Adderall Has a Tech Industry Problem

It’s no secret Silicon Valley has a problem with conspicuous consumption and drug abuse. Trace this behavior back up the pipeline to colleges where popping a pill gets a paper done on time. Instead of resting after working hard, recovery is substituted with playing hard, “blowing off steam,” and partying all night. This culture carries through to the internships, hackathons, crunch periods, and even the day-to-day work culture of tech startups and the gaming industry. As performance expectations rise, deadlines tighten, and 80-hour work weeks become the norm, stress and drug addiction rates in the Valley explode. And yet we mythologize this self-abuse as superhuman.

Regardless of what community leaders will tell you, tech loves the narrative of pushing through to a narrow victory. It is hard-baked into the format. Building a prototype in a sleepless 36 hours is considered far more impressive than steady progress over the course of a month yielding the same result. Finishing a project last minute produces a seductive, adrenaline-fueled high that sustained progress doesn’t. But chasing a high isn’t the real reason this culture exists.

The fact is fast-paced overwork at startups reflects the economic interest of investors. Rapid productivity means higher capital with lower overhead. Higher profits. A bigger payout in a quicker exit. Look to the “10x engineer”: the willingness to work longer, harder, produce capital, is prioritized above all. The newest trend is to seek success with as few engineers as possible. Tech workers are chasing the high of the win; tech investors are chasing the high of ROI. This addictive cycle has fostered the myth of the hero hacker from whom maximum labor can be extracted in the shortest time possible. The cultural value derived from this investment strategy is a fetish for young, resilient bodies that bounce back from a hangover or a product launch with equal speed and vigor.

CC-BY McLevn, filtered.

Combine a workforce willing to deny the body’s limitations with an urgent need to perform for investors, employers, or customers, then apply the pressure of competitive one-upmanship—and we arrive at Hacker News posts where young men ask for each other’s non-medical opinions on the pros and cons of nootropics and prescriptions like Provigil/Nuvigil and, of course, a classic: Adderall.

Exploiting ADHD for Recreational Use

The widespread recreational use of drugs used to treat the developmental disability known popularly as Attention Deficit Hyperactivity Disorder (ADHD) should bother us as a community. ADHD medications are now more closely associated with performance enhancement than with remedying the disorder they were intended to treat. Adderall in particular has become normalized as, at best, a stronger version of caffeine, and at worst a more socially acceptable alternative to cocaine. But neither caffeine nor cocaine are regulated by prescription. Which begs the question, how do non-ADHD people come by these drugs in the first place? If you don’t receive, purchase, or even steal Adderall from someone else, there are two ways to secure a prescription:

• Your ADHD-like symptoms are misdiagnosed, or
• You deliberately misrepresent your symptoms for a false diagnosis

It’s true that misdiagnosis—or, as it’s called pejoratively, “overprescription”—is a known problem, often because its symptoms overlap with and can be mistaken for other disorders such as PTSD. However, the latter trend of intentionally fabricating or exaggerating situational symptoms is of greater concern to me. Normalized use of Adderall for performance enhancement has done more to corrupt ADHD and cast it as a frivolous, made-up disorder than any anecdotes of pharmaceutical corporate greed or children turning into well-behaved zombies. Professing the superficial symptoms of ADHD, or faking them altogether, in order to obtain Adderall appropriates and erodes the legitimacy of the disorder itself.

Astoundingly, while Adderall use is nearly as commonplace as alcohol in tech, a demonstrable understanding of ADHD is rare, which exacerbates misdiagnosis. Many people still incorrectly believe it is caused by too much TV, sugar, or bad parenting; some stubbornly refuse to accept its very existence. The inability to concentrate or focus has become so cliché that anyone can testify to it. This perpetuates the myth that “everyone has ADHD sometimes”—the key word, of course, being “sometimes.” There is no such thing as part-time ADHD. If you dig into the lived experience of having ADHD, you’ll find the disorder is as profound as it is misunderstood.

“The A in ADHD is a gross misnomer and oversimplifies the seriousness and pervasiveness of the problem. It’s really a disorder in the brain’s executive system, which allows people to regulate their own behavior, stay organized, manage time, show self-restraint, control their emotions to a socially acceptable level and so on.” — Dr. Russell Barkley on NPR’s Talk of the Nation

Scientifically speaking, ADHD is a structural abnormality in the brain. It has one primary cause: genetics (see Etiologies). Brain imaging of ADHD children and adults have shown substantially reduced neural activity in the frontal lobe and the anterior cingulate, a bridge connecting the frontal lobe with the rest of the brain. This translates to lower “willpower,” long-term “motivation,” “focus,” “self-control,” or “attention.” We of course know this is a finite resource, helpfully illustrated in Kathy Sierra’s hilarious post Your App Makes Me Fat. But while most people start with a full tank, having ADHD means you have less of it. Your ability to regulate your behavior, to stifle your impulses, is diminished. While the symptoms may appear more or less acute depending on the environment, you cannot “grow out” of it or strengthen it like a muscle. No amount of life hacks can train you out of having ADHD.

CC-BY Geoff B Hall, filtered.

The damaging effects of ADHD are insidious, making it a very stealthy disorder for adults. It may not seem like you have a serious problem day to day. You may doubt you have a disorder at all. In our culture, the more apparent your symptoms are, the more your diagnosis is legitimized. It follows that if your symptoms are internal, difficult to articulate, or cumulative over time, they seem less like symptoms and more like behavior patterns you could control, but haven’t bothered to address. Without proper education on ADHD, your failing to meet a deadline because “you procrastinated” or “forgot” will not be understood as symptomatic of a buggy transmission in your frontal lobe; it will be interpreted as a lack of discipline, a moral failing. Not paying attention will be interpreted as rudeness. Failing to regulate your impulsive behavior will cast doubt on your maturity or trustworthiness.

Many of us with ADHD internalize the belief that our disability is a personality defect; that accepting a diagnosis is an excuse, an attempt to deflect responsibility (most people incorrectly believe that an ADHD diagnosis implies reduced accountability; quite the opposite). I call this a “secondary symptom” of ADHD: the inability to fully embrace a diagnosis that our culture sees as frivolous or wholly invented. It’s not quite denial—more like self-inflicted gaslighting. We hide our deficiencies out of shame, hoping that one day we can get them under control and not be doomed to a sort of perpetual mental adolescence. But no matter how hard we try to develop discipline, to learn better habits, our ADHD prevents us from performing it.

Further complicating this is that the science on ADHD is still relatively new, evolving, and the classification and diagnostic criteria shifts every few years. It used to be “ADD”; then “ADHD”; then the ADHD subtypes (Predominantly Inattentive, Predominantly Hyperactive, or Combined); and now new classifications are being proposed. A separate but related disorder, cheerfully dubbed “Sluggish Cognitive Tempo,” is being researched. To this day, we still barely have a name for what is wrong with us.

The temptation to use Adderall as performance enhancement in tech is understandable. The monetary and cultural incentives are compelling. But I bristle at the practice of faking the superficial symptoms, of the handwaving directed at a biological abnormality most people barely understand, in order to access the drugs. What’s more distressing is that, due to performance expectations so high they verge on parody, many people will mistakenly believe they have ADHD, describing their falling short of these expectations as symptomatic of a disorder instead of environmental stress. Anyone would feel they can’t compete at the breakneck pace of many startups. And so the use of these drugs, with or without medical supervision, has become a tolerable practice. Despite the growing number of addictions developing from misuse, young people have embraced the notion that Adderall is safe to use on neurotypical brains. I’ve got news for you: it’s not.

The Cost of Medicating a Cultural Problem

It is perhaps the most compelling case for the existence of a biological problem that a person with ADHD does not become “addicted” to ADHD drugs (at least no more than diabetics are “addicted” to their insulin) and taking Adderall under proper supervision does not increase the chance of later addiction. For an ADHD individual, stimulants do not produce the eurphoria espoused by the neurotypical people who recreationally take it. Doses of Adderall popularly used for performance enhancement may feel like nothing at all to an adult with ADHD. This can be a disappointing revelation for someone who had hoped to be “saved” by the miracle drug’s effects, only to discover that they feel a little more “normal” while their peers are on speed. Stimulants also come with unpleasant side effects; many with ADHD choose not to medicate regularly or at all, or they prefer non-stimulant alternatives. Despite the adamant endorsements of its fans, taking Adderall recreationally is risky. As with most prescriptions, there is a potential for dangerous drug interactions; it is contraindicated for heart conditions; and while it is not nearly as addictive as cocaine, the added dopamine released and absorbed can trigger dependence. Adderall may be technically safer than aspirin when used correctly. But, just like aspirin, when used incorrectly, it can also kill you.

A manifestation of these health concerns is the understandable cultural backlash against prescribing stimulants. Trend pieces on “overprescription” in children often point to the modern classroom as an “unnatural” environment. This argument is paired with the misconception that ADHD and its symptoms falls within the range of normal on a neurological spectrum, implying that ADHD, a developmental disability, is somehow a “gift” or personality type. Combine the reasonable aversion to misusing stimulants, the valid consideration of our K-12 education system as rigid and stifling, and an unscientific, cultural myth-based conception of ADHD, and you get an anti-medication slant. For the school system is hard to change: it’s easier to perpetuate a social stigma and pressure parents not to medicate their children’s perceived non-disorder, which casts suspicion on parents who do.

But when this critique is applied to adults, the environmental factor is left out. Instead of protesting the tech industry’s expectations of productivity as unreasonable, or demanding, “Working hard and playing hard seems to only work for young, able-bodied people—what about the rest of us?” we get canards like “Everyone has ADHD sometimes,” or, heartbreakingly, “I should be able to do better if I were just more motivated.” Where is the critique of brutal, pointlessly competitive college CS programs or 80 hour, always-at-work company lifestyles that push neurotypical people to resort to drastic measures simply to keep up?

Resorting to medication to correct for problems that are largely environmental is problematic, and we cannot criticize the drugs without inspection of the environment that demands their use. The current system is designed to separate the superhuman 10x-ers from the subhuman masses. It has no use for those of us who cannot or simply prefer not to compete. Unfortunately, the money offered in tech and the permissiveness of our work-hard, play-hard culture is currently too big of an incentive to dissuade the practice. We are seeing more burnout and a widening achievement gap of those who persist at their own peril and those who cut their losses and wash out. Tech culture has normalized illicit use of ADHD drugs, rebranded it as viable performance enhancement, and obscured the very real health risks in the interest of productivity.

Deconstructing the Superhuman

It is easy to point to the drugs themselves as the problem, to scapegoat Adderall as a symptom of pharmaceutical greed and call for tighter regulation on its use. But as we know from the so-called Drug War, this will not curb illicit use—as long as there is an incentive to use them, they will be used for performance enhancement. Stigmatizing the drug will do less to prevent its abuse than to erect more barriers to people who need it.

While the pharmaceutical industry does benefit from more sales of Adderall and misconceptions of ADHD, it also responds to the demand for ADHD medications that have less abuse potential, like Vyvanse. The psychiatric community is also making great strides in reducing misdiagnoses through education. But requiring, say, an expensive MRI to qualify for a “legitimate” diagnosis of ADHD will prevent far more people who need it from getting access to treatment than it will curb the misbehavior of people who want to abuse its performance enhancement—after all, it is already more affluent people who can afford diagnoses, legitimate or otherwise. A culture of hostility toward ADHD drugs prevents more people from getting a proper diagnosis than it would prevent people from abusing the drugs that are already in circulation. Like it or not, Adderall is here to stay.

CC-BY Ed Schipul, filtered.

Concerned tech community leaders could choose to actively discourage the use of performance enhancers instead of remaining complicit in allowing forum discussions that normalize recreational use or even tacitly condoning it in prominent publications. But increased awareness of the dangers will only go so far, and those intent on abusing it will understandably do so for the incentives. It would be hypocritical for tech leaders to discourage performance enhancement while simultaneously maintaining unrealistic performance expectations.

What we can do is remove the necessity for performance enhancement. We have to prioritize sustainability and long-term success over shorting a bet. A culture that equates self-abuse, conspicuous consumption, and adrenaline chasing with “winning” must be dismantled in order for drug abuses to lessen and to close the achievement gap between the average tech worker and the mythical 10x engineer. Workaholism, the hero hacker narrative, and fast turnarounds should be scrutinized instead of celebrated. A culture that allows for the contribution of those of us with mental disorders and disabilities eases the pressure for everyone and creates sustainable workplace cultures where talent can be cultivated.

We also must chip away at the stigma of ADHD and promote good science. Reject its origin myths. Stop using it in ableist context as synonymous with laziness or as a moral assessment. Do not conflate its most superficial symptoms with the disorder itself: question whether environmental factors are causing them, rather than an internal dysfunction of the brain. Remember that ADHD is present in all contexts, not just stressful ones. And when in doubt, educate yourself: the resources below have proved helpful to those with and without ADHD.

Tech should to be a viable career path, not an investment market for a wealthy select few who aren’t on the ground floor. And it should be an inclusive industry that doesn’t favor the young, able, and self-destructive. But if we maintain this idolization of high-producing individuals, the rat race will persist. As long as there is an economic incentive to harm oneself in hopes of performing the superhuman, those who will not — or, for those of us with ADHD, cannot — will remain subhuman.

RESOURCES

Learning About ADHD

Dr. Russell Barkley is at the forefront of ADHD research and a superb speaker. I have found his talks to be equally informative and accessible to experts as well as people who are completely new to ADHD.

• “Russell Barkley explains ADHD” Youtube, 29min (Full lecture: 2h 51min)
• “Management of ADHD” – YouTube, 80min
• PBS interview transcript dispelling myths about ADHD, 27min read

Community Support for ADHD

• Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD)
• /r/adhd Subreddit
• Totally ADD

Further Reading

• Taking Charge of Adult ADHD, Russell Barkley
• Delivered from Distraction: Getting the Most out of Life with Attention Deficit Disorder, Edward M. Hallowell. Dr. Hallowell is perhaps the best known writer and educator on childhood ADHD. He also has it and takes a very positive, upbeat tone.
• You Mean I’m Not Lazy, Stupid or Crazy?!: The Classic Self-Help Book for Adults with Attention Deficit Disorder, Kate Kelly and Peggy Ramundo. Written by two women, this explores a lot of the gendered side of ADHD diagnosis and management.