better off if the prescription requirement was removed from the vast majority of drugs and the advertising was restricted instead.
I wouldn't even consider nootropics until you're already getting plenty of sleep, eating well, exercising regularly, and not using too much caffeine or alcohol. Those things have a much bigger impact on your state of mind. Nootropics are attractive in part because they represent the dream of sharpening your focus without all that boring lifestyle stuff.
Piracetam is cheap, studied (at least compared to the rest...), and doesn't have any particularly bad side effects. If you're going to take anything, that might be a better place to start than amphetamines (!) such as adderall. Of course, I'm not a doctor, but I doubt you are, either.
I've had the best results with green tea (which includes l-theanine) and getting enough sleep, FWIW. (Also, meditation helps.)
I'll try my darnedest in the forthcoming semester to have better sleeping/eating/exercising habits. Thank you everyone for taking the time to reply. (I was thinking to add a few more details to my questions and replies that I think are unique in my case, i.e., I hail from a third-world country, the first time I attended school was in America at the age of 12, and I have severe social anxiety, which, very strangely, I trace back to having conflicts in living in a multi-cultural family - but I decided not to add these details, since it would make for a disheveled, disorderly discussion). Thanks again everyone. :)
Also, this made me chuckle a little bit, just because, coincidentally, this is on the front page: http://news.ycombinator.com/item?id=660720.
Definitely consult with a doctor, preferably one who specializes in this type of medication. Keep in mind that everything has a side-effect, and that mixing various drugs (illegal or not) can have unexpected results. In other words, learn as much as you can about anything you might use, and decide whether to use it based on that.
I'm also about whether AD(H)D is a real condition in the sense that some people have it, and others don't. However, I definitely agree with the sentiment in one of the other replies below, of how it's like vision -- everybody has a different preciseness of vision. If your vision is bad enough, you get glasses. If you believe that your attention problems are bad enough (they seem to be, from your post), then consult with a doctor.
I hope you find a good treatment.
One thing in particular I'd like to note is that my dosage has steadily decreased over the years, not just because my symptoms have become less severe, but because I have noticed there is a certain "threshold" dosage - not just of methylphenidate, but of stimulants in general - beyond which the effects of further medication or stimulants on me change. This change is not a complete reversal; a stimulant is still a stimulant. But up to this threshold, stimulants aid my ability to resist impulses and concentrate on things I may not be interested in, while beyond it, they make me hyperactive and give me the jitters without significantly aiding my concentration. Furthering the vision analogy, this threshold seems to me the logical equivalent of 20/20 vision. This threshold dosage has itself been steadily decreasing. (My actual vision, on the other hand, has been steadily getting worse.)
Those a nice goals but it's not life's be-all end-all and not worth the risks of taking those drugs in my opinion. A modest house, with a spouse and family who love you and a decent job where they respect your work and that presents challenges from time to time, doesn't sound all that exciting but can make for a long and happy life.
... sorry if that's a bit preachy.
If class is boring, find some way to distinguish yourself. (If you can't do that, then you need good grades. If you can't do either, then you picked the wrong field.)
I feel though that taking drugs to improve matters is only covering up more crucial factors that lead to this behaviour. Are you bored of the course (my problem).
Are you at uni? or another level of education? At university I eventually realised the course is immaterial - I ignored most of my lectures and scraped through each year because of partying and socialising.I dont regret that and recommend it to everyone - do what's needed and come away with an ok degree. But dont sacrifice the MOST ipmportant part of higher ed (getting out there, meeting people, haveing a good time) just to get a slightly better grade.
I also did an electrical engineering degree (this is a bit scary :o) and found my main problem was a disappointment in the course. There was a lot of content I didnt like (power electronics) despite being on an embedded systems course. Once I addressed that the degree improved but not majorly.
I came out with a 2:1 [mostly due to a corker of a finals thesis which bumbed me up a lot] and certainly could have got a first - but not w/o a lot of work. I think the trade off was worth it threefold or more!
In my case the issues are lot better now I am in the real world working - my job is what I really enjoy doing so I can focus on it. That helps a lot. I also took time to fight my willpower issues - they aint great but I am working on it bit by bit :)
Fix any issues before you consider drugs - something is likely causing the problem (be they course related or not) and you just gotta nail that. :) good luck
Personally, I've found that I can go for days without doing anything useful if I am trying to avoid boring work. I feel really tired and generally run down. The way I combat this is to do something interesting, and let the momentum help me do boring things. (Video games also seem to help, a cup of coffee and an hour of Geometry Wars puts me in a great mood.)
Anyway, if I were going to go on drugs, I would do it in a structured way. Don't medicate yourself, get a doctor. Before you start taking anything, get in the habit of keeping a diary. Write down what you are thinking, how you feel, ideas you have, what you did with the day. Then, start your medication. Keep writing your in journal. If something changes, it should be easy to see. Your drugs might not make you more useful, they might just be lowering your standards. (My friends think they are much more interesting than they actually are when on certain recreational drugs.)
Finally, maybe your standards are just out of whack, and you are imagining things that aren't true. I often feel inadequate, even when I consider that I have written 100+ pieces of software that people actually use (with about 10 maintained at any given time), I've written a book, I write a moderately popular blog, I am invited to give talks around the world, and have high HN and StackOverflow karma. I think we always feel that we can do better, but that's not a medical condition, that's just ambition. You should stop to think about whether you are actually doing as badly as you think you are.
If you are always procrastinating on your studies, maybe it's because you just are not very interested in what you are studying? Getting through a 3 or 4 year degree you have little interest in is a very tough task. I have seen very smart friends fail just about every CS exam they took for this very reason - they had no interest, no will power to study and ended up failing.
Do you enjoy what you're doing?
I've noticed that most people who complain about having trouble with motivation, willpower and procrastination when it comes to their job (or 'occupation' in the case of a student like yourself) actually hate what they are doing.
If you don't enjoy the things you should be spending your time on then obviously it's going to be hard to get the motivation to do them.
My first point of recourse in this situation would be to examine exactly what your motivations are behind taking this course. Is it because you love it or because your parents told you to, or because you couldn't think of anything else to do? If the answer is anything other than "Because I enjoy it" then you probably need to re-examine your decision.
Who is going to pay for him to live a life doing only what he enjoys? You?
No matter what you love, there is almost always a way to make money doing it.
Enough to live on? This is patently false.
In some cases maybe not, but you could always supplement your income by doing something related. Or, if you have to, even something you don't like.
At least in that situation you'll be able to look at your crappy part-time job and daydream about the great job that you do the other 50% of the time.
The converse is also true, you can't have something just because you want it. Sometimes you have to work for things. You have to practice and try hard.
The simple fact of the matter is, if you don't have the will power to say, "I will do these hard things I don't like doing because I want these other things later in life." Then you are probably on the wrong course or simply not cut out for it.
We do have to make sacrifices and it sounds like that sacrifice for the OP is going to class, studying the material, and doing well -- even if he doesn't want to take that particular course.
Granted that sometimes the things you enjoy entail doing additional things that you may not enjoy so much, but if you really enjoy what you are doing then mostly you will be able to justify this as part of the big picture.
Personally I think that the idea that we all need to do things that make us money rather than the things we enjoy is what has made a lot of people over the years very unhappy.
Imagine working a job you hate for your entire life because you think, or have been told, that it's all you can do. We live in a society that allows us to surpass squandering our lives this way, we should endeavor to do so whenever we can.
There is a chart in Mihaly Csikszentmihalyi's classic Flow, that I've found enligtening. It shows the "flow channel", the desirable state where the activity seems friction-free, surrounded by anxiety on one side and boredom on the other. Most people don't think of activities this way, where the goal is a mean rather an an extreme.
I've found that every instance of procrastination or avoidance in my life stems from anxiety or boredom irrespective of things like desire, enjoyment, or willpower, while all of the things I do get done are things that I don't feel much anxiety or boredom about, likewise irrespective of desire, enjoyment or willpower. (Those factors only seem to come into play with planning what to do, not in actually doing them.)
So it follows that the way to get things done is to figure out whether the problem is anxiety or boredom and then do what you can to counterbalance it back towards the flow channel. If you're procrastinating on something because you find it boring, the way to become motivated is to make it more exciting. Add constraints, make it more challenging, tighten deadlines, expand scope, batch repetitive tasks, turn necessary goals into desirable ones, etc. If you're procrastinating on something because it makes you anxious, the way to become motivated is to make it less exciting. Remove constraints, reduce the challenge, loosen deadlines, break up tasks into small pieces, reduce the harm of mistakes, reduce risk, etc.
What that means specifically depends on what bores you or causes anxiety and how much control you have over circumstances, but I think there is always something you can do on a practical and tactical level to bring any activity towards that channel where you don't have to force yourself into doing it.
Modafinal is an interesting drug. It just makes you feel awake and alert, without feeling like you are tweaked. It saved me when I pulled all nighters. Stayed awake for 3 nights once during finals and it was one of the strangest and most uncomfortable trips I've ever been on - but that's a digression I should save for Erowid.org.
That being said, if you rely on "cognitive enhancers" (I hate the euphemism, more like "speed") now, you may have to rely on them for everything in the future. They don't cure your symptoms, they just mask them. The thing is, focus should come about naturally because you have a passion for something. I believe that you would feel the most success from developing the ability to focus on your own. Did you try exercise? Meditation? Are you simply overloading yourself with too many courses? Are you in the right degree program? Such activities and considerations, though a greater time investment with more room for failure, are healthy ways to get your brain "in the zone" and prepare yourself for future cognitive demands in life.
Or, you can depend on drugs. It's really your choice.
People with "ADHD" have a broad range of symptoms that are conveniently lumped together and treated with various drugs on a trial and error basis. The science of psychology is still greatly in it's infancy. We still have a lot to learn about symptoms such as the inability to focus, hyperactivity, impulsivity and the like. It is highly probable that there is an underlying cause to any or all of these symptoms, one that has been fostered as we were growing up. The whole "chemical imbalance" theory really irks me - there is probably an environmental reason to most of the "chemical imbalances" that we read about, hear about or experience.
Another thing to try is getting a really good therapist (hard to come by) and talking these things out - figuring out on your own. In either case, good luck to you.
Here's an amazing thing I learned in college - there is always someone who is smarter than you. A lot smarter than you. The sooner you learn this, the sooner you can stop worrying so much about getting as much from the lectures as peers, doing as well on tests, etc. You have to learn to be comfortable with your abilities. The even more amazing thing is that you don't have to be the smartest person to do well in life and achieve success.
http://yarchive.net/med/lifestyle_drugs.html
I spent many years of undergrad & grad school drinking to vent stress, but eventually it wasn't doing it for me. I got a motorcycle and I picked up a martial art. I haven't been happier.
Look around for better ways to vent stress, not work better under excess stress. The former's a lot easier and more pleasant than the second.
You already know the right answer. Stick with your convictions.
I disagree with only one word you said. You would not be "getting at the problem" with chemical changes, you'd be "getting at the effect".
I'm a firm believer in
You already know this. Good. Find your A and remove it. Have fun and good luck.(1) http://radian.org/notebook/wp-content/uploads/2009/04/brain-...
(2) http://yarchive.net/med/nootropics.html
(3) http://yarchive.net/med/lifestyle_drugs.html
No. 3 is for understanding why most of the prominent naysayers in the field don't have your best interests in mind. No. 1 and 2 will educate you about what substances are available and what trade-offs their use entails.
Obviously, it's a life-changing decision that shouldn't be taken lightly, but consider moving to something that you're more passionate about. My life changed tremendously (for the better, if that wasn't clear) when I switched to a major that I was more passionate about.
If it helps, I'm no longer an engineer. I initially thought it was just me, then just my college, but now I've spoken to enough people to know that engineering programs aren't generally what a lot of people expect.
Now that I'm a programmer in the real world though, I love my job and I've learned more since entering the workforce than I ever did in school. The passion has gone from 2 to 9 and the rest flows from that. Maybe you're just not wired for the college learning format - god knows I wasn't.
Then on New Year's Eve, approaching my final year in college, I decided to shape up and just suck it up. My GPA for my last year in college was over a whole point higher than my average for the last 3.
This is what I did:
1. Sleep at 11, wake up at 7. 2. Eat on a strict diet. 3. Exercise everyday. 4. Sit in the first row of class. 5. Do your homework in-between classes. Treat school like work, it's a 9-5 job, then you're done. 6. Still party like a rock-star on weekends and selected weekdays.
Drugs will not fix this problem. You need to improve your willpower and your study habits.
Taking drugs to solve your problem seems to be a way of solving the symptoms, not the root cause. If you don't want to take drugs for your whole life, you are better off going to the root cause of your lack of will power TODAY.
As for a better way of improving your will power and confidence, I suggest you talk to your friends, go to a doctor, try sports, meditation, play in a band, or do whatever you feel you need to be done. Get some professional advice if you thing it'll make you some good - making a diagnosis over http is not my mojo :) Just make sure you are on the right track.
As a side note, I'm not against drugs. Sometimes you need them in order to get pass some barriers, but I seem them like a kool-aid quick patch instead of a good code base refactor ;)
http://www.becker-posner-blog.com/archives/2008/03/intellige... http://www.becker-posner-blog.com/archives/2008/03/comment_o...
I especially like Posner’s closing paragraph:
Of course the naturally gifted will object to any "artificial" enhancements that enable others to compete with them. But it is not obvious why their objections should be given weight from a public policy standpoint. It is not as if allowing such enhancements would be likely to discourage the naturally gifted from developing and using their gifts (it might have the opposite effect, by creating greater competition for them), let alone discouraging bright people from seeking out other people to marry and produce children by.