by Sara Kazemi
This article was written by a student at the Wheeler School. Brown's chapter of The Triple Helix collaborates with the Wheeler School to engage high school students in science journalism.
You’re about to take your last final of the semester, but you simply cannot focus. The ability to ace this exam is presented to you in the form of a simple pill that plenty of your friends already take. How bad could it be?
Attention deficit hyperactivity disorder, or ADHD, is a disorder characterized by the inability to focus, hyperactivity, impulsive behavior, or a combination of all three (1). ADHD is one of the most common childhood disorders and usually continues to affect those people diagnosed through adolescence and adulthood (1). Although scientists are not completely sure what causes ADHD, studies suggest that genes might play a large role (1). Like other disorders and illnesses, it is most probable that ADHD results from a combination of factors (1). Research has shown that ADHD often runs in families and children with ADHD who carry a particular version of a certain gene have thinner brain tissue in the areas of the brain associated with attention (1). Environmental factors are also linked to ADHD; studies suggest that there is a potential link between cigarette smoking and drinking during pregnancy and offspring with ADHD as well as high exposure to lead during early childhood (1). Also, children who have suffered from brain injuries tend to show some behaviors similar to those diagnosed with ADHD (1). There are other causes of ADHD that are harder to support; there are ideas that refined sugar causes ADHD or makes symptoms worse while British research indicates a possible link between consumption of certain food additives like artificial colors or preservatives and hyperactivity (1). There are a multitude of medications that are said to treat or improve the severity of ADHD, but unfortunately there is no cure to this disorder.
The most commonly prescribed legal medication for treating the disorder is Adderall (amphetamine). This drug is classified as a “stimulant,” but counterintuitively has a calming effect on children, adolescents, and adults with ADHD. Adderall contains the active ingredients dextroamphetamine and levoamphetamine, both of which are physcostimulant amphetamine molecules (2). The chemical structure and action of Adderall is very similar to that of recreational drugs such as methamphetamine (crystal meth) and MDMA (3,4-Methlyenedioxymethamphetamine) (ecstasy) (2). The reason that Adderall is so effective is because of its molecular resemblance to catecholamine neurotransmitters such as epinephrine (adrenaline), norepinephrine (noradrenaline), and dopamine (2). Because of its molecular resemblance, there are similarities in physiological effects of Adderall and these natural neurotransmitters. The amphetamine salts in Adderall can bind to and stimulate receptors in the brain that are usually activated by catecholamines produced in the body (2). The amphetamines in Adderall can also cause the release of more neurotransmitters that can activate the sensory regions throughout the nervous system (2). Adderall increases the concentration of catecholamines in the synapse (area between the presynaptic neuron and the postsynaptic neuron) by blocking the monoamine transporters (2). This process inhibits the reuptake of dopamine back into the presynaptic neuron from the synapse. Although this drug is approved for medical use, recently it has been illegally abused by people without ADHD—especially college students—to concentrate and focus for extended periods of time.
Nowadays, Adderall is commonly and increasingly abused as an effective “study drug”, and is not uncommon in collegiate life. The National Survey of on Drug Use and Health (NSDUH) reports that 15% of college students have admitted to abusing a form of psychotherapeutic drug illegally and of that 15%, 7% admitted to using Adderall for non-medical purposes like increasing attention span and improving grades (3). The same survey uncovered that the college students most likely to abuse Adderall were Caucasian, male, sorority or fraternity members, and college students with lower GPAs (3). About 14% of college students report that they were asked to sell, trade, or distribute Adderall and only 2% of those students actually had a prescription for medical use of Adderall from their doctors (2). There is a shocking ease with which students can distribute and obtain Adderall illegally leaving some experts to speculate that Adderall is the most abused prescription drug in America. In another concerning study, approximately 95% of students reported that they “were able to obtain a false diagnosis of ADHD by faking symptoms” (2). Since it is easy to obtain and in some cases falsely prescribed, it is no wonder that abuse and addiction are on the rise.
Since it is a Schedule II drug under the Controlled Substance Act for the United States, Adderall abusers are at a high risk for dependence and addiction (2). As mentioned earlier, Adderall prolongs the presence of dopamine in the synapse and by doing this, the amphetamines produce long-lasting side effects of euphoria, pleasure, and concentration. The reason that Adderall can become so addictive is that the nerve receptors are constantly being stimulated (2). Like addictive recreational drugs, people who abuse Adderall over a long period of time develop a tolerance to the drug, requiring a greater dosage of the drug to supply a response in the brain (2). Because Adderall has an uncanny chemical similarity to natural neurotransmitters, the likelihood of abuse is high.
Although millions of students are prescribed Adderall for their ADHD, the consequences of Adderall abuse can be fatal. Some of the dangerous physiological effects of Adderall abuse are hypertension, seizures, and mydriasis (dilation of the pupil) (2, 4). Another dangerous side effect is the increase in blood pressure, which is most likely caused by the continued release of norepinephrine (2). Other physical consequences of Adderall are irregular heartbeat, cardiovascular failure, abnormally high body temperatures, and erectile dysfunction (2, 4). High doses of Adderall can potentially lead to some very serious mental issues. Students often believe that they can go back to their normal lifestyle by stopping Adderall use, but this is not always the case (2). Long-term misuse of Adderall can lead to an altered or even permanently damaged brain. This is because Adderall tricks the brain into thinking that it doesn’t need to make anymore dopamine, and unfortunately dopamine is the only chemical in the brain whose natural production is hard to bring back (2). Since dopamine is needed to control one’s emotions and prevent aggression, Adderall abuse can eventually lead to severe depression, an irregular mood or mood swings, hostility, paranoia, psychosis, and even suicide (2, 4). Fortunately, unless abusers use Adderall very frequently and in high dosages, abusers can stop taking Adderall without these serious withdrawal systems. However, they still may face bothersome side effects such as insomnia, extreme fatigue, loss of appetite, irritability, depression, loss of interest, hallucinations, paranoia, and thoughts of suicide (2, 4). With all of these scary side effects it is hard to believe that college students still have trouble seeing the consequences of using Adderall non-medically.
Surprisingly, recent research has shown that many college students who abuse Adderall find themselves justified in doing so (2). In 2007, a study using 175 undergraduate college students found that some students thought that the unprescribed use of Adderall was not only morally acceptable, but also harmless (2). Many students claim that Adderall is legal, unlike other serious drugs such as cocaine and ecstasy, and compared to these drugs Adderall is harmless (2). Another common justification for Adderall abuse is that students believed that Adderall usage in moderation would not threaten their health (2). Other abusers claim that they have self-diagnosed themselves with ADHD and their usage of Adderall is to treat their ADHD (2). The fourth argument is that Adderall’s risks have been minimized in today’s culture and some students see it comparable to energy drinks or coffee (2). A study held by “The Partnership for a Drug-Free America”, reports that 40% of teens believe that prescription drugs are much safer than illegal drugs; 31% thought there was nothing wrong with using a drug without a prescription once in a while; and 29% believed that prescription medications do not have addictive qualities (2). This data shows that too many college students and teens are uneducated about the dangers of Adderall abuse.
The abuse of Adderall among people undiagnosed with ADHD, especially college students, has no doubt become an epidemic in modern society. Obviously, the consequences of abusing this medication are harmful both physically and mentally on the abuser’s health, so why is this drug being abused so often? Disappointingly, the consequences may not be as obvious as they should be. Data shows that high school and college students are not properly educated on the consequences and addictive properties of prescription drugs like Adderall, and this is unacceptable. A course of action needs to be taken to ensure these students understand the full implications of Adderall abuse so they can protect their health.
More drug abuse prevention programs are needed to educate the college community and aim at decreasing long-term abuse of Adderall. High school health and wellness classes should consider adding more focus to the dangers of abusing prescription drugs if they have not done so already. As mentioned earlier, most college students who abuse Adderall do it to excel academically by improving attention span and focus; what does this say about the pressure on students to perform highly in school? Schools need to consider being more lenient with their expectations, especially since this situation has gotten to the point where students are willing to risk their health for their school work. This does not mean students should get a free pass every time they are struggling to focus or perform in school, but maybe educators should be more willing to give extensions if necessary. Also, students should be encouraged to get help and advice from counselors; it should be clear that illegal self-medication is not the only solution to their problems.
Foremost, the abuse of Adderall is dangerous to the abuser, but it is also unfair to students who truly have ADHD. How can people correctly diagnosed with ADHD ever be on an equal playing field with others if the drugs they need to simply act normal, are being used by their fellow students for hyper-focus? In this sense Adderall abuse can be simply considered cheating!
Lastly, there is definitely an issue of over-diagnosing people with ADHD, which puts more and more people at risk and increases the abundance and, by extension, availability of ADHD drugs! Doctors need to assess and improve the guidelines for prescribing Adderall and other psychostimulants or else it will become impossible to limit the abuse of this prescription drug. If immediate action is not taken to stop the severity of this epidemic, the United States may be the next nation added to the list of countries such as Canada, Sweden, and Japan who have banned Adderall usage altogether.