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Comment by jaggederest | Hacker News Reader

Most people I know with ADHD essentially face the choice between medication and homelessness/joblessness, myself included.

Which do you think is worse for long term health?

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Seriously. I've been on stimulants for ADHD for almost 25 years. The price I've paid is a few root canals due to dry mouth and I'm on beta blockers for a mild, benign arrhythmia I developed this spring.

Beats the living hell out of my alternative: on the streets, in jail, or 6 feet under because ADHD is hell. It's a price I'd pay every time without hesitation. It's a price I think EVERYBODY would prefer I pay cuz like yo, I ain't safe to drive unmedicated, this a public safety thing.

I'm curious about your take on something. ADHD was not recognized as a disorder until 1968. And the popularity of pharmaceuticals for ADD/ADHD didn't really take off until the 90s when a pharmaceutical industry astroturfing group called CHADD (Children and Adults with Attention Deficit) started marketing ritalin hard. Since then the use of using various pharmaceutical stimulants has become extremely widespread - jumping up by multiple orders of magnitude.

Okay, so:

- people claim that not being medicated for ADHD would result in homelessness and other such things

- medication only started to really take off in the 90s, and has since exponentially increased

So why is that when we go a bit further back in time, before the 90s, that we don't see some massively exponential increase in homelessness and other such things? I mean if that's the alternative to not taking the drugs, wouldn't this be precisely what we'd expect to see?

We do see many, many strangely unemployable types who from a modern perspective seem to clearly have all the signs of ADHD or other mental issues that have only been recognised comparatively recently. Especially when there is that little bit more history thanks to their being of a famous or diligent journal keeping family. In their time were institutionalised or kept at home as the black sheep of the family, or drifted from inconsequential job to job or were the petty indolent criminal, or even imprisoned for years.

Care was a little different as was the tendency for families to stick together. Perhaps the institutions, prisons and family spare rooms were used in place of modern homelessness? We can't know it wasn't responsible for significant homelessness. Figures were impossible to compare as the record would just show petty thief or lack of work ethic, or poor money management. If that.

I think you're looking a bit further back than necessary. FiveThirtyEight oddly enough did a bit on ADHD pharmaceuticals here [1] that gives some numbers. So for instance just between 2008 and 2013 adult usage of ADHD medication doubled. It was currently at 2.8% and has undoubtedly continued to skyrocket since then. And that number is dwarfed by how quickly we're putting young children and especially boys on it. In 2013 we already had 9.8% of boys 12-18 years old on ADHD drugs - and those numbers again were, and presumably still are, rapidly increasing. And once again the numbers as recently as 1990 were very near 0.

At least from your post it seems to me like you're talking about something like the 50s. You need only go back a decade or two to see tremendous differences in rates of psychotropic prescription and usage. And the sheer numbers here mean that if these drugs are as having as large a positive effect as many users do believe them to be, then we should be able to see tremendous macro level positive indicators. But I'm not sure we really do. By contrast I could certainly point to sharp increases in a variety of physiological and psychological disorders which are considered side effects of these treatments.

[1] - https://fivethirtyeight.com/features/dear-mona-how-many-adul...

Yeah I'm thinking of descriptions of people from the first half of the 20th century. I've no idea what the actual rate of ADHD is in the population, but the chances are it's been roughly that rate forever and long before there was any recognition or treatment of the condition. It certainly seems like we've reached a level of diagnosis that seems wildly excessive.

I've read enough histories and biographies to have thought "ADHD" quite a few times when reading of a life of missed opportunity, or the insufferable politician or military leader who seems to have all the symptoms but succeeded despite it. Maybe sometimes because of it.

The difficulty is appropriate medication can be the difference between achieving a regular career as lawyer or programmer and struggling through a transient series of failed unskilled jobs or ongoing unemployment. I'm not sure we have enough precision in the data to recognise that. I've seen wholly positive effects in those few diagnosed and on medication around me, but that's a useless anecdote. I'm in a country with a far lower rate of diagnosis. :)

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