ADHD and College Students

The abuse of ADHD medications, primarily Ritalin and Adderall, received lots of press when the positive effects on focus were found to be helpful en masse rather than just for acute cases.  Some recent developments in the news have re-sparked the debate, including medication shortages, suspected DEA involvement, and new less abuse-friendly medications.  This blogger thinks it’s beneficial for all college students to know the facts about a drug with a large, persistent presence on campus, one that primarily relies on anecdotal evidence from those with prescriptions.

First, some facts and fiction about ADHD and Adderall.

FACT: Studies show that Adderall helps the heavy majority of the population focus better (it hasn’t been tested on enough people to say with certainty, but random sampling supports this).

FICTION: Adderall has a paradoxically calming effect on actual sufferers.

FACT:  Another, less well-known diagnostic criterion is the inattentive ADHD, the forgetful space cadet who simply avoids tasks that require focusing for any extended length of time.

FICTION:  You can tell who ‘has’ ADHD because they are hyper and disruptive.

What does it mean to ‘be’ ADHD?

First of all, it’s highly controversial how the line is drawn between who ‘is’ and ‘isn’t’ ADHD.  Consider depression, a less controversial diagnosis that has gone through the same cycle ADHD has.  First came stigma.  Is it a ‘real’ disorder?  Is it something genetic or learned?  Should as many people as are medicated, be medicated?  Then came some frightening discoveries:  fluoxentine (better known as Prozac) was leaking into the water stream, causing shrimp to suicidally hang out in well-lit areas where they were more likely to be eaten.   Control groups in Prozac’s studies who weren’t depressed were given Prozac and those groups consistently outperformed groups given placebos at working cooperatively.  Hmmm.  The similarities continue: SSRI’s that treat depression work to restore levels of serotonin in the brain to a ‘normal’ amount.  Too much serotonin is also disordered—someone too happy will be unmotivated to do much of anything, but no one is prescribed drugs to make them less happy.

Similarly, there is a strong link between dopamine and ADHD.  Those with too little, the thrill seekers, have trouble focusing because their brains are looking for a ‘hit’ of dopamine.  Those with too much dopamine will take fewer risks and can sustain attention for long periods of time.  This, like those with too much serotonin, is not considered to be a problem (though the worker-bee might envy the risk takers for their spontaneity).

Unfortunately, directly measuring serotonin and dopamine isn’t possible at this time, leading to a lot of guesswork based on symptoms.  Two points should be emphasized here: one is the continuum (those who ‘are’ or ‘aren’t’ disordered depends on an arbitrary cut-off by professionals who almost never operate under certainty), and the second is the hype that surrounds new drugs on the market, particularly those with no long-term studies.  As more and more research comes out on the drug, hysteria tends to die down.

Of course there is one big hitch in the wagon with ADHD, the effects Adderall bestows on its users are seen as an unfair advantage to those given it without a prescription, but this begs the question: if we all had access to it, would it be an issue?  Which leads to a second, more pertinent question: if so, would we all want to be on it?

In short, I believe the answer is no.  Adderall has many side effects, including dry mouth, insomnia, and emotional instability over long periods of time.  It’s expensive: even with a prescription and insurance, it’s not unheard of to spend $300 a month on filling that script.  Shortages have been another issue lately—some blame the DEA for limiting supply.  The DEA in turn released a statement blaming drug companies for creating artificial shortages to increase value of the drugs.  Long-term effects are disheartening for those with disordered focus patterns.  The body develops a tolerance to Adderall, just like it does all stimulants, like coffee.

ADHD and its drugs have sparked a lot of important debate: is artificial enhancement necessary in a competition-fueled economy?  Is it fair?  Should it be made widely available to everyone?  As newer drugs come out that are less abuse-friendly (Vyvanse was an important development on this front: a molecule was attached to the amphetamine to counteract the ‘hyped’ feeling junkies describe when they snort it), these questions will come front and center to the debate.

No law can prevent you from encountering the drug, in either a legal or illegal manner.  Hopefully with this information, you’ll be just a little more educated about what to do if/when it does.

-Wonderbread

I’m reading Interpersonal Communications: Everyday Encounters