More Morris professionals using ADHD meds

Quietly, stimulant medications—some properly prescribed, others not—have crept into workplaces from hospitals to cafes, financial firms to law offices in Morris County and beyond.

"I have Attention Deficit Disorder (ADD) and I'm on Adderall, but I've been on it since before I started working," said one 30-something lawyer at a Morristown firm. "If I worked at something where I didn't have to use my brain so much, maybe I wouldn't need the medication.

"Part of the problem is the prevalence of using the drugs in people our age," she added. "The medications started coming out when we were younger."

No one at work has ever asked her for any of her medication. Then again, she said, conversation about where people get their meds, though common in college, doesn't come up often at the office.

Experts agree that the trend, particularly prevalent in workers in their twenties, thirties, and forties, has in part grown naturally: Those who were diagnosed with ADD or Attention Deficit Hyperactivity Disorder (ADHD) as children grew up on Ritalin (methylphenidate) to focus at school. When they grew up, they switched to Adderall or Vyvanse (dextroamphetamine) to focus at work.

But users such as the lawyer don't fully account for fueling a phenomenon that is statistically on the rise.

The number of adults taking ADHD drugs rose 53.4 percent from 2008 to 2012, according to a 2014 report by Express Scripts, one of the largest prescription drug managers in the U.S. During those same years, the number of children taking the medications rose only 18.9 percent.

To account for the trend, local experts point to two other populations using Adderall in the office—those trying to survive in an ever more difficult workplace, and those who discover, as adults, that they have ADHD.

'Culture of perfectionism'

Rosalind Dorlen, an attending clinical psychologist at Overlook Medical Center with a private practice in Summit, said she sees many people who don't medically need stimulants but take them, anyway.

"We are living in a culture of perfectionism, and people are taking energy drinks, caffeinated drinks, or prescription drugs because they see them as cognitive performance boosters," Dorlen explained. "I call it cosmetic surgery of the mind.

"People are not taking Adderall to get high. They're taking it to get hired," she added. "They've got to be sharp in those interviews. This is a high-level competitive culture. Some industries are worse than others, of course, but this is the spirit of the culture."

But the pressure doesn't stop there, according to Dorlen, who said in the last eight years the realities of smaller staffs at startups and in corporate settings have people working longer hours. Fewer employees are doing more work and, for fear of losing their jobs, not truly addressing the issue. Instead, some are medicating to keep muscling through their workloads.

"We also have all of this fear that you could lose your job," she said. "Or you could be replaced by somebody smarter, faster, or younger. So there's anxiety about keeping your edge."

That anxiety leads people who otherwise wouldn't qualify for ADHD medications to somehow obtain them.

Dr. Sarabjit Singh, a psychiatrist and executive medical director of Behavioral Health Services at St. Clare's, said some of his ADHD patients tell him they share their stimulants with colleagues at work.

"That is referred to as diversion," Singh said, "and diversion is becoming more common because people in a workplace know that So-and-So gets the medicine. They think that if, every now and then, they pop a pill, it will help them get through the workday more easily."

Also, he said, the drugs have a street value, so the medications are being bought and sold on the street, a practice fraught with the danger of buying from a medically unreliable source.

Finally, some people just go to their primary care physicians, lie about their symptoms, and get a prescription. One twentysomething financial professional from Morris County said a lot of her clients use prescription stimulants. She said they are easy to obtain.

"I could go into any doctor's office, say I'm having trouble focusing, and get a medication," she said. "We all, to some degree, have some form of ADD. I really do believe that. It wouldn't be hard for anybody to get Adderall."

Though she used Adderall in college, she said, she doesn't now. The drugs are most useful, she contends, when getting used to a demanding work schedule. These days, she wakes at 4:30 a.m. for work and gets home at 10 p.m., but, since her life is organized around her schedule, she can keep up with the hours without using stimulants. Not even coffee.

Dr. Merritt Hubscher, a psychiatrist and medical director of the ADHD, Mood and Behavior Center of New Jersey in Cedar Knolls, gives full evaluations to patients of all ages who present with attention difficulties. He also treats them. Hardly anyone who comes to his center, he said, including people who have ADHD, actually want stimulants.

"The adults who come to our center are usually people who have struggled and suffered, with frustration, disappointment and humiliation, all their lives," Hubsher said.

"It may be that those seeking stimulants for illegitimate reasons actually go to their family doctors other than to an ADHD specialist," he added. "Perhaps they would feel that they could better 'fool' that doctor than one who really knows ADHD."

Singh called ADHD "one of most Google-able diagnoses." The average citizen can easily search for it, learn the symptoms, and feign the condition.

Late life treatment

A third population of adults using the drugs in the workplace are those who were diagnosed in adulthood. About 60 percent of children with ADHD nationwide become adults with ADHD, according to the Anxiety and Depression Association of America.

Jan, of Morris County, is a case in point. In her early fifties, she said, she felt ridiculous when she pulled into the parking spot for her first appointment at the ADHD, Mood and Behavior Center of New Jersey.

"I remember sitting in my car, and thinking, Who would ever hear of a woman at my age thinking that she has ADD?" she recalled. "I tried Adderall with a lot of hesitation and really thinking it was not going to do anything. But I was very wrong. Within two days, I was aware of all the details I was missing before. I realized I am living in a world with color that I could now see."

On certain days, paying attention to so many details overwhelmed and fatigued her to an extent that she used to literally see in black and white.

Since Jan works in the health care industry, detail is very important. She realizes now she has had ADD since childhood and that it worsened during adulthood. Tasks which she once performed easily at her job had steadily become more difficult.

A 2006 World Health Organization study showed adults with untreated ADHD lose an average of 22 productive work days annually, according to the Attention Deficit Disorder Association. They're also 18 times more likely to be disciplined at work for so-called behavior problems and are 60 percent more likely to lose their jobs.

On Adderall, though, Jan's life fell into place.

"I would never give anyone any of my Adderall. It's a crutch for me, so it's important," said Jan, recalling the Adderall shortage of 2011 when, Medical News Today reported, the federal Drug Enforcement Agency withheld from the market the mixed amphetamine salts essential to make the medication. The agency monitors and controls how much of the ingredients can be distributed to pharmaceutical companies.

In those two months, Jan's life went back to what it used to be. She said she felt frightened and panicked. Today, when she thinks of people taking the drug when they don't truly need it, she gets upset.

"It's scary and disappointing that people would do anything to jeopardize the health of somebody else," she said.

According to Hubsher, there's an increase in the number of adults who come to the center wanting to be evaluated for ADHD. They come, he said, because of increased awareness, which has blossomed in the last 15 years.

For these patients, he said, ADHD medication are not cognitive performance boosters.

"They're lifesavers," he said.

Danger ahead

But for those who are taking an ADHD stimulant they don't need, or who don't take it as prescribed, or who aren't being monitored by a doctor, the drugs most definitely do not work, according to experts.

A 2013 report by the federal Substance Abuse and Mental Health Service Administration showed, between 2005 and 2012, a 200 percent increase in emergency room visits related to ADHD stimulant medications—from 5,212 to 15,585.

That's no wonder, according to Singh, particularly since all the medications can affect a user's heart rate, blood pressure, and heart rhythm.

"The effect of the medications in these cases is very unpredictable," Singh explained. "When an adult says, 'I popped a pill the other day and I was fine,' that person is making a statement that has no meaning. The next time that person pops a pill, there could be a significant cardiovascular effect."

Also, he pointed out, improper use of ADHD stimulants carries a risk of abuse. A classic example, he said, are adults who are prescribed 20 or 30 milligrams of Adderall daily and, on their own, push that to 80 milligrams or higher.

Besides, Dorlen said, so-called smart drugs don't improve work performance in the ways that matter most.

"Those drugs don't make us more creative," she explained. "What makes us more creative is finding our own center, eating properly, and sleeping properly so our minds and brains can really organize and consolidate a thought. Things have a way of marinating in our minds, and that's different than living as an automaton."

For true ADHD patients, who are properly diagnosed, prescribed, and monitored, Hubsher said, ADHD drugs are safe and have been for the 60 years they've been used. One study followed school-age children for 33 years, most to the age of 41, he said, and found no negative effect on medical health or functioning compared to people who were not on the medications.

The alternatives

NewBridge Services, a Morris-based nonprofit that offers a variety of mental health and other supportive services over multiple counties, does thorough ADHD assessments and provides treatment for patients, according to Andrea Wasser-Malmud, chief professional officer.

"One part of the assessment is a really thorough addiction history," Wasser-Malmud said. "If we see a history of illicit use of drugs, we would be less likely to prescribe an ADHD stimulant. People are seen monthly and the prescriptions are monitored."

NewBridge helps treat ADHD in other ways, too, she noted, especially since some of the time the condition is often associated with anxiety and depression. The practice of mindfulness is encouraged, as is exercise and healthy eating. She said patients are taught to focus their mind through breathing and medication.

"In a true case of ADHD, I don't see these things as taking the place of medication," Wasser-Malmud said. "I see them as working together with medication. In cases that are not ADHA, these holistic approaches can work, even more so."

There is a role for employers in helping to curb abuse of stimulants in the workplace, according to the Millburn-based Partnership for a Drug-Free New Jersey. Through its Drugs Don't Work program, the partnership will help any company in the state create a drug-free policy. Currently, 3,000 companies have signed up for the free service.

According to the nonprofit, 70 percent of drug abusers are employed, mostly in companies without a drug policy.

"Companies need a drug-free workplace policy," said Executive Director Angelo Valente. "We advise it for every company, no matter how small or how large."

In the case of ADHD stimulants, including Adderall, he said, such a policy might ban in the workplace use of any drug that is not prescribed to an individual.

Lorraine Ash: 973-428-6660; lash@gannettnj.com

Learn more

Here are resources on living with ADHD, the perils of taking ADHD medications without a prescription, and strategies for dealing with drugs in the workplace:

• ASSOCIATION : Attention Deficit Disorder Association, https://add.org

• BOOK : Is It You, Me, or Adult A.D.D.? by Gina Pera, http://adhdrollercoaster.com/buy-the-book

• BOOK : ADD-Friendly Ways to Organize Your Life, by Judith Kolberg and Kathleen Nadeau, www.amazon.com/ADD-Friendly-Ways-Organize-Your-Life/dp/1583913580

• CENTER : ADHA, Mood and Behavior Center of New Jersey, Cedar Knolls, www.adhdmoodbehaviorcenter.com

• MAGAZINE : ADDitude magazine, www.additudemag.com

• MEETUP : Adults with ADD, Chatham, www.meetup.com/Adults-with-ADD-Meetup

• NONPROFIT : The Partnership for a Drug-Free New Jersey, Drugs Don't Work, Millburn, www.drugfreenj.org/drugs-dont-work/overview

• NONPROFIT : NewBridge Services, Montville, http://newbridge.org

• PRIVATE PRACTICE : Rosalind Dorlen, PhD, Summit, http://drdorlen.com

• PROJECT: Medicine Abuse Project, www.medicineabuseproject.org

• SUPPORT GROUP NETWORK : Children and Adults with Attention-Deficit/Hyperactivity Disorder, www.chadd.org