For doctors across the country, the story is becoming all too familiar: After finishing college, young adults begin looking for their first professional job. Some of these recent graduates arrive with more than just a diploma. They also come with an addiction. They are hooked on “study drugs.” They illegally take these powerful prescription medicines to improve their performance on tests and other tasks.
DeAnsin Parker has just such a patient. Parker works in New York City as a clinical neuropsychologist. That’s a psychologist who studies and treats mental disorders. Her 23-year-old patient recently graduated from a competitive university in Canada. And she is addicted to Adderall. It’s one of a handful of drugs commonly prescribed to people with Attention Deficit Hyperactivity Disorder.
The symptoms of ADHD, as the disorder is commonly known, include difficulty focusing, controlling impulsive behavior and stopping fidgeting. Doctors describe this last symptom as over-activity or hyperactivity. ADHD is usually diagnosed by age 6 or 7. Its symptoms often continue into adolescence and adulthood. ADHD is common too: The disorder affects 9 percent of American children between the ages 13 and 18.
Parker’s patient starting taking Adderall in high school, but she doesn’t even have ADHD. “She faked the symptoms,” Parker explains. The young woman wanted the medication because “she thought it would help her with her SAT.” The Scholastic Aptitude Test is a standardized college entrance exam. An SAT score can play a major role in determining whether a student gets accepted to a top-notch school.
Research has shown Adderall and other similar drugs — sold as Vyvanse, Ritalin and Concerta — effectively treat ADHD. The medicines help patients avoid distractions and stay focused during important tasks, including schoolwork. Although it may seem surprising, these drugs actually are stimulants. These medicines can have an effect similar to caffeine: They “stimulate” the brain. However, stimulants can have a calming effect on children.
Students may see ADHD drugs as a way to enhance their mental performance. Misusing the drugs helps them do their best — or so they think. Research shows that students who misuse prescription drugs get worse grades over time than do students who don’t take study drugs.
Abusing ADHD drugs is cheating too. It is just like Lance Armstrong and other athletes using drugs to enhance their physical performance. Unfortunately, students don’t always see it that way. And worse, the misuse — or abuse — of ADHD drugs can be hard to quit.
Inappropriately prescribed and used
Parker’s patient didn’t stop using Adderall after taking the SAT. She told herself that she could not have performed nearly as well without the drug. Afraid she might not be able to keep up in college, she kept using Adderall, says Parker. Even after graduation, the young woman and many others just like her began looking for jobs — still “strung out on Adderall.”
High school students frequently come to Parker’s office, asking her to diagnose them with a learning disability or with ADHD. If Parker determines they do not have a disorder, she refuses to recommend medication. Unfortunately, teens often refuse to accept that decision.
Many mental health professionals encounter that same problem. Rather than be discouraged, patients say they will ask a family physician or a psychiatrist for a prescription instead. A psychiatrist is a medical doctor who specializes in the diagnosis and treatment of mental disorders.
“All they have to do is say they can’t focus,” Parker says. That can be enough to convince some doctors to prescribe ADHD drugs. And once students start taking these medications, they may convince themselves “that they focus better and can study better,” she adds.
Even some parents will pester doctors about getting their child on an ADHD drug, Parker says. They hope it will help their children keep up their grades and stay competitive with other students. A growing problem is that students who cannot get a prescription often buy study drugs from others who do have a prescription.
This has serious consequences: ADHD drugs are not harmless. Medications such as Adderall can be dangerous when used inappropriately. They are controlled substances. That means it is illegal to use them without a valid prescription. This is because there are serious health risks to misusing these drugs. ADHD medicines also can create a dependency: The brain comes to rely on them in order to function properly. This is called an addiction.
When people try to stop using ADHD drugs, they may experience extreme mood swings and behave strangely or unpredictably. The symptoms are “all the things that we see if someone were getting off a cocaine addiction,” Parker notes. In rare cases, people who have misused ADHD medications have even died by suicide.
In addition, study drugs can lead to a cycle of drug abuse. In the short term, study drugs can help students stay alert and study late into the night. Over time, without enough sleep, overly tired students may turn to other drugs each morning to help jolt their bodies awake. And since study drugs make the mind alert for long periods, some users may need other drugs to help them relax or fall asleep. For too many of these students, Parker concludes: “There will be a cocktail of drugs that they take all day long.”
A 2013 national poll by the C.S. Mott Children’s Hospital at the University of Michigan found that 1 in 10 high school sophomores and more than 1 in 8 high school seniors have used a prescription drug to help them study. Older research, supported by anecdotal reports, suggests the actual share of students misusing ADHD drugs is much higher.
Only 1 in 100 parents report that their children have used a study drug, the new Mott poll found. That suggests parents are largely unaware of how commonly these medicines are misused.
Pushing the accelerator
ADHD medications combine a blend of amphetamine (am FET a meen) compounds, commonly referred to as “uppers.” One tablet of Adderall, for instance, contains four different types of these stimulants. Amphetamines push certain chemical messengers in the brain into overdrive. This leads to increased heart rate and blood pressure. When used for recreation, amphetamine is known as “speed.”
Indeed, Adderall “jazzes the brain up, turns it on and makes it more active, quicker,” says Don Catlin. He’s the founder and former director of the Olympic Analytical Laboratory at the University of California, Los Angeles.
For children, teens or adults diagnosed with ADHD, taking the right dose of prescription stimulants can help them concentrate. Doctors have confirmed the drugs’ effectiveness in people who truly have the disorder.
One reason why it is dangerous to misuse ADHD drugs is that peoples’ brains have specific wave patterns throughout the day, explains Parker, the neuropsychologist. These patterns of electrical activity in the brain are named with Greek letters, such as alpha, beta, gamma and delta. Which waves dominate depend on what our bodies have asked the brain to do — for example, think, rest or listen to music.
In the beta state, the brain lies alert and ready. Meanwhile, in the alpha state the brain is meditative and calm, like when we are daydreaming. “We have to have both in our lives everyday,” Parker says. “You’re not supposed to be stimulated and alert all the time.
For this reason, when doctors prescribe ADHD drugs to schoolchildren, they typically ask parents to give their kids these meds only during the academic day. They should hold off giving them on weekends or over the summer break. In people who don’t truly need ADHD drugs at all, using these stimulants “over-excites the nervous system,” Parker says.
Over time, people who misuse these drugs come to depend on the chemical signals that the medicines send to the brain to stay alert. So when people stop taking the drugs, they go through withdrawals — commonly called a “crash.” These stimulant abusers have trouble managing their emotions, often experiencing severe mood swings. Many no longer believe they can function without the drugs. This stimulant abuse also can lead to racing and irregular heartbeats. In severe cases, abuse of ADHD study drugs can cause hallucinations and delusions, or a false sense of reality.
To cheat or not
In 1984, Catlin developed the Olympic Analytical Laboratory as the first drug-testing facility for sports in the United States. In addition to steroids and hormones, many athletes also abuse ADHD drugs, he notes. “Nowadays Olympians can get permission to use a drug if they can show that they have the appropriate underlying disease,” Catlin says.
Additionally, “If you look at the number of Major League Baseball players that are permitted by baseball to use ADHD medications, it’s a huge number,” Catlin adds, hinting that these diagnoses are not realistic. Many baseball players and other athletes use these prescription drugs, he says, because they believe the medications “help them be more attentive, jump higher, swing faster and run farther.”
In sports, the misuse of drugs to get an edge is commonly called doping. Athletes who compete in the Olympics or other international sporting events must forfeit their medals if caught doping. Last year, for example, the International Cycling Union stripped Lance Armstrong of his seven Tour de France titles because of his longstanding use of doping agents.
In sports, doping is clearly cheating. In school, students who misuse study drugs see their doping differently, experts observe. “Students don’t really see prescription stimulants as cheating,” says Tonya Dodge. She conducts social psychology research at the George Washington University in Washington, D.C. “They’ll use Concerta or Adderall with their friends, but they don’t walk around thinking they’re a cheater.” Dodge believes that one reason for this difference is that sports often produces only a single winner. But in academics there can be multiple winners. “Everybody could get an ‘A,’ but not everybody can win a 100-meter race,” she explains.
Dodge decided to test her hypothesis. She suspected more students would consider steroid-using athletes as cheaters than they would people who used study drugs. For “Judging Cheaters,” a 2012 study published in the scientific journal Psychology of Addictive Behaviors, Dodge and her colleagues surveyed about 1,200 men in their first year at a large university. Her team gave each participant two hypothetical scenarios.
In the first scenario, they learned about “Bill,” a sprinter on a college track team with an important championship just a few weeks away. Worried that he does not have enough time to prepare, Bill gets steroids from a friend. Bill goes on to win the race.
In the next scenario, “Jeff” fears he is not prepared for an upcoming midterm exam. He’s also having trouble focusing when he studies. Jeff knows someone who has a prescription for Adderall. Jeff has heard it can help students focus. So Jeff asks his friend for some pills. When he takes his exam a few days later, Jeff scores much better than he expected.
Dodge asked the college freshmen in her survey to rate how much they agreed or disagreed with the following two statements: 1) Bill or Jeff were cheaters for taking prescription drugs; and 2) Taking the drugs had been necessary for Bill and Jeff. Dodge also asked the surveyed men how many times they had misused a prescription drug in the previous year.
As Dodge suspected, most of her survey takers viewed Bill (the athlete) as a bigger cheater than Jeff (the midterm-taker). She suspects that is because these students don’t believe that Jeff robbed anyone else of a good test score by taking study drugs. Furthermore, the study participants who had misused ADHD drugs themselves took a harder view of the steroid use. But they were willing to excuse Jeff’s misuse of Adderall for studying. Dodge also found that the college freshmen saw Jeff’s drug use as more necessary for success than Bill’s.
Don’t deceive yourself
Even parents may fall into this trap, Dodge says. Instead of seeing the abuse of prescription stimulants as cheating, parents may believe it is “for a greater good.” They might justify that attitude by pointing out that their child didn’t get enough sleep. Or they might feel a teacher hadn’t allowed enough time to prepare. Some parents might even argue that “It’s not a big deal — it’s no more than a cup of coffee,” Dodge says (paraphrasing what a parent might say).
Researchers emphasize that just as in sports, using study drugs to enhance one’s test performance is nothing less than cheating. “You’re not doing it on your own; you’re doing it with the aid of something else,” Dodge says.
If students and parents learn about the dangers of study drugs and accept that using them is a form of cheating, it would likely compel some students to stop, she believes. As in sports, Dodge argues — for some athletes, at least — if they “feel something is wrong, that it’s cheating, that it goes against the nature of their sport, then they might think twice about it.”