So an internet phenomenon I've encountered is the person who thinks that ADHD is being diagnosed willy-nilly, and that everyone is "seeking labels these days", and that "doctors hand out meds if you go in and say that you can't concentrate"

Let's just examine this for a moment.

I've said it often enough but I didn't realise before I got diagnosed and medicated what ADHD meds actually are.

We all love to joke that they're speed, and when I first saw diagnosed ADHDers talking about their "legal speed", I assumed they were being hyperbolic.

They/we are not. Speed, for most of the world, is amphetamine: Wizz. Billy. Poor man's cocaine. Dexys. Call it what you will.

The current state of the art in ADHD treatment is Elvanse (Vyvanse in the US). This is the only custom designed second generation ADHD drug on the market. It is lisdexamphetamine dimesylate.

"Ah, so it's not speed! It's some weird derivative!"

Well no.

I mean, fair enough, a LOT of medicine is substituted amphetamines. Sudafed contains pseudoephedrine which is Beta Hydroxy N-methyl amphetamine, for example, and you don't get Jarvis Cocker writing songs about being sorted for lemsip.

But no. Lisdex, as we like to call it, is a prodrug. It converts in the blood to dexamphetamine, which is the most potent of the two amphetamine stereo isomers. It's delayed release speed, basically.

And then after mine runs out (I start the say on 70mg lisdex), I then take, usually, 10mg of dexampetamine and then 10mg more a few hours later. Dexamphetamine is pure, pharmaceutical grade, speed.

In the United States, they have a drug you have probably heard of called "Adderall". This is a 3 parts to 1 part mix of dexamphetamine and levoamphetamine. Levo is the other isomer. It's not as effective, has more side effects, but I believe it had a longer half life. Ostensibly they added it for that. In reality, it was for patent reasons.

Adderall is much closer to street speed (which is 50/50, typically). The US also has an ADHD drug of "last resort" called Desoxyn.

Desoxyn is methamphetamine. Straight up meth. As in Breaking Bad. That one. They prescribe it. To people with ADHD.

The other main drug used is methylphenidate, which was discovered by a Swiss chemist in the 19th century who promptly named it after his wife, who everyone called Rita. Methylphenidate is Ritalin. Like amphetamine, it is a central nervous system stimulant but possibly not as potent (this point is complicated). Call it a speed tribute act.

So that's point one. The FIRST LINE treatment for ADHD in much of the world is speed. Literal speed. I have taken in every day for nearly 13 months now. I am on speed writing this right now. It's making me feel a bit sleepy.

So the second point: ADHD is one of THE most objectively testable mental health conditions. Quite possibly the most testable.

You can do a thing called a "continuous performance task" (I did one as part of my diagnosis), and what's really cool is that you can do these on a computer, in a web browser. Mine took 21 minutes, and the webcam watched my eyes while I did it.

People without ADHD describe these as "a bit zen" or "quite relaxing really".

After 10 minutes I was sobbing.

After 15 I was trying to claw my face off.

After it finished, I was basically shaking from trauma and drank an entire bottle of wine. That was the last time I was drunk. 14 months ago.

In my subsequent diagnosis appointment it turns out I redlined it. They are designed to torture ADHD brains and we tend to utterly suck at them. They are not perfect. They produce false negatives, bur rarely false positives.

And after that there is the diagnostic interview, which is called DIVA V. You are interviewed by a clinician who not only listens to your answers but evaluates HOW you give them and your manner while doing so. You can train a nurse practitioner to administer DIVA V in a weekend. It's not hard. It's a standardised questionnaire to diagnose adult ADHD and you have to hit a certain number of categories out of 18 in adulthood, and the same 18 in childhood, to be diagnosed. 9 are for inattention, 9 are for hyperactivity. I think you need like, 6 in each for childhood and maybe 5 for adulthood? Can't remember. So like, 12:10

I was 18:18

What's the point of all this? Well, standardised and pretty reliable testing regime (be nice if people actually used it rather than telling people they can't have ADHD because they have one of "A-Levels" or "Tits"), and the treatment is speed. Wizz, as in sorted for.

And yet these eejits live in a world where you can apparently just waltz into a GP office, tell them you're easily distracted, and walk out with a script for "some profoundly good shit".

And I'm like ... how is it that they think drug dealers still exist?

(Oh, and if you're interested in the CPT test thing, and we know each other decently, HMU in DMs)