Education Wed Apr 29 2015

Adderall On the Brain

By James Wendt, Damilola Ajasa, Victor J. Andrew and Sarah Zhang

Tucked inside dresser drawers, sold in school bathrooms and popped before exams, "study drugs" like Adderall are prescription medications that many teens are familiar with.

The pills are sold and traded with bold promises: You'll be able to study all night, focus all day, boost your test scores, suppress your appetite and socialize with ease.

But with the audacious claims come huge risks and dangerous health repercussions for teens who abuse these drugs.

Adderall is a stimulant medication prescribed to treat attention deficit hyperactivity disorder (ADHD). For patients who struggle with ADHD, key areas of the brain are under-stimulated, resulting in a lack of sustained attention and impulse control, hyperactivity and decreased executive functioning, said Dr. Khalid Afzal, director of Child and Adolescent Psychiatry at the University of Chicago.

In 2011, 3.5 million children were reported by their parents to be taking medication for ADHD, according to the Centers for Disease Control and Prevention.

"When we prescribe stimulants, ... kids or individuals who have ADHD have more attention span, their impulsivity decreases, their hyperactivity decreases and they have relatively better executive functioning," Afzal said.

But the chemical properties of stimulants also make Adderall and other "study drugs" attractive to teens without a prescription as both an academic steroid and a recreational drug. In their 2014 Monitoring the Future study, the National Institute on Drug Abuse (NIDA) found that nearly 7 percent of high school seniors had used Adderall without a prescription. Fewer than 2 percent reported taking Ritalin, another stimulant used to treat ADHD, without a prescription.

"I think people use Adderall in high school because they are convinced that they will not succeed in school without it," said Sandburg junior Maryam Mohamed. "Because so many kids are stressed out and worried about their academic lives, they are not confident in their ability to do well in school. Honestly, it seems that so many kids do well with it, and the temptation for kids to take it is so overwhelming."

Afzal explained that the majority of teens who misuse Adderall take the drug as a neuroenhancer, the clinical term for drugs that enhance brain performance. Some teens report using the drug for high-pressure tests like the ACT or SAT. They may cite intense focus and quicker response rate as perks of the pills.

"With stimulant medication such as Adderall, attention is increased," Afzal said. "So when attention is increased, memory encoding is faster and memory recall is faster."

But not all users are looking for an academic boost. Some are chasing a different kind of high from the little orange pill.

According to Afzal, Adderall doubles the amount of dopamine in the reward center of the brain. Dopamine is the feel-good neurotransmitter--sexual satisfaction, increased libido and a sense of achievement all trigger a sudden surge of dopamine.

Research shows that the abuse of prescription stimulants actually increases as students move from high school to college. According to a 2012 study published in the Journal of American College Health, almost two-thirds of college students were offered prescription stimulants like Adderall by their senior year. Thirty-one percent reported abusing the medication.

Still, over 41 percent of high school seniors said they believe occasionally using Adderall proved to be a great risk, according to the 2014 Monitoring the Future study.

Professionals explain that teen users who focus on the benefits of the drug may be in for a rude awakening in the near future.

"I think they are kidding themselves," said Dr. Sharon Hirsch, director of the ADHD Clinic at the University of Chicago. "Certainly any stimulant will help you focus, but the ramifications may make for more problems in the long run."

Hirsch went on to explain that there are many possible short- and long-term effects of taking Adderall without a prescription. Short-term effects include stomachaches, increased heart rate and blood pressure and decreased sleep. Long-term effects include heart attack, stroke, psychosis, hallucination and paranoia.

Afzal said there are several factors that contribute to someone's susceptibility to addiction. He cited genetic predisposition, biology, environment and psychological feelings.

"All of these components complicate the trajectory of us predicting if someone is going to misuse it or start to abuse it later on," Afzal said.

The Drug Enforcement Administration (DEA) classifies Adderall as a Schedule II controlled substance, a drug with "high potential for abuse" that can lead to "severe psychological or physical dependence." Illinois drug laws classify these medications as controlled substances. When abusers are caught with pills but no prescription, there can be legal consequences. The same is true for those who are caught distributing their prescriptions.

The penalties for juvenile possession of Schedule II drugs are potentially serious. Some juvenile courts have the right to mandate drug counseling, probation and detention. These consequences require juveniles to comply with court-ordered rules including rehabilitation, community service, home confinement and juvenile detention.

The difficulty with curbing teen Adderall abuse stems in part from the availability of the drug. A 2014 study from Cohen Children's Medical Center of New York found that 59 percent of physicians suspected that some of their teen ADHD patients were sharing their medications. Fifty-four percent said they believed some of their patients were exaggerating symptoms to get their hands on stimulant drugs.

Afzal said that many times pediatricians and other doctors don't prescribe medication at the appropriate dosage nor monitor their patients as rigorously as they should. As a result, many teens can get Adderall from their friends or family members.

While academic steroids may seem like a quick way to temporarily strengthen study skills, Hirsch advised adjusting other habits for safe, long-term results. For teens looking to increase their attention spans, she suggested decreasing anxiety. Research suggests that kicking caffeine and eating and sleeping well are key, she said. Sometimes students doubt the effectiveness of these minor adjustments.

"I don't think students in high school realize how smart [they are] and how much knowledge they really have," Hirsch said. "I would just emphasize to trust yourself. Be able to focus."

This article was written by James Wendt of Naperville North High School and Damilola Ajasa, Victor J. Andrew and Sarah Zhang of New Trier High School and was originally published at TheMash.com on Apr. 23, 2015. It is featured here as part of our new content exchange program with TheMash, the Chicago Tribune's teen edition.