Perspective: Miracle drug?

Courtney* uses Adderall to help pull all-nighters finishing papers or studying for tests, even though she does not have a prescription.

"I use it every time I have a big paper or exam due," she says. "I primarily use it for study, basically any major assignments."

Courtney gets Adderall from her friends who have prescriptions.

"I never have to buy it," she says. "I just ask my friends for some whenever I need to study."

Susan has been taking Adderall since 11th grade.

"I was having trouble concentrating in school and got kicked out of all my classes for disruptive and inappropriate behavior," she says. "It's all fun and games when you get kicked out of class in third grade, but by 11th grade, it's just not cool anymore."

She was diagnosed with attention deficit disorder in kindergarten, but her parents did not want her taking medications for fear of damage to her developing brain.

"I functioned for a good part of my life without it, and I managed to do well with grades and classes," Susan says. "It just took me a lot more effort than the average bear. My attention span is less than normal."

It is the heightened sense of concentration and the ability to focus that has resulted in the rampant use of Adderall among college students, many of them unprescribed users.

The University does not specifically track the number of students using Adderall, because it is difficult to discern the difference between prescription and nonprescription users.

But what is certain is that in the high-pressure environment that many college students find themselves in, where grades and GPA determine future job offers and career paths, a drug that allows the user to study for extended periods of time without sleep is becoming increasingly popular.

The study drug

Adderall, or amphetamine-dextroamphetamine, was first marketed in the 1960s as the diet pill of choice. It is currently classified as a stimulant medication and appetite suppressant and is mostly used to treat both ADD and attention deficit hyperactivity disorder.

Adderall stimulates the central nervous system by increasing the amount of certain chemicals, such as dopamine and norepinephrine, in the brain. These chemicals, or neurotransmitters, help the brain send signals between nerve cells.

Adderall helps restore the balance of these neurotransmitters to the parts of the brain that control the ability to focus and pay attention.

"Think of a staticky radio signal," says Anthony Rostain, professor of Psychiatry and Pediatrics at the Penn School of Medicine. "You turn the dial, and you get a better signal. It's roughly the same thing as Adderall -- the focusing and concentration are better."

For those who have prescriptions for the drug, doctors say it is almost completely safe. It is nonprescribed users who sometimes run into health risks.

Availability

There has recently been a flurry of national discussion over possible overdiagnosis of ADD and ADHD. The number of prescribed users has increased rapidly, and the increase in diagnoses has carried with it a rise in supply for users without prescriptions as well.

"I really only take Adderall twice every semester, on average," Jane says. "Maybe once during midterms and once during finals."

Jane, a nonprescription user like Courtney, gets her Adderall from friends who have prescriptions.

"I would just get it from one of my friends who have it," she says. "I definitely would never have to pay for it -- we have lots of ADD buddies running around here."

However, many doctors still believe the diagnostic system makes it difficult for people without ADD or ADHD to get prescriptions for Adderall.

"You can't just walk into a doctor's office and say, 'I have ADD, give me Adderall,'" says Rostain, who also directs the adult ADHD treatment and research program. "It shouldn't be too easy and should only be given when someone needs it, because there is an extensive process of evaluation before you are diagnosed and prescribed."

This process includes objective assessments, clinical interviews, testing, psychiatric interviews and a standardized approach to diagnosis across the country.

"You really have to, in essence, demonstrate why you think you have it, as well as go through a series of tests that determine whether or not you indeed will be diagnosed with ADD or ADHD," Rostain says.

Hard data on how many Penn students are prescribed Adderall or take it on a regular basis is largely unavailable due to the nature of the prescription process.

"We know that it's pretty common among young people, especially undergraduates," says William Alexander, deputy director of Counseling and Psychological Services at Penn. "It's hard to estimate how many Penn students take it regularly, because many students have prescriptions from doctors at home that we don't even know about. It is definitely one of the most widely prescribed drugs."

Side effects

One of the most apparent side effects of Adderall is loss of appetite, one of the main reasons it was originally marked for the diet craze.

Those who are prescribed the drug and take it on a daily basis learn to adjust their schedules to make time for meals.

"When I first started taking it, it suppressed my appetite," Susan says. "Then you learn that you can't let it do that, and now my body has adjusted, [so] I still get hungry when I'm on it."

"I'm obsessed with food, so when I first started Adderall, it was weird," says Josie, who has a prescription for Adderall for her ADHD. "I won't know what I'm in the mood for, because I don't have an appetite, but once you start eating, you get over it. You just need less to get full."

The appetite-suppressant aspect of Adderall is one of the contributing factors to its popularity among female college students, some of whom use it as a diet pill.

There are other side effects, as well, that include dehydration, hot flashes, stomach pains, nausea, heavy sweating, headaches and even involuntary movements.

"Sometimes I get really dehydrated, and I need to drink lots of water," Josie says. "My heart starts racing, and I get hot flashes, but only sometimes."

Recreational use

More recently, Adderall has emerged as a recreational drug as well. Once used primarily for studying purposes, its effect as an "upper" drug -- a stimulant -- has increased its popularity among students who use it on weekends. Primarily recreational users snort, rather than ingest, the drug.

"It's probably the most serious health risk a college student can engage in," Rostain says. "By snorting it, you are directly applying it to the brain, injecting it into your brain almost. The amount is much greater, and the resulting blood pressure changes could result in some really ugly heart rhythm problems. You could have a stroke or an arrhythmia. Combine this with alcohol, and the [chances for] cardiac problems get even greater."

But recreational users typically are unaware of the added danger of snorting, and they seek the quick high that accompanies it.

"When I study, I only use it orally," Courtney says. "But if I'm going out, then I'll snort it. Snorting it makes it hit your system faster and have a faster effect. It also tends to go away faster."

"I use it recreationally whenever I can get it," she added. "Sometimes you're going out in Manhattan, and you want to hit a bunch of clubs in one night. If they're not close together, you can't always count on a cab and you have to get there fast. In stilettos, the night doesn't last forever."

Comparative advantage

Adderall is still first and foremost used as a study drug because of its ability to enhance concentration and the ability to focus for long periods of time.

One of the reasons for its popularity is that everyone can benefit from Adderall's performance- enhancement capabilities, not just those with ADD or ADHD. This often gives nonprescribed users an unfair advantage over those who actually are prescribed Adderall to combat the effects of their attention deficit disorders.

"I'm jealous of the people I give my Adderall to who aren't prescribed it," Josie says. "Because I know what it does to them, and I know that it doesn't have that effect on me."

Susan echoed her sentiments.

"It's the kind of medication that can help anyone concentrate, and that's why it's unfair," she says. "It gives people an unfair academic advantage. For people with ADD, it just makes them normal, and for people without ADD, it makes them above average. If both me and someone without ADD were both on Adderall, I could never outdo them."

Dependence/addiction

With the rise in diagnoses of attention deficit disorders and the subsequent increase in Adderall prescriptions, there is a growing fear of a new generation of adolescents growing up addicted to study drugs.

"Technically, any stimulant used at high enough dosages can be addictive," Rostain says. "But with Adderall, I think dependence is more likely than addiction, and there is a difference between the two."

"People with ADD and ADHD who take Adderall need it to help them focus and function better. People without attention problems in the first place are the ones more likely to develop a dependency on the drug, especially if they are taking it every time they have a test or a midterm," he added.

Those who are prescribed Adderall take it on a regular basis as part of their daily routine. They do, however, see a time in the future when they will function normally without the help Adderall provides.

"I don't think I'm addicted, because I don't crave it," Josie says. "I don't really like it that much, and I'd rather not have to take it, but I know I need it when I'm doing work."

"I don't think I'm addicted, because I functioned for so long without it, and I don't need it every day," Susan says. "I guess I can see myself stopping when I have kids -- it's just hard to imagine not taking it."

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