Based on the general atmosphere of suspicion that surrounds the ADHD diagnostic process in many clinics, you could probably guess that something is happening with ADHD meds that doesn’t happen with most other medications. That something, of course, is that a sizable number of people seem to be faking ADHD symptoms in order to obtain ADHD meds that can be sold to others or used as “study drugs.”
Now, if there’s one thing our society is always willing to throw money at, it’s finding ways to restrict who has access to psychoactive substances. In the case of ADHD meds, that means finding ways to separate out people who are really seeking treatment for ADHD and people who are faking ADHD symptoms to get their hands on amphetamines. And there’s a whole branch of research trying to find ways of doing this separating out of “good” and “bad” patients.
For example, a recent study tested a state-of-the-art machine learning algorithm that has been proposed for identifying patients who are faking ADHD symptoms. When tested on 331 college students, however, the algorithm turned out to be basically worthless.
At this point, I want to stop and point out that if you are going to implement an algorithm that groups ADHD patients as either trustworthy or untrustworthy, you had better make sure that algorithm is pretty damn good. Consider the costs of mislabeling a genuine ADHDer as a med seeker: that person is denied treatment for a mental health condition, which possibly exacerbates other mental health conditions such as depression and substance use, interferes with that person’s work, relationships, everyday functioning, and so on.
The authors of the study I mentioned do propose a standard for making sure that this type of algorithm doesn’t do too much damage: they say that 90 percent of non-ADHD-fakers should be correctly labeled as such.
The algorithm they tested didn’t come anywhere near meeting that standard, but even if it had, think about what that means. The goal of this research is to implement an algorithm where one in ten genuine ADHDers has to dig themselves out of the hole of being labeled as a malingerer.
Which brings us to the problem of trying to separate out “good” and “bad” ADHD patients: Ultimately, it’s the good ADHD patients who pay the price because treatment for ADHD becomes more inaccessible. If you try to weed out people who are faking with ADHD, you’re going to end up weeding out people who actually need treatment, too.
So why is so much work going to figure out how to restrict access to a substance that was available over-the-counter through the 1950s? There are obvious public health reasons to discourage amphetamine use, but my impression is that there’s a little more than that to the panic over illicit use of ADHD meds: first, there’s the perception that non-ADHD students who get their hands on ADHD meds are gaining an “unfair advantage,” then there’s the general moral obsession we seem to have with regulating people’s access to psychoactive substances, regardless of the substance or dosage in question.
As far as college students without ADHD “cheating” by using ADHD meds, I find it hard to get very worked up because there are so many unfair advantages and disadvantages that make much more of a difference in educational outcomes than amphetamines.
But the larger problem is that, historically, trying to stop drug use by restricting access to drugs simply doesn’t work. We’re all familiar with the lessons of Prohibition, but let’s not forget the more recent War on Drugs – which has been going on, incidentally, since the year amphetamines became a controlled substance in the US and which taxpayers have happily poured over a trillion dollars into with no positive effects to show for it.
Even if we could develop a good algorithm for separating “good” and “bad” patients, it’s not clear that we would accomplish anything. The main consequences I can foresee are that (1) some people with genuine ADHD symptoms would get mis-labeled as malingerers and (2) college students (or their dealers) would have to get a little more creative about where they get study drugs from.
Hence why I find it hard to care too much that, at least for now, it’s hard to spot the difference between people who actually have ADHD symptoms and those who are faking it. By all means, educate people about the serious health effects of drug abuse, improve treatment for people who are dependent on substances, and maybe reflect a little about why so many college students feel compelled to use “study drugs.”
But all the time, energy, and money that is going into trying to catch ADHD fakers in the act, or to otherwise restrict people’s ability to get their hands on pills? I can’t help but think that could be better spent on research into how the ADHD brain works and how diagnostic methods can be improved, which would actually help people with ADHD and would probably do more to stop ADHD meds being prescribed to malingerers anyway.