Policy Brief on Adderall Abuse
Frank L. Greenagel, Jr.
May 9, 2013
What is Adderall
People take Adderall to concentrate better, avoid fatigue and for treatment of ADHD1. A
number of individuals also take it to gain euphoria and/or appetite suppression. Adderall
is an amphetamine and was introduced to America in 1996. Adderall is a schedule II
drug2, which means that it has a high level of physiological and psychological
dependence (other schedule II drugs include cocaine, oxycodone and other
amphetamines).
In addition to the short term effects that people seek (such as better concentration and
avoiding fatigue), deleterious short term side effects include: lack of appetite, headaches,
insomnia, dry mouth, abdominal pain, weight loss and restlessness. 3 Long term side
effects include high blood pressure, delusions, birth defects, difficulty breathing, chest
pain, blurry or double vision, seizures, mood swings, depression, and anxiety. 4 Chronic
use can also hurt one’s natural ability to concentrate (meaning that after taking Adderall
for an extended period of time, their concentration baseline is worse than before they
started taking Adderall).5
Adderall and ADHD
It is impossible to discuss Adderall without discussing ADHD, which is vastly over
diagnosed. Adderall6 is vastly overprescribed for that diagnosis. The number of people
under 18 that were diagnosed with ADHD increased by 24% between 2001 and 2011.7
Most people take Adderall in order to help them perform better at school or work, and
they go to their pediatrician, doctor or psychiatrist and claim that they have ADHD. Dr.
Lou Baxter, the past president of the American Society of Addiction Medicine (ASAM),
described the process for the Newark Star Ledger in the fall of 2012:
Everything is on the internet so people look it up and they go and they say, ‘I got
this symptom, I got that symptom, I can’t concentrate.’ And some physicians
don’t thoroughly evaluate the situation, and they make the diagnosis.8
1
2
3
4
A few people take it for narcolepsy. I will not be addressing that in this brief.
http://www.justice.gov/dea/druginfo/ds.shtml
http://sideeffectsbase.com/adderall-side-effects/
Ibid
5
http://www.greenagel.com/index_htm_files/2012_0822_21st_Century_Drugs20121024_112142_stamp.pdf
6
Other stimulant-based ADHD drugs that are prescribed and abused include Ritalin, Concerta, Vyvanse,
and Focalin. Adderall is the most prescribed and abused ADHD drug though
7
http://www.npr.org/blogs/health/2013/03/13/174193454/neurologists-warn-against-adhd-drugs-to-helpkids-study
Some children are diagnosed with ADHD at the age of 6, and it is often because day care
workers or classroom teachers report that they are hard to control.9 Eight year old boys
have been misbehaving for centuries, but it is only in the last 20 years that they have been
potentially receiving a diagnosis for it.10
According to a 2013 New York Times report, over 20% of high school age males and
10% of high school age females are diagnosed with ADHD.11 Curiously, teenagers in
Southern and Midwestern states have a much higher rate of diagnosis12 than teenagers on
the coasts. These differing rates of diagnoses illustrate that professionals have different
standards in different regions of the country and reinforces that notion that an ADHD
diagnosis depends upon the subjectivity of the professional.
Adderall as a Normal Thing to Take
As more and more people get diagnosed with ADHD, taking Adderall has become
normalized. Even in Utah, drug treatment counselors report a surge in the abuse of
Adderall and lament that taking Adderall has become as “socially acceptable” as
drinking.13
As the top high schools and colleges in America become ever more competitive, students
feel greater pressure and study ever longer to get ahead. Adderall has become known as
“the good grade drug”14 and has been pushed onto middle and upper class kids around the
country by their ambitious parents.15 Adderall has become acceptable even in schools
with powerful anti-drug programs, as students are heard saying, “I don’t do drugs, but I
do take Adderall.”16
One doctor achieved notoriety in the fall of 2012 when he openly admitted that he was
prescribing Adderall to young people that did not have ADHD. He stated that he was
prescribing it to poor minority students so that they could succeed despite attending
8
http://www.nj.com/giants/index.ssf/2012/11/adderall_has_nfl_players_testi.html
http://www.cnn.com/2010/HEALTH/08/11/adhd.medication.schools/index.html
10
One can do some cursory research to see the problems with many diagnoses in the soon-to-be released
DSM-V and the controversies about the changes in diagnoses and the horsetrading that went on in the past
between professionals in coming up with diagnostic criteria.
11
http://www.nytimes.com/2013/04/01/health/more-diagnoses-of-hyperactivity-causingconcern.html?pagewanted=all
12
Ibid
13
http://www.abc4.com/content/news/state/story/Abuse-of-ADD-and-ADHD-drugs-rises-in-theteenage/JhFAoam-EkmcH8JH2QghcQ.cspx
14
http://www.nytimes.com/2012/06/10/education/seeking-academic-edge-teenagers-abusestimulants.html?pagewanted=all
9
15
http://www.nbcnews.com/id/14590058/ns/health-childrens_health/t/seeking-straightparents-push-pills/
16
http://www.slate.com/articles/technology/superman/2013/03/adderall_ritalin_vyvanse_
do_smart_pills_work_if_you_don_t_have_adhd.html
terrible inner city schools.17 This illustrates the crux of the problem: parents, doctors and
mental health professionals do not view Adderall as a dangerous drug, but rather as a
socially acceptable performing enhancing way to achieve better grades. As a result,
young people do not view it as dangerous either.
Adderall on College Campuses
Young people (18-22) in college are two to three times as likely to use Adderall as their
non-college attending peers.18 Many college students say that they will take it just to help
with one test or paper, but then they just keep using it again and again. There are
numerous stories of young people continuing to use it once they get into the professional
world, despite their intentions of never using it again after college.19
Adderall is the 3rd most abused drug at Rutgers (after alcohol & marijuana). Pills on the
black market at Rutgers range in cost from $5 to $40. Adderall costs the most in the
months of December and May, because of the demand for them during finals. This is a
phenomenon that happens on campuses around the country.20
Over the past year, the New York Times published a series of articles about Adderall.21
In February, 2013, there was a front page story about a 24 year old college graduate and
aspiring medical student who committed suicide after years of Adderall abuse.22 The
father of the young man reportedly told one of his son’s doctors, “If you keep giving
Adderall to my son, you are going to kill him.”23
Because the use & abuse of Adderall and other ADHD medications have continued to
increase (6.3% of students in 2006 used them without a prescription vs. 8.3% in 2011),24
more and more college counseling centers are “opting out” of diagnosing ADHD and
prescribing students with stimulants.25 It is important to note that the 8.3% figure is for
college students who used Adderall without a prescription in 2011. We do not have the
numbers for students who used Adderall with a prescription.
17
http://www.nytimes.com/2012/10/09/health/attention-disorder-or-not-childrenprescribed-pills-to-help-in-school.html?pagewanted=all
18
19
http://www.iowastatedaily.com/news/article_82ad5eda-3f14-11e2-8788-001a4bcf887a.html
http://opinionator.blogs.nytimes.com/2013/03/04/the-last-all-nighter/
20
http://www.itechpost.com/articles/8867/20130507/prescription-drug-abuse-continueshit-college-campuses-finals-week-rages.htm
21
http://www.nytimes.com/2013/03/05/opinion/global/roger-cohen-adderall-the-academic-competitiondrug.html?_r=0
22
http://www.nytimes.com/2013/02/03/us/concerns-about-adhd-practices-and-amphetamineaddiction.html?hp
23
Ibid
24
http://www.collegian.psu.edu/archive/2012/10/24/Adderall_feature.aspx
25
http://www.nytimes.com/2013/05/01/us/colleges-tackle-illicit-use-of-adhdpills.html?pagewanted=1&_r=0&hp
The Dangers of Adderall Use and Abuse
In 2009, the National Survey on Drug Use and Health stated college students who
engaged in the nonmedical use of stimulants such as Adderall reported considerably
higher rates of frequent binge alcohol use, marijuana use, and cocaine use compared with
their counterparts who had not used stimulants non-medically.26
A more recent study reported that people with ADHD (correctly or incorrectly diagnosed)
have higher rates of alcohol, marijuana and tobacco use.27 The authors of the study could
not say whether the diagnosis of ADHD was the cause of the increased substance use, or
if it was the result of years of using prescription stimulants.28
In 2013, the American Academy of Neurologists released a paper in which they took the
position that prescribing Adderall as a study enhancement to people under 18 can cause
serious long term damage to the developing brain.29
Recommendations
A careful case history and study of behaviors should be taken before a doctor or clinician
makes a diagnosis of ADHD. Factors that contribute to ADHD-like symptoms include
inadequate sleep, an inconsistent sleep schedule, too much sugar, too much caffeine, too
much nicotine, and environmental stress. Before a diagnosis is given, clients should try
get regular sleep and to reduce or quit sugar, caffeine and nicotine. We also should be
much more cautious in our diagnosing – all too often someone gets a diagnosis after a 15
minute visit, instead of two to six sessions. Kids are sometimes incorrectly diagnosed
because they fidget or misbehave, and that their parents and/or teachers have taken a
pharmacological way to control them.
I think that drug tests should be given before medications are prescribed. ADHD-like
symptoms could easily be explained by regular marijuana use (lack of motivation,
problems concentrating, inability to get work done) or other substance use. Drug screens
should also be given upon each refill (to see if the prescribee is actually taking the correct
amount or if she is taking more than is prescribed, taking other substances or not taking it
at all (and is therefore probably selling it or giving it away to peers)).
We need better training of prescribing physicians, psychiatrists and nurse practicioners.
Prescription drug education should start for students in the beginning of middle school
and continue each year through high school. We need to train parents, teachers and
school administrators about the use, abuse and dangers of stimulant medications.
26
27
http://www.samhsa.gov/data/2k9/adderall/adderall.htm
http://www.futurity.org/health-medicine/drug-abuse-rates-higher-in-teens-with-adhd/
28
I believe that giving kids stimulants between the ages of 8 and 16 makes them much more likely to
develop a substance problem later on, especially if they do not have a legitimate ADHD diagnosis.
29
http://neurology.org/content/80/13/1251
Recovery Inc., LLC can train professionals, parents, community members, high school
and college students in all of the aforementioned areas.
Frank L. Greenagel Jr.
LCSW, LCADC, ACSW, CJC, ICADC
Managing Partner – Recovery Inc.30
Adjunct Professor – Rutgers School of Social Work
Chair – NJ Heroin & Other Opiate Task Force
30
http://www.schoolrecovery.com/