This post by Johanna Ryan touches on the problems of compulsive gambling and other compulsive behaviors that are linked to Abilify, SSRIs and Dopamine Agonists and also to Dopamine Agonist Withdrawal Syndrome (DAWS).
It was Lester Grinspoon’s 1975 book The Speed Culture that introduced me to the concept of “punding”: a drug-induced compulsion for repetitive, sometimes elaborate but essentially useless busywork. I read it, and something clicked: “Punding” explained an awful lot about my own behavior and that of other Adderall users in 2015.
The word was coined by a Swedish forensic psychologist, G. Rylander, who studied chronic IV amphetamine abusers. Here’s one account of punding behaviors among “speed freaks” in the 1960’s, which often centered on taking apart and re-assembling objects:
Watches, doorknobs, television sets, radios and phonographs, typewriters and children’s toys were among the common items of curiosity and analysis. Some were valueless … Many were quite expensive; one man dismantled a $1,200 hi-fi set. Another sorted, filed and put on display repainted electronic parts. This same man tiled his apartment, including the walls, in Armstrong vinyl pebble tiling, then painted the individual pebbles red, yellow, gold and black.
The Speed Culture, pp. 103-04. Punders usually seemed to enjoy their projects, but often were unable to stop even when they became unrewarding or counter-productive. Rylander described a burglar who began punding in the middle of a job and persisted, despite “an increasing fear that someone would discover him.” These human compulsions dovetailed with the “stereotypic” repetitive behaviors he noted in lab animals given amphetamines.
All this sounded a bit too familiar. I’d picked up The Speed Culture as part of my attempt to give up Adderall, the amphetamine I’d been prescribed as an “adjunct” when antidepressants failed or stopped working. In the process, I’d discovered an online community of recovering Adderall addicts at www.quittingadderall.com, about evenly divided between black-market “abusers” and people with doctor’s prescriptions for the stuff. Compulsive behaviors were a problem for many of them as well. A few of these – collecting, cleaning, scrapbooking – sounded just like the punding of Sixties speed addicts.
But by far the Top Two compulsions discussed on QA were excessive Internet use, and compulsive shopping. Were these the 21st century forms of punding? I’d found myself wasting plenty of hours on both: compulsive bargain-hunting that could at best save only trivial amounts of money, endless Googling of sometimes random topics that caught my attention. These “projects” seemed fun or practical at first, but quickly became like irritating and embarrassing itches it was impossible not to scratch. The link to Adderall was hard to deny, once it was pointed out.
If my own Web-surfing amounted to borderline punding, others in QA had been real master punders. Most were younger “digital natives,” totally at home with Facebook, online communities and Internet shopping. Some were also into complex gaming or virtual worlds such as Second Life. The opportunities to descend into punding seemed endless.
Many of these people worked in IT or in other jobs that required long hours on the computer. The Adderall-induced personality traits they disliked in themselves – indifference and impatience with people, compulsive fascination with tasks and things – were not always liabilities on the job. They could even be assets. Web-surfing and shopping (two closely related activities tightly integrated into American life) could be hiding a world of drug-induced punding among stimulant users, but the same could apply to long work hours and “getting ahead,” I realized.
So I started a new punding-project: searching the medical literature on punding. I found very little on amphetamines, most of it focused on methamphetamine addicts. However, the problem has really “come out of the closet” recently thanks to a new class of drugs called dopamine agonists, which stimulate the dopamine system even more powerfully than amphetamines. They’re mainly used to treat Parkinson’s Disease, which (unlike ADHD or depression) is clearly linked to a shortage of dopamine in the brain. These drugs have also been prescribed to treat Restless Legs Syndrome.
The drugs (Mirapex or pramipexole, Requip or ropinirole and others) first raised alarms for their ability to trigger two obviously dangerous compulsions: addictive gambling and compulsive sexual behavior or “hypersexuality.” As these were acknowledged and studied, other problem behaviors came into view: binge eating, compulsive shopping and a wide range of punding activities or “hobbyism.” There were studies and case reports from the US, UK, Ireland, Italy, France, Japan, Korea, Turkey and several other countries. I had no trouble finding references to compulsive computer use as a form of punding. Endless web-surfing was mentioned, along with compulsive production of spreadsheets and charts.
Punding, it seems, can take many forms. Often it’s a longtime hobby or occupation that escalates into a disruptive compulsion, making it hard to spot at first. The carpenter tinkers endlessly in his basement shop; the weekend card player spends hours playing solitaire or online games; the person who once simply kept a nice clean house now obsessively scrubs and organizes closets. And for those who spend a large part of their day online, Web searches and social media can also spin out of control. (Gambling and hypersexuality could also be indulged awfully easily online.)
Then I checked Twitter, and uncovered the Punding Motherlode. Here are just a few of the confessions I found posted under the hashtag #AdderallProblems:
These odd behaviors were a college in-joke for some, a genuine problem for others … but they were eerily similar to the “punding behaviors” of Parkinson’s patients on dopamine agonists. They appeared alongside Tweets about other Adderall and Vyvanse problems like tooth-grinding, heavy sweating, cigarette cravings, loss of appetite and insomnia. They seem to equally affect students “abusing” stimulants to cram for exams, and those “using” them as approved treatments for ADHD.
Young adults on Twitter clearly know a lot about the downsides of prescription stimulants, even if their doctors don’t. It’s little wonder QuittingAdderall.com now has several thousand registered users.
Why does punding matter? First, it can cause dysfunction and distress all by itself. It can waste enormous amounts of time, cause shame and embarrassment in the sufferer and interfere with work, sleep and personal relationships. If the cause is not understood, it may be seen as a character flaw for which punders blame themselves and are blamed by others.
It may also hold important clues to the problem of addiction and withdrawal. A problem called DAWS – Dopamine Agonist Withdrawal Syndrome – afflicts some of those who try to stop the drugs, plunging them into agonizing depression and causing a range of physical and cognitive problems. DAWS sufferers have a lot in common with amphetamine addicts, and some Parkinson’s researchers have compared DAWS to methamphetamine and cocaine withdrawal.
Since DAWS does not strike everyone, several studies have tried to determine who is most at risk. They have found a strong link between developing “impulse control disorders” (ICD’s) like punding, gambling or compulsive shopping while on these drugs, and developing DAWS symptoms on stopping them. In one study of patients who stopped dopamine agonists, 100% of the DAWS sufferers listed ICD’s as their reason for stopping, compared to just 41% of patients in general. Another study found strong correlations among DAWS, overuse of dopaminergic medication and ICD’s, especially punding.
Could this link between punding and addiction exist in Adderall and Vyvanse users as well? Certainly not all users get hooked. Many who use (or abuse) these drugs in college put them away when they leave school without much trouble. Others struggle with their addiction for years. Are Adderall users who get riveted to the computer, color-code their study notes and organize their closets at 2 am more likely to suffer from withdrawal symptoms when they try to quit?
If so, spotting punding and other ICD’s early might be very important, perhaps serving as a signal that the individual should taper off the drug as soon as possible. (One study linked punding not only to gaps in “executive function” but to thinning of the cerebral cortex. It’s possible, though far from proven, that we should regard punding as a marker for more serious damage.) Patients could be educated to recognize punding behaviors (as well as more shocking ICD’s like gambling or hypersexuality) as adverse drug reactions rather than personal flaws or quirks, and discuss them with their doctors.
The final reason to take punding seriously is the clues it could give us to a wide range of mood and behavioral problems. Take, for example, the recent popular fascination with Asperger’s Syndrome. Why do psychiatrists report increasing numbers of seemingly well-adjusted people seeking treatment for self-diagnosed Asperger’s – while other self-identified “Aspies” band together seeking acceptance? Why does it have such currency as a pop-psych diagnosis for difficult people (males especially) in our daily lives, while still being a rather “cool” problem to have?
The “Aspie” or “geek” traits most people find irritating – indifference or cluelessness as to others’ feelings, preoccupation with the technical details of one’s work or favorite pastime, rigid habits and obsessive leisure interests – overlap heavily both with punding and with the “Adderall personalities” our QA friends grew to hate and are trying to shed. In other words, stimulant-induced traits and behaviors. I’d like to know how many people who are diagnosed with Asperger’s syndrome in adulthood, or who identify with the disorder on hearing about it, have a history of stimulant use.
These traits aren’t limited to a geeky few. They’re found among society’s in-crowds as well as the folks we pigeonhole with pop-psych labels. Stimulants like Ritalin and Adderall aren’t the only drugs that can cause them. The “emotional blunting” piece of this puzzle—social withdrawal and reduced ability to care about others— is a common feature of SSRI anti-depressants. And while those drugs have been used to treat compulsive behaviors in some people (ranging from habits like skin-picking and hair-pulling to compulsive shopping and binge eating), they also have a pretty fair track record for causing them.
Of course, there are many pressures in the economy, workplace and culture that promote “Adderall” or “Aspie” traits and punding behaviors. It can’t possibly be just a drug-induced problem; some blame digital technology itself. But the drug component may be large enough to both magnify the numbers, and influence our attitudes towards the behavior. Learning to recognize punding-style compulsions, and their links to various drugs, might help many people who feel trapped in a depressing lifestyle without quite knowing why to name their problem and find a way out.
Hopefully it would not pathologize a whole new crop of people for their chosen pastimes or personalities. Still, de-normalizing and de-glamorizing some of these behaviors a bit might help us all. More than a few QA members will tell you they used Adderall to improve their performance on a job that required endless, exhausting screen-time … and now their efforts to kick the habit are making work a struggle again. “You cannot DO my job without Adderall,” they moan—and fellow “Adderallics” reassure them that “it’s OK to suck at work for awhile.” If our economic system is generating jobs that seem to cry out for Adderall (or Vicodin or Xanax, for that matter), maybe it’s the system that has a problem, not us.