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Adderal: Treatment, Recreation, And Students' Little Helper

by The Bridge
05/25/2006

"Joni" (that's right, it's a pseudonym) does not look like a drug addict or your usual juvie delinquent. While the petite blond looks a tad younger than she is, she comes across as older, or at least unusually self-assured for a girl in her early twenties.

A gifted singer-songwriter, Joni grew up in Athens and is, in many ways, the quintessential college-town girl, artsy and precocious. By the time she was seventeen, she had already built a fairly solid local reputation as a musician, playing house shows as well as bars and clubs, headlining well-known nightspots before she was actually old enough to drink at their bars.

So when, at the age of twenty-one, she packed up and moved hundreds of miles to another small town - one with a rather understated music scene - it seemed like an odd decision. Why ditch an indie-rock community like Athens just when you're starting to make headway in the scene?

"Speed is a huge part of why I moved. To get away from it," she says, matter-of-factly. Joni is, by her own admission, a recovered amphetamine addict. Her drug of choice was not cocaine, which she has tried before and found pointless ("It doesn't last"). Not crack or meth - nothing, in fact, that requires an illegal drug dealer. Joni was, according to the law, legitimately medicating herself with Adderall, a drug used primarily for the treatment of Attention Deficit Disorder, or ADD, and Attention Deficit/Hyperactivity Disorder, or ADHD.

According to Adderall's official website, the drug has been prescribed over forty million times since it went on the market in 1996. In 2000, that number was at 200,000; it had risen to over six million by 2003. This number obviously does not include the scores of people using the drug illegally - a statistic which is next to impossible to pin down. However, if you spend a day with your eyes and ears open at just about any university in the country, you'll find that Adderall is a hot trend among today's young people. Unlike a lot of drug fads, Adderall has burrowed its way into youth culture as a tool for the overachiever. Sure, a lot of folks take it for fun, but it has become better known as an infallible study aide, perfect for all-nighters.

This is all a familiar story to anyone who paid attention to Ritalin's history as the magic ADHD pill. Introduced in 1956, Ritalin, the brand name for a stimulant called methylphenidate, became a huge seller as ADD became a popular diagnosis in the late 80's and early 90's, but reports of abuse and negative side effects led to a tarnished image for the drug, which soon acquired all sorts of telling nicknames: "kiddie cocaine" being my personal favorite. These days, anywhere from forty to fifty percent of teens in drug rehabilitation programs cop to Ritalin abuse. It is still prescribed, and not exactly in small numbers.

But the market is much more crowded now than it was in 1956. Kandy (not her real name, but the fake name she really wanted) is a twenty-two year old who has switched from Ritalin and Adderall and back "Like, six times. When I was little they just put you on Ritalin, there was no discussing options. At least, I never heard of any. But now there's all this stuff, Adderall and Ritalin and some other whose name I forgot, and you've got time-released, extended release... the market's just really catered to whatever you want now."

Adderall's indicated uses are pretty much the same as Ritalin's, and it has been on the market for the past decade. Yet there is surprisingly little information available about it. The drug is a combination of amphetamine salts and is quite close in structure to methamphetamine, the only difference being an extra methyl group on the amphetamine molecule. The similarity to crank is not something the makers like to highlight, of course. On their very website, the manufacturers boast that it has been tested in "over twenty clinical studies." Gee, over twenty! Just think, that's more than two studies a year over the past decade!

Lest we suspect that Adderall is being prescribed carelessly, the site assures us: "Because everyone can, from time to time, show signs of inattention, hyperactivity, and impulsivity, professionals use strict criteria when diagnosing ADD." These "strict criteria," outlined by the Diagnostic and Statistics Manual of Mental Health (fourth edition), include requirements that the symptomatic behaviors must appear before age seven, be evident for more than six months, and affect the individuals ability to function normally in two or more separate areas of their life (school, work, social, et cetera). The site emphasizes that these evaluations are done carefully by licensed professionals in the psychiatric field.

"I went to see a doctor, and he gave me this impromptu test in his office," says Nikki, a thirty-three year old graduate student. "It was short. Listing all the of U.S. Presidents, starting with the current president, going backwards, and then reversing the list. Having to do simple math problems - long ones, but still simple ones. I can't remember what else." Joni's experience with the diagnostic procedure was brief, as well: "It was about five questions in really large text that all fit on one page. It was just funny. If you had ever read an article on ADD you'd know what to say." The questions consisted of stumpers like "Do you have a hard time sitting still?" and were all yes or no, with the "yes" answer rather obviously bearing the brunt of positive diagnostic weight.

"I was really stupid about it," Joni adds. She saw two different doctors in her quest for the drug. "Both times I said 'I want Adderall... with the second one, I had stayed up for two days [due to Adderall abuse], and I felt myself crashing, so my friend gave me a Dexedrine. I was falling asleep in the doctor's office, but my heart was racing. I had to look like Courtney Love." The doctor woke Joni up and asked her what was wrong. Joni jerked awake and muttered, "I need Adderall," almost as if she were talking to herself. "She looked at me funny," Joni says. "But then she called my shrink and gave me Adderall." Joni shrugs.

Joni had first encountered the drug in middle school, taking pills from friends who had prescriptions. "The thinking was, if you had ADD, it would slow you down. But if you didn't, it would speed you up, get you high. So we were like, hey, we don't have ADD; we'll get high!" Due to an unusually overcrowded school, Joni and her classmates found it easy to get away with just about anything. "We were smoking cigarettes; sometimes someone would bring in a little vodka. Mine was the last class before they split it into two different schools because of the overcrowding. So you could get away with a lot."

Eventually, Joni's brother was diagnosed with ADD, and she began to pilfer pills from his supply. "He would skip a pill or two on the weekends, so I knew I could get away with it." By the time she was sixteen, she was taking the drug regularly. Once she secured her own personal prescription, she began to learn the art of finessing extra milligrams out of doctors. She mentioned one particular doctor, a local psychiatrist whose name came up in several different interviews. At least five separate people mentioned this doctor as being the go-to guy for easy access to just about any prescription you might want. We'll call him "Dr. More."

"I heard of this guy as being the pill doctor. Everyone said you could just get whatever you want from him. He's very popular with my mom and her friends for their Valium and Xanax supplies." Joni had very little trouble getting what she wanted from Dr. More. "I would just go in and say, you know, sometimes I just take twenty, but sometimes I feel like I need forty, you know? Or maybe sixty...and he just had no problems with any of it. 'Everyone has ADD these days.' He actually said that, and he said, you know, life is hectic these days for everyone, and college is hard, and work is hard, but-" and she pantomimes writing a prescription in the air. "He actually made that gesture."

Joni does not believe that she actually has ADD. "If anything, I'm one of those borderline cases. You know: I don't really like sitting in classrooms, but with any task I enjoy I have no problems concentrating." But with the help of Adderall, Joni found that she had the energy to do even enjoyable tasks for ridiculously long periods of time. "I was really into drawing, and on Adderall I could draw for eight hours." She also wrote a hundred songs in a year while on the drug. "I'm still recording some of those songs on current albums. There were a lot, and some of them were good."

Nikki's assessment of her attention problems is similar to Joni's, although she initially sounds oddly like Joni's doctor. "I believe that everyone has ADD. I mean, you watch TV, and every X number of minutes, your attention gets cut because there are commercials. And it's not just one commercial, it's a bunch of commercials, and you've got a remote control..." But I don't get the idea that Nikki is really talking about an affliction that necessitates medication. "I didn't believe that I needed it. I wanted it. I am part of a market, and I understand that. I wanted the drug because I knew I could use the drug."

Indeed, Nikki is still using the drug. Unlike Joni, her initial experience with Adderall came relatively late in life (she was twenty-nine), and it was not recreational. She used it for the first time at an all-night study session, and, outside of "occasional" recreational doses ("It makes me more aggressive, outgoing at parties") she still uses it for "mostly academic purposes. There are obviously exceptions to that rule." Nikki's attitude toward her Adderall usage is very odd. Like Joni, she uses the word "addict" to describe herself freely and acknowledges that she likes amphetamines because they are fun. Unlike Joni, she hasn't quit. "I have cut back a good bit," she says. She plans to stop using once she gets her degree. "After I get the degree, I'll have to. I won't be able to justify it. I won't have a legitimate reason to take the medication." Nikki does not feel that she cannot function in normal life without an ADD drug. To her, Adderall is a product that she is entitled to choose. Her addiction is a consumer's choice.

It's an interesting viewpoint. "It does bother me that I'm an addict, but I actively chose to become one," she says. "When I first got it, I abused it. I stepped back and stopped taking it for a couple of months to regroup and decide what I wanted from it. It's a tool. You have to use it properly." At one point, Nikki voiced some concerns to her doctor about the possibility of addiction. "She said, 'If you really need the medication, you're not getting addicted to it,' which is bullshit."

Despite her insistence that she uses the drug primarily as a study aide, Nikki makes frequent references to getting intentionally "jacked up" with friends. When I ask her to tell me what the highest dosage she's ever had is, there is a long pause. "I've never counted, because I don't wanna know... I was just visiting [a friend who also does the drug] last week. We got really jacked up one day - I could count - do you want me to count? It might take me a minute." She narrows her eyes and begins tapping her fingertips together, whispering, "twenty... forty... and another one... and sixty... and..." It does take her a minute, at least. "Okay. Over a twenty-four hour period, two hundred and forty milligrams, approximately." This sounds like a lot, and it is - sort of. Nikki, like Joni, has learned to amp up her prescriptions. She's currently getting ninety-eight twenty milligram pills a month. "That's enough for me to take over sixty milligrams a day. But I can skip a day or two if I want, and then I can have more the next."

Kandy is a local art student and the only person I talked to who was diagnosed with ADHD not because she was playacting for a prescription, but because her parents and teachers honestly believed she had the disorder. "I'll admit I don't know what my future holds, who knows. But I might take it for the rest of my life." Kandy's story is perhaps a bit more legit: she was tested for ADHD as a child "because I would sing in class, and all sorts of stuff. I was just crazy, an out-of-control kid," she says. Well, this is more or less what she says. In the transcription process, everyone's grammar gets cleaned up a bit, with ums and you-knows, for the most part, edited out. But transcribing Kandy's interview required the most dialog modification. Kandy interrupts herself frequently, at one point halting an explanation of her dosing habits to exclaim "That is so cool! I love my yard," over a pair of nattering squirrels. More salient is that her responses to my questions often drift from the topic in mid-narrative. I ask her about the nature of her last psychiatric evaluation, and she begins to describe the testing process, but then starts talking about how accustomed people in today's society are to being observed. Admittedly, most of her tangents are somewhat relevant to the original topic (squirrels notwithstanding) and they don't really seem to interfere with her ability to communicate. If anything, they enhance the conversation.

"Anyone can see that I have attention problems - I'm all over the place... but I don't mind it," she adds, emphatically. Kandy is a pretty happy girl, all around. When her parents secured her a prescription for Ritalin ("I was ten or eleven or twelve - in that range," she says vaguely), she was not particularly pleased with the notion of taking a pill to "fix" herself. "And I didn't really notice a difference. I felt the same. I definitely didn't know it was speed." No one - not her parents or any of her doctors - explained what the drug was or how it worked: "It was never explained. It was just 'Take this; it'll fix you.'"

This is similar to Joni's experience. "I don't think that they really knew it was speed - I think they just thought, for a headache, you take aspirin; for ADHD, you take Adderall." Kandy, however, was pretty sure that her parents understood the nature of the drug. "Oh, I'm sure they knew," she says, and she doesn't sound mad about it. "Do you know what Adderall does to your body - to your organs, the long term effects?" I ask her. The reply is a swift, firm "No." I suppose I look a bit taken aback, because she amends, quickly: "I know it's a drug, though - I know it can't be good. That's a risk you take." She pauses. "Do you know what it does?"

I do know a bit. I know that, besides the cardiovascular wear and tear that any long-term amphetamine use inevitably causes, there is substantial strain placed on the kidneys and particularly the liver. I also know that alcohol will be particularly hard on the liver of someone who is currently dosed. I ask her if she was ever warned not to drink while taking the medication. "No. Not at all. No one said anything at all about what it would do to my body." Kandy is no little lamb, however. She had suspected that it did bad things. "I mean, it's speed. It's gonna be bad. I do all kinds of dumb things because I like them."

That's the thing that's disturbing about Kandy. She is the one person I talked with who billed themselves as legitimately ADD afflicted, and yet she, too, makes constant references to taking the drug because she wants to, not because she needs to. "I don't need it to function," she agrees. "It helps - it gives me a kick. I like being able to work for eight hours straight and not take a break and not need to eat." Well, I'm sure most of us like to feel superhuman, but is that really supposed to happen? Eight hours of work with no break and no meal?

Kandy does not seem to think this is alarming. To be fair, she seems to be abusing the drug less than anyone I have talked to. She never takes it recreationally, although she does refer to it as "A recreational experience. I don't take it more than twice a week. I don't like it that often. I have to be feeling it to take it." She gets a prescription of sixty twenty-milligram pills "About once every six months. My doctor's even commented: 'These last you a long time." Kandy just finished an Adderall prescription when I spoke with her. Now she's back to the Ritalin. "I take Ritalin and I feel like - this isn't enough. I feel dissatisfied. Then I'll switch to Adderall and that's so intense... Then I realize I'm not sleeping very well, it's too much. Then it's back to Ritalin."

Kandy is also the only person I spoke with who ever encountered anything like the comprehensive testing that the Adderall website insists is a prelude to prescribing any ADD medication. "It was several sessions, over several days. A lot of questions, observing me, word association, seeing how well I stayed on task when they left the room, watching me talk..." That was when she was ten (or eleven or twelve). She took the drug intermittently for a few years. "I would throw it away a lot. I didn't want to take it, and I don't remember it ever affecting the way I felt. I felt the same."

According to some studies, children feel the "upper" effects of Ritalin much less than adults, so this makes some sense. Whatever the reason, Kandy was not impressed with Ritalin, and basically wrote it off until college. "The classes were tough stuff - I'm not good at, like, reading a book and then writing a big long paper analyzing it - it's not my thing. So I went to the health center and paid to get tested for ADHD again." This time, the test was "One session on one day. Maybe two hours. Maybe that was because I already had the history with ADD, maybe not. Actually, I really got the feeling that it wasn't that at all. I don't think it was." At the end of the test, they determined that she was ADD ("Well, duh,," Kandy laughs,) and prescribed Adderall.

Like Nikki, Kandy is enjoying the benefits of Adderall and Ritalin, and she has no plans to stop taking either one. Joni has stopped for good and has no plans to ever take another pill. Nikki is gearing up to quit in January, once she secures her degree.

Talking to these girls raised a lot of questions about the validity of the ADD diagnosis for me. Let me be clear: I am NOT saying that I don't believe the disorder exists. I am not a doctor. But psychiatry is a shady science, with very few black and white delineations. I sort of agree with Nikki and the infamous Dr. More: in our society, who doesn't have a short attention span? But surely there are degrees, surely there is some way to separate your average Joe Schmoe who's watched a bit too much Nickelodeon in his youth from some brat-tastical nerve bundle of a kid who can't sit still for three minutes straight? And even if you can discern between the two, is speed really helping?

I called several psychiatrists' offices, hoping to find someone willing to shed a little professional light on the matter. The first one I tried was Dr. More. After two days of attempting to reach him, I finally left a message with his secretary explaining that I was doing a story on prescription medications. When I check back a day later, she told me, rather curtly, "He said he's not gonna do that. He's not interested."

I try a few more docs, reaching a lot of answering services. Finally, a Dr. David Jarrett calls me back. Dr. Jarrett has an Athens-based practice that specializes in, among other things, ADD. I ask Dr. Jarrett to tell me how he went about diagnosing ADD patients. Basically, he goes over the same criteria that the Adderall site lists, adding that he would check for a history of drug abuse before prescribing stimulants.

"How do you determine that they don't have a history of drug abuse?"

"It's all based on what they tell me," he says. "We all have the possibility of being fooled, of course. Anybody can be fooled at any time. We have the responsibility of looking out for the signs that someone is being deceptive. And I'm sure that sometimes we do get fooled." On this point, he is refreshingly humble, none of the God-complex airs that so many physicians put on when talking to a layperson. He patiently explains the differences between a normal person's brain and one with ADD, as evidenced in studies done with PET scans. "With the normal person, the center of the brain, which is where the attention should be, lights up in a PET scan when you've asked them to do something," he says, explaining that the "lit up" part of the scan indicates which part of the brain is working on the task at hand. "With ADD people, the periphery of the brain lights up. That means they're having problems using the part that normally supplies attention and having to substitute by using higher levels, which is much more distracting."

If this sounds vague, that's because it is. Doctors know that this happens - the scan studies are pretty solid. PET scan technology has been around for a while, and it can show a pretty impressive picture of brain activity. Essentially, PET scans are brain x-rays, showing doctors which parts of the brain are metabolizing at higher rates, which areas respond to what stimuli, et cetera. But it's a map with no words. The scans don't tell them why any of it is happening - doctors can merely draw inferences from various apparent correlations. Indeed, none of the drug sites I browsed claimed to know why, exactly, their product alleviated ADD symptoms, merely that it did.

Still, the scans draw an obvious line between ADD folks and normal folks. "I suppose the scans are too expensive to use as a diagnostic measure?" I ask.

"Oh, yeah. These scans are experimental. There's no way insurance would cover them." I had figured as much. Seems a real shame, though.

Dr. Jarrett is firm in his belief that ADD medications are worth the risks. "They've done studies of populations and found that there are more people who could benefit from these medications who are not getting them than there are people who are abusing it," he asserts. "Like, ten-to-one is the ratio, the number of people who could be benefitting from [the drugs] versus the number of people who are abusing them." I have no idea how a study could show, conclusively, the number of folks that are abusing Adderall. How could any study suss out all the Jonis and Nikkis, separate them from the Kandys? Alas, I'm too grateful for Dr. Jarrett's call, and I don't ask him that, for fear I'll offend him. No matter how the studies are done, he clearly has a lot of faith in them. As for whether or not drugs like Adderall are actually effective: "There's very good evidence that people with ADD who are treated with stimulants have a much lower incidence of drug abuse, a substantially lower incidence of traffic incidents, and less crime overall. If you give ADD medication to people, the chances that they will abuse drugs goes way down."

I want to ask him if he knows my infamous Dr. More, but I think better of it. Even if he has something specific to say about him, I'd probably get sued for printing it. Instead, I beat around the bush a bit, asking if he feels any of his colleagues are too loose with meds.

"Not my colleagues, no. There are certain doctors in the area that I know are very free with certain medications," he says. "I don't know any specifically that are free with stimulants. But I know some that are free with narcotics." He states, unequivocally, that he's not comfortable with doctors who do this. I tell him a bit about the websites I've seen that offer Adderall "shipped discreetly to your own home! Get diagnosed on-line!" "That's terrible," he says.

Dr. Jarrett seems sincere in his desire to see stimulants used for the good of ADD sufferers. He is clearly convinced that stimulants are a useful tool for ADD, and that ADD is a specific ailment, not something that we all have "these days." I'm not inclined to argue with him on these points. I just can't help but think that his assertion that the abusers of drugs like Adderall are outnumbered by those who need it, ten to one, is incredibly naive. While working on this story, I did not have any problems finding people who abused Adderall. In fact, once I started asking around, I was hard pressed to find anyone who didn't at least have a friend who took the drug illicitly.

The fact is, drugs - especially the fun ones - tend to be ubiquitous. There will always be whiskey at the party, weed at the rock show, ecstasy at the rave - and all this stuff will also be in your church parking lot and your kid's playground and just about anywhere else you can think of. The problem with prescription drugs, or, at least, the one I'm worried about, is that they are the ones most folks aren't warning their kids about. Hell, half the time, they're giving them to 'em. A lot of the literature I read insisted that the numbers of prescriptions for ADD being written matches, roughly, the estimated five to seven percent of the population that is supposedly afflicted with the disorder. But despite all the people I spoke with who had prescriptions, I didn't find any who said that they couldn't function well without it. And only one who even claimed to be ADD at all, the one who took the drugs the least, and in the lowest, most infrequent doses. Surely, there's some numbers missing here. Quick, show of hands: how many of you did speed last week?