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    发表:  2017/1/03 9:35pm
遭Adderall绑架的一代人

《纽约时代杂志》

2016年10月12日

翻译:雷春

2016年12月26日完成

(作者Casey Schwartz说:“和很多我的朋友一样,我靠处方兴奋药完成学业和开创事业。然后,我企图戒掉它们。”)




你去过Enfield吗?我直到23岁在伦敦读研究生时才听说了这个地方。一天下午,我收到一个通知,我等了好几天的一个包裹被海关检查后到了伦敦郊外的一个不起眼的小镇Enfield的FedEx仓库里。我不到一个小时就上了火车。被查的包裹是从洛杉矶寄来的,里面有我一个月所需的Adderall。



Adderall是以苯丙胺盐为主要活性成分的品牌药。英国对这类神经兴奋药的监管比美国严格。在去英国的前一年,也就是2005年,我已经和美国数以百万的人一样,通过医生处方使用这个药了 。



在 Adderall上瘾的十多年中,我为了拿药,坐火车去Enfield这样的边远小镇的行为, 已经是司空见惯了。我会为了找药,不经允许打开别人的药柜,翻我扔过药的垃圾箱,通过为别人写作业来换取药片。一次,住在New Hampshire的时候,我旷工一天,开车单程3个小时去一个保留有我的处方的诊所。我会竭尽全力来得到所需的Adderall。



Adderall是治疗注意力不集中、多动和冲动行为的多动症ADHD的处方药。这个病最早是1987年归入《精神疾病诊断手册》(Diagnostic and Statistical Manual for mental disorders, DSM), 主要出现于儿童,又被称为注意力缺失症,近几十年的诊断在逐年增加:1990年代,美国疾病防控中心CDC估计约3-5%的美国学龄儿童有ADHD;2013年,增加到11%;还在继续增长。诊断的增加,也就导致处方药的增加。1990年,有60万儿童服用神经兴奋剂药,当时是Ritalin,一个比较老的药,经常需要一天吃几次。2013年,这个数据达到了350万,而且大部分Ritalin被Adderall所取代。Adderall是1996年上市的,被认为是新一代的治疗多动症的药物,更有效,作用时间更长。



Alan Swartz 的书《ADHD Nation多动症国家》指出,Adderall的命名是以扩大销售为目的的:ADD=attention deficit disorder注意力不集中;er=for给;all所有的;也就是所有的注意力不集中的人都可以用。事实上,在我2000年读大学、Adderall已经上市4年时,Adderall的处方已经达到了近5百万;我毕业后的2005年,这个数字到了差不多9百万。当时美国多动症药物的年销售总额超过了20亿美元。



2000年代中期, Adderall的成人数量剧增。QuintilesIMS是一家搜集公共卫生资料的信息公司,它的数据显示,2012年,有1600万年龄在20至39岁的成人取得了Adderall的处方。如今,Adderall在大学校园里极为普遍,有处方和没处方的学生都在用。黑市交易, 在几乎所有的大学都,应运而生。2012年发表在《Brain and Behavior大脑和行为》杂志上的一篇综述阐明,到2004年,滥用处方兴奋剂药,已经成了继大麻之后,校园中最普遍的非法毒品。大麻仍然是使用最多的。



我们对多年服用Adderall,特别是在大学期间和成人早期的影响,几乎一无所知。至今为止,几乎还没有长期使用Adderall的作用的科学研究。从某种程度讲,我们就是试验品。这些是和我年龄相仿的一代人,先是在高中或大学期间,突然发现它如此唾手可得时开始使用,很多年后,要么没有意识到需要戒掉,要么根本戒不掉。我们将活生生地,从心理学和神经学的角度来验证,服用不应该长期使用的药效强烈的神经兴奋剂药物的实际后果。有时候我认为我们是Adderall时代的产物。



Adderall的最初发现纯属偶然。1920年代末,美国一个化学家Gordon Alles在寻找治疗哮喘病的药物时,合成了一个肾上腺素adrenaline的衍生物,它会帮助支气管舒张,这个物质是beta-phenyl-isopropylamine,就是现今所知的amphetamine苯丙胺。为了测试这个药的效果,他给自己进行了静脉注射。在Nicolas Rasmussen写的书《On Speed: The Many Lives of Amphetamine》中,他记录到首先是“感觉良好”,随即是“无眠之夜”。1930年代,苯丙胺的名牌药Benzedrine上市。它被用于改善情绪、增加能量、提高警觉。在第二次世界大战时期,美国军方为士兵提供Benzedrine,又称作“Go Pills冲锋药”。战争结束后,稍加改动,苯丙胺被包装成另一个名牌药Dexedrine,用于治疗抑郁症。许多人,特别是妇女,喜欢节食药Obetrol中苯丙胺抑制食欲的副作用,保持身材苗条。但1970年代早期,约有一千万成人使用苯丙胺药时,食品药品管理局采取了严格的限制措施,它的使用骤减。20多年后,一个药品生产厂的老总Roger Griggs对当时被遗忘的Obetrol进行了重新审视,改了一下配方,命名为Adderall后投放市场,特别针对被医生诊断为多动症ADHD的美国几百万儿童和青少年。缓释Adderall在几年后上市,它会延长药物进入血液的时间,并且据说会降低上瘾的可能,容易戒药。理论上讲。



我第一次接触Adderall是我在布朗大学读大二时。当时我在和一个朋友对几乎无法完成的课业诉苦:有一篇5页的读书心得要第二天下午交,而我才开始看这本书。“你要一粒Adderall吗?”她问。“它的效果太强了——会让我想在楼道里打一整夜的侧手翻。”



有什么能比这个描述更诱惑人呢?我的朋友从锡箔纸里拿出两粒蓝色的药片,递给我。一个小时后,我在图书馆的地下室里,进入了心醉神迷的状态。这个世界的喧嚣渐渐消失;我完全沉浸在书的激动人心的情节中,我的思绪从天而降,达到了难以想象的丰富程度。清晨来临,我蜷缩在宿舍大厅的一角,在电脑上敲打着最后一部分豪情满怀的书评,根本没有注意到窗外的天空已经泛起了粉色。我独自享受着这个新的神秘的世界,而这寂寞感却成了使人极为沉迷的一部分。我不需要其它任何事,也不需要其它任何人。



在接下来的两年里,我竭力在学校寻觅Adderall,一次又一次地经历着它给我带来的这种感受。Adderall让我痴迷于绝对独处的时间。我喜欢隐藏于校园里最边缘的远离一切喧嚣的黑暗的角落,对热闹的校园生活完全失去了兴趣。完全沉浸在孤独中,全神贯注于,比如说,德国哲学家康德的“崇高”思想之中。



结果是,它是无可挑剔的:我可以毫不费力地集中精神学习极为复杂的理论,做出敏锐的判断,完全吸收理解,并成为我的一部分。更准确地说,我成了一个想要成为的坚韧不拔的人,而不是原来那个懒惰、马虎的自己,我实在是太容易散漫,并且吃太多软糖Swedish Fish。



Adderall使我所向披靡。现在我能通宵学习,然后跑10英里,紧接着轻松地读完本周的《纽约人》杂志,完全不会想着要停下来和同学聊天或者去看场电影。那感觉真是妙不可言。我变瘦了。那也是个好事。然而,我开始对朋友发火,突然间有了火山爆发般的怒气,这是从来没发生过的。一次我的同宿舍的同学周末回家,忘了把闹钟关掉,它一直在她锁着的屋里叫了48个小时,我完全疯掉了,打电话去纽约责备她。我都不记得啥时候连续睡过5个小时。这有什么大不了的呢?



大学四年级时,我的学业更加难以应对。有生以来,我第一次无法做完作业。我的既幽默又有风度的俄罗斯历史教授开恩,推迟了我交期末论文的时间。十二月中下旬的一个周五傍晚,寒假将至,田园般的有新英格兰特色的校园人员稀少,我独自一人在科学图书馆——那个通宵开放的图书馆——眯着眼看我的俄罗斯历史笔记。外面,风雪交加。里面,荧光灯照着空无他人的地下室的房间。我感到晕眩和不适。这是难熬的一周,几天加起来也没睡几个小时觉,我靠着越来越多的药片来保持工作状态。突然,我抬头一看,明亮的房间在我周围膨胀,我好像根本不在那里,而是被困在某种奇怪的幻影中。我陷入惊恐之中——我怎么了?我尽力深呼吸,希望突然回到现实,但我做不到。颤颤巍巍地,我站起来,挪向电话。我给我的朋友Dave的宿舍打了个电话。我告诉他:“我在科学图书馆,遇到麻烦了。”我的声音听起来像是另一个人的。



一个小时以后,我被急救车,穿过暴风雪送到附近的医院。急救车上的志愿者是布朗大学的学生,我以前见过一两次。他一路上都紧握着我的手。我不停的问他:“我会死吗?”我和Dave在急诊室呆了好几个小时后,终于被带到一个帘子后面,一个满脸疑惑的医生来看我。我很不习惯他看我的样子,仿佛在说,我很可能是疯了,甚至可以保证我是疯了。这时,我已经感觉好多了,不再相信我会死,我躺在病床上接受检查时,我和他开玩笑地说:“我会像罗马人就餐那样悠闲地躺着。”他的表情无动于衷。我告诉他我吃了什么药。他的诊断:“苯丙胺引起的焦虑。”我第一次得了恐慌症——少见的Adderall过量引起的未知反应。我离开医院的时候,我把我费了九牛二虎之力搜集来的一瓶蓝药片留在了那里。我还清晰的记得它在病床边的样子。



几天以后,我病休回到了纽约的家。我父亲知道了我因药物过量而进了急诊室的事,我向他保证不再吃这个药了。我确实是这样想的。我利用这个漫长的寒假,在42街的公共图书馆里,昏昏沉沉地继续完成那篇苯丙胺无法帮我完成的论文。我那时候不知道、也根本不可能知道的是:是否Adderall真的可以帮助非多动症的人加强认知水平——是否能让你更聪明——这在当时是个迷。几年以后的研究显示Adderall提高认知水平的结论仍不确定。Martha Farah,一个宾夕法尼亚大学认知神经科学家,对此进行了研究。她通过标化考试,测试了Adderall对控制力、记忆力、和创造力的影响。结果是,Farah和同事发现几乎没有提高。最后,她说,“这种药对平时考试成绩差的人可能确实有效,但对平时考得好的人没有提高作用,甚至可能会变得更差。”



我不吃药的日子没能持续多久。我交了没完成的作业,黯然地接受了成绩;但春季毕业前,我又陷入到了熟悉的周期:令人陶醉的专注强度和孤僻意识,随之而来的是几天的慵懒——我可以几个小时都无所事事,大勺大勺地吃雪糕,急切地希望雪糕中的糖会给我能量,然而,我仍旧几乎连去淋浴的力气都没有。



毕业整整一年以后,我做了一个改变我下一段人生的决定。我突然醒悟:我可以摆脱各种卖我高价药的ADHD孩子,找医生开我自己的处方药。这个主意是我在UCLA大学校园的棕榈林里边走边想出来的。那时候,我住在洛杉矶,给高中孩子做私教,很多这些孩子也在吃Adderall;同时,我在上心理学和神经科学的暑期课,为申请研究生做准备。我决定要成为心理学家——我想,比我暗暗努力要成为的作家,靠谱多了。绝对是更现实。和许多20几岁的年轻人一样,我的决定受着恐慌感和紧迫感的影响,但是,当然也受到我手头上仅有的药片的影响。



这段时间,我的周围都是和Adderall有着紧密联系的人。那年,在洛杉矶,我有两个最亲密的朋友。我们不停地高度紧张地在城里穿梭,交换事后都不记得的秘密。Adderall是我们关系的纽带;如果我们中的一个人的药吃完了,另一个人一定会提供。沐浴在洛杉矶令人昏睡的阳光下,开车在拥挤不堪的道路上钻来穿去,我发现很容易会忘记那天到底吃了几片药。



一想到可以获取我自己的处方药,我马上就近找到一台学校的计算机,查找“认知行为精神科医生cognitive behavior psychiatrist, Westwood, 洛杉矶市,加州。”我那时学习了足够的心理学知识来避免,受到精神分析师,几个星期甚至几个月的盘问,去验证为什么我需要吃药。不,我不能去找这样的治疗师,我需要一个有处方权的注重实际“结果”的医生,而且诊所离UCLA只有10分钟的车程。



第二天,我就坐在了一个和我想象的一模一样的地方,一个灰色墙、摆着黑皮家具的非个性化的房间,和坐在对面的一位有魅力的年轻的精神科医生描述:我总是不得不花很大的力气来强迫自己完成作业,不能集中注意力只做一件事,一心多用的事往往较容易,比如餐馆服务员的工作。所有的故事都是编造的。我是一个很能集中注意力的学生,根本不擅长餐馆服务员的工作。然而,这些表现正是多动症的诊断所需的,我花了很少的时间在网上搜索到的。有了这些“症状”,医生们就会拿笔在处方签上写:“Adderall 20毫克,每天一次”。所以,我就这么说了。



五十分钟后,我站在San Vicente Boulevard大街上,沐浴在加州的阳光中,手里拿着处方签。这一个医生不到一个小时的评估结果,可以随着我到世界任何地方:我在洛杉矶的随后的日子;然后通过Fedex到了伦敦;接着是康州的New Haven,我每个月在耶鲁大学的健康服务中心领一次药;回到纽约时,由于我前几年一直在吃这个药,医生很容易就通过我的健康保险,接着给我开药。



任何一本神经科学方面的教科书都会解释Adderall对大脑的作用原理——而且为什么容易上瘾。美国国家毒品滥用研究所(National Institute on Drug Abuse)的Nora Volkow主任发表的文献里多年以来阐明它是通过神经递质多巴胺(dopamine)而成瘾的。苯丙胺使大脑释放多巴胺和去甲肾上激素,进入大脑神经元的突触,提高觉醒力、注意力、警惕性和能动性。事实上,只要有多巴胺,心情就会好,性生活和吃巧克力蛋糕的美好感受都是多巴胺的效果。多巴胺是上瘾机制的主要因素。如果过量,大脑会竭力进行平衡调节,为了降低多巴胺的作用,会减少突触中多巴胺受体的数量。受体的减少,导致需要越来越多毒品,使大脑产生越来越多的多巴胺来达到幸福感。多巴胺受体的减少,是毒瘾发作的原因:没有刺激多巴胺的物质,大脑多巴胺和受体的平衡水平显著低于正常,无法自然达到愉悦感。脱离刺激物后,大脑是否能够回到原来的状态,还是一个未知。



2008年,在持续性使用处方Adderall后的第三年,研究生快毕业时,我发现自己在New Heaven的诊所里对着精神科医生哭述,我的生活已经乱套了。我一直以为,Adderall会帮助我战胜不完美的自己,但事实却相反:Adderall使我变得反复无常,无缘无故地大发脾气。但是,我戒不了它。这个精神科医生是一个和蔼可亲的塞尔维亚人,沉着地观察着我的沮丧情绪,开了处方药Wellbutrin,这是一种抗抑郁药,对药瘾的发作有较快的缓解作用,会帮助我相对容易地戒掉Adderall。理论上很有道理。但是,不久,我变得对两个药都上瘾。



吃Adderall的那些年,我非常矛盾,一方面觉得没它就无法生存,另一方面清楚地知道它在毁灭我的艺术灵感、爱情和生活。2009年,我获得了一份写心理分析和神经科学方面的书的合同;不久,我又成为了一个新闻网站朝九晚五的新闻记者。这份工作需要我不停地撰写引人入目的短文:简略而圆滑,然后转到下一个。这种节奏很符合我这种Adderall思维,但不适合缓慢深层的写作模式。一周一周地过去了,我需要进行深度思考和写作的目标越来越不现实。我意识到,当Adderall大量流入市场的90年代,网络也同时开始盛行,二者在美国生活中齐头并进。





偶尔,我会试图戒药。每一次的尝试都是这样开始的:第一步,把我所有的药片都搜集起来,那些故意藏在抽屉和衣橱的也不例外,和自己争辩几个小时,是否应该留一粒应急,然后不顾一切地把所有的药片都冲到马桶里。第二步,一到两天感觉良好,好像戒药根本不是问题。第三步,这是一段很颓废的时间,每天度日如年,生活几乎不能自理,我是如此地疲惫不堪,未来的责任简直无法想象。无法写书。恐慌情绪爆发。然后,突然间,体内Adderall的呼唤俘虏了我,我会从桌子那儿跳起来,急匆匆地去买处方药——这几乎总是很容易做到,或者如果有必要,向朋友借几粒药。周期又开始了。那时候心里总是充满了不为人知的羞耻感。几乎没人知道这个药对我的生活有多么深刻的影响。



多年以来,很多专家告诉我,戒掉Adderall不应该很困难。戒这个药会相对较快,而且不会有多少痛苦。我经常觉得自己没能力戒掉Adderall这件事,是我人生最大的失败。当在网上看见与我有同样经历的人大有人在时,我得到了一点安慰。其中一条博客让我记忆犹新,一个已为人母的女士在QuittingAdderall.com上写到:我是2010年10月开始吃Adderall的。我的故事也不离奇……:蜜月期,然后是越来越糟。我不知道没有Adderall我怎么可能生存,自己是谁,或会如何感受。看着吃药前自己的照片,我难以想象没有它我怎么可能“快乐”。因为,现在,如果只是想到可能这天没有药了,我都会达到极度的恐慌。多少个晚上,在我带女儿上床睡觉时,泪流满面。因为我很羞愧,和她一起度过那一天的,不是她真实的妈妈。



“没有人一开始就说,我想对药物上瘾。” Jeanette Friedman是一个药品成瘾方面的社工,今年八月在纽约曼哈顿中央公园东面(Upper East Side)的诊所里见到她时说,“虽然没人想成瘾,但现在人们使用Adderall这样的处方药时太不小心了——认为它不是毒品、是良性的,或者有利于提高学习工作效率。我们当今的文化中,效率就是一切。现代人的压力巨大,不仅仅要做好,还要做到异乎寻常的好。”



当她面对一个成瘾的病人时,Friedman解释说,戒药最大的挑战是病人品格的完整性,他们是否有能力在脱离药物后“成为一个完整的、不生活在总是依赖某种物质的阴影中的人。” 比一般的药品成瘾更复杂的因素在于,Adderall与学习工作效率、成就感和成功密切相连。“病人难以想象脱离它的日子,因为他们不知道自己是否还能够有工作的能力。”她说,“很多人戒掉了它,并能用亲身经历来证明,是的,他们一定可以正常地工作和生活。但是,害怕不能,是人们戒不掉它的主要原因。”



我清楚地记得这是一种什么样的感受,读书时,以及后来工作时,都是如此。网络博客的分享中也显而易见的表达了:



我现在的感受比我有ADD但没有吃药前糟糕不知道多少。我现在不觉得,我能够完成博士学业。我无法完成功课,我对从前热爱的事失去了兴趣和热情。我需要你们,我的读者,告诉我,这是暂时性的。



心理学家Harris Stratyner是纽约曼哈顿的Carton治疗中心的戒毒专家。他告诉我,他从业以来,每一年都看见越来越多的人,拼命地想戒掉Adderall。Stratyner估计他治疗过50多个想要戒掉Adderall的病人,年龄在24到40之间。他的Adderall病人,绝大多数是很有创造力的想要从事艺术行业的人,但是,许多人不得不改行,在还没有努力尝试他们想做的事情之前就打了退堂鼓,从事有保障的职业。“他们屈服于现实,”他说。“然后,他们后悔失去了机会。一旦他们吃了Adderall,马上感觉良好,他们就不会关注自己的失落了。”许多人吃Adderall是想逃避对自己的失望之情,Stratyner说,它会让他们只注意每天的繁杂细节,而失去了对人生进行规划的能力。“他们从心理和生理两个层面都变得不可自拔,”他说,“因此,这是一个非常难戒的药。”药瘾发作时的症状有恶心、发冷、拉肚子、浑身疼痛,甚至癫痫。有时候,他得送他的病人住院治疗。



最终,我没能单靠自己戒掉Adderall。我得到了一个才华横溢的精神科医生的极大帮助。我相信她救了我的命。她的办公室的墙上,唯一的装饰品,是一个镶着法国著名现代艺术家亨利-马蒂斯Henri Matisse画的印刷品的相框。在整个治疗过程中,马蒂斯成了我创造力的支持者。你从一个地方起步,通过艰难跋涉,到达了另一个境界,那是一个给你带来惊喜的地方。我们俩一致同意,Adderall是这个历程的绊脚石。渐渐的,她的话触动了我的内心、使我坚强。我在30岁的时候真正戒掉了Adderall。即使是三年后的今天,我仍然觉得恐怖,因为这个药,浪费了我多少宝贵的青春。



在我最终戒掉Adderall的前几周,困乏无力的状况和从前经历的完全相同,极小的生活琐事都很费力,去健身房锻炼是不可想象的事。药瘾无时不在:即便有人只是在我面前提到“Adderall”这个词,我立即就会开始策划如何得到哪怕是一粒药。也许两粒。我焦虑、恐惧,害怕我做了使我大脑不可逆转的蠢事,害怕我会发现没有这特殊的药片我将什么也写不出来。我那时不知道,我是在戒掉Adderall之后的几年里完成那本书的。



即便在戒药的前几周,状况不太稳定的时候,我已经感受到了令人欣慰的变化。我重拾了一些简单的快乐。和朋友的谈话中,我有了更多的欢声笑语,我也注意到,他们也更开心了。我过去的许多年一直在强迫自己有紧迫感,总是觉得自己得去干点儿别的,更努力地工作,得到更大的成就。在药瘾发作的昏沉日子里,我能够摆脱药物带给我的紧急情绪。正是这种感受,使我远离了周围的人,也远离了真实的自己。



开始戒药不久,一天,我缓慢地、晕晕沉沉地、努力地走过繁华的几英里街道,去看曼哈顿商业区的医生。那是一个美妙的夏日的傍晚,夕阳正在西下。我走近Bryant公园时,听见乐队演奏,于是去看个究竟。一个摇滚乐队正在表演。演唱者双手握着麦克风,动情地唱着每一个字。突然间,我泪如泉涌。我感到很尴尬,但无法止住泪水。仿佛我多年都没有听到音乐了。



http://www.nytimes.com/2016/10/16/magazine/generation-adderall-addiction.html?_r=0



Generation Adderall

Like many of my friends, I spent years using prescription stimulants to get through school and start my career. Then I tried to get off them.



BY CASEY SCHWARTZOCT. 12, 2016



Have you ever been to Enfield? I had never even heard of it until I was 23 and living in London for graduate school. One afternoon, I received notification that a package whose arrival I had been anticipating for days had been bogged down in customs and was now in a FedEx warehouse in Enfield, an unremarkable London suburb. I was outside my flat within minutes of receiving this news and on the train to Enfield within the hour, staring through the window at the gray sky. The package in question, sent from Los Angeles, contained my monthly supply of Adderall.



Adderall, the brand name for a mixture of amphetamine salts, is more strictly regulated in Britain than in the United States, where, the year before, in 2005, I became one of the millions of Americans to be prescribed a stimulant medication.



The train to Enfield was hardly the greatest extreme to which I would go during the decade I was entangled with Adderall. I would open other people’s medicine cabinets, root through trash cans where I had previously disposed of pills, write friends’ college essays for barter. Once, while living in New Hampshire, I skipped a day of work to drive three hours each way to the health clinic where my prescription was still on file. Never was I more resourceful or unswerving than when I was devising ways to secure more Adderall.



Adderall is prescribed to treat Attention Deficit Hyperactivity Disorder, a neurobehavioral condition marked by inattention, hyperactivity and impulsivity that was first included in the D.S.M. in 1987 and predominantly seen in children. That condition, which has also been called Attention Deficit Disorder, has been increasingly diagnosed over recent decades: In the 1990s, an estimated 3 to 5 percent of school-age American children were believed to have A.D.H.D., according to the Centers for Disease Control and Prevention; by 2013, that figure was 11 percent. It continues to rise. And the increase in diagnoses has been followed by an increase in prescriptions. In 1990, 600,000 children were on stimulants, usually Ritalin, an older medication that often had to be taken multiple times a day. By 2013, 3.5 million children were on stimulants, and in many cases, the Ritalin had been replaced by Adderall, officially brought to market in 1996 as the new, upgraded choice for A.D.H.D. — more effective, longer lasting.



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Suzi October 18, 2016

I tried to find Ms. Schwartz's contact information, but she is untraceable. This is what I wanted to send her in a private email:"Casey,...

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Adderall and benzos - the choice of our generations. How is it that so many doctors blithely prescribe mind-altering drugs with no oversight...

Phillipa October 17, 2016

i got through 10 years of university - undergrad and graduate studies - and never once took a performance or concentration enhancing drug. i...

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Adderall’s very name reflects its makers’ hopes for an expanding customer base: “A.D.D. for all” is the phrase that inspired it, Alan Schwarz writes in his new book, “A.D.H.D. Nation.” And in fact, by the time I arrived at college in 2000, four years after Adderall hit the market, nearly five million prescriptions were written; in 2005, the year after I graduated, that number was just under nine million. By then, sales of A.D.H.D. medication in the United States totaled more than $2 billion.



By the mid-2000s, adults were the fastest-growing group receiving the drug. In 2012, roughly 16 million Adderall prescriptions were written for adults between ages 20 and 39, according to QuintilesIMS, an information-and-technology-services company that gathers health-care-related data. Adderall has now become ubiquitous on college campuses, widely taken by students both with and without a prescription. Black markets have sprung up at many, if not most, schools. In fact, according to a review published in 2012 in the journal Brain and Behavior, the off-label use of prescription stimulants had come to represent the second-most-common form of illicit drug use in college by 2004. Only marijuana was more popular.



We know very little about what Adderall does over years of use, in and out of college, throughout all the experiences that constitute early adulthood. To date, there is almost no research on the long-term effects on humans of using Adderall. In a sense, then, we are the walking experiment, those of us around my age who first got involved with this drug in high school or college when it was suddenly everywhere and then did not manage to get off it for years afterward — if we got off it at all. We are living out what it might mean, both psychologically and neurologically, to take a powerful drug we do not need over long stretches of time. Sometimes I think of us as Generation Adderall.



Adderall as we know it today owes its origins to accident. In the late 1920s, an American chemist named Gordon Alles, searching for a treatment for asthma, synthesized a substance related to adrenaline, which was known to aid bronchial relaxation. Alles had created beta-phenyl-isopropylamine, the chemical now known as amphetamine. Injecting himself to test the results, he noted a “feeling of well being,” followed by a “rather sleepless night,” according to “On Speed: The Many Lives of Amphetamine,” by Nicolas Rasmussen. By the 1930s, the drug Benzedrine, a brand-name amphetamine, was being taken to elevate mood, boost energy and increase vigilance. The American military dispensed Benzedrine tablets, also known as “go pills,” to soldiers during World War II. After the war, with slight modification, an amphetamine called Dexedrine was prescribed to treat depression. Many people, especially women, loved amphetamines for their appetite-suppressing side effects and took them to stay thin, often in the form of the diet drug Obetrol. But in the early 1970s, with around 10 million adults using amphetamines, the Food and Drug Administration stepped in with strict regulations, and the drug fell out of such common use. More than 20 years later, a pharmaceutical executive named Roger Griggs thought to revisit the now largely forgotten Obetrol. Tweaking the formula, he named it Adderall and brought it to market aimed at the millions of children and teenagers who doctors said had A.D.H.D. A time-release version of Adderall came out a few years later, which prolonged the delivery of the drug to the bloodstream and which was said to be less addictive — and therefore easier to walk away from. In theory.



The first time I took Adderall, I was a sophomore at Brown University, lamenting to a friend the impossibility of my plight: a five-page paper due the next afternoon on a book I had only just begun reading. “Do you want an Adderall?” she asked. “I can’t stand it — it makes me want to stay up all night doing cartwheels in the hallway.”



Could there be a more enticing description? My friend pulled two blue pills out of tinfoil and handed them to me. An hour later, I was in the basement of the library, hunkered down in the Absolute Quiet Room, in a state of peerless ecstasy. The world fell away; it was only me, locked in a passionate embrace with the book I was reading and the thoughts I was having about it, which tumbled out of nowhere and built into what seemed an amazing pile of riches. When dawn came to Providence, R.I., I was hunched over in the grubby lounge of my dormitory, typing my last fevered perceptions, vaguely aware that outside the window, the sky was turning pink. I was alone in my new secret world, and that very aloneness was part of the great intoxication. I needed nothing and no one.



I would experience this same sensation again and again over the next two years, whenever I could get my hands on Adderall on campus, which was frequently, but not, I began to feel, frequently enough. My Adderall hours became the most precious hours of my life, far too precious for the Absolute Quiet Room. I now needed to locate the most remote desk in the darkest, most neglected corner of the upper-level stacks, tucked farthest from the humming campus life going on outside. That life was no longer the life that interested me. Instead, what mattered, what compelled, were the hours I spent in isolation, poring over, for instance, Immanuel Kant’s thoughts on “the sublime.”



It was fitting: This was sublime, these afternoons I spent in untrammeled focus, absorbing the complicated ideas in the texts in front of me, mastering them, covering their every surface with my razor-like comprehension, devouring them, making them a part of myself. Or rather, of what I now thought of as my self, which is to say, the steely, undistractable person whom I vastly preferred to the lazier, glitchier person I knew my actual self to be, the one who was subject to fits of lassitude and a tendency to eat too many Swedish Fish.



Adderall wiped away the question of willpower. Now I could study all night, then run 10 miles, then breeze through that week’s New Yorker, all without pausing to consider whether I might prefer to chat with classmates or go to the movies. It was fantastic. I lost weight. That was nice, too. Though I did snap at friends, abruptly accessing huge depths of fury I wouldn’t have thought I possessed. When a roommate went home one weekend and forgot to turn off her alarm clock so that it beeped behind her locked door for 48 hours, I entirely lost control, calling her in New York to berate her. I didn’t know how long it had been since I’d slept more than five hours. Why bother?



By my senior year of college, my school work had grown more unmanageable, not less. For the first time in my life, I wasn’t able to complete it. My droll, aristocratic Russian-history professor granted me an extension on the final term paper. One Friday evening well into December, when the idyllic New England campus had already begun to empty out for winter break, I was alone in the Sciences Library — the one that stayed open all night — squinting down at my notes on the Russian intelligentsia. Outside, it was blizzarding. Inside, the fluorescent lights beat down on the empty basement-level room. I felt dizzy and strange. It had been a particularly chemical week; several days had passed since I had slept more than a handful of hours, and I was taking more and more pills to compensate. Suddenly, when I looked up from the page, the bright room seemed to dilate around me, as if I weren’t really there but rather stuck in some strange mirage. I seized with panic — what was happening? I tried to breathe, to snap myself back into reality, but I couldn’t. Shakily, I stood and made my way toward the phones. I dialed my friend Dave in his dorm room. “I’m having some kind of problem in the Sci Li,” I told him. My own voice sounded as if it belonged to someone else.



An hour later, I was in an ambulance, being taken through the snowstorm to the nearest hospital. The volunteer E.M.T. was a Brown student I’d met once or twice. He held my hand the whole way. “Am I going to die?” I kept asking him. Dave and I sat for hours in the emergency room, until I was ushered behind a curtain and a skeptical-looking doctor came in to see me. I wasn’t used to being looked at the way he was looking at me, which is to say, as if I were potentially insane, certifiable even. By then, I was feeling a little better, no longer so sure I was dying, and as I lay down on the examination table, I joked to him, “I will recline, like the Romans!” His expression remained unamused. I described what I’d been taking. His diagnosis: “Anxiety, amphetamine induced.” I had had my first panic attack — an uncommon but by no means unknown reaction to taking too much Adderall. When I left the hospital, I left behind the canister of blue pills that I had painstakingly scrounged together. I still remember the sight of it sitting next to the examination bed.



A few days later, I drew incompletes in my classes and went back home to New York. My father knew about the hospital incident, but I promised him I would stop taking the drug. And I fully intended to. I spent that long winter break at the public library on 42nd Street, soldiering lethargically through the essays I hadn’t been able to cope with while taking amphetamines. What I didn’t know then, what I couldn’t have known, was that the question of whether Adderall actually improves cognitive performance when taken off-label — whether or not it is a “smart drug” — was unresolved. It would be another few years before studies appeared showing that Adderall’s effect on cognitive enhancement is more than a little ambiguous. Martha Farah, a cognitive neuroscientist at the University of Pennsylvania, has conducted much of this research. She has studied the effect of Adderall on subjects taking a host of standardized tests that measure restraint, memory and creativity. On balance, Farah and others have found very little to no improvement when their research subjects confront these tests on Adderall. Ultimately, she says, it is possible that “lower-performing people actually do improve on the drug, and higher-performing people show no improvement or actually get worse.”



My pill-free period didn’t last very long. I turned in my incomplete school work and duly received my grades, but by graduation that spring, I was again locked into the familiar pattern, the blissful intensity and isolation followed by days of slow-motion comedown, when I would laze around for hours, eating spoonfuls of ice cream from the carton, desperate for the sugar rush, barely able to muster the energy necessary to take a shower.



It took me exactly one year from the time of college graduation to come to the decision that would, to a great extent, shape the next phase of my life. It hit me like a revelation: It might be possible to declare my independence from the various A.D.H.D. kids who sold me their prescription pills at exorbitant markups and get a prescription all my own. The idea occurred to me as I walked among the palm trees on the campus of U.C.L.A. By then, I was living in Los Angeles, working as a private tutor for high-school kids, many of whom were themselves on Adderall, and taking summer-school classes in psychology and neuroscience in order to be able to apply for graduate school. I had decided I wanted to be a psychologist — infinitely more manageable than my secret ambition of being a writer, I thought. Infinitely more realistic. Like many 20-somethings, my decisions were informed by panic and haste, but also, of course, by whatever short-lived supply of the pills I happened to be in possession of.



I was now surrounded — or had surrounded myself — by others caught up in the Adderall web. Together with two of my closest friends in Los Angeles that year, we traversed the city in a state of perpetual, hyped-up intensity, exchanging confidences that later we would not recall. Adderall was the currency of our friendship; when one of us ran short of pills, another would cover the deficit. Driving through Los Angeles in a sun-drenched trance, weaving in and out of traffic, I found it all too easy to lose track of exactly how many pills I had swallowed that day.



As soon as it occurred to me that I might be able to get my own prescription, I went to the nearest campus computer and searched for “cognitive behavioral psychiatrist, Westwood, Los Angeles, California.” I knew enough about psychology by then to avoid the psychoanalysts, who would want to go deep and talk to me for weeks or maybe months about why I felt I needed chemical enhancement. No, I couldn’t turn to them — I needed a therapist with an M.D., a focus on concrete “results” and an office within a 10-minute drive of U.C.L.A.



The very next day, I was sitting in exactly the kind of place I had envisioned, an impersonal room with gray walls and black leather furniture, describing to the attractive young psychiatrist in the chair opposite me how I had always had to develop elaborate compensatory strategies for getting through my school work, how staying with any one thing was a challenge for me, how I was best at jobs that required elaborate multitasking, like waitressing. Untrue, all of it. I was a focused student and a terrible waitress. And yet these were the answers that I discovered from the briefest online research were characteristic of the A.D.H.D. diagnostic criteria. These were the answers they were looking for in order to pick up their pens and write down “Adderall, 20 mg, once a day” on their prescription pads. So these were the answers I gave.



Fifty minutes later, I was standing on San Vicente Boulevard in the bright California sun, prescription slip in hand. That single doctor’s assessment, granted in less than an hour, would follow me everywhere I went: through the rest of my time in Los Angeles; then off to London, with the help of FedEx; then to New Haven, where I would pick it up once a month at the Yale Health Center; then back to New York, where the doctor I found on my insurance plan would have no problem continuing to prescribe this medication, based only on my saying that it had been previously prescribed to me, that I’d been taking it for years.



Any basic neuroscience textbook will explain how Adderall works in the brain — and why it’s so hard to break the habit. For years, the predominant explanation of addiction, promulgated by researchers like Nora Volkow, director of the National Institute on Drug Abuse, has revolved around the neurotransmitter dopamine. Amphetamines unleash dopamine along with norepinephrine, which rush through the brain’s synapses and increase levels of arousal, attention, vigilance and motivation. Dopamine, in fact, tends to feature in every experience that feels especially great, be it having sex or eating chocolate cake. It’s for this reason that dopamine is so heavily implicated in current models of addiction. As a person begins to overuse a substance, the brain — which craves homeostasis and fights for it — tries to compensate for all the extra dopamine by stripping out its own dopamine receptors. With the reduction of dopamine receptors, the person needs more and more of her favored substance to produce the euphoria it once offered her. The vanishing dopamine receptors also help explain the agony of withdrawal: Without that favored substance, a person is suddenly left with a brain whose capacity to experience reward is well below its natural levels. It is an open question whether every brain returns to its original settings once off the drug.



Nearly three years after getting the prescription, in 2008, I found myself sobbing in a psychiatrist’s office in New Haven, where I was finishing graduate school, explaining to him that my life was no longer my own. I had long been telling myself that by taking Adderall, I was exerting total control over my fallible self, but in truth, it was the opposite: The Adderall made my life unpredictable, blowing black storm systems over my horizon with no warning at all. Still, I couldn’t give it up. The psychiatrist was a kind Serbian man with an unflappable expression. He observed my distress calmly and prescribed Wellbutrin, an antidepressant with a slightly speedy quality that could cushion the blow of withdrawal and make it less painful to get off the Adderall. His theory was sound. But soon enough, I was simply taking both medications.



Through my Adderall years, I lived a paradox, believing that the drug was indispensable to my very survival while also knowing that it was nothing short of toxic, poisonous to art, love and life. By 2009, I had a contract to write a book about psychoanalysis and neuroscience; shortly after, I took a day job as a reporter for a news website. What was required of me there was the constant filing of short, catchy pieces: to be quick and glib and move on to the next one. It was the kind of rhythm perfect for an Adderall-head like me — and the kind of writing at odds with the effort to think slowly and carefully, at book length. The goal of slow and careful thinking came to feel more and more anachronistic with each passing week. It didn’t escape me that just as Adderall was surging onto the market in the 1990s, so, too, was the internet, that the two have ascended within American life in perfect lock-step.



Occasionally, I would try to get off the drug. Each attempt began the same way. Step 1: the rounding up of all the pills in my possession, including those secret stashes hidden away in drawers and closets. Debating for hours whether to keep just one, “for emergencies.” Then the leap of faith and the flushing of the pills down the toilet. Step 2: a day or two of feeling all right, as if I could manage this after all. Step 3: a bleak slab of time when the effort needed to get through even the simple tasks of a single day felt stupendous, where the future stretched out before me like a grim series of obligations I was far too tired to carry out. All work on my book would stop. Panic would set in. Then, suddenly, an internal Adderall voice would take over, and I would jump up from my desk and scurry out to refill my prescription — almost always a simple thing to achieve — or borrow pills from a friend, if need be. And the cycle would begin again. Those moments were all shrouded in secrecy and shame. Very few people in my life knew the extent to which the drug had come to define me.



Over the years, I’ve been told by various experts on the subject that it should not have been so hard to get off Adderall. The drug is supposed to be relatively quick and painless to relinquish. I’ve often wondered whether my inability to give it up was my deepest failing. I’ve found some comfort in seeing my own experience mirrored back to me in the dozens and dozens of disembodied voices on the internet, filling the message boards of the websites devoted to giving up this drug. One post, in particular, has stayed with me, a mother writing on QuittingAdderall.com:



I started taking Adderall in OCT 2010. And my story isn’t much different than most. ... The honeymoon period, then all downhill. I feel like I cannot remember who I was, or how it felt, to go one minute of the day not on Adderall. I look back at pictures of myself from before this began and I wonder how I was ever “happy” without it because now I am a nervous wreck if I even come close to not having my pills for the day. There have been nights I have cried laying my daughter down to sleep because I was so ashamed that the time she spent with her mommy that day wasn’t real.



“Nobody starts off by saying, I’m going to go develop a drug problem,” said Jeanette Friedman, a social worker with a specialty in addiction, when I met her in August at her Upper East Side office. “No one means to get addicted. But there’s such a casual use of something like Adderall nowadays — because it’s seen as benign, or a help to becoming more productive. And in our culture, to be productive is kind of everything. There’s a tremendous pressure not just to do well but to excel.”



When she is face to face with an addicted patient, Friedman explains, what is at stake is that patient’s very ability “to become a full person without the shadow of always needing something.” Adderall complicates the usual dynamic of drug addiction by being squarely associated with productivity, achievement and success. “It’s very hard to think about going off it, because you don’t know if you’re going to be able to produce,” she says. “Plenty of people have gone off of it and have been able to tell the story, that yes, they definitely can produce. But the fear of not being able to is what keeps people still using.”



I remember that fear, in school and, later, at work, and it’s palpable in those message-board pleas:



The way I feel now is way worse than my A.D.D. ever was before I went on this stuff. I no longer feel, at this present time, able to get a Ph.D. I don’t feel able to do coursework, I don’t feel interested and passionate about the things I loved. I need to know from you, dear readers, that this will be temporary.



Harris Stratyner, a psychologist and addiction specialist at the Caron Treatment Center in Manhattan, told me that each year he’s in practice, he sees more people desperate to get off Adderall. Stratyner estimates that he has treated more than 50 patients trying to stop using the drug; currently, they range in age from 24 to 40. His Adderall patients are overwhelmingly creative people who wanted to work in the arts — yet, he says, many have chosen other paths, safer paths, resigning themselves before they’ve even really tried to achieve what they hoped for. “They often give in to practicality,” he says. “Then they feel they missed out. And when they take Adderall, it makes them feel good, so they don’t focus on the fact that they feel like they sold out.” Many people are using Adderall to mask a sense of disappointment in themselves, Stratyner says, because it narrows their focus down to simply getting through each day, instead of the larger context of what they’re trying to build with their lives. “It becomes extremely psychologically and physiologically addictive,” he says. “It’s really a tough drug to get off of.” The side effects of Adderall withdrawal that his patients report include nausea, chills, diarrhea, body aches and pains, even seizures. Occasionally, it is necessary for him to hospitalize his patients as they come down off Adderall.



In the end, I did not get off Adderall alone. I had a brilliant psychiatrist. I believe she saved my life. On the wall of her office, she had a single image: a framed print of an Henri Matisse painting. Through our time together, Matisse came to stand for the creative process. You start one place, go through hell and wind up somewhere else, somewhere that surprises you. Adderall, we both agreed, was a perversion of that journey. Gradually, her words entered my inner dialogue and sustained me. I was 30 by the time I got off Adderall for good. This statement horrifies me even now, more than three years later, recognizing the amount of precious time I gave away to that drug.



During the first weeks of finally giving up Adderall, the fatigue was as real as it had been before, the effort required to run even a tiny errand momentous, the gym unthinkable. The cravings were a force of their own: If someone so much as said “Adderall” in my presence, I would instantly begin to scheme about how to get just one more pill. Or maybe two. I was anxious, terrified I had done something irreversible to my brain, terrified that I was going to discover that I couldn’t write at all without my special pills. I didn’t yet know that it would only be in the amphetamine-free years to follow that my book would finally come together.



Even in those first faltering weeks, there were consolations. Simple pleasures were available to me again. I laughed more in conversation with my friends, and I noticed that they did, too. I had spent years of my life in a state of false intensity, always wondering if I should be somewhere else, working harder, achieving more. In the deep lethargy of withdrawal, I could shed that chemical urgency that kept me at a subtle distance from everyone around me — and from myself.



On one of those earliest days of being off the drug, I was moving slowly, more than a little daunted, trying to walk the few miles to an appointment I had in Midtown Manhattan. It was a glorious summer evening, the sun just going down. As I approached Bryant Park, I heard live music and wandered in to see. A rock band was performing onstage. I hovered at the back of the crowd. The singer, muscular and bearded, gripped the microphone in front of him with two hands, pouring his heart into every word that left his mouth. His voice soared into that summer night. Suddenly, tears were streaming down my face. I was embarrassed, but I couldn’t stop. It was as if I hadn’t heard music in years.



Casey Schwartz is the author of “In the Mind Fields: Exploring the New Science of Neuropsychoanalysis.” She last wrote for the magazine on whether brain-scanning can help save Freudian psychoanalysis.




评论 (6)


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真光(Lily)
雷老师,您好。今天同事转发了您的帖子给我,觉得这篇文章对国内很多家长会有很多帮助。想冒昧的问您,您这文章可以让我转发在公司的微信公众号上吗?我们公司目前定位是学习困难支援中心,非药物帮助有多动症、阿斯伯格等小脑发育不完善的孩子或成年人。期待您的帮助和回答。
2:15 PM
Jademay
雷老师,您好!
我儿7岁时不能完成作业,后交白卷,最喜欢啃手指,对他惩罚也无效,后去医院才知道ADHD,医生让吃药加行为干预,但爸爸认为孩子长大就会好,不同意用药,他认为干预是伪科学,现在四年级了,娃爸自己管孩子1个多月,就给孩子报了注意力训练培训班和语数英一对一的课,孩子有一点进步,他爸有时说朋友说可以吃药,我没表态,当时医生说7岁吃药可以培养好的习惯,也许过几年孩子就好了,可以慢慢停药,他不同意,现在孩子自卑,他就又想用药了,我也不敢支持,但也很纠结,孩子对学习的磨叽是需要靠强压的,两个副作用都有……
我一直很迷茫
12/28/16 8:37 AM
雷春
@Jademay:
一般情况下,发育延迟造成的多动在8岁以后会有明显的好转,可以不用药。也许你先生希望会是这样的情况。如果到了4年级还不行,可以考虑用药,药物有很多种,可以尽量不用兴奋药,用也可以只是上课的那几天吃,周末和节假日不吃,这会尽量减少依赖,也降低成瘾的风险。每一种要对每一个人的副作用都不一样,一定要在医生的指导进行。你是在中国吗?
12/31/16 4:35 AM
雷春
特教石荟老师点评:我很少发朋友圈,但看到这篇雷春的译文感触太多,希望分享给所有做父母的朋友。在这个越来越功利的社会,教育也一步步走向功利。相当一部分家长一心想当“藤爸“”藤妈”,希望有朝一日能把名校的bumper sticker贴在自己的汽车后面;老师们一心忙于教孩子reading,writing,math,标准化考试成绩。这种对狭隘的成功的定义,让很多不fit into这种定义下的“成功”的孩子们被label成“ADHD”,“children with disabilities”,“anxiety disorder”,送去接受“特殊教育”。很多所谓的“好学区”,其实就是把应试的知识“灌”给孩子们,从preschool开始就要长时间坐下来“阅读”“写作”。对于“坐不住”,“注意力不集中”的孩子们,吃药变成了多快好省的途径。老师没有足够的经验和耐心来教育孩子,最好的办法就是告诉家长给孩子吃药。在哥大上学的时候,每逢考试季节,就有人在宿舍买卖ADHD的处方药,咖啡和红牛早已不能满足需要。
我不是说所有吃处方药的孩子都不应该吃,我也承认行为干预对于ADHD的局限性。但是我想请每一位家长都再认真的审视一遍自己的孩子,想想自己孩子到底是什么样的孩子,想想自己对成功的定义,想想自己对孩子的要求是真的为了孩子将来的幸福,还是为了自己在朋友圈子里说出去好听?想想是不是每一个孩子都要成为全A学生?想想成为了全A之后又怎么样?想想就算孩子去上了“藤校”又怎么样……
12/28/16 6:10 AM
雷春
这是我昨天发到群里时的简介:这是我今天刚刚完成的译文,前后花了近一个月的时间。希望对家长们有所启发。在一个畸形的讲究效率和注重成功的年代,各种不同能力的人都会有极大的压力。好的需要更好,成功的需要更成功,对失败的恐惧,使我们丧失了自我,无法追逐自己的内心。孩子们付出的代价会是更为惨烈。帮助孩子学会经历失败,比保证他们不断成功,更具挑战!
12/28/16 3:57 AM
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