One of the most common prescription medications on any given college campus is a stimulant called Adderall, designed to help users maintain focus and appropriately govern their attention. Adderall is a central nervous system (CNS) stimulant of the phenethylamine class and is most frequently prescribed to people afflicted with Attention Deficit Hyperactivity Disorder (ADHD). Approximately 11 percent of American children have been formally diagnosed with ADHD, per the Center for Disease Control; the actual percentage may now be even higher, as the CDC notes that diagnoses rose by more than 40 percent from 2003 until 2012, the last year for which the agency offers data.
Typically, symptoms of ADHD begin to appear around age twelve and can cause issues in class or extracurricular activities. The symptoms can be broken down into two categories: hyperactivity and inattention. Symptoms of hyperactivity include having trouble sitting still, difficulty in waiting one’s turn, habitually interrupting others, and blurting out answers before the speaker has finished their question. Given that modern education requires students to sit still and patiently absorb information for several hours at a time, it is no surprise that hyperactivity can become a distraction in the classroom. Symptoms of inattention include a lack of attention to details, failure to follow instructions, difficulty finishing tasks, trouble with organization, and frequent forgetfulness, including losing track of personal items. While hyperactivity is likely to cause behavioral issues, inattention frequently affects performance for afflicted students. Many concerned parents bring their children to a psychiatrist or licensed clinician, who is able to diagnose the disorder and prescribe medication in hopes of keeping the hyperactivity contained.
Sadly, like most prescription medications, Adderall is not without side effects. Adderall commonly causes dryness of mouth and grinding of the teeth, a behavioral response to stress; stimulants like Adderall release norepinephrine and dopamine and this release results in a state mimicking stress. While teeth grinding can be mitigated with over-the-counter magnesium supplements, other potential physical side effects like hypertension, nausea, difficulty urinating, and erectile dysfunction could require additional prescription medications to offset. Finally, the appetite suppressing qualities of routine amphetamine use can lead to significant weight loss, though this may be either a bug or a feature depending on the user’s distance from their ideal body weight.
There are also psychological side effects to reckon with. At normal therapeutic doses, it is not uncommon for Adderall to cause increased self-confidence, mood swings, insomnia, changes in libido, and changes in sociability. Adderall may also augment anxiety or irritability, depending on the user’s personality and mental state. The enhanced concentration granted by Adderall is by no means guaranteed to remain directed at productive pursuits, and users may become obsessively engaged in various distractions and procrastinatory activities instead of the tasks intended.
Just as serious as the risk of side effects is the risk that Adderall poses for misuse. As mentioned earlier, Adderall’s effects as an appetite suppressant can lead to significant weight loss. Given human nature, this has resulted in an abuse of the substance as a diet pill in much the same way that other stimulants, like cocaine and methamphetamine, have been used as a shortcut to weight reduction. While some clinicians may actually prescribe Adderall off-label – that is, in a way not approved or reviewed by the FDA – as a weight loss tool, problems arise when people lie to their clinicians about ADHD symptoms or make black market purchases in order to gain access to this weight loss tool unsupervised, often in a way fueled by anorexia or other body dysmorphic disorders.
Adderall also poses a risk for misuse by athletes, both at a professional level and at a collegiate or recreational level. Adderall provides performance-enhancing effects such as increased endurance and alertness, increases in muscle strength, and improvements in reaction time. Physiologically, this is primarily through the substance’s regulatory effects on dopamine, but it also can override the body’s core temperature limit in order to push power output further in much the same way that hobbyists can “overclock” their computers at a risk to the CPU. Due to its performance enhancing effects and the potentially deleterious impacts of supra-therapeutic doses, Adderall is banned by the NBA, MLB, and NFL sports leagues as well as the NCAA.
Like other amphetamines, Adderall can be abused to combat symptoms of sleepiness. This can commonly take the form of a student misusing the pill to pull a last-minute all-nighter or a truck driver abusing the pill to drive for more than 24 hours at a time. Both scenarios constitute a blatant misuse of the medication in a way that puts severe strain on one’s body and invites abuse at higher than prescribed dosages.
Perhaps most dangerously, Adderall has a high potential for recreational abuse as a party drug. Instant release Adderall tablets may be crushed and snorted in order to obtain heightened effects for a shorter period. In extreme cases, Adderall tablets can even be dissolved in water and injected into the blood stream, typically by addicts to other stimulants looking to simulate the rush of e.g. methamphetamine. When combined with alcohol, Adderall can dull the symptoms of being drunk, thereby exacerbating the risk of alcohol poisoning. Furthermore, Adderall can increase alcohol’s capacity to reduce inhibitions and elicit aggressive behavior.
Due to Adderall’s high risk for abuse and the danger its misuse poses, the Drug Enforcement Agency has categorized Adderall as a Schedule II controlled substance. This is the highest level of control that a medicine may be categorized in and still be legally prescribed by a physician. Schedule I substances are typically only available for research, and even then only with special government permission.
Research has demonstrated that Adderall abuse is extremely common among college campuses, but also that holders of a valid Adderall prescription are not generally the major abusers of the drug. Rather, Adderall abusers typically procure it from a friend or relative or purchase it illegally. Some may even come by the substance through opportunistic theft, and students possessing Adderall are advised to keep it out of sight and preferably in a secure location. An unfortunate reality is that many patients who are appropriately prescribed Adderall will sell or even give away some of their medication to those not licensed to use it, whether out of financial exigency, peer pressure, or just a desire to make some extra cash.
Despite all of the risks discussed in this article, Adderall remains invaluable to millions of Americans suffering from ADHD. Psychiatrists have largely retained an optimistic view of the drug, despite its potential for misuse and abuse. According to Dr. Sonny Joseph, a seasoned, Harvard-educated psychiatrist, “If Adderall is used responsibly, it can improve an individual’s quality of life and work performance while studying. I see Adderall in a positive way, as long as it is not abused.”
Dr. Joseph went on to issue some professional guidelines for proper Adderall use: “Adderall should only be used when an individual needs to study or focus on something. It is not a medication that is meant to be taken everyday. If you take it everyday, you will quickly build up a tolerance, and it will become increasingly less effective. Use only at prescribed doses. Do not use Adderall as a coffee replacement or to pull all-nighters. Do not use it for purposes other than those sanctioned by your provider. Never sell or offer your medication to others, and never take others’ medications that have ostensibly been prescribed for the same purpose. Finally, never forget that Adderall is merely a tool to aid effective concentration and not a substitute for willpower when it comes to disagreeable tasks.”