ATTENTION DEFICIT DISORDER

ADHD drugs not just for children any more

Like dormitories and dining halls, Adderall was something Cory Clair figured he'd leave behind in college. But when he went off the medication and started a new job in January, his mind began wandering at work — just as it did in class before he was diagnosed with attention deficit disorder and prescribed the drug, a common treatment for a related problem, attention deficit and hyperactivity disorder.
“I thought I'd have it for school, and then I'd be out and wouldn't need it anymore,” said Clair, who works in public relations in New York. “I was wrong.”
After a few months of struggling to pay attention to coworkers and complete assignments on time, Clair finally made an appointment with a doctor and renewed his Adderall prescription, which his health insurance covers.
“The difference is remarkable,” Clair said. “When you're on it, you stay focused on what you're doing.”

The kids of the ADHD drug boom are growing up, and some finding that what they thought would be a school-age ailment may in fact last a lifetime. As they enter the workforce — and as older people are increasingly diagnosed — drugs for the disorder are becoming more common in the workplace.
ADHD is seen in 3 percent to 5 percent of children, according to the National Institute of Mental Health. About half continue to experience symptoms into adulthood, said Louis Kraus, chief of child and adolescent psychiatry at Rush Medical Center in Chicago. Symptoms include distraction, forgetfulness, fidgeting, impulsivity and disorganization. Some patients, like Clair, are diagnosed with attention deficit disorder only, not including hyperactivity.
ADHD drug sales have skyrocketed over in recent years, and pharmaceutical companies are increasingly marketing their drugs to adults. U.S. retail sales of the total ADHD drug market more than tripled between 2000 and 2004, according to health care information company Verispan. From 2003 to 2004, U.S. sales of Adderall XR grew nearly 40 percent, while U.S. sales of Eli Lilly & Co.'s drug Strattera, which came on the market in 2002, nearly doubled.
Experts disagree on whether the surge in sales is due to better recognition and publicity of the disorder, or doctors prescribing the drugs too leniently.

Also, many question the safety of prescription stimulants — in February, Adderall XR, sold by Shire Pharmaceuticals Group, was pulled from the Canadian market amid reports connecting it to deaths. The U.S. Food and Drug Administration said it would continue evaluating the drug, but has not taken regulatory action. Sales of Adderall XR — the most popular type of Adderall in the United States, and the kind that Clair takes — rose 4 percent in the first quarter of 2005 from the first quarter of 2004, according to Shire.
Even Strattera, a non-stimulant ADHD drug, has come under fire after Eli Lilly issued a warning in December that the drug can cause liver damage in rare cases. Strattera's first-quarter 2005 sales fell 15 percent from year-ago levels.
But when used correctly, ADHD drugs can be career savers, said Gary, a 41-year-old from Memphis, Tenn., who asked that his last name be withheld. Before he was diagnosed with adult ADD in 2003, Gary lost two jobs due to missed deadlines. He also self-medicated with alcohol and marijuana to reduce his anxiety about falling behind.
Gary's inability to focus, which he describes as a “fog,” was something he suffered since grade school.
“I was a frat boy who could make a gentleman's Cs without doing any homework,” Gary said. “I always felt like I could be doing better.”
Part of what held him back from seeing a psychiatrist for so many years was that he didn't want to identify himself as hyperactive. His revelation came a few years ago when he learned that an author he admired had been diagnosed with the disorder — somehow, it wasn't such a stigma anymore.

“It's quite culturally acceptable, almost party talk at this point,” Kraus agreed. But he added that while the drugs' ubiquity has helped lessen the stigma, it has also raised the occurrence of abuse.
Some adult users adopt a “pseudo-doctor” role, illegally lending their medication to friends and colleagues that they believe need it, Kraus said.
The drugs are relatively inexpensive (a few dollars a pill) and easy to stock up on. Physicians write one-month prescriptions, but insurance companies allow people to order three-month supplies, Kraus said. That's a system that some people manipulate.
ADHD drug abuse isn't as rampant in the workplace as it is on college campuses, where it's estimated that one in five students has abused prescription stimulants to study or get high. But it does exist, notably among bankers, stock brokers and others in high-pressure, long-hour positions, said Punyamurtula Kishore, president and director of the National Library of Addictions in Brookline, Mass.
If you think you have adult ADHD, don't test out the drugs on your own — see a doctor first. Because most of the drugs are stimulants, they raise blood pressure and speed up the heart. Unmonitored, they can cause heart problems and psychosis, said pharmacologist Peter Anderson, a clinical instructor in psychiatry at Harvard Medical School.

To treat adult ADHD, most experts recommend relying on not only medication, but also therapy and lifestyle changes. These include maintaining a quiet work space, using personal digital assistants and task books to organize your duties, requesting one-on-one training instead of group training, and using tape recorders during meetings. Such non-medication techniques can, for some sufferers, be a substitute for drugs, Anderson said.
But if your bosses aren't accommodating, you may need to tell them up front about your disorder. Gary, for one, chose to tell his boss when he started taking Adderall to ensure that his workplace needs would be met.
One can only be eligible for protection offered by the Americans with Disabilities Act and the Rehabilitation Act if one discloses the disability to the employer, according to the National Resource Center on ADHD. The act requires employers to make accommodations for employees with disabilities.
Gary admits that Adderall isn't a cure, but being diagnosed was a step in the right direction for his career.

“This is about chemistry,” he said. “You should not feel bad about seeking psychological help.”

Madlen Read
11 May 2005

http://www.thestate.com/mld/thestate/business/11611902.htm

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