Ever since he was five, an Elon University communications student — who will not be named to protect his identity — has been prescribed medication for attention deficit disorder (ADD). As the student got older, he began controlling the doses himself and soon realized he could no longer handle the daily medication.
“It just makes me feel uncomfortable,” he said. “I wouldn’t want to take it every day because it suppresses my appetite and makes it hard to fall asleep, so I only take it when I need to.”
The communications student is prescribed 40 milligrams of Vyvanse and 10 milligrams of Adderall daily, but said he only prefers to take his medication for “school-related events” such as studying for or taking tests, or any other classwork where he needs to stay focused. To him, Vyvanse and Adderall have become nothing more than “study drugs.”
“I think that even if I could focus perfectly, I would still take it when I needed it for a big test because it gives you an advantage,” he said.
While some, like this particular student, are diagnosed at an early age, another Elon student took a more unconventional route. After taking unprescribed Adderall to help her study, this Elon junior went and got a prescription herself.
She first noticed having attention issues in fifth or sixth grade and took prescription medication for the first time her sophomore year of high school. She’d get it from her friends with prescriptions and said it was during her junior year where her usage picked up.
This past summer, before the start of her junior year at Elon, she sought out an ADD prescription of her own so her insurance could pick up the tab, instead of having to pay out-of-pocket herself. The junior said her parents were opposed to the idea of ADD medication while she was growing up and weren’t fully sold on the legitimacy of the condition, so she went to her pediatrician herself. After a brief consultation where she expressed her symptoms, the doctor prescribed her 30 daily milligrams of Adderall.
Ginette Archinal, medical director of Elon Student Health Services and university physician, said quick consultations like that — which end in ADD or ADHD diagnoses — are problematic.
“Unfortunately there will always be physicians who will find it easier to just write a prescription rather than doing a full history,” she said. “It’s much easier to write a prescription, get the patient out the door and get another one in.”
The number of ADHD diagnoses increased at a rate of 5 percent per year from 2003 to 2011, according to the Centers for Disease Control and Prevention (CDC). That means more and more students are entering college with scripts for ADD and ADHD medications. Moore said that creates favorable conditions for students without ADD or ADHD to abuse those medications.
It’s what’s on the inside that counts
One of the key factors as to why these medications are abused by college students is because of internal factors such as the biological functions of the body and the chemical compositions of the drugs themselves. Adderall, Ritalin and other name brand ADD and ADHD medications all cross the blood-brain barrier, meaning they have a direct cognitive effect on the brain.
In a classical model, a person with ADHD would require something such as dopamine to increase their ability to focus and be sharp. Dopamine itself can’t cross the blood-brain barrier, so ADD and ADHD medication use amphetamines and variants of amphetamines to cross into the brain.
at Gendle, professor of psychology at Elon said while chemists can manipulate drugs to the minute detail, they still aren’t completely certain what causes ADHD. They know the problem, just not why the problem exists.
Gendle said those with ADHD have a reduction in catecholamine — chemicals that move between cells — in the prefrontal cortex , which is the front part of your brain right above your eyes.
“This is an area of the brain that’s really important in regulation of higher level behavior, executive control, planning [and] higher level attentional control,” he said.
Creating practical policy
Archinal said the policy of Elon, and many other small colleges, is to not prescribe ADD or ADHD medication on campus because they are so widely abused.
The National Institute on Drug Abuse’s (NIDA) latest survey from 2013 reported that just under 11 percent of college students surveyed took Adderall non-medically and just under 4 percent used Ritalin non-medically. The combined rate of 14.3 percent was more than 5 percent higher than the conducted survey of people who are of college age, but not in college.
If a student comes in expressing symptoms of ADD or ADHD, Archinal often will do an evaluation herself, before recommending the student to a more specialized physician for a further analysis and final diagnosis and prescriptions. Elon also does not refill existing prescriptions for students with ADD or ADHD.
Elon’s Office of Student Conduct has its own policy laid out in the student handbook regarding using and distributing prescription drugs. Possession or using prescription drugs without a prescription can result in punishment ranging from restitution hours, fines or suspension. Distributing or selling prescriptions normally results in a suspension for one calendar year for first-time offenders and permanent separation from the university for second-time offenders.
Students still are able to access these study drugs despite the safeguards in place. The senior communications student said he is asked for spare pills on a regular basis.
“So many people have prescriptions so every single person knows a couple of people with a prescription so if you need one, it’s not far away,” he said.
“And because so many people have prescriptions and it’s from a doctor, people don’t think it’s bad or feel any remorse for going and finding it and getting it.”
Despite the law and Elon’s own policy, the senior does not view diverting his pills as a problem.
“It’s not drug dealing because with drug dealing you’re trying to make money, whereas this, you’re trying to help somebody,” he said.
“If I don’t use it every day, I don’t use my full prescription every month, if I can help one of my friends out when they need help, then why not?”
Science made easy
Ruben Baler, health science administrator for the National Institute on Drug Abuse, spends most of his time speaking with high school and college students, as well as their parents. Baler said he likes to use analogies during his talks, so the audience can understand the inherently complex topics such as the neuroscience of how the brain works.
Baler said educating college students is a unique challenge.
“Adolescents don’t really look at themselves as vulnerable,” he said. “They see themselves as somewhat immortal and nothing can happen to them, so talking about the vulnerability of the brain is a tough sell.”
Baler said prescription drugs are a “double-edged sword” because while they are manufactured for medicinal purposes, they are still very dangerous and highly addictive.
When he discusses abusing ADD and ADHD medication, Baler encourages his audience to visualize a bell curve. The curve represents dopamine levels in your brain. An average person without ADD or ADHD is at or near the peak of the curve, and has normal dopamine levels.
“Those with ADHD are to the left of the peak so they need to take stimulants to move right along the curve [toward the peak,]” Baler explained.
When more is less
Baler uses the same model to illustrate what happens when people abuse ADD and ADHD medication.
“When normal populations, who are already at the peak level of dopamine take something like Adderall or Ritalin, what they are doing is moving to the right [of the curve]," he said. "It's suboptimal because you are moving past the point of optimal performance.”
Since the function between a person’s dopamine levels and cognitive function is non-linear, people on medication without ADD or ADHD are actually lowering their ability to function. Baler added that students who abuse the medication are running the risk of not being able to think outside the box, despite feeling more alert and focused.
Gendle said this aspect is particularly tricky because students will anecdotally say they feel more alert and are able to study more when taking the medication. He suggests the reason for that lies in the chemical makeup of the majority of ADD and ADHD medication.
The two active ingredients in Adderall are amphetamines and the most effective ADD and ADHD medications are often amphetamine-based. Amphetamines increase levels of synaptic catecholamine in the brain and boost dopamine levels. Essentially, they make people feel more alert, sharp and feel better.
“It’s not enhancing the higher-level functions that you need to actually sit down and write a 20-page paper,” he said.
Gendle said the effects of amphetamines can hide the more serious consequences, like operating at a lower than optimal level.
“Given the complex, multifaceted nature of the cognitive features that you need to employ to write that really good final paper or to study for an exam, I don’t know that it’s going to help you.”
Finding motives
David Rabiner, associate dean of the Trinity College of Arts and Sciences at Duke University, coauthored a study entitled “Motives and Perceived Consequences of Nonmedical ADHD Medication Use by College Students.” In their data gathered in 2008, just under 10 percent of students admitted to using ADHD medication non-medically.
“We found the overwhelming majority of students who use these drugs without a prescription, the primary reason is to enhance their academic performance,” he said.
Rabiner said he anticipates the number to be higher now, similar to the NIDA figure. Though, Rabiner’s study showed wide disparities depending on year and ethnicity. For example, abuse among seniors was significantly higher than for first-year students.
“It went from 2 percent of first-year students who reported that, up to nearly 20 percent of seniors who had reported that they had used non-medically,” he said.
The most prevalent demographic of users in Rabiner’s survey were white males in fraternities where just under 40 percent reported using non-medically. The senior communications student is a member of a fraternity at Elon and said some friends use it not just to study, but to party.
“I guess they do it to be able to drink more and stay up longer,” he said. “They’ll take it to wake up if they’re feeling sleepy before they go out.”
Although he will give his friends medication to study, he said he would not give it to them for the purpose of partying, because he said that’s not what it’s for. But if somebody needs it for studying, he’s happy to give them a pill.
He also said he would not use it himself for the purpose of partying.
“I personally know that it’s not fun,” he said. “It is not something that I take to have fun so I would never even think to take it when I was drinking.”
The junior also admitted to giving her friends pills for free to help them study. She would also occasionally take it to stay awake when going out on the weekends. She said she notices a difference when she mixes Adderall with alcohol, and she doesn’t always like the result.
“You black out when you take Adderall and when you drink,” she said. “It’s way easier to black out. When you take it you get really, really, really drunk.”
She also never enjoys the coming down effect after taking Adderall.
“You feel like you can’t do anything except stare at a wall,” she said. “But you can’t sleep, so it’s the worst feeling ever.”
Despite all of these negative effects, the junior said the benefits outweigh the risks, making it hard to stop using it altogether. She calls it a crutch, one that she can rely on when she needs to be productive.
The communications major had similar feelings and reasons for why he uses and willingly gives to his friends.
“It’s hard because you want them to do well [in school] too,” he said. “But part of the thing is, so many people don’t view it as dangerous because so many people have it and it’s not hard to get.”
Rabiner said the fact that ADD and ADHD medication is a prescription makes college students think of them as less dangerous.
Finding a balance
Rabiner said another reason for abusing the medication comes from additional stresses of being a student he didn’t have to face when he was he himself was a student.
“Students are trying to cram in more and more things into a typical day,” he said. “I meet with students all the time now and usually when I listen to most students' schedules, I think to myself, ‘I couldn’t [do that] for a day and a half. How are they going to keep that up for a whole semester?’”
The student said Elon’s culture of fully- if not over-involved students also plays a part in her usage.
“It’s such a social culture here,” she said. “There is always things to do and it’s hard to do your school work too.”
Gendle said he’s noticed Elon students’ tendency to load up their schedules during his 12 years on campus.
“It’s completely insane,” he said. “I don’t understand why though, I’ve never had a student give me an answer that I would consider to be acceptable about why that is.”
Gendle suggests it may come down to the attitude originating back in high school, where extracurricular activities are crucial for getting into a good college. He said students don’t necessarily understand that doesn’t matter as much anymore once you get to college.
“Y’all as students are fairly high achievers, which is how you ended up here and for whatever reason,” he chuckled. “It’s like go hard or go home. It’s an attitude I don’t understand. It’s a very American attitude.”