Drug-Expectancy Induced Benchmark Feedback: Measuring Distress and Disability Under the Influence

This was written for Washington State University’s SOC-368 course. There are minor edits post submission here for readability.


Being unable to focus on class, fidgety, and inability to sit still, might garner a diagnosis or overdiagnosis of attention-deficit hyperactivity disorder (ADHD). Yet the American Psychiatric Association, not to be confused with the American Psychological Association, defines mental disorders as reliant on comparison within a prevailing culture. This prevailing culture effectively includes those already drugged as treatments of choice in said disorders., such as stimulants for ADHD (e.g., Adderall, Ritalin etc.). It may be said, considering the American Psychiatric Associations’ acceptance of cultural benchmarks, that bars of performance are driven higher and higher under cultural influence of stimulants. This phenomenon herein is consolidated as drug-expectancy induced benchmark feedback

Found in the American Psychiatric Association’s (2013) Diagnostic and Statistical Manual, Fifth Edition is a cultural benchmark of human disorder: “thresholds of tolerance for specific symptoms or behaviors differs across cultures, social settings, and families” (p. 14), where these thresholds later determine “distress and disability” in the definition of mental disorders (p. 20). It is in this case that stimulant drug using groups (e.g., schools, races, ethnicities, societies, businesses, families, communities of practice etc.) themselves exhibit feedback loops in cultural thresholds used in the diagnosing of disorders. These benchmarks themselves, sociologically, are in themselves social facts pressuring individuals (i.e., strain) aspiring to greater levels of status (i.e., success, grades, merit, celebrity etc.), where incomplete understanding is run with to excess in promising the next big thing for success. The story of ADHD medication, and increasing benchmarks is not without precedent: consider the morally disengaged, euphemistically labeled (Bandura, 1999), “performance enhancers”.

A Parallel with Athletic Sports

During an Intelligence2 Debate in 2008, Norman Fost of the University of Wisconsin argued for performance enhancers in sports, employing a technique of neutralization (Sykes and Matza, 1957), that Kalich (2001) titled everyone else is doing it adding “and getting away with it”. Fost argued that “everyone in this room using performance enhancing technology and drugs… every athlete in recorded history has used performance enhancing drugs. Babylonians and Romans used herbs to improve their performance in battle. Naked Greeks put on shoes to run faster, and runners everywhere carbo-loaded before races to enhance their performance” (as cited in Katz, 2008, 00:01:46). Who might this “everyone else” be in the case of ADHD? Is it those on ADHD drugs? 

In response to Fost, Richard Pound, former Chairman of the World Anti-Doping Agency lays an ethical claim against performance enhancers, “… and if everyone else is doing what they’re doing, then instead of taking 10g or 10cc of whatever it is, they’ll take 20, or 30, or 40, and a vicious circle simply gets bigger. The end game will be an activity that is increasingly violent, extreme, and meaningless, practiced by a class of chemical, or genetic mutant gladiators” (as cited in Katz, 2008, 00:05:21). And there it is, a feedback loop, and it has evidence in market economics, it’s called compounding—the stuff success is made of. Considering the parallel of competition sports, it may be worth pausing to consider the epidemiology of ADHD.

Epidemiology of ADHD

Shi et al. (2021) reported in meta-analysis, in children, an ADHD prevalence rate of 4.8% with an incidence rate of .69% (p. 4). What is striking however is that racial differences are significant, where 78% of children diagnosed are white, 32% are Asian, 6% are black, 9.1% are Hispanic, and 3% are “other” (p. 4). Even more curious is that 50% of the diagnosed come from the southern census region, where 68% come from household incomes above $75,000. While a 4.8% prevalence seems small, this prevalence is a national population statistic, where this prevalence varies significantly by locality and racial composition. Even more interesting is that ADHD drugs are now sold to more adults than children (Mosher & Akins, 2022, p. 108). While some adults self-report use of ADHD drugs for recreation, 12thgraders in 2018 reported this at a 4.8% prevalence (as cited in Mosher & Akins, 2022, p. 109). This means that >95% of 12th graders in 2018 used ADHD drugs for diagnosed conditions. Is it possible that there is something happening in white southern census regions? It’s time to “fact check” social facts of ADHD drug efficacy.

Are ADHD Drugs Going to Lose Angel Status?

According to a widely supported study of ADHD efficacy in the Journal of Consulting and Clinical Psychology, Pelham et al. (2022) concluded:

Stimulant medication had no detectible impact on how much children with ADHD learned from three types of evidence-based, academic curriculum units taught in small groups in a summer classroom setting. These data are inconsistent with the belief held by many physicians, parents, and teachers that stimulant medications are likely to help children with ADHD learn academic material in school (Fiks et al., 2013). (Pelham et al., 2022, p. 377; citations retained).

That may deserve reading several times (there will be a test on ability to focus and sit still after this discussion). But wait, because another study from McBride et al. (2021) found that ADHD drug use in adults, while not affecting problem-solving, did help with “originality, flexibility, and fluency” in tests of creative thinking. These results seem contradicting.

And there are more contradictions from parallels with other drugs. Alcohol’s effects are known to be not only mediated but moderated by psychological expectancy (as cited in Mosher & Akins, 2022, p. 116). There are even arguments that cannabis itself may be an “active placebo” (as cited in Mosher & Akins, 2022, p. 158). Physicians, parents, and teachers may very well be exhibiting differential associated, labeled, and socially learned social facts in the moderation of attitudes (i.e., affect, cognition, and behavior) around expected outcomes. These drug effects are on a dimension with expectancy effects, where society collectively markets the good or service that is most attributed (or most likely attributed) the cause of said effects, whether efficacious or not in serving strain adaptations. Considering that evidence is now building that there is a faulty promise of success in the use of stimulant drugs to those diagnosed with ADHD, it is worth bolstering the argument of drug-expectancy induced benchmark feedback.  

A Parallel in the Film Industry

Logan Hill (2014) of Men’s Journal authors a compelling piece on the rising bar of appearance in action films, a rising bar driven by demand no longer satisfied by those willing to play action heroes, but those willing to, according to Deborah Snyder “to transform themselves… to be big and powerful and commanding”. Gunnar Peterson who worked with Sylvester Stallone and Bruce Willis claims there is an “arms race” for action heroes (Hill, 2014). Actors can be working non-stop hours in the workouts for films (Hill, 2014). Philip Winchester in Cinemax’s Strike Back, reports that “the drug of choice is the drug that makes you look good” (Hill, 2014). Human growth hormone (HGH), testosterone, and steroids are used in the film industry; there are hormone-replacement clinics, “dozens” of them (Hill, 2014). Echoes of a medicopharmocological athletic sports industrial complex abound. How can this be any different of a strain adaptation in physicians, parents, and teachers utilizing culturally contextualized benchmarks, influenced by expected drug effects (i.e., expectancy effects) and actual drug effects (i.e., drug effects) used in the demand for accelerated pathways to success? 


It is not surprising that the demand for big, powerful, and commanding is matched by valuations of tech companies in the largest companies of the world (Statista, 2022). These companies are demanding the big (halo effect of institutional degree), powerful (in labor efficiency ratio driving valuations), and commanding (attributing success to individualized dispositional qualities of command [i.e., male dominant ethnocentric imperialist culture]). It appears that overall, drugs used in academic, creative, and athletic domains share a common sociological phenomenon. A social sociological phenomenon whereby a dimension of expectancy effects to drug effects influence the very benchmarks used to label disorders at play in the business processes of industrial complexes’ distribution of solutions attributed efficacies expected and/or real in the acceleration of gains of… what exactly? A planet in the process of a mass-extinction event as a result of an acceleration of gains of… what exactly? A feedback loop of drug-expectancy induced benchmark feedback for… what exactly? Society’s the judge, society is as a judge—a judge that does not operate blind.


American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Bandura, A. (1999). Moral disengagement in the perpetration of inhumanities. Personality and Social Psychology Review, 3(3), 193-209. https://doi.org/10.1207%2Fs15327957pspr0303_3

Fiks, A. G., Mayne, S., Debartolo, E., Power, T. J., & Guevara, J. P. (2013). Parental preferences and goals regarding ADHD treatment. Pediatrics, 132(4), 692–702. https://doi.org/10.1542/peds.2013-0152

Hill, L. (2014, April 18). Building a bigger action hero. Men’s Journal. Retrieved from https://www.mensjournal.com/health-fitness/building-a-bigger-action-hero-20140418/

Kalich, D. M. (2001). Professional lapses: Occupational deviance and neutralization techniques in veterinary medical practice. Deviant Behavior, 22, 467-490.

Katz, J. (2008, January 23). Should we accept stereoid use in sports? [Audio podcast episode]. NPR Intelligence2 US. https://www.npr.org/2008/01/23/18299098/should-we-accept-steroid-use-in-sports.

McBride, M., Appling, C., Ferguson, B., Gonzalez, A., Schaeffer, A., Zand, A., Wang, D., Sam, A., Hart, E., Tosh, A., Fontcha, I., Parmacek, S., & Beversdorf, D. (2021). Effects of stimulant medication on divergent and convergent thinking tasks related to creativity in adults with attention-deficit hyperactivity disorder. Psychopharmacology, 238(12), 3533-3541. https://doi.org/10.1007/s00213-021-05970-0

Merton, R. K. (1938). Social structure and anomie. American Sociological Review 3(5), 672-682. https://doi.org/10.2307/2084686

Mosher, C. J., & Akins, S. M. (2021). Drugs and drug policy, 2nd ed. Sage.

Pelham, W. E. III, Altszuler, A. R., Merrill, B. M., Raiker, J. S., Macphee, F. L., Ramos, M., Gnagy, E. M., Greiner, A. R., Coles, E. K., Connor, C. M., Lonigan, C. J., Burger, L., Morrow, A. S., Zhao, X., Swanson, J. M., Waxmonsky, J. G., & Pelham, W. E., Jr. (2022). The effect of stimulant medication on the learning of academic curricula in children with ADHD: A randomized crossover study. Journal of Consulting and Clinical Psychology, 90(5), 367–380. https://doi.org/10.1037/ccp0000725

Shi, Y., Hunter Guevara, L. R., Dykhoff, H. J., Sangaralingham, L. R., Phelan, S., Zaccariello, M. J., & Warner, D. O. (2021). Racial Disparities in Diagnosis of Attention-Deficit/Hyperactivity Disorder in a US National Birth Cohort. JAMA Network Open, 4(3), e210321–e210321. https://doi.org/10.1001/jamanetworkopen.2021.0321

Statista. (2022). The 100 largest companies in the world by market capitalization. Statista. Retrieved from https://www.statista.com/statistics/263264/top-companies-in-the-world-by-market-capitalization/.Sykes, G. M., & Matza, D. (1957). Techniques of neutralization: A theory of delinquency. American Sociological Review, 22(6), 664–670. https://doi.org/10.2307/2089195