The Adderall Advantage
By ANDREW JACOBS
Published: July 31, 2005
IT was finals week at Columbia University and Angela needed a miracle. Like many of her classmates, Angela, a bleary-eyed junior, had already pulled a pair of all-nighters to get through a paper on "Finnegans Wake," a French test and an exam for her music humanities class. All that remained was a Latin American literature final, but as midnight approached, her stamina was beginning to fade. "This week is killing me," she said, taking a cigarette break in front of the school library. "At this point, I could use a little help."At many colleges across the country, the ingredients for academic success now include a steady flow of analeptics, the class of prescription amphetamines that is used to treat attention deficit hyperactivity disorder. Since Ritalin abuse first hit the radar screen several years ago, the reliance on prescription stimulants to enhance performance has risen, becoming almost as commonplace as No-Doz, Red Bull and maybe even caffeine. As many as 20 percent of college students have used Ritalin or Adderall to study, write papers and take exams, according to recent surveys focused on individual campuses. A study released this month by the National Center on Addiction and Substance Abuse at Columbia found that the number of teenagers who admit to abusing prescription medications tripled from 1992 to 2003, while in the general population such abuse had doubled. Dr. Robert A. Winfield, director of University Health Service at the University of Michigan, Ann Arbor, sees a growing number of students who falsely claim to be A.D.H.D. so they can get a prescription. At least once a week, a jittery, frightened, sleep-deprived student who has taken too many tablets for too many days shows up at his office. "Things have really gotten out of hand in the last four to five years," he said. "Students have become convinced that this will help them achieve academic success." On campus, the drugs are either sold or given away by people with prescriptions, or they are procured by students who have learned to navigate the psychiatric exams offered by campus health centers, which usually provide the drugs at a discount. Unlike Ritalin, two newer members of the family of analeptics - Adderall and Concerta - come in time-release forms and can keep a patient medicated an entire day. Much like performance-enhancing drugs in professional sports, the spread of analeptics among college students is raising issues of competitiveness and fairness. But interviews and e-mail exchanges with two dozen Columbia students suggest that the prevailing ethos is that Adderall, the drug of choice these days, is a legitimate and even hip way to get through the rigors of a hectic academic and social life. "The culture here actually encourages people to use stimulants," said Barak Ben-Ezer, a computer science and economics major who prefers Red Bull, a caffeinated beverage, and cigarettes over prescription drugs. But pure recreational use of the drugs, which sometimes includes crushing and snorting a tablet, is generally frowned on, he and others said. Libby, a writing major at Columbia who received a diagnosis of A.D.H.D. in first grade, is a typical drug dealer. She often sells her 10-milligram tablets to strangers for $5 or barters them with friends for meals. The demand during exam week can get intense, said Libby, who, like most people interviewed for this article, asked that her last name be withheld. "I'm constantly being bombarded with requests," she said. "People can get desperate." She said that the attitude toward stimulants has changed drastically since her days in elementary school, when she was forced by her parents to down a daily regimen of Ritalin. "As a kid, I was made to feel different for taking these drugs," she said. "Now it's almost cool to take them." Many mental health counselors point out that the proliferation of analeptics on college campuses is partly a matter of demographics. The hundreds of thousands of children who were diagnosed with A.D.H.D. and attention deficit disorder in the early 1990's are now entering college, and bringing their drugs with them. Libby, for one, takes them only to pull through the occasional paper. "It really messes with my head," she said, adding that in the past the medication has intensified underlying obsessive-compulsive habits. Some experts, while fretting about the use of analeptics without a prescription, see the advent and acceptance of the drugs as a great revolution that has helped a generation of children with learning disabilities achieve academic success. Dr. Robert Herman, a staff psychiatrist at the University of Maryland, College Park, says he regularly sees students whose grade point averages rise markedly after taking the medication. "Students tell me it's really changed their lives for the better, that they are so much more focused and organized," he said. Sorting out those with legitimate diagnoses from the deceivers can be nearly impossible, he said, because "in psychiatry, there is no blood test." He said he always tells patients that it's illegal to share their medicine, but added, "I can't exactly go into their dorm room and count their pills." Requests for comment by Columbia administrators were referred to Dr. Laurence Greenhill, a clinical psychiatrist at the university, who said that the idea that Adderall is a performance enhancer is a myth. "It won't increase your intelligence, it just increases your diligence," he said. "Essentially, the drugs delay the onset of sleep so you can stay up all night and cram." Designer stimulants like Adderall are far less dangerous than cocaine or methamphetamines. According to the Shire Pharmaceuticals Group, which makes Adderall, medical research has found it has no potential for addiction. But Adderall, like many other medications, can interact with other drugs and create problems, particularly when taken in other-than-prescribed dosages, a spokesman said. The main side effects of analeptics are increased heart rate, agitation and the kind of paranoia and disorientation that results from amphetamine-induced insomnia. In February, the Canadian government suspended sales of Adderall XR, the time-release version of the medication, noting "20 international reports" of sudden deaths, heart-related deaths and strokes in children and adults. (The standard Adderall is not sold in Canada.) In Washington, the Food and Drug Administration took note of the Canadian ban but said it would take no action. "These are very safe medications," said Timothy E. Wilens, author of "Straight Talk About Psychiatric Medications for Kids" and a child psychiatrist at Harvard Medical School. "They have been used for 70 years, and we haven't had terrible catastrophes." For many college students, the issue about Adderall is not so much health as it is fairness. Among those who refuse to dabble in performance-enhancing substances, the disapproval and bitterness can be fierce. Angelica Gonzales, a civil engineering major at Columbia, said she resented that nearly all her friends have taken Adderall at some point in their academic careers. "It's cheating, and it really bothers me," she said, a bundle of notes in her lap. "I mean, everyone here is smart. They should be able to get by without the extra help." The more popular sentiment about Adderall's role in academic success was explained by John, an economics major who was raised in a conservative Midwestern culture. He said he always believed that if you had trouble in school, you should just study harder. But since coming to Columbia three years ago, his thinking has changed. "The environment here is incredibly competitive," he said. "If you don't take them, you'll be at a disadvantage to everyone else." With that, he swallowed a 20-milligram tablet of Adderall and headed back into the library.
Robert Stolarik for The New York Times
Thanks to a friend, the tiny orange pill in her purse would provide the needed miracle. Angela, who asked that her last name not be published for fear of alarming her family and angering university officials, popped a 30-milligram tablet of Adderall into her mouth, washed it down with coffee and headed back to the library for another night of cramming. The next morning, she sailed through the exam confidently and scored an A. "I don't think I could keep a 3.9 average without this stuff," she said afterward.