By Teresa Bergen
What does it take to get ahead in college these days? For a growing number of students, the answer may involve intense hours of study, all-night paper-writing sessions, a laser-like focus to achieve good grades — and a stimulant to help them achieve those goals. The stimulant, however, is not coffee or even a street drug bought illegally, but Adderall or Ritalin, common prescription drugs used to treat ADHD. In many cases, students take these psychostimulants, or “smart drugs,” off-label, meaning they are taking the drugs for a condition they do not have.
Why? Drugs like Adderall and Ritalin can enhance cognitive performance, helping a student to get motivated, fight off fatigue, cram for tests, improve concentration and focus, and — some say — gain a competitive academic edge. But the drugs don’t come without side effects: In the short term, they may cause problems such as increased heart rate, irritability, insomnia, loss of appetite, headaches, nausea and other side effects. In the long term, the so-called “study drugs” may rob developing brains of their plasticity, meaning that a “good student” now may become a less flexible, less creative thinker down the road.
The Drug Next Door
For a little background, consider this: Adderall and Ritalin are classified as Schedule II drugs, which means they have both accepted medical use and a high potential for abuse and addiction. By comparison, morphine, methadone and cocaine are also in the Schedule II category.
But ADHD drugs are used so frequently and casually on college campuses that a research project at West Virginia University dubbed them the “drug next door.” The WVU survey, with 208 respondents, revealed that 30% of users admitted to having taken ADHD drugs as study aids, and 10% felt dependent on ADHD meds to finish schoolwork. Students also used ADHD drugs for recreational purposes and to lose weight.
In another study, presented at the Pediatric Academic Societies annual meeting in May, researchers polled 616 students at an undisclosed Ivy League college. Nearly 1 in 5 students (18%) reported misusing a prescription stimulant while studying, and 33% of the students did not view such misuse as cheating.
Here are some signs that might point toward abuse of ADHD drugs:
- Dilated pupils
- Excessive excitement, talking or irritability
- Increased thirst
- Decrease in appetite or weight loss
- Obsessive studying, cleaning, drawing or other compulsive behaviors
- Erratic sleep patterns
ADHD drugs are so widely used because they’re fairly easy to get. Some students feign the symptoms of ADHD to get their own prescription from their doctor or the campus health clinic. Others buy pills from a student who got the drugs legitimately or by some other means. Since the rise in ADHD as a common diagnosis in the 1980s, the drugs are approaching ubiquity, at least on high school and college campuses. Because of ADHD drugs’ prevalence, people regard these drugs much less seriously than street drugs and often fail to consider their side effects.
Kimberly Urban, a postdoctoral research fellow at Children’s Hospital in Philadelphia, who holds a PhD in neuroscience, has done research on ADHD drugs. She became interested in the topic when she couldn’t find any good studies on how ADHD drugs affect developing brains. “A lot of the work has been done in adult rats, but we give the drugs to human children,” she says. “There was a huge gap in research.”
Urban decided to fill this gap by studying the effects of ADHD drugs on developing brains. She concurs that ADHD drugs are widely used and abused on high school and college campuses — particularly during times of academic stress. In a study conducted at the University of Puget Sound, in Tacoma, WA, chemists tested the college waste water system for amphetamine and ritalinic acid, the metabolites of Adderall and Ritalin. (A metabolite is the product that remains after a drug is broken down or metabolized by the body.) They concluded that ADHD drug use was more prevalent during high-stress exam periods during the school year. During low-stress times — such as the first week of classes — only a small number of students took amphetamines, which could correlate with legitimate prescription use. Amphetamine use increased during midterms, finals and the last week of classes, with the highest increase — 760% over baseline — occurring during finals week of the second semester.
Dealing With Side Effects
How exactly do ADHD drugs work? Neurotransmitters are chemicals that transfer information between neurons in the brain. ADHD drugs work by boosting neurotransmitters, especially dopamine and norepinephrine, which regulate mood and behavior. When taken as prescribed, these drugs can calm people with ADHD and help them to better focus.
But students who take ADHD drugs off-label may experience different outcomes. For example, off-label users often try to adjust drug levels to achieve optimal effects. If they take too much of the drug (prescribed dosages are based on age and sometimes weight), the ADHD meds can overwhelm the prefrontal cortex — or command center — of the brain. This causes users to become distracted or impulsive, much like someone with ADHD. Individual brain chemistry will also dictate how the drugs affect certain people, especially since different users will metabolize the drugs more quickly or slowly.
ADHD drugs come in pill form for oral ingestion. But some students find ways to speed up the drugs’ effects by snorting, injecting or inserting the powdered pills into the rectum. This may trigger a big release of dopamine, causing a feeling of euphoria.
Here are 3 types of ADHD drugs, popular among college students:
Adderall and Vyvanse are the most common amphetamines prescribed for ADHD. Adderall is illegal in many countries, including France, India and Japan, because of its high abuse potential. It triggers the release of adrenaline, which increases blood flow to muscles and quickens the heart rate, causing users to feel invigorated and better able to concentrate.
Side effects: Since amphetamines like Adderall and Vyvanse speed up heart rate, they can lead to cardiovascular problems such as high blood pressure and arrhythmia. The adrenaline can also trigger side effects such as loss of appetite, weight loss, dry mouth, stomach upset and pain, nausea, dizziness, diarrhea, nervousness and trouble sleeping. A few days of amphetamine abuse coupled with sleep deprivation could cause paranoia and psychosis — symptoms that could worsen until a person stops the amphetamine use and returns to a normal eating and sleeping schedule.
Adderall can also be dangerous when used recreationally in conjunction with alcohol, as it offsets the effects of the liquor. Students using both drugs might not realize how much alcohol they’ve consumed, which can lead to sudden alcohol poisoning.
These drugs, which include Ritalin and Concerta, have the same effect on the brain as cocaine. Like cocaine, Ritalin is a powerful stimulant that increases alertness and productivity. Ritalin and cocaine also look and act very much alike. They have a similar chemical structure, and both increase dopamine levels in the brain, leading to increased focus and concentration. These psychostimulants are prescribed to treat ADHD and narcolepsy, a disorder that causes excessive sleepiness and frequent daytime sleep attacks.
Side effects: Because methylphenidates affect the central nervous system, they can cause fast, pounding or uneven heartbeat, restlessness and aggression. They can also contribute to nausea, insomnia, dizziness, weight loss, numbness and diarrhea.
Sold under the brand name Provigil and prescribed for sleeping disorders, modafinil has been used to treat ADHD on an off-label basis. It alters the natural chemicals (neurotransmitters) in the brain and boosts dopamine levels, thereby enhancing memory, promoting wakefulness and improving concentration on mental tasks. Modafinil — which is not an amphetamine — is classified as a Schedule IV controlled substance, which is 2 classes milder than Adderall and Ritalin and has a lower potential for abuse. Other Schedule IV drugs include lorazepam (Ativan) and diazepam (Valium), medications used to treat anxiety, insomnia and other conditions.
Side effects: Modafinil’s most common side effects include headache, nausea, nervousness, diarrhea, back pain, anxiety, dizziness and insomnia. Since the drug is relatively new to the market (it was approved in 1998 by the FDA for the treatment of narcolepsy), its long-term effects are as yet unknown.
While the short-term side effects of ADHD drugs are well-documented, the long-term implications for young people may be surprising and worrisome. Most parts of the brain finish developing in childhood. But the prefrontal cortex — the part of the brain ADHD drugs most affect — isn’t fully formed until the age of 31 or 32, says Urban. She and Wen-Jun Gao, a professor in the department of neurobiology and anatomy at Drexel University College of Medicine, in Philadelphia, published a literature review on the effects of ADHD drugs on developing brains in the May 2014 issue of Frontiers in Systems Neuroscience. They found that using these drugs can rob healthy developing brains of their plasticity.
Plasticity means having a sufficient amount of behavioral and attentional flexibility. To explain behavioral flexibility, Urban gives the example of a rat in a box with two levers and a dish in the center. The hungry rat quickly learns that pressing the right-hand lever makes food rain into the dish. But then the rules change and pushing the right-hand lever no longer yields food. A flexible brain will try the left-hand lever to see if that works. “If you don’t have behavioral flexibility, you keep on pressing the right-hand lever even though you don’t get food,” says Urban.
Attentional flexibility refers to one’s ability to quickly shift attention from one stimulus to another. For example, when you’re driving a car and someone cuts you off, you must quickly focus on not rear-ending it. Cutting down on attentional flexibility can appear to be a good thing in a classroom, Urban says, if it makes the student focus solely on the teacher. But over time it can lead to decreased creativity.
William Graf, MD, a professor in the neurology department at the Yale School of Medicine, in New Haven, CT, worries that young people taking these drugs are deprived of the chance to develop into authentic individuals. “Neuroscience studies show that amphetamines may help people maintain focus on mundane tasks, but the drugs tend to decrease cognitive flexibility,” he wrote in an email. “There is no evidence amphetamines help the process of creativity. I guess my biggest worries are that we might raise children to feel they need to take drugs to compete in school — but in the long term, amphetamines will only tend to make people into robotic thinkers, not creative thinkers.”
The Possibility of Addiction
Do people get addicted to ADHD drugs? The manufacturers say no. Jeff Jonas, MD, former senior vice president for research and development at Shire Pharmaceuticals, said in a 2012 interview with the New York Times, “I’m not aware of any systematic data that suggests there’s a widespread problem. You can always find people who testify that it happens.” Shire makes Adderall and Vyvanse.
Sure enough, people testify to their struggles with these drugs all over the Internet. Physically the body can withstand withdrawal from these drugs, but the psychological impact is heavy. When you’re in the habit of adjusting neurotransmitters that control your feelings of pleasure and reward, stopping suddenly can cause disturbed sleep patterns, extreme fatigue and depression, explains the National Institute on Drug Abuse. According to a High Times article, “Withdrawing from an amphetamine addiction doesn’t cause vomiting or sickness as with heroin, but it does cause extreme agitation, irritability and (ironically) an inability to focus. Long-term amphetamine addicts also report anhedonia, or the inability to feel a sense of enjoyment or pleasure without the aid of some chemical stimulant, which can linger for long periods after quitting.”
One anonymous user posted online that Adderall is “a soul crusher,” adding, “I don’t want to feel sad, and scared, and suicidal because of a pill.” She called her addiction worse than crack because the Adderall is so easy to get. A Brigham Young University study cited another user’s tweet: “Adderall, Coffee, Red Bull. Epic focus. Or a heart attack.”
More patients are landing in rehab centers from ADHD drug abuse, or after using these drugs as a gateway to other prescription drugs, such as the popular time-release painkiller OxyContin. Insight Counseling, a small center in Ridgefield, CT, treated more than 50 high school students for prescription stimulant abuse in a single school year, according to the New York Times.
College students with prescription stimulant habits may doubt their ability to succeed in school without their drugs. More and more, an analogy is being drawn between smart drugs and academic success, and steroids and sports performance. Just as many athletes start taking steroids to keep up with their opponents, many students feel they must use Adderall and other ADHD drugs to remain academically competitive.
Using ADHD drugs as neuroenhancers isn’t going to stop any time soon. So researchers like Urban are trying to learn the facts about these drugs. “Everybody has to make a decision for themselves about what they want to do with their own body and brain,” she says. “But I think it’s important that we iron out the risks for all these different people in different age groups.” Students seeking a straight-A average or to gain that elusive academic edge may not pay much heed to those risks. But with more information in hand, “they can make their own educated decisions,” Urban says.
Narcotics Anonymous (free help with any drug addiction, not just narcotics)
For More Information
Rise of the Study Drug: What Social Media Reveals About Students’ Abuse and Use of Adderall (Coalition Against Drug Abuse)
The Teen Brain: Still Under Construction (National Institute of Mental Health)
Tweaking and Tweeting: Exploring Twitter for Nonmedical Use of a Psychostimulant Drug (Adderall) Among College Students (Journal of Medical Internet Research)
Are Smart Drugs a Smart Way to Get Ahead? (Psychology Today)
Teresa Bergen is a Portland, Oregon-based health, fitness and travel writer. She’s the author of Meditations for Gym Yogis: An Easy Intro to Yoga Philosophy. Visit her website www.teresabergen.com.