Last week, “meducation” was the word of the day on Stephen Colbert’s political comedy show, the Colbert Report. “We have tried everything to improve our public schools,” Colbert joked. “One thing we’ve overlooked is the most obvious answer of them all—wonder drugs.”
Colbert coined the term “meducation” in satirical response to a New York Times story about Dr. Michael Anderson, a Georgia physician who prescribes ADHD medication to help low-income kids perform better in schools even though he calls Attention Deficit Hyperactivity Disorder (ADHD) “made up” and “an excuse” for the failures of our school system. “We’ve decided as a society that it’s too expensive to modify the kid’s environment,” Dr. Anderson says. “So we have to modify the kid.”
Using medication to “modify” a child without a proper diagnosis goes against all of my training as a child and adolescent psychiatrist and in addiction medicine. Thoughtlessly prescribing addictive medications to improve a child’s grades is wrong, and so is perpetuating the idea that ADHD is “made up”—a notion that can lead the undiagnosed to self-medicate their ADHD by abusing other drugs.
The New York Times reporter said he wrote the story to show that some people take medication without a proper diagnosis for ADHD, and the line “has become dangerously blurred.” He has a point. In any psychiatric diagnosis, whether it’s depression or schizophrenia or ADHD, a person may fall on that “blurred” border line and the diagnosis may not be clear. With any controlled substance there is the potential for abuse, particularly when medical practitioners prescribe carelessly. NBC News recently profiled Stephan Perez, a Columbia student who took a friend’s Adderall pill to help him focus on his studies. “They give it out like it’s candy,” said the friend; and after filling out a short questionnaire and meeting with a psychiatrist for ten minutes, Perez had his own prescription.
Following the proper protocol keeps stimulants away from people who don’t have ADHD and helps the people who do have the disorder. Despite what Dr. Anderson thinks, the struggling children in the New York Times story may in fact have ADHD; however, before I diagnose them I would look closely at whether they fit the diagnostic criteria for ADHD and consider the extent of their functional impairment at school. I would look at other reasons a child might be failing in school, like mood disorders or learning disabilities. I would talk to outside sources like teachers and even look at school records.
It’s best to treat ADHD before people decide to treat it themselves by abusing drugs and alcohol. Clients who show signs of undiagnosed ADHD sometimes tell me they started abusing drugs like methamphetamines not to get high but just to feel normal—to be able to function academically and focus on the task at hand. People with ADHD are more prone to substance abuse, and studies show that 15 to 25 percent of adults with substance abuse disorders also have ADHD. However, research shows that treating ADHD appropriately and early has a protective effect against drug and alcohol use. One 2006 study found that early treatment of ADHD coincides with a reduced risk of tobacco and substance abuse.
Here at Phoenix House Academy of Los Angeles, we carefully consider how to treat people with both substance abuse and ADHD. We consider each individual case, looking at the drugs the client is taking, their withdrawal symptoms, and their ADHD history. We often have them continue taking the medication if they’ve already been diagnosed with ADHD, have a history of successful treatment, and the medication isn’t interfering with their recovery.
When parents clamor for a “wonder drug,” doctors may feel tempted to use psychotropic medications as “meducation,” a solution for poor academic performance or a way to drug kids into behaving. We should modify our own practices—with careful diagnosis based on protocol and early treatment—instead of modifying kids.
Jonathan Whitfield, MD
Phoenix House Academy of Los Angeles