Thank you for the interesting articles on ADHD. The topic has been popularized by multiple media, including magazines for lay people. As a result, I am encountering more and more adults who are requesting, even demanding, to start or continue amphetamine medications in ever increasing numbers.

Because patients know the symptoms of ADD to report, they have elaborate histories justifying their need for stimulants. They can fill out questionnaires to justify their own requests. Some become highly upset when switched from short-acting (immediate effect, sellable) to long-acting (less risk of abuse) stimulants. Other patients openly admit they are taking stimulants for morning energy and just feeling good.

Patients I see are typically middle class, employed, and higher functioning and yet still have these requests. I even had a new patient with a Ph.D. ask for a stimulant because of “poor focus and difficulty concentrating.” Typically patients prescribed alternative medications—atomoxetine. clonidine, guanfacine—are not satisfied and request amphetamines. If after a first-time psychiatric evaluation the patient does not receive what he requests, typically he does not return—a waste of time, effort, and money for everyone.

It can sometimes be difficult to differentiate between people with adult ADD and controlled medicine seeking. When I do prescribe stimulants, I give once-daily, long-acting formulations only—even with notable patient objections (more reason to suspect abuse). See the post “Adderall Tips: How to Convince Your Shrink You Have ADD/ADHD” at http://exiledonline.com/adderall-tips-how-to-convince-your-shrink-you-have-addadhd/all/1/.  

John Helfer, M.D.,
Salt Lake City, Utah