October 17, 2009

A Misuser’s Guide to Adderall

(first appeared in the Harvard Crimson, April 28,2009)

The history of amphetamines shows that the use of Adderall to study or to get high at college campuses has exploded. While drugs like Adderall, Ritalin, and Concerta are prescribed primarily to treat ADHD/ADD, multiple surveys reveal rampant use—as great as 35 percent of students on some campuses—of students who admit to the illegal use of a prescription stimulant.

Everyone on campus knows about illegal Adderall or Concerta usage and knows where these drugs can be obtained quickly—in order to study, to cram, to pull an all-nighter, or to get high. Technically, while selling and distributing prescription stimulants is a federal crime, the Drug Enforcement Agency rarely takes action against students.

There is much urban legend at college and high-school scenes about the effects and side effects of Adderall. Having prescribed stimulants like Adderall to patients for over 30 years, I offer the following as a misuser’s guide to Adderall.

Adderall does improve performance in normal, learning-disabled, and ADHD/ADD students, as measured by short-term improvements in tests and grades. The improvement comes as a result of more efficient test-taking and studying, in the form of more focus, deliberation, efficient methodology, and decreased fatigue.

However, Adderall does not improve complex thinking tasks. For example, Adderall will not improve reading comprehension but will allow the user to go over the paragraph multiple times to obtain the answer. Without the drug, fatigue, boredom, or distractibility might occur. It is also not clear whether Adderall “works” by actually improving performance or by simply improving motivation. It decreases procrastination but will not turn the “no” of a defiant child into a “yes” for getting homework done.

Adderall’s most consistent effect is to give users the sense that they are doing better in their tasks. This positive sense, which can become grandiose and manic, may be the strongest contribution to the real improved performance. Under the influence of the drug, people feel better about their performance. Therefore, they perform at least a little better in reality, yet not as well as they think.

Despite the short-term academic gains, there is no evidence that Adderall improves learning overall or that short-term gains in learning persist without the continued use of the drug. What a user produces on an exam will not necessarily translate to long-term knowledge or improved performance without the continued use of the drug.

Common side effects of Adderall are loss of appetite and trouble falling asleep—for some, desired effects. While highly publicized, psychotic reactions to occasional oral doses of Adderall are rare. Serious misjudgment can occur, such as writing an hour’s worth of essay in microscopic print. More gravely, snorting crushed Adderall increases the very small risk of a cardiac arrhythmia that can be fatal.

Government data from surveys conducted in 2002 suggest that about one in 10 casual college-age users of illegally obtained Adderall reports his use as consistent with clinical levels of abuse and addiction. If you’re using Adderall illegally, the risk of becoming addicted to it or another stimulant drug (like cocaine or methamphetamine) is about 10 percent.

So, if you use Adderall illegally or legally, it’s worth asking why you are in college and whether the path you’ve chosen best fits your personality and talents. It may be that many of you are in school because the other option is to live at home with your parents, playing video games and working at a restaurant. Or the academic work may be too hard. Your skills and interests lie elsewhere or are still to be determined. If you regularly require Adderall to cope or do well, you are likely still trying to squeeze yourself into that old, rigid educational hole your parents tried to shove you into before you were “on your own.”

If you’re doing Adderall on a regular basis to cope, you may soon also need another drug. Perhaps it will be Xanax—to deal with the anxiety of having gotten to a place where you really don’t belong based upon your own chemical makeup. If you don’t want to go to an MD for anti-anxiety medication, just smoke more weed. If you’re using Adderall to get high, you are running the same risks of getting truly caught up with one of the worst drug addictions possible (they weren’t kidding in the 1960s when “Speed Kills” first appeared as wall graffiti in the Haight-Ashbury district of San Francisco).

If you’re a regular misuser of Adderall, maybe this is a good time to reexamine your immediate goals and career path. These are tough economic times for everyone, with or without a college degree. Take a close look at your talents and what actually interests you. While you only run a one in 10 chance of becoming addicted to Adderall, the chances are much higher that, if you don’t figure out what you want and what you can do well, you will not only need Adderall, but also a few other psychiatric drugs, for the rest of your life.

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