Of course, we must start with Dr. Russell Barkley, whomst I have previously called my archnemesis, mostly just because he gives me big right-wing retired cop uncle lecturing me at the dinner table vibes1 (but also because, being gaydhd, I obviously live for the drama).

You’ve likely tripped over Barkley’s work if you’ve read anything about executive function,2 which he’s spent most of his career studying and theorizing. He’s retired now, but recently started a Youtube channel where he presents aesthetically hideous PowerPoints on various topics like ‘ADHD as Motivation Deficit Disorder’ and ‘Why Dr. Gabor Mate Is Worse Than Wrong About ADHD’.3

I do appreciate his commitment to accessible science communication, but my feelings as a viewer are also accurately summed up by this Reddit post:

An Evolutionary Theory of Self-Control

To truly analyze executive function as Barkley theorizes it, we must dust off his 1997 book ADHD and the Nature of Self-Control.

One of Barkley’s absolute icons is the late science popularizer and humanist Jacob Bronowski, whose paper Human and Animal Languages inspired him to theorize about where self-control might be located in the brain. Bronowski was a polymath whose work was kind of all over the place, but we do love a messy bitch.

He was deeply interested in both science and poetry, and this paper was his attempt to explain the difference between human language — which he calls a ‘structural system’ — and the ‘code book’ of other animals. The main factor differentiating the two, he thought, was delay.

The human brain takes in a message, stops to think about it internally, and then puts out a response. This delay makes it possible to separate our emotions from our communications, to conceptualize the future and the past, and to create an internal voice that helps us think before we act. Bronowski wrote:

“There must be some biological mechanisms which produce this delay in the human brain..”

Read more

“We know this is happening in colleges. A major takeaway of the new study is that misuse and sharing of stimulant prescription medications is happening in middle and high schools.”

Sounds like a scary new threat! But, is it?? (lol no) Take my hand. To understand where we are, we must first see where we have been. To the archives! (newspapers.com)

Timestamps:

00:05 - my adhd news-gathering process

01:17 - “ADHD Medication Abuse in Schools is a Wake-up Call” CNN article

02:34 - “diversion”

03:59 - the medicine-drug divide

06:16 - NBC + ADDitude Mag coverage

08:02 - ADDitude Mag says: gatekeep, gaslight, girlboss!!!!!

8:40 - original press release for the 1 in 4 study

09:17 - some stats + facts on US amphetamine history

11:10 - going down the newspapers.com rabbit hole / pre-ADHD stories (1950-1980)

19:08 - post-ADHD stories (1980-2010)

24:54 - Monitoring the Future & history repeating

25:00 - Conclusions

Read more

A second post in the same week — is this high of 67 in February thawing me out? Maybe! At any rate, I found something intriguing on TikTok that I would like to discuss.

A lot of people think they’re being sold fake prescription amphetamines. They say they’re falling asleep at work on 50mg of Vyvanse, taking old pills and feeling a noticeable difference to their new ones, and feeling that even increased doses are less effective.

I hesitated to dig into this, because TikTok is basically a massive algorithmic rumor mill, but then I saw this video of a woman saying that her drug screening came back negative for amphetamines, 3 hours after taking Vyvanse. Here she shares a copy of her results:

@mirandadavis28Replying to @majormisfit333 #greenscreen

Tiktok failed to load.

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Soo.. that’s weird, and it seemed to validate a lot of people’s experiences with stimulant medications in the last few months. Yes, the body does build up a tolerance to stimulants over time, requiring a higher dose, but that’s gradual, not sudden, and certainly not directly after a dosage increase!

In a capitalist prohibition market where authorities hold all the power, people do not have the resources to test their own drugs and understand exactly what they’re putting in their bodies. This can be deadly for users of illicit drugs, but these experiences show how little power prescription drug users have, too.

Consumers are at the mercy of companies and regulators — if the drug you rely on everyday suddenly stops working, what can you do?

I am not an investigative reporter, so it’s a bit beyond me to really figure out what’s going on here, but it’s not like there isn’t precedent.

Pfizer was ordered to pay $2.3 billion in 2009 for lying about the efficacy of their drugs, and in 2012, GlaxoSmithKline paid out $3 billion in the largest healthcare fraud settlement in US history. The FDA is also pretty bad at regulating drug quality, and as Katherine Eban discovered in her investigation of generic drug manufacturing, companies have been found to just fully make shit up.

In alternative theories: one TikToker noted it’s possible that manufacturers are using new kinds of binding agents, which can alter the way a drug feels and present new side effects — in her case, switching to a different manufacturer made an antidepressant that was previously working well start to increase suicidal thoughts.

While I cannot promise you answers, one thing I can do is gather stories. If your stimulant meds have suddenly stopped working, if you’re getting strange new side effects that you shouldn’t (like starving and falling asleep? on amphetamines?!), if you’re a healthcare professional or you work in a school and you’ve heard or seen this happening — if you have a direct experience of this you’d be willing to share for an article (anonymously or not), I want to talk!

Here are some things I want to know:

• What drug and dose are you taking, and is it generic?

• Who is the manufacturer?

• How long have you been on this drug and dose, and when did you start to feel it change?

• What does the drug “working” mean to you? (because I realize the phrase “this drug works” is vague and subjective, and I’m looking for specifics)

• How is this affecting your life?

You can reply to this email, or reach me at jessemeadows@gmail.com. Also, the comment section on this post is open if ya’ll want to compare notes.

Leave a comment

Last week in Part 1, I wrote about a YouTube video by How to ADHD that argues we should fight the stigma against stimulant medication by reinforcing the line between Adderall and meth — a line which, chemically at least, is very thin.

Culturally and politically, this line was drawn in order to determine who deserves access to certain drugs, and who should be criminalized and targeted for using the same drugs without a doctor’s approval.

The “medicine-drug divide,” as drug historian David Herzberg calls it, is possible due to a process called biocertification, which takes many forms: the determination of federal disability benefits through a bureaucratic maze of doctor’s notes and court appeals, genetic tests that claim to prove Native American ancestry for tribal membership, and, of course, a psychiatric diagnosis that gets a person access to certain kinds of healthcare.

In their book Health Communism, Beatrice Adler-Bolton and Artie Vierkant explain that biocertification is a way for authorities to ration care based on the expertise of state-certified medical professionals. It’s “assumed to be a necessary gatekeeping mechanism or checkpoint to prevent the ‘wasting’ of resources on fakers” — a threat, they explain, was mostly invented by a statistician at the Prudential Insurance Company in the early 1900’s to argue against socialized medicine.1

The medicine-drug divide was being constructed around the same time, and it was led by doctors who saw an opportunity to expand their authority. Herzberg writes:

“They pushed for stronger state licensing laws; increased educational standards; and more robust enforcement of ethical codes for physicians, pharmacists, and the pharmaceutical industry. An addiction crisis blamed on poorly educated physicians and pharmacists dramatized the need for such reforms, casting them as a noble social good rather than an elite’s selfish grab for power.”

The FDA we know today was built out of a 1906 law called the Pure Food and Drug Act, a consumer protection bill that was pushed through by arguing that white women were accidentally getting addicted to drugs because they didn’t know what was in their products.

According to Herzberg, the justification was that “native-born white consumers were innocent (they had no desire to experience pleasure from drugs and wanted to avoid addiction) but also ignorant (they needed expert guidance to avoid drug dangers).”

These assumptions show up in How To ADHD’s video when they interview a psychiatrist who says:

“What I see in my own clinic is young people coming to me vaping nicotine, smoking weed or vaping THC in particular, to self-medicate for their ADHD but also to self-medicate for the depression and the anxiety that is developed from their ADHD either going untreated or not being ideally treated. And I've got to tell you, trying to help them, trying to get them off of those substances, so that we can best manage their ADHD, is really hard.”

The message here is that “self-medication” is bad, regardless of whether it helps you, because only doctors are supposed to have the authority to medicate. As a former ADHD patient who’s been “self-medicating”2 with various substances for most of my life, I think ADHDers and drug users actually have a lot in common.

Adler-Bolton and Vierkant point out that drug users, disabled people, and the poor were all pathologized as having a contagious disease that caused crime and the dreaded dependency, and to address these social ills, authorities turned to carceral solutions like asylums and prisons.

Research is currently being funded to suggest that ADHD causes crime — last year The Guardian described “a new report drawn up by the ADHD Foundation, a panel of experts in the disorder and the drug company Takeda” that found one in four incarcerated people in the UK qualified for an ADHD diagnosis, and that “the failure to spot prisoners with ADHD when they arrive to start their sentence contributes to difficulties managing jails”.

Authorities, experts, and corporations do not care about us — they care about managing us, and biocertification is a crucial strategy for this. Sometimes the strategy is to deny people their agency altogether by calling them crazy, a common tactic used against the psychiatrized and the criminalized alike.

In a podcast episode on harm reduction for Undark, journalist Zachary Siegel3 quotes Elinore McCance-Katz, the Trump-appointed former US Assistant Secretary for Mental Health and Substance Use, who criticized the life-saving use of fentanyl test strips by writing:

“The entire approach is based on the premise that a drug user poised to use a drug is making rational choices, is weighing pros and cons, and is thinking completely logically about his or her drug use. Based on my clinical experience, I know this could not be further from the truth.”

This prohibition logic assumes that people who use drugs can’t make their own decisions about their bodies and need authorities to save them — but that’s just not true. Members of the street economy have been implementing their own safety protocols for decades in the face of a state that would rather punish than help them.

In Saving Our Own Lives, activist and artist Tourmaline writes:

“Harm reduction happens in the pockets of exquisite care we show our loved ones, without questioning or judging their life choices, or imagining that we know better than they do. It’s extending a belief system of true autonomy and self-determination: I trust you, I’m not afraid of you, here are tools that might be useful to you, do with them what you will.”

Liberatory harm reduction is a philosophy that starts with presuming competence — a tenet of disability rights. Self-determination is a struggle shared by drug users and disabled people alike, and when we look through this lens, “self-medication” is just medication.

That doesn’t mean just passing out drugs with abandon. It means fully explaining the benefits and the risks, and allowing people to decide for themselves. It’s not like we don’t have any idea how this approach could work for drugs — we already have an informed consent model around hormones and cannabis, as my friend Devon Price pointed out this week, describing his experience with both:

“My nurse practitioner is not there to decide what is best for me, or to limit which kinds of care I can access, only to inform me of the benefits and risk of my decisions, and help guide me through the process I’ve initiated. Under informed consent, I get to hold onto nearly all of my power and dignity. I am trusted as the authority on my own experience and feelings. I am informed, and the future of my body is in my own hands.”

There’s one thing I can’t stop thinking about: Herzberg wrote that during the deliberation over the Pure Food and Drug Act, the desire to experience pleasure from drugs was argued to be what distinguished “addicts” from deserving patients. Now, doctors are still wary of “drug-seekers” coming to their office, “faking” ADHD to get stimulants.

When they use the term drug-seeking, is what they really mean pleasure-seeking? We’ve been told that we can’t have a drug just because it feels good — it has to be treating some kind of “legitimate illness.” You can’t want it, but you can need it, if a doctor bio-certifies you for it.

I think about posts I’ve seen by ADHDers on their first day of stimulants that say something like, Is this how it feels to be normal? Does everyone just feel this good all the time? The answer to which is: no, they don’t, and there’s no such thing as normal. Stimulants feel good because they increase confidence, dull emotional response, and make mundane tasks more enjoyable.

There’s a reason they were used extensively by militaries in both World Wars, sold as a treatment for everything from housewives’ depression to asylum residents’ catatonia, and got so popular in the US that the fear of “thrill pills” was used to pass the Controlled Substances Act in 1971.4

I get the impulse to defend your access to a stimulant that makes the activities of daily living possible, especially when that access has been hinged on the denial of pleasure. It is terrifying to be faced with the proposition that a drug you rely on could suddenly be ripped away, so it makes sense that people lean into medicalizing amphetamines and denying any affinity with drug users.

But after what I've learned about drugs by "self-medicating" with them, I can't accept that mixed amphetamine salts work by “fixing” my neurology, just like I don’t consider alcohol to be balancing my neurotransmitters when it helps me cope with loud parties, or Xanax to be curing a benzodiazepine deficiency when it stops my panic attacks.5

Psychoactive drugs have direct effects on us, and sometimes those effects feel good, which can be helpful in itself. Puritanical thought and anti-drug propaganda have led us to think of pleasure as destructive, but pleasure can be therapeutic, too. That should be reason enough to have safe access to a substance, but due to the past century of power struggles and profit motives, we’re no longer allowed to see it that way.

“Recovering” from a “legitimate illness” is not supposed to have anything to do with pleasure. It’s just about tuning the body like a machine, getting back to that mythical state of normal, productive, efficient worker — a standard both people with ADHD and people who use drugs fall short of. We are not so different, and we could demand so much more together.

The boring interstate I’d traversed a hundred times suddenly opened up to me, and my mind unfurled into an elaborate, excited idea. I became totally engrossed in conversation with my partner — my words, which so easily get stuck, flowed effortlessly out of my mouth. It was both a pleasurable treat and a useful tool, and it got me through a slog of a drive that I always deeply dread. 

This mix of amphetamine salts, which you probably know as Adderall, is currently in shortage, causing all kinds of problems for people with prescriptions who rely on it everyday. And, predictably, the discourse has been abuzz about why we’re running low, with many pointing to overprescribing by shady telehealth companies that capitalized on “drug-seekers” who don’t “really have” ADHD during the pandemic.

There have been comparisons to the opioid epidemic, too. A WIRED headline claims “America’s Adderall Shortage Could Kill People”, expressing fear that patients could be forced into the illicit drug market for their medicine and accidentally buy meth instead.

Chemically, these two are almost twins. But Adderall is medicine, many argue, and comparing it to meth is deeply offensive. Adderall is respectable, because it’s prescribed by a doctor — it’s not just something you want to take for pleasure, it’s something you need.

So I started wondering: who deserves this drug, and who doesn’t? How did amphetamine become a hallowed medicine, and methamphetamine an evil poison? And what does prohibition have to do with all of it?

Creating the The Medicine-Drug Divide

The popular YouTube channel How To ADHD begins a video on medication stigma like this:

“There is an intense stigma against stimulant medication… In the media and on social media we are bombarded with misleading and shame-inducing messages.”

The video cuts immediately to a clip of Dr. Carl Hart, a neuroscientist and pharmacology researcher, in a 2014 interview with MSNBC’s Chris Hayes. The exchange goes:

DR. HART: When we think about methamphetamine, think about Adderall, Adderall is the attention deficit disorder drug that a lot of college students take, same drug, nobody’s talking about—

HAYES: [interrupting] It’s not the same drug.

DR. HART: It’s the exact same drug.

They insert a shot of Hayes' face looking skeptical (which was not in the original edit), before jumping into more examples of ways that people compare Adderall to street drugs. These editing choices portray Hart as a fear-mongering talking head that wants to take your medicine away from you, but being a fan of his work, I knew that was a gross mischaracterization.

Dr. Hart, a Black man who grew up in a poor neighborhood in Miami, published a book in 2021 called Drug Use for Grown-Ups, in which he openly discusses his recreational drug use. He argues that most of what we think we know about the dangers of drugs is just racist, classist propaganda, and the real danger is the way prohibition laws mandate widespread ignorance about the drugs we take and how they work.

The drug panic du jour fentanyl, for instance, is used safely in hospitals every single day, because medical professionals have access to information about dosage that the layperson does not. Likewise, the danger of accidentally buying meth on the street instead of Adderall is not the methamphetamine1 itself, but the fact that you have no idea what you’re taking.

It’s strange to see Dr. Hart appear as an enemy in a video about drug stigma, because fighting it is actually his life’s work. Agitated by this misrepresentation, I looked up the rest of the clip that How To ADHD cut short. Hart continues:

“The only difference is that methamphetamine has a methyl group attached to it, but we did a study in which we…tested the effects of a drug like Adderall compared to methamphetamine. They produced identical effects. They are almost identical chemically, in terms of the chemical structure. They’re the same effects, but we have these wildly different narratives.”

These narratives are what he believes we need to confront if we want to tackle stigma and make drugs safer for everyone, not just those who can access a prescription for them.

Breaking down the constructed barrier between medicine and drug, deserving patient and non-deserving user, is central to Hart’s mission. But How To ADHD apparently disagrees with this strategy, instead choosing to reinforce the divide.

What they’re calling “medication stigma” about stimulants is actually just drug stigma in general, but the problem for How to ADHD is not that drugs have been stigmatized for political reasons — it’s that this stigma is sticking a little too hard to a drug they want to see as medicine.

In the video, they show some responses they received when they asked ADHD Twitter for personal experiences with medication stigma, saying:

“One person’s mom avoided getting her diagnosed at all because they didn’t want her to become an addict.”

This fear of becoming “an addict” did not come out of nowhere — there’s over a century of state propaganda behind it in the US. Addiction has become an American boogeyman because we were scared straight into thinking that illicit drugs have some magical power to ruin our lives after “just one hit.”

Take this copy from a 1930’s propaganda poster:

“Hear How Boys and Girls From Our Best Homes Are Snatched From the Sunshine of Happiness into the Night of Pain, Horror, and Disgrace by this High Priest of Insanity and Death…Dope!”

Okay?? The drama! Except, that isn’t how addiction works. Compulsive habits develop over time through what neuroscientist Marc Lewis calls “motivated repetition,” and a person is motivated to repeat drug use for complex social and psychological reasons, often things like poverty, isolation, and trauma.

Much popular discourse about Adderall centers on easing the fear of addiction by insisting that “when taken as prescribed,” there is no risk. But all drugs have both benefits and risks, and all drugs can be used in both helpful and harmful ways. The difference here is not the drug, it’s the supervision by authority.

In his recent book, drug historian David Herzberg explains how the medicine-drug divide was constructed, largely by doctors in the early 20th century who saw an opportunity to expand their power. This created what he calls a “white market” for substances:

“For over a century, providing sedatives, stimulants, and opioids to patients has been one of the single most common therapeutic acts in American medical and pharmacy practice. This has been so consistently true, for so long, that it cannot be written off as an accident or aberration; it has been a primary function of the medical system. The driving question in American drug history has not been how to prohibit use of addictive drugs, but how to define the medical—that is, how to determine who should have access to drugs, under what circumstances.” [emphasis mine]

Herzberg explains that in the later half of the 1800’s, rapid industrialization led to widespread use of opium and cocaine by “white, native born, Protestant, middle aged, and middle class” people, who he calls the “doctor-visiting classes”. People who could not afford to see a doctor also used drugs, they just got them through more informal channels, often in urban “vice districts” where immigrants and people of color were segregated.

Rapid industrialization meant lots of products became more easily accessible with few safety guidelines, and this led to a public health crisis that affected all kinds of products. When it came to drugs, Herzberg explains, officials saw the medical market and the vice market as distinct issues:

“Opium smoking and other informal-market drug use attracted the attention and zeal of moral crusaders and anti-immigrant activists, who incorporated addiction into their broader campaign to govern urban vices, especially by policing white women’s sexuality. Morphine and other medical-market drugs, on the other hand, were tackled by a slowly emerging coalition of consumer advocates and therapeutic reformers who saw addiction as one more example of the need to protect the public by regulating commerce. Together, these two campaigns built the legal and cultural architecture of the medicine-drug divide.”

While both groups were essentially using the same chemicals, white morphine users were seen as deserving, because they suffered from “neurasthenia” due to the unique pressures of being so educated and civilized (seriously, that is what the newspapers said back then), while Chinese opium users were referred to as evil and undeserving, getting high in sinister “dens” that lured white women into debauchery.2

This is the same racist argument that would be made in the decades following about cannabis — white women were assumed innocent and used as pawns3 in a crusade against Mexican immigrants, who were accused of bringing “marijuana” into the US, and Black musicians, who were targeted for smoking it in jazz clubs.

These are political constructions based in race and class, and they are still with us today. Journalists are using the term "modern opium den" in headlines to scare people about safe injection sites. Turn on Fox News and you’ll see plenty of handwringing over “Mexican drug cartels” luring your (innocent, white) kids with colorful fentanyl candies — despite the fact that the War on Drugs created the prohibition market for those drug cartels in the first place.4

I see this legacy, albeit a bit more subtly, in the insistence that Adderall is completely different from meth. The difference is not so much chemical as it is contextual — Adderall the medicine for the doctor-visiting classes, meth the poison on the street.

Maybe it’s because I’ve been both an ADHD patient and a recreational drug user, but I just can’t get behind any stigma-fighting strategy that off-loads my stigma onto another vulnerable group of people instead. When asked what we can really do to address stigma in society, anthropologist Roy Richard Grinker had this to say:

“I think there are two things that I find important for us to do. One of them is to recognize what the real source of the persistence of stigma is. It’s not lack of education, it’s not ignorance, it’s not lack of awareness. The source of the persistence of stigma is whatever our ideal person is at a particular point in time. What is stigmatized is that which is not considered good. So what we are starting to do is change that perception of what is good and useful…we need to challenge those as devalued, and say that we value these different ways of being. That is what will reduce stigma.”

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The other day, I was reading a post on Burnt Toast, journalist Virginia Sole-Smith’s newsletter, challenging the idea that sugar is physically addictive. I like Sole-Smith’s work and have learned a lot from her about diet culture, so this is by no means an indictment, but I stumbled across something she missed.

It got me thinking about how ubiquitous certain ideas are, and how the people who craft and sell those ideas show up all over the place, but we rarely pull the curtain back on them and look at all the cheap props backstage.

I don’t blame anyone for missing these things, by the way — you wouldn’t know unless you read neuroscience papers about dopamine and behavior late at night when you could not sleep and then obsessively looked up all the lead authors in order to understand who is asking such reductive questions of brain science.

For some reason, I cannot stop doing this, so consider it my very niche and entirely unprompted service to the world, I guess?

Sole-Smith’s post was an answer to a question from a concerned parent about their child with ADHD:

I’m trying not to put limits on food for my kids but I’m really struggling with the question of sugar-filled foods, which my son craves and tends to OD on if he has the chance. He has ADHD so he’s more inclined to seek out sugar/carbs because of the dopamine surge they provide. What do we do when the notion of “no food is off limits” clashes with what’s indicated for other conditions our kids might have?

She responds that metaphors which liken sugar to a drug are inaccurate and it’s likely that restriction contributes more to these cravings. We want what we can’t have, basically. She says that what we perceive as a “sugar high” in kids overlooks the combined influence of a high-excitement event where more sugar is often consumed, like a birthday party, and a culture of food restriction that makes the opportunity to eat sugar more exciting than it should be.

I appreciate that Sole-Smith’s arguments are based in an understanding of how deeply our social environment affects us (and honestly, I would make a similar argument about drug prohibition), but here’s the part of her response that gave me pause:

..there is some evidence that people with ADHD eat more sugar than neurotypical folks, and as you mentioned, that may stem from their heightened dopamine cravings.

Oh god. There it is, the dopamine deficiency discourse, once again! I clicked the link (you know I clicked the link) and it’s a paper called Attention-deficit-hyperactivity disorder and reward deficiency syndrome. The first author on this study was a guy named Kenneth Blum, and immediately I was like, where have I seen that name before?

OH, right, he invented Reward Deficiency Syndrome. He also invented a genetic test for Reward Deficiency Syndrome, “nutrigenomic” treatments for Reward Deficiency Syndrome, and he’s editor-in-chief of the Journal of Reward Deficiency Syndrome & Addictive Sciences.

What is this Reward Deficiency Syndrome, you ask? It’s Blum’s answer to everything from ADHD to addiction to “the obesity epidemic” — a concept widely denounced by fat activists (which Sole-Smith has also done much great work to debunk).

RDS is “a term that connects addictive, obsessive, compulsive, and impulsive behavioral disorders” and attributes these behaviors to “a reduction in dopamine signaling within the reward pathway.”

Never mind that all of these behaviors are deeply affected by the social and political environment we live in, or that human behavior in general cannot be reduced to a simple chemical reaction in the brain.

Blum has built a career on the premise that you can, actually, attribute something as complex as alcoholism to one variation of the DRD2 gene that codes for dopamine receptors. If you have the DRD2 A1 variant, according to Blum, you have less dopamine receptors, thus, more “dopamine cravings” and addictions.

His ORCID bio proudly notes that he has been called “The Father of Psychiatric Genetics”, but I’m not sure who is calling him that, or if it’s just something he also invented. It looks like he’s been busy over the last few years filing all kinds of “genetic risk analysis” patents for things like PTSD and ADHD, and “Anti-RDS compounds” that can “induce anti-stress states”.

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This work very clearly individualizes systemic social problems, and it frustrates me that I often see people who make progressive social critiques in other areas suddenly pull up short at psychiatry. A DSM diagnosis comes up and then all of a sudden, we are back to reducing human behavior to a chemical, making drug-based metaphors about our neurotransmitters, and accepting reductive arguments that would be totally unacceptable in other contexts.

Reducing body size down to a brain deficiency is an offensive argument that stems from a long history of racism and ableism — all the way back to Adolph Quetelet’s body mass index. But Quetelet did not just propose the BMI.

His work opened up all sorts of ways to apply the cold rationale of statistics to society, including the construction of normalcy that led to the development of the DSM. Disability scholar Lennard Davis wrote that Quetelet’s concept of “the average” idealized the middle, or the norm, as something good and beautiful:

…one must observe that Quetelet meant this hegemony of the middle to apply not only to moral qualities but to the body as well. He wrote: ‘deviations more or less great from the mean have constituted [for artists] ugliness in body as well as vice in morals and a state of sickness with regard to the constitution.’

ADHD, addiction, and body size, once upon a time moralized, have now been refashioned as brain diseases, all coming together under Blum’s Grand Theory of Reward Deficiency.

In a 2014 paper, he argued:

“Recently a number of theories backed by a plethora of scientifically sound neurochemical and genetic studies provide strong evidence that food addiction is similar to psychoactive drug addiction.”

Two years later he gave a presentation on RDS that included this slide:

Along with addiction, ADHD, Tourette’s, and basically all the personality disorders, Blum thinks your S&M kinks are caused by “a dysfunction of the reward genes,” too! His argument for RDS is based on the idea that dopamine controls us, as if we are but robots piloted by our neurochemicals:

Dopamine, a very powerful neurotransmitter, controls feelings of well-being.

“Feelings of well-being” is frustratingly vague, and the popular idea that dopamine equals pleasure is not true. I have critiqued this before, writing that people talk about dopamine like it’s “a kind of heroin that your brain makes when you enjoy things,” and then they turn around and slap old US drug war narratives about being “powerless to drugs” on top of it.

Blum’s theory seems nicely buoyed by narratives like these, so it’s maybe not surprising that his research also plays into racist tropes about drug addiction in the US that go back to the beginning of the 20th century.

In the video, he jokes about “the controversy” that he encountered when doing this research, controversy that is rightly deserved, considering the implications of his claims. Remember the DRD2 A1 variant is supposed to mean a person has less dopamine receptors and thus is more susceptible to addiction? When this slide came up, I choked on my coffee:

Curiously missing here are any stats for white Americans, who, according to SAMSHA’s 2017 data, report drug addictions at very similar rates to Black and Hispanic populations.

Addiction is not a genetic disease, it’s a compulsive habit that results from motivated repetition, according to neuroscientist Marc Lewis. What motivates a person to do something over and over again until they become unable to stop regardless of the harm it’s causing them is usually isolation, trauma, poverty, oppression, or some other kind of major hardship in their lives. But Blum’s work strips all that social context away and presents simple solutions he can patent.

In a 2012 paper, he writes:

“Since [dopamine] has been established as the “pleasure molecule” and the “anti-stress molecule,” any reduction in function could lead to reward deficiency and resultant aberrant substance-seeking behavior and a lack of wellness”

What does “a lack of wellness” mean?! Do I have a “wellness” meter somewhere that you can read? Will I gain more “wellness” if I take Synaptalean RX?

Yes, this is also a Kenneth Blum creation, and I can hear a shady late-night infomercial playing in my head when I look at it. It contains a combination of vitamins and minerals called “Synaptamine” that is supposed to treat all manner of “cravings” without pesky side effects.

Synaptamine and its successor, SynaptaGenX, come from a substance called KB220z. Here’s how the blogger Neuroskeptic described it:

"KB220z" is presumably named after Kenneth Blum. Which brings us back to the new Journal of Reward Deficiency Syndrome. One of the papers there is about KB220z. This paper is a) authored by Blum b) published in a journal edited by Blum c) about a product named after Blum and d) hosted on a URL starting with "blum". What kind of academic publisher would host an outfit like this? Well, JRDS is published by United Scientific Group (USG), which is on Beall's List of 'predatory' open access publishers. Who's the founding president of USG? Inevitably, it's none other than Kenneth Blum. In summary, this is the most extreme example of academic editorial self-publication I've ever seen.

He’s done studies that administer KB220Z intravenously in drug rehab centers, in hopes of solving a problem that other pharmacological treatments for things like addiction and ADHD run into — drugs that initially stimulate the dopamine system also cause unwanted down-regulation of dopamine receptors over time.

This is because the body is always seeking homeostasis and will compensate for the substances you put into it accordingly (and is, similarly, why calories in/calories out diets do not work long-term).

In a 2012 study, he writes:

The challenge is to find a safe, nonaddicting natural substance that would activate the “brain reward site,” causing up-regulation of [dopamine] receptors (D2 in particular) without side effects but having therapeutic value.

They want a good drug that only does good things (which, I’m sorry Kenneth, doesn’t exist! All drugs have both benefits and risks). While Blum began by targeting drug users, his ultimate goal is to use this treatment for all the “RDS behaviors” — the wider the tent, the bigger the product market. I even found this image from a 2018 case study on a woman who took KB220Z and suddenly... cleaned her room, I guess?

It would be nice if being a human was as simple as Kenneth Blum seems to believe it is. If just finding the right lever to pull in the brain with the right chemical formula would magically fix an entire spreadsheet full of human problems. But we are thankfully, beautifully, painfully far more complicated than that, and true fixes for our distress are not going to be something you can patent and sell on Amazon.

Back to the little citation that opened this rabbit hole — it’s clear how much of a financial stake Blum has in convincing everyone that kids diagnosed with ADHD eat more sugar than other kids, because he’s built an entire universe where every deviant human behavior is genetic, and all cravings are caused by a dopamine deficiency in the brain that can only be fixed by his special patented formulas.

“Dopamine deficiency” as an explainer for social problems has become such an omnipresent discourse that we don’t even really notice it anymore. It’s becoming a common sense sort of truth, like the now-debunked “serotonin imbalance” before it. We assume that a study published in an academic journal counts as scientific evidence, but science is a process — a production of knowledge — and the truly scientific thing to do is question its products.

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@ritalinprc @ritalinprc ♬ original sound - peach prc

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She proceeds to joke about how excruciating it is to watch people ring up her groceries too slowly, and as someone who’s worked plenty of jobs behind a cash register, I did not find this bit very cute at all!

Your impatience with service workers is not a neurological disorder, and I think it’s far more informed by your culture than your diagnosis. But ADHD is fast becoming the universal scapegoat for all that ails us, from heart attacks to hoarding, a simple internal answer to bigger, more difficult questions.

In the interest of good faith, it’s possible ritalinprc was talking about fellow customers at self-checkouts (she does not explicitly say she’s referring to workers), but still, this impatience with others points to a worldview that is aggressively individualistic.

As Jonathan Crary writes in his book on the politics of sleep, 24/7:

The problem of waiting is tied to the larger issue of the incompatibility of 24/7 capitalism with any social behaviors that have a rhythmic pattern of action and pause. This would include any social exchange involving sharing, reciprocity, or cooperation.

Ritalinprc describes how frustrating it is for another person to pass her an object, demonstrating how she would bruskly snatch it from their hand, saying, “Give me that shit.”

She fails to see herself as a product of her culture, instead ascribing this behavior to an inner clock on “squirrel time”1. But who taught your clock to run so frantically? Is squirrel time not the capitalist’s favorite kind? Rushing from place to place, consuming and producing in a frenzy so scattered, you have no time for anything resembling personal contemplation or social cooperation?

I don’t deny that some people have internal rhythms dissonant with the world around them — I have plenty of my own struggles with a mind that races and constantly skips ahead. But I think we should question how much of that rhythm has been instilled in us by our social conditions, and if it’s truly good for us to embrace it.

I found this article from 1997 that reads a bit like an ancient text now, or an eerie prophecy. It’s called The Tick-Tock Syndrome, and it’s about a doctor named Larry Dossey who proposed something he called time sickness:

Time sickness, says Dossey, is nearing epidemic proportions today as people deploy state-of-the-art weaponry like fax machines, cellular phones, and power PCs in their efforts to beat the clock. Victims of time sickness, he adds, are obsessed with the notion “that time is getting away, that there isn’t enough of it, and that you must pedal faster and faster to keep up. The trouble is, the body has limits that it imposes on us. And the body will not be fooled if we try to beat it into submission and ask more of it than it can deliver in a 24-hour day. It will let us know.”

ADHD influencers often describe the popular notion of time blindness this way, too — a constant sense that “time is getting away” and “there’s never enough time”. The difference, though, is that time blindness locates the cause within, and time sickness acknowledges how the pressures of clock time make us ill.

Whatever you want to call it, this phenomenon is largely caused by our linear, monochronic perception of time. A 2018 review of research on time shortage says: 

..the pace of life feels faster and time more scarce in cultures where time is viewed as a straight line along which one progresses and where individuals typically let an external clock dictate when tasks begin and end.

In contrast, life tends to feel less rushed and time more abundant in cultures where time is viewed as a circular system in which the same events repeat according to some cyclical pattern and where tasks are planned relative to other tasks (and people transition from one to the next when they internally sense the former task is complete..)

The common symptoms of Dossey’s time sickness were “migraine headaches, irritable bowels, sleep disorders and low-grade depression,” and the article notes:

What sets time-sick people apart, according to Dossey, is that when stressful conditions are removed, they continue to race the clock. They find it agonizing to wait, because waiting means that precious seconds are slipping away.

This sounds more like a kind of anxiety than an innate sense of time — an anxiety instilled by the ticking hands of the 24-hour industrial clock, exacerbated by an app literally called TikTok that shapes the worldview and internal clock of its users, creating an “algorithmized self”.

In a 2021 paper, Aparajita Bhandari and Sara Bimo explain this concept:

The user is forced to negotiate identity not by connecting to the outside world through the mechanism of the machine, but rather by engaging with “machinized” selves: the curated algorithm that presents their interests, personality, and identity to them, and the original content they create that is processed by the machine that is Tiktok. In Tiktok, the boundaries between user and platform are intentionally blurred; here more than ever do we see a restless machine, one with as much of a “life” as its human user.

If the primary interaction happening on the app is between you and the “restless machine”, there’s no waiting on TikTok. Machines can be instantaneous in ways that other humans cannot — you can swipe to the next video, but you can’t skip a checkout line if it’s not fast enough.

Tech writer Nicholas Carr wrote on his blog in 2012 about studies that show the faster internet connection speeds get, the less patience people have. In 2006, internet users were willing to wait four seconds for a page to load. By 2012, another study found that four seconds had become 250 milliseconds. Carr wrote:

One thing this study doesn’t tell us — but I would hypothesize as true (based on what I see in myself as well as others) — is that the loss of patience persists even when we’re not online. In other words, digital technologies are training us to be more conscious of and more resistant to delays of all sorts — and perhaps more intolerant of moments of time that pass without the arrival of new stimuli.

Lest you begin to think I’m saying technology causes ADHD, I’m not. (That’s a take I find equally as reductive as saying ADHD causes time stress.) But we can’t deny that our experience of time is shaped by a culture that prioritizes speed, efficiency, and instant gratification, and sometimes, those things make us sick.

If you’re interested in my critiques of timeblindness, I’ve been working on an audio series that paid subscribers can access:

• Is There Scientific Evidence for Timeblindness?

• We’re All In A Time Famine

Subscribe now

If you’ve been a patron of mine for a while, you may have seen a first draft of this script that I posted on Patreon — it only took me approximately 500 years, but finally, I turned it into a video essay. (And I added an entirely new section fact-checking the medication chapter at the e…

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Okay, “Critical ADHD Studies” is sort of a joke, because I’m not an academic and that field doesn’t exist (yet), but I have been very into Critical Autism Studies and sort of throwing the phrase around on Instagram when I saw Dr. Dyi Dieuwertje Huijg actually call for it to become a field of study “produced by ADHDers themselves”, so I wrote this essay …

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