Blue lines of powder are neatly organized across a textbook, as a young man sits in his room reading a book while bobbing his leg to an unknown rhythm. For centuries coffee has been the go-to elixir of choice for weary scholars and tired workers, but on this day the young man has other plans.
Leaning over, he places the hollowed out shell of a pen inside one of his nostrils, leans over the textbook and inhales deeply. Almost instantaneously his brain releases a flood of chemicals which increases his alertness, sharpens his focus and provides a sense of euphoria.
While this behavior may be considered reckless or excessive, it certainly wasn’t illegal, because the substance in question didn’t come from a shady, back alley drug dealer, it was the crushed up form of an Adderall pill, which was prescribed to him by his doctor.
However, this story may be more common than most think. In fact, some studies have suggested its illicit use may be as high as 35 percent of all college students. A recent study by the Centers for Disease Control and Prevention found that nearly one in five high school aged boys has been diagnosed with some form of attention deficit hyperactivity disorder – a 41 percent increase over the last decade. The drug Adderall belongs to a family of prescription amphetamines that is commonly used to treat the disorder, but the increasing number of diagnoses has made it not only more accessible but has also helped remove the social stigma associated with its use and misuse.
“I’m 30 years old now, and I was first prescribed Ritalin in the fourth grade,” Frazer, who asked to not be fully identified, said. “From then until this day, pretty much all of the time, I’ve been prescribed some kind of ADD medication. I’ve used it properly, and I’ve also used it very improperly and excessively.”
Frazer, who currently lives in Austin, Texas, said he no longer abuses his prescription, and that when used properly, it significantly helps him function. However, in his youth he frequently misused the drug — which is chemically similar to the street-drug crystal methamphetamine — as a study-aid and euphoric stimulant.
“Once I figured that it could be over-used and that you can get a big buzz off it, I never really went back to using as intended,” Frazer said. “I definitely knew I was over-using it, but I didn’t really care. I was a teenager and all I wanted to do was listen to punk music and do drugs.”
Looking back, though, he doesn’t regret being prescribed the medication, although he admits that his prescription may have been unnecessary, especially at a young age.
“I think anybody, whether they have ADD or not, can use it as a tool to improve learning, Frazer said. “There is so much stuff that I love about myself that is a direct result of me spending so much time on Adderall studying things that I like.”
Frazer was tested for the disorder when he was initially diagnosed in the fourth grade, and then again in the sixth grade.
“I only got tested two times very early on, and then for the next two decades, nobody ever performed any kind of test,” Frazer said. “They just took my word for it.”
Frazer’s story is not that uncommon among his peers. According to Robert Maichrowicz, associate director of the Counseling Center at the University of Memphis, about 75 students get tested for ADHD, and of those 75 about three quarters are positively diagnosed. However, most students who come through the center have been previously diagnosed. Maichrowicz said the formal diagnosis process performed at the center helps curb over-diagnosis.
“Sometimes an individual will go to a medical doctor, but the only people that do the (formal) testing are psychologists,” Maichrowicz said. “Then they will be given a little checklist of symptoms and prescribed medication. If somebody’s motivated to be on medication, it wouldn’t be that hard to read up on the symptoms and tell the doctor.”
Maichrowicz was quick to point out, however, that a student who obtained a diagnosis under those circumstances would not be formally accommodated by the university’s disability office.
“Our consulting psychiatric provider would not prescribe medication for a student unless they have been formally diagnosed within the last three years,” he said.
He also said he believed that formal testing should be required for a prescription, and that requirement might help curb its misuse by students who are just looking to obtain a prescription for recreational use or to sell it to classmates.
“It all goes back to proper testing and diagnosing,” Maichrowicz said. “There are some people that think that ADHD doesn’t exist now because of the misdiagnosing, and that’s not true — there is legitimate ADHD, but there are also people that are not properly tested that may not have it.”
Users generally see the recreational use of ADHD medication as a cognitive enhancer as an effective study aid. However, another study done in Frontiers in Neuroscience, an open-access academic publisher and research network, found that stimulant drugs do not improve the academic performance of students and also found little or no benefit of stimulants on neuropsychological tests of ADHD-diagnosed as well as normal individuals.
“There is a difference between being awake and being competent,” Charles D. Blaha, director of the Division of Experimental Psychology at the University of Memphis, said. “Showing up fully awake without the consolidated information required to pass the exam would likely lead to failure. You’ll just be more awake.”
Adderall, Ritalin and other ADHD medications are grouped in a family of drugs known as “psychostimulants,” which also includes the street drugs cocaine and methamphetamine. All of the drugs mimic the naturally occurring neurochemical, dopamine, and have a common base structure of phenyl-ethyl-amine.
While it may seem odd to prescribe such powerful drugs to children and young adults, Blaha pointed out that there is a correlation to lower levels of dopamine in the frontal cortex and individuals with ADHD. The stimulants simply increase the levels of dopamine in the brains of the individuals with ADHD to normal levels.
“They are great for ADHD patients because they bring them up to a level of attention that allows them to focus like you and I can,” Blaha said.
In normal individuals, the stimulants can increase the levels of dopamine in the brain to potentially toxic levels and may cause insomnia, rapid heart rate, aggressive behavior, panic attacks and may cause damage to a number of internal functions. The effects can also compound and worsen with chronic over-use.
Blaha concluded that sleep is the most effective study aid of all.
“Sleep is extremely important,” he said. “Even though I can stay up till 3 a.m. to study because I’m on Adderall, if I’m not an ADHD patient, and I don’t sleep, I won’t consolidate that information as effectively as I would with a full night of sleep.”
Despite the over-diagnosis of ADHD and abuse of the drug by those who use it recreationally or as a study aid, there are nonetheless some children who seriously need the drug.
Ashley Bruenig is a 29-year-old mother of four. Her oldest son, Jordan Pennington, was diagnosed with ADHD when he was 5 years old. After exploring several different options over 18 months with his therapist that included many changes to his diet, daily routine and other factors, the family reluctantly agreed to experiment with medication.
“As a mother of multiple children, you can see the difference between the normal five and six years olds and kids like Jordan,” she said. “One of the tell-tell things is knowing that he wants to, knowing that he knows he is supposed to do something, and that he still can’t.”
Initially, Jordan was placed on Vyvanse, but the results were less than satisfactory. Bruenig felt like she lost her son due to the emotional rollercoaster it created. All too often the once active 7-year-old would breakdown in tears and couldn’t even remember why he was sad. Finally, after switching medications, Jordan began to show signs of improvement.
“I didn’t want a zombie,” Bruenig said. “I remember when I first put him on Vyvanse I was in tears for a month because I just wanted my little boy back.”
While Bruenig was reluctant to medicate her son, she now believes in the necessity of it for him.
“I sincerely believe that his mind does not allow him to function with a straight train of thought, she said. “I’ve seen the pain in his eyes when he realizes he didn’t do something he was supposed to. You can tell he wants to do good, but his mind won’t let him.”
However, she also believes that Jordan’s case is an outlier and that some doctors and parents may be too quick to diagnose.
“I do not think one in five children has ADHD,” Bruenig said. “If more parents took the time to try everything they possibly can to grab their attention and redirect them, then a majority of children would not be diagnosed with ADHD. A lot of it is parent laziness, but I also believe that it is an actual disease.”
Currently, Jordan is receiving better grades in school and the medication seems to be achieving its intended effect. However, Bruenig expressed concerns about the long-term use of ADHD medication and hope that one day Jordan will be able to wean himself off of them.
“I felt guilty that that was the only option we had,” she said. “I wanted to fix it on my own. I wanted him to be able to do it on his own, and I want it to go away. I don’t want my son to have to medicate himself for the rest of his life.”
