Lost in the Fog: The Search for Focus and Energy in an Era of Stimulants
Brain fog, fatigue, focus, ADHD, and stimulants: Lessons from Life and Medicine
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My worst fear, the crush of reality, and holistic medicine
During my childhood in Washington, DC, and nearby rural Montgomery County, I experienced a deeply traumatic yet eye-opening event. It occurred in the early 1950s during the frightening polio epidemic, before the polio vaccine was available. At that time, a child’s worst fear was becoming a random victim—possibly ending up paralyzed and in a wheelchair like one of my elementary school classmates or enduring life with breathing support devices, such as the iron lungs we often saw in newspapers and magazines. Suddenly, the healthy kid I was—enjoying the summer, working around the house, swimming, hiking with my dog Major, and climbing apple trees without fear—was hit with high fevers, a stiff neck, and headaches. I became so weak that I had to stay in bed. After several days, my parents grew worried and took me to the city to see a pediatrician. This time, there was no lollipop or penicillin shot.
The pediatrician, with his usual arrogant confidence, realized his worst fears during my exam and shifted from his calm, methodical manner into crisis mode. He immediately started calling the local children’s hospital. Despite everything, he managed to show a bit of his pleasant, calming bedside manner to my parents and me, saying everything would be alright, but we would need to take me to the children’s hospital ER for some tests and admission because I showed the classic signs of early polio. On our way to the hospital, my older brother began teasing me about polio, but I blocked out what the pediatrician had said and yelled back that he had never mentioned it. I was beyond worry, frozen with dread and anticipation of terrible possibilities.
After three weeks of evaluation and successful treatment for “Post Polio Meningitis,” not the paralyzing kind, thankfully, I was discharged feeling like a hero who had survived a journey through stormy waters. The experience gave me deep respect for dedicated, often-unsung heroes—the staff, nurses, and doctors—who worked tirelessly and cared for me despite some of my rebellious and mischievous behavior. It was during the days before modern, corporate-run hospital systems. Today, patient-centered care is less common, and the business model emphasizes efficiency and profits. Also, it was a time when reliance on medications, which were less accessible then, as well as surgical procedures, was lower, with a greater dependence on natural interventions like physical therapy in hot tubs, warm packs, personal attention, exercise, and rest. It left me with an indelible appreciation for teamwork, collaboration, and holistic approaches when available—and when they are considered safer and more beneficial than simply overusing medications.
Fascination and unrealistic expectations of stimulant medication and natural remedies
Later, when I decided to become a physician, I remembered being fascinated with the use of medications; it seemed to be a boon for whatever ailment you had. The demand for studying a lot and staying up late caused increasing fatigue, less concentration, and distractibility. My fellow students were always wanting to go out, party, and socialize—anything but keep their noses to the grindstone. One of my classmates, whose father was a doctor, had gotten one of the stimulant meds, probably something like Ritalin. He said, “Here, try this before we go into that tough exam tomorrow. It will help you study better and concentrate more.” I figured it would be a safe miracle of modern medicine. And since his father was a doctor, it seemed like a reasonable thing to do, better than that terrible-tasting, GI-upsetting coffee I used on occasion since college.
Taking the pill turned out to be a near disaster. When I got to the test, I felt wired and anxious. When I encountered problems that I couldn’t solve or answer, my heart began pounding in my chest, and feelings of panic were setting in. Luckily, I had the common sense to put my head down on my desk for a few minutes until I calmed enough to resume and complete the test. It was a great learning experience that medication was not always the best strategy, and that perhaps more sensible, natural, and strategic ways to learn and succeed were the best considerations.
Difficulty with Adderall and stimulant medication
Using Adderall and similar prescription stimulants is prevalent both among those with legitimate ADHD diagnoses and a growing number of young professionals and students seeking enhanced productivity. Recent years have seen a sharp increase in ADHD diagnoses and stimulant prescriptions, driven in part by easier online access and self-diagnosis through social media. This surge, combined with manufacturing delays and federal production limits, has led to a nationwide shortage of Adderall, causing significant disruptions for those who depend on it to function in their daily lives.
Adderall and similar prescription stimulants have been prescribed more frequently to people officially diagnosed with attention deficit hyperactivity disorder (ADHD). An increasing number of individuals are independently seeking both prescription and non-prescription medications or alternatives, including young professionals and students aiming to improve focus, energy, and productivity. There has been a sharp rise in ADHD diagnoses and stimulant prescriptions, or self-diagnosing and using stimulants, because of easier online access and self-diagnosis through social media and influence from others in their social networks.
Misuse of Adderall or other stimulants is becoming more common. Getting stimulants without prescriptions or using counterfeit versions can be dangerous to health and life. While medications like Adderall can enhance focus and productivity, misuse and lack of medical oversight can lead to serious side effects, including cardiac arrhythmia, mood swings, and substance use dependency.1
The Diversion Control Division of the Drug Enforcement Administration has informed practitioners about a seminar on Stimulant Safety in ADHD, since it is the most common neurobehavioral disorder treated by healthcare providers. The stimulants, including methylphenidate and amphetamine, are frequently prescribed medications. These stimulants have potential for abuse, and nonmedical use (NMU), including misuse and diversion, has raised significant concern among practitioners.2
I remember when I was consulting, early in my medical career, at a specialized day school for teenagers with behavioral and learning difficulties. The program was subsidized by the county and state to serve these students and provide needed services. There were special education teachers, support staff, therapists, and social workers, along with a team that conducted home visits to assess the child’s home environment and support the parents or guardians to help the child succeed in school. As a consulting psychiatrist, I visited several days each week to perform evaluations and provide treatment as needed. There was always pressure from referral sources, usually the schools, and the staff of our agency, to use medication to reduce disruptive behaviors and hyperactivity, and to improve academic performance, focus, and concentration.
One child I saw was small for his age and was frequently bullied by the other children. Most of the time, he would sleep in the classroom with his head on his folded arms, falling behind in classwork. Teachers and his grandmother insisted I put him on one of the stimulant medications of the day to help him, with this, thought to be ADHD. When his grandmother, with whom he lived, was interviewed, it became clear he wasn’t sleeping more than a few hours a night, as he drank caffeinated soda most of the day and at night too, and he watched TV into the late-night hours. Also, he was an unhappy child, as other peers in the neighborhood bullied him. In addition, he would receive punishment from his grandmother when he was late coming home, avoiding the threatening children who tormented him on his way.
A specialized staff with our program set up home visits and worked with him and his grandmother in the home about simple and effective changes to allow him a quiet sleeping space without a TV, improving his diet with avoidance of caffeine, especially in the afternoon and evening, towards bedtime. Also, strategies to build his self-esteem and confidence were made, such as after-school programs where he was involved in activities that interested him and taught him skills. Interventions were made to help him protect himself from bullies. The school curriculum was changed to have more in his areas of interest, where his learning style allowed better mastery. With these available services in a specialized school program, he did well, was a more attentive and focused learner, and his moods improved with less anxiety. Of course, in today’s world, with education funding and programs with staffing being cut back, the specialized classroom program where I worked will be eliminated. Unfortunately, more children will go without their needs being met, and there will probably be more use of medications in the hope of at least short-term benefits.
In my experience, many treated with psychostimulant medications such as Ritalin or Adderall, or other ADHD-specific interventions, do not always benefit as expected, when other more productive and essential needs are not addressed, such as critical immediate needs, environmental factors, and adverse lifestyle. The medications can show benefits for a hyperactive, disruptive child or adult with angry or dysphoric moods. Benefits, unfortunately, are not always sustained. Medication side effects can lead to poor compliance or cessation of medications. Stimulant medications can energize a mind bored with an uninteresting or unstimulating environment or exposure to unstimulating educational material that does not align with a person’s interests. Holistic approaches impressed me, especially when they appeared to be more effective than relying solely on medications, leading to notable improvements in the child’s mood, behavior, and academic performance.
Dr. Lisa Weyandt, the director of the Interdisciplinary Neuroscience Program at the University of Rhode Island, studied ADHD, medication use in treatment, and drug misuse. In her research on Adderall use by college students who do not have ADHD but regularly obtain the drug without a prescription as a study aid, she found that although they felt their academic performance improved while on Adderall, the study revealed “that not only did it not improve their reading comprehension, or their problem-solving, or their executive function skills, but found that it impairs their short-term memory.” It appeared to have little impact on neurocognitive performance. Though her study had a small sample size, the results should be interpreted cautiously. Although it challenges some of the popular assumptions about the use of stimulant medication in the treatment of ADHD, her study warrants more extensive study, especially with the widespread use and unfortunate misuse.3
Beyond the Pill: The Struggle for Mental Sharpness in a Distracted World
An article by Park MacDougald, “I Tried Wall Street’s Famous Brain Drugs,” highlights the widespread use of both natural and pharmaceutical stimulants to increase productivity, focus, and concentration. The author has personal experience with productivity-enhancing drugs (PEDs), including prescription stimulants and nootropics, which are chemicals that claim to boost cognitive functions like attention, memory, and wakefulness. Prescribed Vyvanse was used during graduate school to handle heavy workloads, which he felt improved his focus and productivity, but also caused significant side effects and ultimately led him to stop taking it.
MacDougald eloquently said, “But it’s no real mystery about their popularity. The human mind does not want to spend eight hours or more per day planted in front of a computer screen, when there are far more inherently interesting activities it could be dedicating its attention to. Learning to suppress these impulses and knuckle down anyway is, of course, the work of civilization, and yet our minds nonetheless frequently revolt. We feel bored, tired, distracted; we are assailed with bouts of “brain fog,” in which we seem to be operating a standard deviation below our normal IQ; our brains keep us up at night with worries or misplaced energy, ruining our sleep and thus sapping our performance the next day. Nonetheless, we must work. And so we seek a little help.”4
Having experienced brain fog, fatigue, reduced focus, and concentration issues at times in my own life and career, I have also been particularly interested in the struggles of some of my colleagues and individuals I encountered in my medical and psychiatric practice. Additionally, I have become more aware of how symptoms like these are often labeled in unhelpful ways and of the self-help strategies that are sought as remedies or solutions. Understanding brain fog, fatigue, and concentration issues may help in finding sensible solutions to common cognitive complaints that could otherwise lead to problematic treatments or substance misuse behaviors. Getting a medical or mental health evaluation can be crucial if an underlying cause or treatable condition is a possibility.
Click on the link below for my companion article, which is more specific to brain fog, fatigue, and concentration issues!5
I appreciate your interest. Please share with others. Thanks to Shan Parks, editor and project manager, for his valuable contributions and editing. All content is created and published for educational purposes only. It should not be considered as a substitute for professional medical services or guidance. Always consult a healthcare provider for care related to medical or mental health conditions. This communication does not provide medical diagnoses, recommendations, treatment, or endorsements.
U.S. Department of Justice Drug Administration Diversion Control Division, Stimulant Safety in ADHD Virtual Seminar, Wednesday, September 3, 2025
Virtual Session (ZOOM), REGISTER NOW FOR THE VIRTUAL SEMINAR. Questions regarding this conference may be directed to: VDAT@dea.gov
Neurocognitive, Autonomic, and Mood Effects of Adderall: A Pilot Study of Healthy College Students by Dr. Lisa Weyandt, the director of the Interdisciplinary Neuroscience Program at the University of Rhode Island
I Tried Wall Street’s Famous Brain Drugs 08.02.25 by Park MacDougald, “My experimental high and crash through the not-quite-legal, sort of effective, occasionally heart-pounding medicine cabinet of Wall Street and Silicon Valley’s productivity optimizers.” Park MacDougald is editor of The Scroll, a daily afternoon newsletter from Tablet magazine, and a fellow at the Manhattan Institute. The article was originally published in Colossus Review
very timely info, thanks, Ron!