Questioning Adderall

*All student names have been changed or omitted as students wish to remain anonymous on this issue.

A stimulant composed of amphetamine salts, Adderall is commonly prescribed for children and adults who have been diagnosed with attention-deficit hyperactivity disorder (ADHD). But in recent years, Adderall has been adopted for a different purpose: cognitive enhancement. Call it the brain gain.

Zoe*, a junior in Stern studying Finance and Economics, purchased the little orange pill for about $4 from a friend with ADHD. Coupled with a steady stream of caffeine, she was prepared to pull an all-nighter studying for the exam. Within an hour, she was experiencing an intense focus. She claims that it felt as though her mind had tunneled in on her notes, shielding her from the distractions of other students and the pull of her Facebook messages.

“Like all medications, stimulants have pharmacological effects that are desired, but they also have undesirable side effects,” said Dr. Brunhild Kring, Associate Director of Psychiatry Services at the New York University Health Center. “They increase the ability to pay attention and focus and thus have a calming effect on the hyperactive individual. Common side effects include difficulties falling asleep, decreased appetite and weight loss, headaches, irritability, feeling edgy and wired. Blood pressure and pulse need to be monitored and students with pre-existing heart conditions should avoid stimulants.

A new study from the University of Pennsylvania shows that students who took Adderall did not actually perform better on tests of cognitive function – they only thought they did. In essence, Adderall often gives students an inflated sense of productivity.

“The idea that stimulant medications are useful aids for studying is a persistent urban myth. Research demonstrates that the cognitive performance of healthy volunteers on standardized isolated viewpoint. In a 2008 study of 1,800 college students tests is only marginally improved by the intake of stimulant medications (Smith, 2011). People can keep themselves awake under the influence of these chemicals, but being alert and vigilant for longer hours, does not make the person any smarter,” said Dr. Kring.

Zoe took Adderall Immediate Release (IR), the original form of the stimulant that lasts for four to six hours. In 2004, Shire Pharmaceuticals launched a drug called Adderall Extended Release (XR), as a means to provide relief for attentional-deficits spanning up to twelve hours. Shire manufactures Adderall XR in the form of a capsule, in contrast to the IR tablet. This capsule consists of small beads, 50% of which are immediate release and 50% of which are delayed release.

Both the immediate release and extended release pills are defined as “Schedule II” controlled substances, which means they have a high potential for abuse and dependence. Other Schedule II drugs include Vicodin, cocaine, methamphetamine, and oxycodone.

“These medications do have an abuse potential and require a very careful follow-up screening or education procedure to minimize the recreational use of these drugs,” cautions Dr. Renu Kotwal, a consultant and psychiatrist in a private practice and staff member of Christ Hospital in Cincinnati, Ohio.

However, many students who use Adderall do not see it as a dangerous drug.

“Because Adderall is legal, I don’t really associate it with harder drugs like cocaine or oxycodone. I don’t think it really affects me in a negative way and I’ve never felt unsafe using it,” said a senior in Stern, studying Finance and Statistics, who has used the drug for the last four years during exam season. It should be noted that it is only legal when specifically prescribed – not when shared or sold.

Nevertheless, lack of concern for possible ill effects is not an conducted by the University of Wisconsin, 81% of students interviewed thought that the non-medical use of ADHD medication was “not dangerous at all” or “slightly dangerous.”

However, other students interviewed, who have used the drug for cognitive enhancement, have since sworn off Adderall.

“After you take Adderall, you can tell that it’s not good for you. Yes, you have that intense focus and it helps you get through studying, but the come-down from that type of high is equally intense. I started feeling the after-effects of Adderall during a test and started crying because I felt so overwhelmed,” said a sophomore in Stern, studying Finance and Marketing.

Is staying up the night before an exam worth harmful repercussions? The short-term medical effects of the drug include sleep difficulties, restlessness, headaches, irritability, and depressed feelings. Additionally, consistent users may also expect to experience loss of appetite, nervousness, and changes in sex drive. Long-term non-medical users face the risk of psychological and physical dependence.

Dr. Kring warns: “Continued use of stimulant medications without medical supervision carries significant health risks: there is a worrisome potential for drug/drug interactions with other prescription medications. Physical symptoms of continued non- medical use of stimulant medications include dangerously high body temperature, irregular heartbeat, seizures, or heart attacks. Mental symptoms include irritability, edginess and a tendency to feel suspicious of others.”

“People run the risk of developing a dependency on stimulants, especially when they take these medications at higher than clinical doses and in combination with alcohol and other psychoactive substances. Non-medical use also has legal risks for the person diverting these medications because they are controlled substances,” explains Dr. Kring.

Despite these medical and legal consequences, a study done in 2012 by the Center on Young Adult and Development at the University of Maryland School of Public Health showed that approximately 74% of all college nonmedical users get the drugs from a friend with a prescription – like Zoe. In fact, it is quite common for some people diagnosed with ADHD to sell some of their pills on the side to make a little extra cash. Each 10mg pill usually ranges from $4-$7.

These nonmedical users often fit a general type, according to a study conducted by the University of Michigan. The “typical” Adderall user is a northeastern Caucasian male in Greek life with below average grades. But that type may be based on the original test population and it may be evolving.

As the focus on Adderall grows, the drug presents an academic issue: is nonmedical use of the drug unethical?

One could argue that it provides students without ADHD an unfair advantage – “academic doping,” so to speak.

“This class of drugs was developed and designed for people who have legitimate medical issues. Taking Adderall outside of those circumstances is ethically wrong. Not only is it illegal, but it disadvantages others,” said Professor Matthew Statler, who teaches Professional Responsibility and Leadership.

However, for some students, like Stern senior Kashish Kumar, it makes little to no difference. “At the end of the day, I go to class to learn, grades come second. So if someone is using that to get better grades, good for them as it doesn’t change how much I learn from the class,” explained Kumar.

Interestingly, nonmedical use of Adderall may not actually support a long-term advantage over non-using students. Some Stern students have reported difficulty retaining the information they learned while on Adderall in the long run. Additionally, many look back at the work they produce while on the drug and question its accuracy.

Despite this skepticism, some Stern students who use this “study steroid” admit they might even consider using the drug post-college, in a professional environment.

As Sternies enter high-pressure and intense work environments like investment banking and consulting, they will likely be required to work long hours and function at odd times of the day. To some, Adderall seems like the perfect stimulant for this type of environment. Along with acute focus, Adderall also aids in keeping you awake for hours.

“I would take it if I need to stay up all night, so I would consider using it for work. I don’t think it would be that out of the ordinary in my office, either,” said a male Stern senior going into banking next year. However, many companies have strict anti- drug policies so that opinion might change in the face of reality.

A Stern junior, who has used the drug non-medically several times, expressed a bit more apprehension. “I would only consider taking Adderall in a professional environment if I was working on something tedious, by myself, and for a very long time. It increases productivity and efficiency, but only for a brief period. When the crash inevitably hits, it can be incapacitating. This is why it’s dangerous to use in a workplace environment where you have to maintain a standard,” she said.

Still, the issue merits discussion. Recently, Adderall has become a topic in the national conversation – publications across the country have been focusing on this “brain gain.” In a piece in the New Yorker, journalist Joshua Foer wrote, “Depressives have Prozac, worrywarts have Valium, gym rats have steroids, and overachievers have Adderall.”

Does this point to a greater issue? Has our society become so intensely focused on success that it is driving students to drugs?

Professor Statler seems to think so: “My students live with incredibly strong pressures to succeed. The notion that you would be well advised to succeed by any means necessary has been culturally growing over time. It’s concerning to me. Students seem to think, ‘if this is going to help me in any way, I’ll do it -no matter the consequences.’”

Students who feel this deep-rooted desire to be successful at all costs may, at times, turn to the drug. However, given the medical and legal risks associated with it, Adderall does not seem to be the answer.

Note: NYU Stern does not condone the illegal use of drugs.