Behind the Campus Buzz
At Chicago and across the nation, the latest study aids are prescription drugs.
In high school Lynn, AB’03, had “incredibly bad study habits,” leaving homework and projects to the last minute. During 11th grade, when a friend was diagnosed with attention deficit hyperactivity disorder (ADHD) and got a prescription for Adderall, Lynn (some names have been changed) started snagging pills to help her get things done, thrilled with the results. “I thought, ‘Oh my gosh, this stuff is incredible,’” she says. “It was a wonder drug” that made school work more exciting. When she approached the family physician for her own prescription, he “was pretty loose about it,” she recalls. Though the results of one test didn’t show that she had ADHD, her responses on a symptom checklist garnered her a 20-milligram-a-day prescription by the time she enrolled in the College.
Lynn is not alone. When looming deadlines and uncracked texts require all-nighters, Chicago students, and their peers nationwide, have more in their arsenal than over-the-counter uppers such as No-Doz and Red Bull–style energy drinks. Today’s students often turn to a livelier pick-me-up: the commonly prescribed amphetamines Ritalin and Adderall, which pack a more powerful punch than caffeine. As Ann, AB’03, puts it, “It’s easier to snort something than to drink four cups of coffee.”
Over the past decade diagnoses of ADHD have soared among schoolchildren and young adults. As a result Adderall and Ritalin, another attention-deficit drug, have become ubiquitous in grade schools, high schools, and now colleges and universities across the country. And students with prescriptions aren’t the only ones reaping their benefits, which include increased concentration and alertness. Since the mid-’90s illicit use of Ritalin, Adderall, and other psychostimulants—both for studying and for fun—has increased dramatically among young adults, rising sixfold from .7 percent of the 12–17 population in 1990 to 4.3 percent in 2002, and nearly doubling to 10.8 percent of the 18–25 population, according to the 2002 National Survey on Drug Use and Health, conducted by the Department of Health and Human Services. Now colleges face a generation of students turning to these prescription drugs as the latest study aids.
Attention deficit disorders affect about 6 percent of the nation’s children, 4 percent of adolescents, and 2 percent of adults, according to Mark Stein, head of the University’s Hyperactivity, Attention Deficit, and Learning Problems Clinic (HALP). “We used to think that people grew out of ADHD,” says Stein, “and now we realize that many do not,” though hyperactivity symptoms often diminish with age. The most commonly diagnosed childhood behavioral disorder, according to the National Institute on Drug Abuse, attention deficit has also become the second-most common adult psychological problem, Harvard and World Health Organization researchers reported.
Although ADHD’s causes aren’t entirely clear, both nature and nurture have been implicated. “There are likely multiple genes involved,” Stein says, also citing possible environmental factors such as television viewing and maternal smoking.
First labeled as morbid defect of moral control in 1902, the symptoms that make up ADHD were later known as post-encephalitic behavior disorder, minimal brain dysfunction, and hyperkinetic reaction. In 1937 amphetamines were introduced to treat hyperactive children, and in 1956 methylphenidate, branded Ritalin, began its career as an attention-deficit drug. In 1980 the National Institute of Mental Health officially recognized attention deficit disorder (ADD), adding ADHD—to include common hyperactivity symptoms—to the Diagnostic and Statistical Manual of Mental Disorders in 1994. Two years later Adderall, or amphetamine mixed salts, originally marketed as a weight-loss medication, was approved to treat attention deficit hyperactivity disorder, joined since then by several other drugs.
Most ADHD drugs work the same way. They block neurons from reabsorbing the neurotransmitters dopamine and norepinephrine, influencing cerebral circuits in the brain’s prefrontal cortex, basal ganglia, and cerebellum, which are associated with motivation and reward, executive functioning, and motor coordination. By leaving the neurotransmitters in circulation, the medicines trigger the systems that control focus and attention.
But the drugs have their downsides. At the low levels commonly prescribed, mild side effects can include insomnia, loss of appetite, headaches, stomachaches, and increased blood pressure. The same dopaminergic action that helps ADHD sufferers focus also stimulates the brain’s pleasure centers, particularly at high levels, which can cause addiction. Toxic doses—a danger when stimulants are taken illegally or without physician supervision—can trigger irregular heartbeat, hyperthermia, hallucinations, and psychosis. The drugs can also aggravate such physical and psychiatric conditions as hypertension, glaucoma, and eating disorders or interact poorly with cold medicines, asthma medications, and certain antidepressants.
Lynn and students who have used the drugs without a prescription reported experiencing some unpleasant reactions to Ritalin and Adderall, including “crippling nervousness,” headaches, teeth grinding, diarrhea, and obsessiveness.
Long-acting versions of the compounds, such as Concerta and Adderall XR, which release medicine slowly, mitigate many of the side effects and, by avoiding peaks of stimulation, possibly reduce the risk of dependence. But abusers learn to circumvent extended-release mechanisms by crushing and snorting the drugs or by dissolving and injecting them (a particular danger because insoluble particles may block small blood vessels). In fact, since 1971 methylphenidate and amphetamine mixed salts have been designated by the DEA as schedule II substances, a category that includes morphine and cocaine. Though subject to fewer restrictions than schedule I—reserved for nonmedicinal addictive compounds such as heroin—schedule II substances are the therapeutic drugs most likely to be abused.
Every time Caren, AB’04, wrote a College paper, she followed the same routine: take a few days to complete the reading, spend several hours forming thoughts and outlining a thesis, and then sit down at the computer to write about a page an hour—the same frequency with which she would snort a bump of Ritalin. Using stimulants, she says, made it easier to translate her ideas into words. It also raised her enthusiasm and made writing papers “more fun.” Though Ritalin was occasionally hard to find, she persuaded a friend with a prescription to share his stash.
In 2000 congressional testimony DEA officials warned that lax handling of ADHD medication, improper diagnoses, and paltry information about the dangers had led to increased abuse. According to the 2002 National Survey on Drug Use and Health, in 2001 808,000 people illicitly tried prescription stimulants for the first time, up from 270,000 in 1991.
Witnessing the trend, college newspapers from Yale to the University of Texas have reported that students with prescriptions often give away or sell pills for $1 to $5, depending on the school and the time of year (during finals the price spikes). Following suit, a November 3, 2003, Maroon article on U of C Adderall and Ritalin use reported that students increasingly turn to psychostimulants “to help concentrate and study.”
In a 2003–04 survey, about 2 percent of 833 undergraduate respondents reported taking amphetamines in the past 12 months, according to the Student Care Center (SCC), the campus health-care office. However, because the survey didn’t mention Ritalin or Adderall by name—an omission administrators plan to correct for the 2004–05 version—students likely underreported, says SCC health-education specialist Kelley Carameli. “There’s a connection that students are not making about misusing prescription drugs,” Carameli says. “I don’t think students are connecting Adderall or Ritalin with the stimulant category.”
Student use is probably more widespread than the survey suggests, agrees Sarah Van Orman, head of Student Care. “Whether the number of people you see in front of you reflects the actual population, it’s hard to know,” she says. “But anecdotally” she hears more students admit to abusing prescription drugs and believes “use is on the upswing.” The Peer Health Educators, a group of undergraduate liaisons between campus health offices and the student body, have reported an increase in Ritalin and Adderall use and distribution, particularly in the libraries.
Some students object to their peers’ behavior, arguing that taking the stimulants as study aids amounts to cheating. “It is one thing to do [Adderall] for recreational purposes, but using drugs to gain an advantage over other people is fraudulent,” a first-year told the Maroon. But Ann, who argues for stronger stimulants’ comparative advantages to caffeine, disagrees. If using Ritalin is cheating, she contends, “then drinking coffee is cheating too. And I can’t imagine coffee being outlawed, especially at the U of C.”
Ritalin and Adderall misuse isn’t limited to schoolwork. Ann, Lynn, and Caren have each tried the drugs recreationally, mostly, as Lynn says, to stay up “and drink all night.” “Adderall makes me happy and hyper,” explains Caren, who during school took it while drinking and smoking pot—a dangerous combination, the SCC’s Carameli warns, that occurs frequently. But many students are unaware of the hazards. They “may be given the prescription pills, and they’re seen as very safe medication,” says Van Orman. “So it seems very easy to give your extras to your friend.”
While increased diagnosis and medication options have helped ADHD sufferers attend college at higher rates, more students are showing up with prescriptions in hand, and many university health systems aren’t yet prepared to treat them. “What happens a lot of the time is that the people who are most familiar with [ADHD] are people that take care of children: pediatricians, child psychologists, child neurologists,” says Stein. “So children are diagnosed and they go off to college, and who follows them there?”
At Student Counseling and Resource Services, Jacqueline Pardo, who trained with Stein at the HALP Clinic, evaluates most students who come in with ADHD complaints. Chicago’s affected population, she believes, reflects the rising national trend. But more students who come to her, she suspects, are malingering to a degree, angling to score a prescription. Tom Kramer, head of the Counseling Services, has experienced the same phenomenon but cautions that the prevarication “is not particularly evil.” Some students, he says, arrive with a problem and a self diagnosis: “I’m not functioning. I must have ADHD.” After an evaluation, he often finds the students are “depressed, they have an anxiety disorder, they have something else interfering with their ability to function.” It could be stress or poor study skills—which, after an initial interview, are assessed. Indeed, Van Orman agrees, part of helping those who misuse stimulants—who have perhaps diagnosed themselves with ADHD—“is figuring out why the student is struggling…and treating that problem.”
But not all abusers approach University counselors or health-care providers. Campus specialists reach out to these students in many ways. Easiest to spot is the rainbow of pamphlets lining the SCC’s waiting-room wall and the Counseling Services lobby. Addressing issues including stress, time management, and academic difficulties, the brochures offer practical advice for the overwhelmed student: “choose your own goals,” “take care of your health,” and “buy a calendar.” Student Care and the Counseling Services augment these upbeat tips with outreach efforts including brown-bag lunches, “tabling”—providing information (and a snack or bottled water) at the Reynolds Club—and dormitory events. In the spring issue of the SCC’s newsletter Chicago Health, peer health educator Hannah Park, ’05, warned students against viewing Ritalin and Adderall as a way to “get it all done,” noting the dangers associated with injecting or combining the drugs. Primarily, says Van Orman, campus health-care providers want to make sure students know “about the negative effects [psychostimulants] might have. We try to be balanced and realistic about why someone might use them and what alternative strategies might be.”
Though stimulant misuse is a problem, “I wouldn’t say it’s a crisis,” Van Orman stresses. “There are trends and fads, and I’d like to think part of the reason there are trends and fads is that we identify problems, we try to address them, and that way we can reduce levels of use.” In trying to blunt stimulant abuse, campus caregivers walk a thin line. “Our goal here is to help the students,” explains Kramer. “We’re kind of between a rock and a hard place. We want to treat the people that need treatment—that’s our job. On the other hand, we don’t want to make the stuff so available that people are abusing it.” Van Orman concurs: “We don’t want to have such a backlash that patients who have attention deficit are afraid to take these medications—because when used properly they really make all the difference for people with ADHD.” Besides experiencing the drugs’ primary effects, ADHD sufferers treated with Ritalin or Adderall are also less likely to abuse alcohol and other drugs than their unmedicated counterparts, according to studies funded by the National Institute on Drug Abuse and the National Institute of Mental Health. “It’s more likely that untreated kids would develop substance abuse,” agrees Pardo, “than kids we treat with stimulants.”
One engine behind the surge in ADHD diagnosis and treatment is a promotional push by pharmaceutical companies. Jockeying for their share of an approximately $2-billion market, drugmakers spend millions of dollars in advertising. While critics worry that such campaigns may promote overmedication, increased awareness has also led to some positive changes. Once considered an embarrassment, the disorder is now widely recognized and support groups have sprouted across the country. But the pendulum, Pardo worries, may have swung too far. “Where 20 or 30 years ago there was still a stigma, [the medications] are now for a lot of students seen as kind of a panacea.”
In other words, Adderall and Ritalin are becoming commonly accepted performance enhancers, like Viagra. And with similar medications—to enhance memory or mood—on the market or in development, a pharmacopoeia of lifestyle drugs soon will be available to help the modern-day student. People without depression are now using antidepressants in an attempt to be “better than well,” according to the June 25 Chronicle of Higher Education. Likewise, the June 29 New York Times reports, the new drug Provigil, touted as a cure for sleepiness, has experts worried that stressed students will see it as “the next Ritalin.”
Another new medication, Strattera, a nonstimulant and the first ADHD drug approved for adults, already has grabbed some of the market and sales are growing. Early studies suggest that Strattera, which doesn’t trigger the brain’s pleasure centers to the same degree as the other drugs, has little or no abuse potential. But, says Kramer, “it takes a really long time to work”—its effects might not kick in for weeks compared to Ritalin and Adderall’s instant results—“and it doesn’t work for everybody.” So for now Ritalin, Adderall, or their longer-lasting counterparts continue to maintain pride of place in the medicine cabinets of attention-deficit sufferers as well as those who don’t have the disorder.
Lynn, who doesn’t have ADHD, recognizes that Adderall didn’t solve her dismaying study habits but only provided a boost “over the wall” of procrastination—and a host of unwanted side effects. Fed up with how the medication made her feel, she turned to meditation, a practice that requires “you to sit down with yourself and make yourself concentrate,” she says, something she was never forced to do while using stimulants. “That kind of self-discipline is hard if you’ve never had to develop it.”
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