The Adderall effect

AV THE MAJOR S1

»F ROM S T

THE W

Baby-faced Joe is a student at an elite East Coast uni­versity who deals drugs on the side to make a bit of spare cash. It's not a major operation: a little weed here, a little acid there. But the most sought-after item on his menu is Adderall, the popular prescrip­tion drug that family doctors and psychiatrists give to kids as young as six to treat attention-deficit/hyperactivity disorder.

It's finals time, and Joe, a skinny teenager with a mop of curly hair, sits in his crowded dorm room, listening to the Vel­vet Underground's paean to amphetamine psychosis "White Light/White Heat." He and his three roommates are readying for another all-night studying session on Adderall. A book about macroeconomics sits on his desk, awaiting his attention. Joe's cell phone buzzes. His friends have been text-messaging him all

day: NEED 3 ADDY. R U AROUND. Joe texts back: COME OVER 15 MIN.

Joe (not his real name) grabs a plastic medicine container with a high abuse potential label on it and pours pills onto his bedspread. He separates and counts them: There are the 20-milligram standard-release tablets, which go for up to $5 each and can be crushed into a fine powder, making them popular with students who like to snort the drug to quicken its onset. Better yet, there are the orange-colored 20-milligram extended-release Adderall XRs, which also sell for $5 a pop and last up to 12 hours. Adderall XR is the Lamborghini of study drugs, the version students take when they need to drive themselves faster, longer and harder than the competition.

At 16 Joe was diagnosed as having ADHD by a psychiatrist

and prescribed Adderall. Joe doubts he has a condition, cer­tainly not one that requires a big pharmaceutical dose (60 mil­ligrams) on a daily basis. His schoolwork noticeably improved while he was taking Adderall, but he felt hyped up all the time, like an energized zombie, as if some person other than himself were operating his body. He feared he would become dependent on the drug, and without telling his psychiatrist he stopped taking his meds. But he retained his prescription so he could sell the pills to his friends.

"My three-month prescription, if I were to sell it all, would be worth $1,500, which is a lot of money to me," says Joe, who still takes Adderall at exam time. "I have the ideal situ­ation for selling Adderall: I live in a dormitory with 800 other students. All my neighbors are potential buyers."

Twenty milligrams is enough to give the user what seems like superhuman powers of concentration; it banishes distractibility and delays sleep. It can turn tedious work into fascinating mate­rial; a boring textbook can become a riveting page-turner.

"I feel like the drier the subject is, the more effective Adder­all is," says Joe. "Little details I have to go over six times when I'm straight, on Adderall they stick in my brain right away."

Joe worries the Adderall craze on campus is getting out of control. A third of his friends use the drug. Two of his roommates also have prescriptions, one from a doctor father who knows full well his son doesn't have ADHD yet gives it to him anyway.

"Colleges are increasingly competitive," Joe says. "There's an ever-increasing desire among young people to make money

and become successful because that is what's being promoted by their parents, by the university and by the culture at large. In that sense Adderall is the perfect drug for the times. I think it embodies and defines what this culture of medicating kids is all about." He pauses. "It's the drug of conformity. Adderall is the drug your parents want you to take."

Drug use on college campuses in America has always served as a barometer of what's going on in the culture at large. In the 1960s drugs were about the counterculture and rebellion. In the 1970s and 1980s they were about partying, sex and excess. Students in the 1990s rediscovered drugs as a source of illumination, becoming foot soldiers in the rave and neo-hippie movements. In the new millennium, however, Adderall is threatening to sur­pass marijuana as the most common illicit substance on some ramnuses. Students use it not so much to get high as for a rather

prosaic purpose: to get better grades.

According to recent research done by the University of Michigan's Sean Esteban McCabe, up to 25 percent of students at high-powered universities have used prescrip­tion stimulants like Adderall. According to the numerous interviews I conducted with stu­dents, professors and scientists for this story, use of the drug shows no sign of declining.

Adderall is a mixture of amphetamine and dextroamphetamine. It's speed. From the 1930s to the 1970s doctor-prescribed amphetamine was a socially acceptable main­stream medicine. Every segment of American society—students, housewives, soldiers, doc­tors, factory workers, politicians—consumed massive amounts of amphetamine to get an extra boost for what had become known as the rat race. In the "Just Say No" era, doctor-prescribed amphetamine disappeared from college campuses. Two decades later it's back with a vengeance.

How ironic that methamphetamine contin­ues to be demonized by the media and law enforcement as the most frightening sub­stance since crack cocaine, while amphet­amine and dextroamphetamine—different versions of the same basic drug—have once again become an intrinsic part of campus life. The major supply of speed on college cam­puses today comes not from scabby street chemists but from the freshly scrubbed men

and women in white coats who belong to the medical establish­ment. Many parents who would be horrified if their children were using crystal meth are happy to see them dosed up on what is essentially the same drug, as long as it comes from a pharmaceu­tical company and little Jimmy or Jenny gets good grades.

Few who pop these pills have any idea of Adderall's strange history. The drug was invented as a diet pill called Obetrol in the 1960s. It crept into the counterculture as well, including into Andy Warhol's crowd. (Warhol had just picked up a prescription for it the day Valerie Solanas shot him at his Union Square studio.)

Obetrol's selling point was its smooth onset. It was said to be less harsh than the more popular weight-loss pills of the time—like Desoxyn (pure methamphetamine) and Dex-edrine (pure dextroamphetamine)—because of its mixture of amphetamine and dextroamphetamine salts. In the 1970s the Food and Drug Administration cracked down on doctors who prescribed amphetamine pills for weight loss. Obetrol was withdrawn from the market.

Enter Shire Pharmaceuticals, a British company at the time known less for inventing new medicines than for taking exist­ing ones and rebranding them. Shire bought the company that owned the rights to Obetrol—as well as the factory that

produced it—in 1997 and then began promoting the drug as a treatment for attention-deficit disorder.

It was a case of being in the right place at the right time. The number of kids prescribed drugs to treat ADD and ADHD in the late 1990s skyrocketed. Ritalin—which is methylphemdate. a nonamphetamine stimulant that acts in the brain like cocaine— was the most popular treatment for ADD. But after newspaper articles, and Scientologists, raised concerns about the safety of prescribing such a powerful drug to children, Adderall was aggressively marketed to physicians as a safe and longer-lasting alternative to Ritalin. By the end of 1999 Adderall had boosted Shire's revenue to more than $400 million a year.

The moral debate over dosing children with powerful drugs continues to rage. "I don't think there's any question doc­tors overprescribe these drugs," says William Frankenberger, a psychology professor at the University of Wisconsin at Eau

Claire who has spent the past decade study­ing the effects of stimulant medications on academic performance. "There was a huge increase in the 1990s, thousands of percent, of children being diagnosed with ADHD and being treated with stimulant medication. Those children are now in college."

Adderall's popularity as a study aid really took off in 2001. when Shire introduced Adderall XR, the extended-release version of the drug. XR is a capsule containing two types of time-release beads, half of which dissolve immediately, the other half four hours later. Sales of Adderall XR grew on average 20 percent a year, and it quickly became the most widely prescribed ADHD drug in America, generating $1 billion of Shire's $2.4 billion in revenue last year.

Although small doses used occasion­ally don't result in much of a hangover, slightly higher doses extended over time can result in a harsh comedown: sweaty palms, blotchy skin, heart palpitations, strawlike hair, insomnia and limp-dick episodes. Cardiologists worry about the effects daily doses may have on the heart. In February 2005 Canadian authorities temporarily banned XR after reports of 20 deaths linked to the drug. In this country the FDA looked at the same data but con­cluded that the rate of fatal heart attacks among kids on Adderall was little different

from the rate among those who didn't take stimulant drugs. The feds allowed doctors to continue to prescribe it.

"Because it comes from a doctor, students don't think it's that risky," says Dr. Lawrence Diller, author of Running on Ritalin and a frequent critic of doctors who overprescribe stimulant drugs to kids. "For most of them who take it occasionally in small doses, it isn't. But a small group will overuse and get into trouble."

Beyond the question of physical effects, what does the current campus Adderall craze say about kids these days? About the mar­keting power of pharmaceutical companies reaping huge profits? And the medical community, which stands between the two?

David (not his real name) is sitting in an exam hall, and he's losing his mind. He thinks he's having a panic attack. The 19-year-old economics major now realizes that washing down 75 milligrams of Adderall with eight cans of Red Bull wasn't the best study plan he ever had. His hands shake, his mind races in a hundred different directions, and his heart feels as if it's about to burst out of his chest. He's pouring with sweat, and he can barely breathe. Holding up his hand, he leaves his seat and stumbles into the hallway, where after 10 minutes of drinking cup after cup of water and taking (continued on page 128)

ADDERALL

{continued from page ^2i deep lin-adis. lu's calm enough 10 refiner the hall and take the exam

"I did belter on that exam than on ,im exam I've ever taken." he later recall* "I got a ncai-perfect More."

A slightly built youth with gelled brown hair and a casual hall-hipster, half-preppie stvle. David is a Ian ol Adder.ill lie has been tak­ing it lor about a year on a iairlv regular basis, and except lor that time he ucarh passed out in the exam room, it has Ix'en a cool ride. "It takes away your worries." he savs ol the drug "Instead of freaking out and thinking. Oh man. I'm going to fail tomorrow, you lake a pill and everything is fine."

When 1 meet David, he is in the middle of finals, and in four days he has slept only eight hours, lie shows no signs ol tiredness. In lac I, he's feeling great thanks to the (it) milligrams ol Adder.ill he has taken over the past 21 hours. lies from a well-to-do sub­urban family, and once finals are over he's headed to l'.uiopc lor the summer and vows he won't lunch the drug lor months. 1 le savs he uses Adder.ill mainly as a study aid. bill sometimes he uses it lo sociali/.e. too.

"Addcrall has added a lot to inv life." he says. "I owe a lot of my friendships to Adder-all. Normally. 1 don't like talking to random people, but on Adderall you're really inter­ested in people. It's the gel-up-and-go drug. Instead ol sitting on the couch, smoking pot and watiiiing television. I want to go out and do things." (David has also discovered another useful role lor llie drug: "|etking off on Adderall is an ama/ing cxperienc c.")

When asked il Adderall has improved. Ins glades. David pauses. "Ac lualK." he savs. "now that I think about il. it doesn't. Mv fust semes­ter I had straight As. 'I"he second term, when I started taking Adderall. I had straight Bs. 1 continued using it. and now 1 have an A-. 11 + mix. So maybe the Adderall hasn't helped."

David underscores a seductive part of amphetamine's appeal thai scientists have known for decades: I he substance doesn I just give you extra energy: it makes you feel good about yourself. The drug releases in the brain high levels of the pleasure chemical clopamine. the same substance disc hargccl while making love or smoking a cigarette. That's why amphetamine was America's fust widely prescribed anlide-prcssanl. decades belore I'ro/ac.

A common complain! among loda\ s stu­dents is (he constant stress and mental ex­haustion they feel competing in such an academically clem,Hiding environment. The pendulum has swung away from the slac ker generation, so much so in lad that one could argue college students have never before found themselves under so much pressure lo pcrlc ii in and excel—not just to get gin id grades lint lt> outdo one another. It's not only harder logei into a good college these days (some Ivy League schools receive twice its many applica­tions as they did a decade ago), but once you get there the pressure is unrelenting to main-lain g<Mid grades so you can gel a six-ligiue |oh upon graduation. The majority of students interviewed for this story expressed anxiety about disappointing their parents, some of

whom arc spending as muc h ;ls S2OO.OOD lor a four-year degree. Addciall boosts sell-eMeem. It's a drug that noi only helps students manage a complex world Lml also makes them leel good about their place in it.

"When it cosl.s my parents S.r)O,(KX) a year lo put me through college, you ran bet I'm going lo be stressed alxmt gelling good grades," says David. "The reason I started taking Adderall in ihe first place was I thought I was going to gel an I on a palter, and my father would have been pissed. My dad, who is a dentist, often says. Do you know how many teeth I have lo pull to pul you through college for a year? '

Does Adderall raise academic performance over lime? This much is certain: Amphet­amine medications have Iki n used lor a brain

boost since the (ireal 1 >epi ession. As far Ixick as 1«>:17. .11 a Rhode Island mental hospital, psychiatrist (Diaries Bradley, widely cred­ited with discover­ing ADHD, dosed HO learning-disabled chil­dren with Ben/.edrine (the original brand name lor amphet­amine) and loiincl hall the children showed "a spectacular im­provement" in school performance. Bradley had ,n c idenlallv lound that amphetamine has the paradoxical (-fleet of calming hyperactive kids, enabling them to better concentrate on (heir class work.

Within a year slu-dent test subjects in psychological studies had spread the word to their friends about amphetamine's ellec-tiveness as a study aid. Timf magazine report­ed that "the use of a new powerful but poi­sonous brain stimulant called Benzedrine |b.icl| college directors nl health in dithers of

worry." One British psychologist at the time claimed "students have come to cherish this drug as a gill ol'ihe gods."

"There's pretty much been a 70-vear use ol amphetamine to help children do better in school, Kxoiuentr.ileaud control then Ix'hav-ior," says Diller. "Personally. I think Adderall has more ol an elled on improving one s sense ol sell ih.in improving one's performance.'

"I've Ixen studying this lor years, and I'm still not sure there's an advantage (or student* taking tests on Adderall .ls opposed to students who study in the normal way.' says Kranken-berger. " There's good evidence that in the short term when children go on stimulant medications, the <jti.iikii\ and (jtialitv of their work increases. There's no debating that. Hut are thev learning more in the long run!' The answer seems to Ix1 no."

If it is a myth that Adderall and drugs like it are cognitive enhancers, it's one that many scientists and researchers have taken as truth. A recent survey hy Nature magazine, whose main readership works in science and acadcmia, found roughly one in five readers used prescription drugs—including Adderall, Ritalin and I'rovigil—to Icxus concentration and increase productivity. Pilots in the mili­tary have used these drugs to stay awake and concentrate for long periods. The Adderall-on-campus issue is, in cflcct. the same debate that's going on with steroids in professional spoils. If the drug works, even in the short term, does taking it constitute cheating? Should all students be allowed to take it to level the playing field"'

"Society is rife with hypoi risy," says Diller. "These kids are taking these drugs for the

same reason athletes are taking these drugs, the same reason their teachers are taking these drugs, the same reason businessmen are tak­ing these drugs. It's lor performaiu e enhance­ment. We live in a < ompclilive society that demands performance at all costs and equates material acquisition wilh emotional and spiri­tual contentment. This is a culture perfect lor using performance enhancers. Whether they actually work or not is another question."

Susan (not her real name), 21. is a pretty blonde in a clingy black dress who goes to a well-regarded college in upstate New York. It's summertime, and we're sitting in a restaurant in midlown Manhattan. She describes her sorority lile .is being like \ alley oj the Dolls redux. These days there's a drug

for every occasion—OxyC.ontin for when you want to get really zoned out. Xanax for anxiety. Valium for relaxation and Klonopin. a hypnotic drug used to treat seizures, for a pleasantly drowsy evening when there's nothing better to do. But the crown jewel is Adderall. The drug is particularlv popular among female students because, while they believe it helps with their studies, it also sup­presses their appetite and helps them lose weight. After all. it was originally created as Obetrol. the diet drug. (For the same rea­son, Adderall has been called "the miracle pill" for Hollywood celebrities trying to con­trol their weight.)

""I "here's definitely a return to pill culture on campus." says Susan. "I don't know il it's that students are more scaled today to experiment with street drugs than in the past, but part

ot (he appeal of pill culture is the feeling thut these dings are safe and legal because they come from a doc­tor. There's still a lot of ecstasy and cocaine around, but increas­ingly, students prefer prescription drugs.'

Susan estimates well over half her soror­ity sisters have taken Adderall at least once. All sorts of students take the drug, she says, from straight­edge types who would never dream ol taking street drugs to slack­ers who think they can cram a term's worth of study into one week. ()n Susan's campus lit­tle or no social stigma is attached to the drug. It s such a normal pan oi campus lilt that stu­dents openly pop the candy-colored cap­sules in the library, even though Adderall is a Schedule II con­trolled substance, the possession of which without a prescription is tcclmicallv punish­able In jail time.

Says Susan, "It's not i-vrn considered a drug anymore."

But il is a drug, one that when taken in high doses ran have some unhappy consequences. Fortunately, the students who take Adderall ate usually sensible enough to take it only when the\ think it ran help them and in small closes—usually 'JO milligrams at a time, which lulls well below the threshold thai produces euphoria and is unlikely to cause harm.

Larger closes taken regularly over an extended lime |>eriod—that's a dillerenl story. As the legendary undei^round < hemist L nele Fester, w ho wrote the melh cook's bible Senrb of Miiluimpluiiiminf Miiiiii/arlurr, once told me. amphetamine "makes a great short-term Iriend but .1 lousy long-term companion.

ADDERALL. A DRUG WITH A CHEMICAL COMPOUND SIMILAR TO CRYSTAL METH. WAS ORIGINALLY LAUNCHED AS A WEIGHT-LOSS PILL IN THE 1960S TODAY SHIRE PHARMA­CEUTICALS MARKETS IT AS A DRUG FOR ADHD. THE COMPANY SOLD MORE THAN $1 BILLION WORTH OF ADDERALL OVER THE PAST YEAR.