The ADHD medication Adderall, which is based on an amphetamine, is commonly abused by college students. According to the National Survey on Drug Use and Health more than 6% of full-time college students report using Adderall for non-medical purposes, which is twice the rate of Adderall abuse seen among 18 to 22 year olds not attending college(1). The survey also revealed that non-medical use of Adderall among college students is also linked to a greater likelihood of alcohol, marijuana, cocaine, prescription opiate and tranquilizer abuse. This is particularly worrying, as combining depressants like alcohol or another stimulant like cocaine with an ADHD stimulant increases the risk of adverse Adderall effects. Despite the side-effects of Adderall misuse, why are college students so keen to use this ADHD drug?
Adderall and College Students
As Adderall controls ADHD symptoms, such as poor concentration, and is linked to improved academic performance among children and teens with ADHD, taking this cognitive enhancer is seen by many students as a way to get ahead in their studies. Indeed, a research paper published in Brain and Behavior highlights that this is the main reason for Adderall abuse among college students(2), with students believing this will help them achieve better focus on their work. Its misuse is most common towards the end of term when exams and academic deadlines require students to work late at night, with the stimulant effects of Adderall allowing them to stay awake and maintain their concentration as long as they need to. Undergraduates juggling part-time work, extra-curricular activities and a busy social life alongside their studies are also particularly prone to Adderall misuse. However, the perceived value of cognitive enhancement drugs is not the only reason why students misuse this prescription stimulant. For instance, as an amphetamine Adderall offers a high, so both students with and without ADHD take the drug to experience feelings of euphoria, in the same way that they might turn to prescription painkillers or illegal stimulants for a similar effect. With Adderall energy levels are also enhanced, so the drug is favored by some college athletes who want to enahnce their sporting performance, even though these stimulants offer an unfair advantage in competitive sport and a random drug test could highlight their use. The appetite suppressing effects of stimulants are another reason why some college students misuse this ADHD medication, as with Adderall weight loss is possible as long as someone keeps taking the drug.
Even though Adderall is a Schedule II Controlled Substance, just like cocaine, students don’t believe that the drug is harmful. In fact, a research study by East Tennessee University found that students described its use as safe and beneficial, believing it is no different than having a cup of coffee or using energy tablets or drinks to remain alert or boost their vitality(3). The fact that Adderall is a prescription drug that is taken by children may help to explain this common misconception and why its use is seen as acceptable by college students.
Adderall Benefits without an ADHD Diagnosis
Although prescription stimulants show definite benefits for students with ADHD, the value of these drugs for students without an ADHD diagnosis is more questionable. A review of the evidence for non-medical use of ADHD stimulants for cognitive gains, which was reported in the Psychological Bulletin, found that while these medications can improve declarative memory (the ability to recall facts and knowledge) owing to their ability to improve consolidation of memories, the evidence is less clear for enhanced working memory and cognitive control(4). As the ability to manipulate information, reason and problem solve are more valuable to college students than their ability to simply recall information, the Adderall memory improvements on offer may not help undergraduates as much as they hope in their studies.
When it comes to Adderall and sports performance, Penn State University discusses that there is evidence that the stimulant can help athletes to keep their focus and energy levels up(5). Just as the appeal of Adderall is greater as end of term exams and deadlines loom, the same is true in sports players who are looking for a boost to get them through to the end of the season. While the energy benefits of ADHD stimulants are obvious, the ability to stay alert and concentrate for longer periods should not be underestimated in sports. With greater alertness players can spend more time studying the opposition and their performance in previous games, at a time when they might otherwise be sleeping, and with Adderall concentration enhancement offers greater focus during competitions too. While Adderall use is acceptable for athletes with confirmed ADHD, it cannot be considered anything other than a performance enhancing drug and creates an unlevel playing field.
Short Term Effects of Adderall
Whether students abuse ADHD drugs to enhance their academic or sporting performance, or for another reason entirely, they should not ignore the risks of Adderall use. Among the adverse effects of Adderall discussed by Cornell University are(6):
- Dehydration This can arise due to increased sweating, as a result of a raised body temperature, if you do not drink sufficient to replace lost fluids. The combination of a high temperature and dehydration can lead to potentially fatal heat stroke, with the risks of this greater when Adderall is taken as a party drug.
- Heart Palpitations As with other stimulants, Adderall can increase heart rate and may sometimes lead to an irregular heartbeat. There is the potential for the drug to trigger a heart attack, even among students who are in otherwise good health.
- Headaches Migraine sufferers in particular may find they experience headaches on Adderall, which may result from chemical changes triggered by the medication in the brain. As ADHD stimulants can also send blood pressure soaring, this is another possible explanation for these headaches, though they may simply arise from dehydration.
- Sleep Problems For students wishing to stay awake all night, the short-term effects Adderall has on sleep is desirable, but if taking the medication for another reason, insomnia is unwelcome.
- Low mood and anxiety. Once the stimulant effects wear off, this can leave users feeling depressed and anxious.
The risk of adverse Adderall effects is greater when combined with certain medications. The FDA therefore advises that the ADHD drug may not be suitable with certain antidepressants and antipsychotics, prescription opiates, medications to treat high blood pressure, seizures and acid refleux, and even over-the-counter cold remedies(7). Mixing alcohol and Adderall is also a dangerous combination, as the University of Michigan discusses that stimulants counteract the depressant effects of alcohol, making it more difficult to judge when you have had enough to drink and increasing the risk of intoxication(8).
Long Term Effects of Adderall
Regular use of brain enhancing drugs like Adderall over time can lead to further problems. Campbell University explains that the following may occur with sustained use(9):
- Sleep deprivation While the occasional night of little or no sleep is not a major issue, regularly missing sleep can lead to serious health problems and will take its toll on academic and sporting achievements.
- Paranoia Anxious feelings can quickly turn to fear and paranoia.
- Psychosis This is similar to amphetamine psychosis, characterized by symptoms such as hallucinations, delusions and disordered thoughts. It is thought the sleep deprivation associated with chronic Adderall abuse contributes to this psychosis.
- Weight loss Whether or not weight loss is the intention of Adderall misuse, poor appetite that persists in the longer-term can lead to malnutrition, not only due to significant weight changes, but also nutrient deficiencies.
- Digestive Problems Nausea and abdominal pain are common with repeated use of Adderall.
- Addiction Owing to changes in the brain, it is easy to become dependent on Adderall.
Adderall Addiction
Like other habit forming drugs, with frequent misuse Adderall dependency soon develops. Both physical and psychological dependence can occur, so students will find themselves suffering from unpleasant withdrawal symptoms if they go without this ADHD stimulant, but also that they are addicted so will go out of their way to satisfy their drug cravings. The increase in dopamine triggered by ADHD medications explains why users seek out the drugs repeatedly, as they associate its use with feelings of pleasure. An article in Progress in Neurobiology explains that over time though exposure to Adderall triggers changes in gene regulation, which leads to changes within brain cells and reward circuits, and enables an addiction, similar to meth, to take hold(10). As drug dependency can adversely impact on academic performance and make users lose interest in other activities, taking drugs that make you smarter or enhance your sporting performance can actually lead to their downfall. Once in the grip of Adderall addiction, abuse of other stimulants like speed and cocaine is also common, which may explain higher rates of illicit stimulant misuse among undergraduates who take Adderall. Illegal stimulants offer an alternative way to get their fix, but impurities in street drugs potentially make their use even more dangerous.
References:
1. “Non-medical use of Adderall among full-time college students,” SAMHSA, accessed December 10 2014
2. Shaheen Lakhan & Annette Kirchgessner, “Prescription stimulants in individuals with and without ADHD: misuse, cognitive impact and adverse effects,” Brain and Behavior, 2(2012):661, accessed December 10 2014
3. “ADHD stimulant justification among college students,” East Tennessee State University, accessed December 10 2014
4. Elizabeth Smith & Martha Farah, “Are prescription stimulants smart pills?” Psychological Bulletin, 137(2011):717, accessed December 10 2014
5. “Is Adderall the next big performance enhancer in sports,” Penn State University, accessed December 10 2014
6. “What are the physical effects of prescription stimulants?” Cornell University, accessed December 10 2014
7. “Medication guide: Adderall,” FDA, accessed December 10 2014
8. “Drugs alcohol combination proves dangerous practice,” University of Michigan, accessed December 10 2014
9. “Types of abused drugs: stimulants,” Campbell University, accessed December 10 2014
10. Heinz Steiner & Vincent Waes, “Addiction related gene regulation: risks of exposure to cognitive enhancers vs other psychostimulants,” Progress in Neurobiology, 100(2013):60, accessed December 10 2014
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