Alert, Productive-and Addicted

A growing number of young adults entering the workplace take ADHD medications on a daily basis, with some abusing those drugs as an easy-but dangerous-way to improve their concentration and alertness at work. While experts say it's difficult for HR to address such medical issues and treatments, there are options available.

Thursday, April 30, 2015
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A few years ago, Eric Paskin worked with a young professional who'd become addicted to Focalin, a stronger version of the attention-deficit-hyperactivity disorder medication Adderall. The woman had been diagnosed with ADHD at a young age and had initially been prescribed Ritalin and then Adderall.

"She was holding down a full-time job but [her Focalin abuse] was starting to get away from her: She was starting to get sick and wasn't sleeping, yet when she stopped taking it she went into withdrawal and was unable to go into work, so she'd start taking it again," says Paskin, founder and director of Potential Behavioral Health Advisors, a treatment center with locations in New York and Fort Lauderdale, Fla.

The woman ended up taking a leave of absence from work to go to a detox center, followed by 60 days of treatment at an accredited facility. After that, she visited a therapist regularly to address her addiction issues, says Paskin. She's been sober and working steadily for the past two years, he says.

People often end up abusing drugs such as Adderall and Concerta as an easy way to improve their concentration and alertness at work, says Paskin.

"I think, psychologically, people tell themselves they can perform better, get more accomplished, focus more [by using ADHD medication]-they can even skip lunch, because it makes their appetite almost nonexistent," he says. growing number of young adults entering the workplace take ADHD medications on a daily basis.

A report last year from St. Louis-based Express Scripts, the nation's largest pharmacy benefit manager, found that the number of young American adults taking ADHD medications nearly doubled from 2008 to 2012, from 340,000 to 640,000 among those between the ages 26 and 34. These medications include stimulants such as Adderall and Concerta as well as non-stimulants such as Strattera. The total number of American adults taking ADHD medications rose 53 percent, to 2.6 million, during that time, according to the report.

The drugs can alleviate symptoms associated with ADHD, such as severe inattention and hyperactivity, but can also lead to sleep deprivation and appetite suppression. In rare cases, they can result in addiction and hallucinations.

Now it appears that ADHD drugs are being misused for the purpose of increased productivity.

A recent story in the New York Times profiled Elizabeth, a young health-tech entrepreneur (who did not want to disclose her full name), who bought ADHD medications from a dealer in order to stay focused and alert from late at night to well into the morning so she could finish writing PowerPoint presentations and other tasks.

The story was based on interviews with dozens of people who worked in a variety of professions who said they and their co-workers misused stimulants such as Adderall to improve their work performance. Many of the interviewees said they obtained the drugs fairly easily by faking symptoms of ADHD to doctors in order to get their prescriptions.

Kevin Troutman, who spent 17 years as an HR practitioner in the healthcare industry before switching careers to become an employment attorney, says the misuse by employees of legal drugs-long a concern in the healthcare sector-has now spread to most other industries.

"It is becoming more of an issue because more and stronger medicines are available and people are tempted to use them in the workplace," says Troutman, a partner at Fisher & Phillips in Houston.

One reason for the prevalence of addiction to legal drugs is cultural, says Paskin.

"In modern medicine today, instead of prescribing some sort of behavioral modification and therapy-things that tend to take time-doctors prescribe drugs instead," says Paskin, himself a recovering addict. "And those drugs have a propensity for abuse and dependence.

"It's a belief system we're indoctrinated with: Why not just take this medication that makes the pain go away?" he says. Indeed, opiate addiction arising from the misuse of painkillers has become a scourge of many workers compensation programs, he adds.

The misuse of these drugs is a tough issue for HR to address, says Joseph Utecht, service delivery manager for Minneapolis-based employee-assistance program provider Ceridian LifeWorks, adding that such cases made up only a small number of the 1,000-plus substance-abuse cases referred to his firm last year.

"These are legally prescribed drugs-if someone has a valid prescription, then it's hard to know if he or she has a problem," he says.

Things are further complicated by the fact that one of the potential signs of addiction-a sharp increase in productivity-is something that managers and supervisors tend to celebrate, not discourage, says Utecht.

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HR should stress that productivity arising from the misuse of an ADHD drug will likely lead to problems down the road, says Troutman.

"I'm sure there are times when supervisors are feeling the pressure to do more with less and so are employees," says Troutman. "So it comes down to articulating the company's values: 'We're not going to compromise the health and safety of our employees just to get things done-it's not the right thing to do and it's harmful in the long-term.'"

Another option is enhanced drug screening, says Troutman.

"Most companies have been doing the traditional five-panel drug screen, but should probably look at doing a seven- or nine-panel drug screen that can detect these medications," says Troutman. "Employees who test positive and who don't have a prescription can be referred to the EAP."

Employees themselves are often reluctant to seek help from HR, says Paskin.

"A lot of times, HR exists to benefit the company, not the quality of life for the employees," he says. "When you're an employee talking to HR, you often feel a certain amount of distrust."

Member-assistance programs, which are usually sponsored by unions as well as a small number of employers, offer an alternative, says Paskin. These programs give employees an opportunity to seek counseling and support on a confidential basis from peers who've gone through similar struggles, including addiction, he says.

HR can also refer to the company's wellness strategy in discouraging abuse-and note that the misuse of any drug is the opposite of well behavior, says Utecht.

"If a company fosters a culture of wellness from the top down, and stresses that employee health is too important to sacrifice for the sake of short-term productivity, that may help," he says.

In all cases, HR should do what it can to discourage the stigma that often discourages employees from seeking help in the first place.

"There should be greater understanding that addiction is a medical and mental health issue-the workplace should try and instill an atmosphere of love, compassion and understanding regarding this issue," says Paskin.

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