Overzealous recommendation of ADD meds?

August 2, 2007 5:57 AM

My partner just went to the doctor for a urinary tract infection and came out with a referral to a psychiatrist and a recommendation to be put on dexamphetamine! This doctor also insists it is important she meets me as well. Is this normal?

Background hist:

My partner is 32 years old. In his early twenties he had been diagnosed with depression and trialed on every drug imaginable (none of which worked). Eventually he self-diagnosed as ADD, and spoke about this with a psychiatrist, who agreed and put him on dexamphetamine. I don't think he took it as directed.

I met him when he was 28. From the ages of about 26-30 he was moderately using street drugs and so he stopped going to the psychiatrist for dexamphetamine. Speed was generally his drug of choice and he eventually injected it for around one year, stopping when he was 30. That was when we moved interstate. So one year of extreme, almost daily drug use. Context: he was in the music industry.

Since moving, life is completely different. We're clean living, we dont smoke, we study and work full-time, we do normal people things, and we're happy and functional. We've been this way for 2 years. Neither of us can imagine going back. And it is for this reason, that I am a little iffy about this doctor's recommendation for stimulant drugs to treat his ADD.

I am open to having my opinion changed, if his psychiatrist truly believes he is a "textbook case", just as this doctor seems to. But to my mind, he is functional, calm, perhaps a little vague sometimes, but that is just his personality. In short, there is nothing wrong with him. I concede that he has no concentration for reading, I don't think he has ever read a full book, even though he wishes he could. But I had always put that down to him not developing a love of reading in childhood.

He is doing well at his job, he eats well, sleeps well; it is just baffling me how a doctor could take one look at him and go, YOU NEED MEDICATION! Especially when he was just requesting antibiotics for a UTI.

My partner says she asked for his medical history, which could account for this mystery, because he has always felt extremely comfortable with doctors and is very candid with them. He comes across as very thoughtful and trustworthy but I still have doubts about a doctor who doesn't see his past drug use as a red flag? Am I wrong?

2 years isn't that long ago, is it? Is this woman just some sort of over-prescriber? Even that makes no sense though, because she has to refer him to a shrink. By the way, I asked him if he felt he was "edging" the conversation towards wanting treatment for ADD, and he swears he was not.

I would appreciate any opinion on what is going on here. To what extent should we trust the doctor? I am happy for my partner to try the medication and see if it improves his lifestyle, but I am very concerned that I don't want someone tweaked out in my household! But am I correct in my understanding that if he truly does have ADD, it should just calm him down?

FWIW, he also shares my concerns and he said that he will probably try the medication but discontinue use in the case of adverse changes in personality.

Sorry so long. Any questions, direct them to this throwaway account: [e-mail]

posted by anonymous to Health & Fitness (23 answers total)

I'd get a second opinion and talk it over fully with second doctor first.
posted by Phanx at 6:11 AM on August 2, 2007

I think you are right to be concerned. A second opinion from a doc who is knowledgeable about substance abuse and mental health issues sounds like a good idea.

Just because a doctor prescribed it doesn't mean it's good for him.
posted by ottereroticist at 6:15 AM on August 2, 2007

did this doctor test your partner's urine? I mean, if your partner went to the doctor complaining of a UTI (painful, painful -- boo!), at the very least the doctor should have tested for that!
posted by potsmokinghippieoverlord at 6:24 AM on August 2, 2007

Half the doctors in the world graduated in the bottom half of their class. They make mistakes, they are sometimes not good at what they do, etc. Get another opinion.
posted by JohnnyGunn at 6:27 AM on August 2, 2007

Response by poster: When your partner takes dexamphetamine, he is taking an amphetamine derivative--simply a slightly toned-down version of speed. ADD/ADHD medications "tone down" the ADD/ADHD person by allowing them to focus on single tasks at once. The effects will be similar to when he was on speed if not as extreme.

I would highly, highly recommend you get a second opinion on this. First, and most of all, because your SO has a history of drug abuse with virtually the same drug the doctor is trying to prescribe him. That's fucking stupid of the doc. Second, because just because you have ADD/ADHD does not mean you need the meds. The meds are simply a tool to allow people to concentrate and focus a little better than they would otherwise. They make life a little easier but are NOT required for good mental and physical health, and honestly, most ADD/ADHD sufferers only take the meds as a temporary measure anyway. They're not something you want to be taking for your whole life--you take them to use them as a crutch so you can develop the good habits that will allow you to cope with the ADD/ADHD when you stop taking them. The point is, if your SO feels he's doing fine without them and focusing and getting his work done, then he doesn't need them.

As a personal anecdote--I have ADD/ADHD and used Adderall (a mix of dexamphetamine with other derivatives) for a couple of years. It helped me focus quite a bit, but when I decided to stop taking them it was two months before I felt normal again--my energy was completely sapped without the daily dosage of speed! Anyway, now I don't take the meds and I function quite well.
posted by Anonymous at 6:30 AM on August 2, 2007

There are other options here that you might want to consider fully

- that your partner is more concerned about his ADD than you are. I think it would be pretty unusual for a doc to prescribe or recommend something that the patient did not admit dissatisfaction with. ADD is one of those problems that, in many people, isn't really a problem unless it's negatively impacting your life. It may be that you and your partner have differing ideas of what may or may not be negatively affecting his life. You seem to be "pooh pooh"ing things like his inability to read which for me would be a total "my brain is broken" red flag.
- that your partner may not be being completely honest with you about being clean and wanting to stay clean. While I feel this is unlikely, I think you have to at least consider that this could be your partner's way of getting back on speed. Unlikly? Sure, but I notice you didn't even mention it and I think it should be noted
- what everyone else said about trying another doc.
posted by jessamyn at 6:40 AM on August 2, 2007 [2 favorites]

when a male friend of ours got a uti, his doctor, and mutual friends of ours who are also doctors, all thought he'd been having male to male sex. something about the rarity of it, and the particular bacteria found.

this may be what your other half's doctor is thinking.

i'm not vouching for the wrong/right headedness of this thinking... just telling you what our friend went through. he sai d he wasn't having male to male sex. but, who knows. people can lie. he's married. not that that means anything.

good luck, possum.
posted by taff at 6:42 AM on August 2, 2007

As others have said, this sounds weird, and you should certainly be prepared to get a second opinion. But, if the doctor wants to meet you then I think you should do so. Your partner may be overlooking something in their description of the consulation, and it can't hurt, right?
posted by caek at 6:47 AM on August 2, 2007

Sometimes people with untreated ADD self-medicate, hence the speed use by your partner. Putting him back on doctor-approved amphetamines may actually make him LESS likely to abuse street drugs.
posted by Biblio at 6:50 AM on August 2, 2007

There is no sure method for diagnosing ADD. What many doctors look for are symptoms that impair the patient's functioning in multiple spheres: work, family, leisure and social. That your partner wants to read and can't is somewhat suggestive but if there are no problems in his day to day life then I don't see what benefit the medication is supposed to offer. Perhaps your partner has seen problems that he hasn't yet shared with you. Ask and see what he says.

When doctors make an ADD diagnosis a number of them want to speak to the partner or the parents. Not all of them but it isn't rare. Some doctors will prescribe amphetamines to former users of street drugs. The ADD population uses at a higher rate than the general population so it makes sense. Still it's a judgment call for the doctor handling the patient. For this general practitioner to be recommending a specific amphetamine does seem a bit much.
posted by BigSky at 6:54 AM on August 2, 2007

this could be your partner's way of getting back on speed

I thought about this too. If he's not experiencing his ADD as a problem (another possibility Jessamyn talks about), why is he so willing to try speed again?

Not trying to incite distrust, just noting that the mind of an addict is capable of tremendous feats of rationalization.

I figured the doc wanted to see you because of the UTI -- they can be sexually transmitted. She did give him a scrip for the UTI as well, right?
posted by ottereroticist at 6:57 AM on August 2, 2007

When I was diagnosed with ADD a few years ago (in my late 30s), my psychiatrist met with my husband and my parents and had them all complete questionnaires about me and my behavior, including separate forms for both my mother and father. Only after scoring all the forms and going over my history with me was I prescribed Adderall. Now my regular GP prescribes it for me when I need it but he has all the information from the psych. I only take it when I'm at work and then not every day.

I would go see the original doctor and see what she has to say-and definately get a second opinion from the psych.
posted by hollygoheavy at 7:17 AM on August 2, 2007

follow-up from the OP

Yes, he was given antibiotics etc for the UTI.

I wouldn't say that he is "so willing" to try medication despite not experiencing ADD as a problem.
1. As far as I know, he's just open to the idea, rather than leaning towards it.
2. While it isn't interfering with his overall happiness, there are some aspects of his personality that he probably wouldn't mind improving. Some days he forgets everything, for example.

By the way, Biblio makes a good point.

Good to know that it's not unusual for a doc to want to meet the family of people with ADD! I had honestly never heard of it before (except in the case of the parents and teachers of children with ADD obviously).
posted by jessamyn at 7:24 AM on August 2, 2007

You can cut up ADD pills and snort them. At least with ritalin and adderall you can do this, I used to. The effect is very speedy. You can also just swallow more pills than prescribed and you're basically cruising on speed. So I think these pills would be a very dangerous thing for a former speed addict to have sitting around. It sounds to me like the exact opposite of a good idea.

In fact I know someone who was prescribed ADD medication to help him recover from doing too much acid for years, and before long he was overmedicating himself regularly to the point of cracked paranoia. And I guarantee you that speed-freaks and ex-speed-freaks are very aware of exactly how to get high off these pills.
posted by creasy boy at 7:34 AM on August 2, 2007

You have no idea what he said to his doctor. For all you know he made the ultimatum of 'treat me or I'm going back on speed because I cant take it anymore.' When he talks to you he tones it down. He might be suffering on a level he wont show you. The doctor probably thinks that a trial of dex might work out for him. Your partner may also have side-stepped how serious his old addiction was. In short, it may not be a bad doctor but a bad "drug shopping' patient.
posted by damn dirty ape at 7:39 AM on August 2, 2007

And in my experience doctors don't necessarily know anything about illicit drug use. Something I used to hear a lot back when I was working in a high school, from doctors, counsellors, psychiatrists, etc., is: "only kids without ADD get high from the medication". Which is horseshit. The effects on ADD-children, namely greater alertness and ability to concentrate, are the effects of being high on speed. But doctors don't necessarily know what it is to be high on speed and so they deny that what temporarily helps these ADD sufferers is in fact just a mild amphetamine high. So this doctor might be entirely unqualified to advise former addicts about this issue.

The first thing to cross the mind of any former speed addict upon being given this kind of prescription will be to take more of the drug to get more of the high. At the very latest when he takes a pill and his body feels the effects this will bring back the memory of the old highs and he will be desirous. In my opinion.
posted by creasy boy at 7:46 AM on August 2, 2007

I would like to put in my 2 cents. I have psychiatrist diagnosed ADD, and take medications for it. What my psych doesn't know, because I was unwilling to tell him, is that I have a history of self-medicating my ADD (I'll just leave it at that, assume what you will. I knew I had it, but it just wasn't diagnosed). I now take my Adderall regularly and responsibly, and although the thought crosses my mind to abuse them occasionally, I never act on it. Basically, you CAN have problems with drugs in the past and still need them/use them right when you get them. It just takes will power, and in my case, a very thoughtful boyfriend who I could talk to about this.
posted by nursegracer at 8:39 AM on August 2, 2007

Expanding a bit on what creasy boy said, I've read that some doctors think that if ADD meds work, that's what proves a person has ADD. As creasy boy said, that's wrong, because ADD meds increase pretty much everybody's ability to concentrate and focus, so they don't work as a diagnostic tool. But something like that could be going on here, maybe?

Regardless, second opinion is a good idea. And since the doctor wants to see you anyway, go in and talk to her and find out what she's thinking.
posted by occhiblu at 10:40 AM on August 2, 2007

ADD is a very fuzzy disorder to start with. There is no absolute boundary. We set what we decide are normal levels of attentiveness, and when people have less than normal levels of attentiveness, we have decided it is ok for them to take attention-increasing drugs. We have also decided, as a society, that it's not okay for just anyone to take any amount of attention-increasing drugs at their pleasure, because that can be dangerous, have nasty side effects, etc. (Of course, taking them under doctor's supervision can have nasty side effects, too...)

Diagnosis is a series of questions that determine where on a spectrum your partner is. If most other people are capable of much greater attention, and these drugs would help him to achieve greater attention, then all that would be necessary would be that he recontextualize the medication as medication rather than recreation. I know people who've done this to various levels of success.
posted by mdn at 11:00 AM on August 2, 2007

If you went to the mechanic with your car for a strange clanking sound in the front end and the mechanic told you that your car needed the entire rear axle replaced, you'd get a second opinion, wouldn't you? Doctors are just body mechanics. The problem is that they think their job is far more exalted than that.

I would encourage your boyfriend to get a second opinion before he gets that scrip filled.
posted by winna at 2:09 PM on August 2, 2007

"only kids without ADD get high from the medication". Which is horseshit.

It's horse shit because it's an over generalization but it isn't complete horse shit. I am one person with ADD who does not get "high" from the mediation. I'm "zooming" and talking a mile a minute when I don't take Dexedrine and calm when I do. I even get more sleep when I'm taking it.

I can imagine taking ADD medication or speed recreationally. It just makes me feel like going to work or engaging in some other productive activity. I'm adding this just to point out that there are some people, or at least one person, who, if self medicating with street drugs, would be much better off getting them from the doctor and isn't taking either street or prescribed drugs for the "high".
posted by Carbolic at 2:24 PM on August 2, 2007

I can't imagine taking ADD medication or speed recreationally
posted by Carbolic at 2:26 PM on August 2, 2007

ADD meds have a paradoxical effect on the ADD mind. That's the reason why it seems weird that stimulants are used on unfocused minds. It's unlikely that what he's been given would be any fun beyond the first dose or two.

Personally? This is simply your boyfriend's business. If he didn't want to seek treatment he could've said no to the doctor. If I were him I would resent that you're taking charge of his medical care like he's not able to himself. You sound like you're talking about your child.

Anyway you're not bound to get too much help from others because so many people don't even believe ADD is an actual condition much less support medical intervention for it. I suggest you research it yourself.
posted by loiseau at 3:56 PM on August 2, 2007