Fair enough. I just get the feeling that "adult ADHD" gets so much more flak. In reality, I agree, they are one in the same.
The phrase is "one
and the same." But I can think of a couple of reasons "adult ADHD" gets more flak:
First, and I can only speak for myself, we got experience from day 1 in residency dealing with people seeking benzos, and had it drilled into us to be wary of prescribing them, whereas "adult ADHD" was something we got absolutely zero experience with, training in, or exposure to. I've said many times before how blindsided I was by this when I started an outpatient job in the private world--the first time I saw a 35-year-old wanting to be on stimulants I was inwardly doing a double-take and and thinking "wait a minute, it says right here your birth year is 1981, are you in 4th grade?" Then I got another, and another, and another... So I'm fully aware that no one needs to be on Xanax 2 mg TID in order to survive, and when I'm in the mood to put my foot down, can tell people in no uncertain terms that that simply isn't indicated. But when someone tells me they're totally incapable of functioning without Adderall, part of me is thinking "well, maybe that's true. How should I know?" It doesn't make it any easier when people essentially threaten to decompensate if you don't prescribe it, or even make comments that get you worrying about liability (e.g., subtly implying that if you don't prescribe a stimulant they're going to get fired from their job, and it'll be your fault.)
Second, in my experience, most benzo-seekers who are adamant about "needing" them are already addicted and just can't stand the slightest withdrawal symptoms, and if you keep chipping away at them, you can at least get them to accept reducing by 0.25 mg daily every month and taper down extremely slowly. With stimulants, you get more people who tried the drug literally one time and now are convinced they can't live without it. Apparently, everyone who ever tries a stimulant thinks it's the best thing ever. Seriously, I never want to try a stim, because it's like some bad Star Trek episode where a mind control virus is taking over everyone's brain, turning them into automatons whose only function is to spread the virus to more people. People pop one Adderall pill they got from some friend one time, and feel it was like an epiphany--"this is what it's like to finally be alive! Suddenly, I new what I'd been missing my whole life! When I'm on these meds, I can finally be the person I was meant to be for all those years!" And they just will not take no for an answer.
Also, to address the drug dealer analogy, I think another difference is that while street drug users might lack the insight to realize if and when they're addicted, they're at least aware they're using drugs for recreational purposes. I honestly don't think most of our benzo- or stim-seeking patients believe they are just taking these drugs because they like the way they make them feel. In their minds, they have an illness, and that illness gives them symptoms, and these drugs are medicines, and when they take these medicines, they experience relief of symptoms. So, if you want to run a pill mill (not that I advocate that at all,) you do have some cover. You're a
doctor prescribing
medicines to treat an illness! Of course, this only makes it all the more difficult to convince people they don't need these drugs, and to prescribe appropriately.
