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by poultron 951 days ago
Agree - as someone who took Adderall in highschool and college, and has started taking it again as an executive in my career, I always took it to be able to handle multitasking more efficiently with less distraction, and to motivate an action to be performed vs procrastinating. A test in which you HAVE to get a job done and you're being monitored and timed - I wouldn't expect a large improvement in results with 'smart drugs'. I think it would be much more interesting to watch study or work habits while under the influence of these smart drugs, measured in pages reviewed/written or emails sent or slides created or phone calls made, etc. True measures of productivity without knowing someone is looking over your shoulder.

Also notice as I take my "smart drugs" my ability to focus in meetings is increased, and therefore allows me to better recall information in subsequent days... vs when not on meds I'm constantly distracted and my memory is much more foggy, especially specifics or details.

3 comments

> and to motivate an action to be performed vs procrastinating

I’ve watched several peers go down the path of trying to use stimulants for motivation starting in college and again later in my career. There’s no denying that it works at first. They are stimulants, after all, and they stimulate people especially well when they first start taking them.

The problem is that the motivation from stimulants is famously prone to tolerance and rebound effects. It’s also very prone to habit-forming associations. I’ve noticed several people try to use prescription stimulants in an “as needed” fashion when they need to get a lot of work done quickly and they don’t really want to do it. It doesn’t take long before it’s obvious to their friends and coworkers when they’re having an off day or an on day, even though they might deny any rebound effect. It gets scary when they do this so long that they forget how to self-motivate without taking stimulants because they’ve built such a strong mental association between “I have a lot of work to do” being a trigger for “I should take another pill today” or even “I’ll save this work until tomorrow when I can take a pill”. It gets even scarier when tolerance sets in (to the motivating/stimulating effect, not so much the intended attention-enhancing effect) and they’re now flirting with escalating doses, double doses, combinations with ‘nootropics’ to boost effects or ‘reduce tolerance’ and other slippery slopes.

The short-term productivity boost shouldn’t be denied, but I think it’s also short-sighted to hold these drugs up as a free lunch productivity boost. Let’s be honest: A little experimenting here and there isn’t going to show tolerance, extensive rebound, psychological associations, or other effects, but that’s also what gets people in trouble when they start to think it’s a free lunch. There’s a reason the traditional ADHD treatment approach involves taking the same dose every day rather than encouraging the patient to build psychological associations between taking the drug to alter their mood state.

The strange part about this conversation is that if I wrote all of the above text about drinking 2 energy drinks at the start of a work day, few people would argue with it. The tolerance, rebound, and dependence effects of caffeine seem to be well known in pop culture. For some reason people with a little exposure to prescription stimulants seem to think that the normal rules don’t apply to them, at least at first.

A lot of people who have minimal or sporadic experience with stimulants seem to think they’re no-strings-attached productivity boosts, but there’s no free lunch. The brain will adapt over time.

Very good summary of long term situation, I hope OP and similar folks would realize the drawbacks. Indeed, concept of 'free lunch' simply doesn't exist in reality, especially when it comes to drugs. Our bodies and minds constantly adapt and what caused a certain reaction before will gradually cause less of it the more its used. Some folks fare better, some worse, some have very low threshold for addictions.

A very US-centric view I think, i never knew a single person in my University who took these 'enhancing' drugs, we just got wasted from alcohol and smoked weed. And I went through rather stressful University where 2/3 of people who started were thrown out of school in first 2 years in one or the other filtering hardcore courses with slightly psychotic professors (still not getting why by far the hardest course from 5 years for studying freakin' Software engineering had to be 'Theoretical electrotechnics' with some hardcore math way beyond our actual math courses, of course never used any of that, not even on rest of studies).

Anyway, any substance you abuse will eventually kick back quite hard, if it didn't yet give it some time (or take a bit harder look in the mirror next time). Same for bad habits.

I could see someone making the exact same arguments that you're making about caffeine: you need to increase the dose over time, it's habit forming, people are not the same when they're not on it, etc; but many would argue that they drink coffee successfully for entire lifespans and are better off for it. You're demonstrating a 'spiraling out of control' reaction that happens when people habituate to stimulants but—well, I'm not sure how many cases this actually occurs in.

Stimulants may be used by individuals with true deficiencies in an effort to get to baseline. Many people who start using stimulants in their 20's and 30's report being able to express healthy, practical behaviors that they couldn't summon themselves to express before: cleaning the house, making it to meetings on time, paying attention in conversations. The caution that you're expressing is warranted with any substance, but I'm sensing a bit of fearmongering which I think could possibly stop individuals from trying a substance through which they could possibly receive benefit.

I drink coffee every morning and have for pretty much my entire adult life. People might be better off for it because coffee in moderation is healthy and has various bioactive compounds in addition to caffeine that can reduce risk of some diseases... but I don't think the caffeine itself has any cognitive benefits for me at all compared to if I were to never drink coffee. It's just an addiction I'm completely adapted to, and skipping a morning coffee just means I'm a bit extra tired and sluggish through the day. Maybe dopaminergic stimulants are different, especially for people with true ADHD, and they can maintain an effect over time even at a dosage plateau.
I would get a short term productivity boost with caffeine, and then a remarkably unproductive time when it wore off. I deduced that the "up" part of the curve was cancelled out by the "down" part.

So I switched to decaf. I'll still enjoy regular coffee now and then as a special treat.

I get distracted easier if my diet is awful (which it has been in the past)... Refined carbs, sugar, tap water (fluoride in tap water is insane:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5285601/) and highly processed foods. Switch to a diet high in nitric oxide and run and I'm a much better problem solver. And I have no desire to work "for fourteen straight hours" and I'll find another job if I'm being asked too.
The study on fluoride level is basically garbage. It's pure randomness and the IQ level is probably only correlated to the affluence of the region.

Just look at the results

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5285601/table/T...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5285601/figure/...

What about these?

https://ntp.niehs.nih.gov/sites/default/files/ntp/about_ntp/...

"This review finds, with moderate confidence, that higher fluoride exposure (e.g., represented by populations whose total fluoride exposure approximates or exceeds the World Health Organization Guidelines for Drinking-water Quality of 1.5 mg/L of fluoride) is consistently associated with lower IQ in children."

https://www.hsph.harvard.edu/news/features/fluoride-children...

https://pubmed.ncbi.nlm.nih.gov/25446012/

You don't seriously think that drinking fluoride is OK? It's been studied to death and it's obvious at this point that long term fluoride exposure causes developmental neurotoxicity. Multiple countries have sponsored these studies and they show negative correlations to IQ and an increase in fluoride. They've demonstrated this in rats with sodium fluoride as well.

From your first link, they literally state that the "moderate effect" is at concentrations exceeding what flourinated water supplies in the US have. Here's the comment.

>Reviewer comment (DocB1_Monograph, page 2): It would be helpful if the Abstract was clear in the Discussion that the conclusion about effects on IQ in children was derived from high human exposures (higher than US exposures) without getting into more hazard conclusions or assessments.

They repeatedly say that the current research is no where near comprehensive and results are weak.

Why stop here? Just take the 10 first results in Scholar, you have as much low correlations as no correlation results. You can also easily find structural issues in many papers. And finally fluoride supplement from the family can easily tip the scale dramatically in total consumption which make the comparison pointless.

Finally, there is probably a level at which it actually does become toxic. Like with many other minerals, too little is actually harmful, there is a right dosage and too much is again showing toxicity.

Why do the papers against do not mention this, do not mention any theorical model to explain their findings, do not correct for socio-demographics factors when we know that intelligence is generally very poorly related to any other variables except those ones which disproportionately explain it?

"And finally fluoride supplement from the family can easily tip the scale dramatically in total consumption which make the comparison pointless."

In groups of 100? What's the percentage of people that routinely consume toxic levels of fluoride from dental supplements (that study ran four months)? People don't generally eat toothpaste or drink mouthwash but I'm sure it happens. I just wouldn't assume that it would happen often enough to give you poison data.

" Like with many other minerals, too little is actually harmful, there is a right dosage and too much is again showing toxicity."

This is where I'm at on tap water...I assert that LOW-DOSAGE exposure over extended periods of time is bad and I assert that in the US there are area's that have incredibly high-doses of fluoride in tap water (at least 6 parts per million). Which is bad all around. Water is controlled at the jurisdiction level and there's NO guarantee that you're getting below the recommended dose of fluoride. I'm of the opinion that it's completely nuts to put this stuff in the drinking water and the Indian, Harvard, and recent NIH papers appear to back this up.

"Why do the papers against do not mention this, do not mention any theorical model to explain their findings, do not correct for socio-demographics factors when we know that intelligence is generally very poorly related to any other variables except those ones which disproportionately explain it?"

I agree with this...In the first study I could not tell if they controlled for socio-economic status. They identified villages with varying levels of fluoride and called it a day. The Harvard study did though. And the American study I linked to seemed to control for this as well...And they all came back with results that were similar...Repeated low-doses of fluoride have detrimental effects to development health.

Form the harvard study: "We carried out a pilot study of 51 first-grade children in southern Sichuan, China, using the fluoride concentration in morning urine after an exposure-free night; fluoride in well-water source; and dental fluorosis status as indices of past fluoride exposure. We administered a battery of age-appropriate, relatively culture-independent tests that reflect different functional domains: the Wide Range Assessment of Memory and Learning (WRAML), Wechsler Intelligence Scale for Children-Revised (WISC-IV) digit span and block design; finger tapping and grooved pegboard. Confounder-adjusted associations between exposure indicators and test scores were assessed using multiple regression models. "

Agreed - when I dont take Adderall, the closest I feel to it is when I do intermittent carb-free fasting paired with high water intake. If I eat shitty, I have what feels like a severe mental hangover every single day with significant impacts to motivation and productivity.
> I think it would be much more interesting to watch study or work habits while under the influence of these smart drugs, measured in pages reviewed/written or emails sent or slides created or phone calls made, etc. True measures of productivity...

I think you've confused "productivity" with "bulk". Do you evaluate engineers by how many lines of source code they write in a day?

Lots of jobs do actually involve bulk reading and writing with relatively low quality targets. Lawyers and assistants being the prime examples. Also, almost all of undergrad for many, many degrees.
I think you're missing the point. If you struggle with ADHD / executive dysfunction, there is a material benefit to measuring by those in that kind of job. Ultimately it is not that you're at a normal baseline and these things just make you do more busy work, it's that you struggle to keep up with so many competing priorities and demands that you end up dealing with none of it. So yes, for this purpose, that measure is worthwhile in this case.
This is well said. People who dont have ADHD or a similar cognitive dysfunction look at smart drugs as a boost above average to gain high performance - because they havent experienced ADHD or dismiss it. Unfortunately the reality is that folks with ADHD typically feel very below average regardless of their IQ, missing out on meeting details, falling behind in work, procrastinating severely vs their peers. Adderall makes me think "so this is what everyone else feels like" when I take it, and I can just get things done at the most simple levels.
Ask yourself what is actually required to succeed in academia
Depends on level, no? Certainly it seems higher up (PhD or other research-oriented role), rote busy work may be necessary from time to time, but it also requires more creative work trying to synthesize new ideas.
ADHD has too much creativity and barely any capacity for bulk, so trading a bit of that creativity to do the bulk work is worth it.

Imagine if your brain refuses to do worthless uncreative work, that is ADHD, it is great for coming up with ideas but sucks for doing the work you often have to do.

I agree with you there. But the thrust of the article was using drugs as “cognitive enhancers” not to treat a medical condition of ADHD. Bringing someone up to baseline is one thing, but this is not that.
The ability to kowtow to corporate foundations to get funding?