Extreme Tragedy: Addicted to ADHD Drugs

Yesterday as Beyonce shook her famous booty, I read the tragic and deeply troubling story about a young man who took his life after becoming addicted to ADHD drugs. I could hardly miss the photo of the attractive twenty-something class president smiling in graduation cap and gown on the the front page of the Sunday New York Times, Drowned in a Stream of Prescriptions. The three-page above-the-fold article struck others too and quickly rose to the top of the paper's Most Emailed.

Many probably read the story as a cautionary tale of the abuse of ADHD meds, vivid evidence of excessive ADHD prescriptions and a growing epidemic, a new public health threat. 

I read it as another cautionary tale too, a dramatic example of a more common but less serious issue, the increasing use and misuse of ADHD meds among young adults. It was a textbook example of the media's own use and possible misuse of a potent substance -  a highly disturbing, extreme event. It's the kind of rare tragedy Joel Best, Mr. Damn Lies and Statistics sees as all too common:
"Most social problems display this pattern: there are lots of less serious cases, and relatively fewer very serious ones. This point is important because media coverage and other claims about social problems often feature disturbing typifying examples: that is, they use dramatic cases to illustrate the problem. Usually these are atrocity stories, chosen precisely because they are frightening and upsetting...it is easy to couple a terrible example to a statistic about the problem's scope..." Stat-Spotting: A field guide to identifying dubious data, Joel Best (p. 11).
You might have caught some of the red flags in the Time's article. Let's prep for future stories like this by asking some relevant questions for sussing out extreme events (I've paraphrased as best I recall from Joel Best).

Am I shocked? Am I amazed by the sheer scope of the problem?  Here, ADHD drugs causing serious psychological damage.


Did I just become aware of said problem as a large social ill? Was it previously unobserved?


Are there millions of people or dollars involved?

Young adults are by far the fastest-growing segment of people taking A.D.H.D medications. Nearly 14 million monthly prescriptions for the condition were written for Americans ages 20 to 39 in 2011, two and a half times the 5.6 million just four years before, according to the data company I.M.S. Health. While this rise is generally attributed to the maturing of adolescents who have A.D.H.D. into young adults — combined with a greater recognition of adult A.D.H.D. in general — many experts caution that savvy college graduates, freed of parental oversight, can legally and easily obtain stimulant prescriptions from obliging doctors. Drowned in a Stream of Prescriptions 

Is the dramatic case ever put into perspective? Or if it is, does it make clear the rarity of the event? 

Not sufficiently. In three full print pages (9 online), several named professionals and even photos of handwritten prescriptions and medical notes, there is only a small paragraph suggesting what portion of these nearly 14 million become psychotic, depressed or addicted to the meds possibly because it's so rare not many have bothered to keep track:
A 2006 study in the journal Drug and Alcohol Dependence claimed that about 10 percent of adolescents and young adults who misused A.D.H.D. stimulants became addicted to them. Even proper, doctor-supervised use of the medications can trigger psychotic behavior or suicidal thoughts in about 1 in 400 patients, according to a 2006 study in The American Journal of Psychiatry. So while a vast majority of stimulant users will not experience psychosis — and a doctor may never encounter it in decades of careful practice — the sheer volume of prescriptions leads to thousands of cases every year, experts acknowledged.
So a study in a drug addiction journal finds about 10% of adolescents and younger adults misuing the drugs might become addicted. Note the word misuse. It's unclear how many become addicted with proper use. Another study shows .25% (1 in 400) become psychotic or suicidal with proper use (I suppose this includes questionable diagnoses like the featured case?). My next question, naturally is about the rate of psychosis in the young adult population. How close does it match this one? Still none of this evidence answers how rare it is for young adults addicted to ADHD meds to commit suicide but is presumably rarer still.

By the way, the young man did not have an ADHD diagnosis as a child or even high school student. His parents didn't think he ever had ADHD.  To their credit, the NY Times tagged this as amphetamine abuse in their page name. It ended here in a devastating and apparently preventable death but that doesn't mean kids prescribed the meds under the watchful eye of their parents and doctors are at the same risk. There's a risk this highly vivid portrait might raise doubts about proper drug treatment, that's the downside of this media attention.

Did you read about any other extreme events this week?


What Pale Blue Dot? said...

People like me who benefit greatly from these medications are already fighting for legitimacy among our friends, colleagues, and sometimes even our doctors. The carelessness (or more clearly perhaps the purposeful malignancy) of these articles could so swiftly undo all the work we self-advocates could accomplish.

Polly Palumbo, Ph.D. said...

Thanks for illustrating why this article can have negative consequences. Good to hear from you, WPBD. For the reason you point out, it's unfortunate this story was framed as an AHDH story (with ADHD drug stats, etc) bc it probably has more in commom with prescription drug abuse.