By Rose Cytryn, Fall 2019.
A combination of amphetamine-dextroamphetamine, Adderall, or ‘addy’ is an addictive stimulant that affects the central nervous system. Traditionally, Adderall is prescribed to people dealing with attention deficit hyperactivity disorder (ADHD) or narcolepsy and is known to help people focus, pay attention, and control their behavior more closely.
ADHD does not have a common or simple etiology. While there are numerous environmental and genetic factors that are thought to play a role, it is generally known that ADHD affects some combination of the basal ganglia, prefrontal cortex, and cerebellum, as well as deficiencies in dopamine and norepinephrine. Although no single part of the brain controls any one specific behavior or function, the prefrontal cortex is associated with controlling attention, executive functions, and organization, while the basal ganglia acts as a neural intercommunication network. It is believed that deactivation or decreasing stimulants of these regions is, in part, to blame for the symptoms of ADHD. Adderall works to increase the availability and neuron uptake of these neurotransmitters. Though symptoms of ADHD most commonly begin to present themselves during childhood, typically before age 7, it can continue through adolescence and adulthood.
In recent years, there has been an increasing number of people taking Adderall; however, not every individual has a doctor’s prescription. The 2016 National Survey on Drug Use and Health reported that 1.7 million people aged 12 or older were misusers of stimulants. About 92,000 of those surveyed were between 12 and 17 years old. Additionally, 76,000 were young adults between 18 and 25 who reported to misusing stimulants in the month just prior to the survey.[1] Furthermore, an ever-increasing percentage of college students are taking, offering, or selling prescription stimulants at some point during college.
In recent years, self-reported as well as clinician diagnosed anxiety has been on the rise, especially on college campuses. Behavioral medicine clinicians at Boston University and Associate Ph.D. professors at Harvard have noticed a sharp increase in the number of students coming in for anxiety-related help. Though there is no one cause for anxiety, it is generally agreed that the spike on college campuses is unsurprising. The factors which contribute to a heightened risk for anxiety include sleep disruption, loneliness, and academic and professional stressors. College students, especially those who attend highly selective universities, deal with all-nighters, high levels of caffeine intake, job recruiting, and a myriad other institutional pressures.
As these pressures and stress factors change and increase, so do the means of dealing with them. The use of recreational drugs is increasing, and now more than ever, this term includes stimulants like Adderall. For those not prescribed stimulants by a physician, Adderall causes increased concentration and energy as well as increased activity of serotonin, norepinephrine, and especially dopamine. Serotonin is largely responsible for reward pathways, learning, and memory, which frequently contribute to feelings of well-being and happiness, while norepinephrine triggers an increase in the force of skeletal muscle and heart contractions as a result of bodily stress stimuli. Dopamine also affects our neural reward pathways, and by introducing Adderall to our neural network, the bodily ability to experience pleasure without outside substances is altered. A tolerance to Adderall can be formed and further destroy the ability to experience pleasure or focus without increased doses
Beyond the initial biological responses, abuse of Adderall without a prescription may also lead to heart conditions. Stimulants, by definition, increase the activity of the central nervous system, which causes physiological increases in blood pressure and heart rate. Most specifically, hypertension and tachycardia are common in people who have not experienced prolonged Adderall effects. Though studies have not yet been able to prove so conclusively, there is speculation that prolonged use may eventually lead to cardiovascular episodes such as strokes. Strokes can cause brain damage due to interrupted or reduced blood supply. Usually, high blood pressure, blunt force trauma, or concussion cause a stroke, however, it is thought among leading experts, that sudden increases in blood pressure, as caused by stimulants including Adderall, may contribute in the same manner to strokes. Like other recreational drugs, increased use of Adderall followed by termination can cause withdrawal, symptoms of which frequently include depression, difficulty sleeping, fatigue, nausea, and stomach cramping and vomiting. The larger the dependence on the drug, the higher a person’s tolerance, and the greater their experience of withdrawal symptoms.
The lesser-known side effects are one facet of the increasing issue of non-prescribed drugs. A study of over 10,000 college students found that over 50% were asked to sell the medication to their fellow students and friends.[2] Another study showed that 61.8% of students were offered a prescription stimulant at some point during their college careers. According to the Drug Abuse Warning Network, emergency room visits related to or involving Adderall misuse increased from 862 in 2006 to 1,489 in 2011.[3] These events ranged from anxiety attacks to, in very few circumstances, strokes.
The increase in abuse of stimulants is cause for concern, according to Johns Hopkins University’s Bloomberg School of Public Health professor Ramin Mojtabai. Mojtabai continues to say that this increase in abuse in Adderall should be treated similarly to the way organizations monitor painkillers; active documentation of prescriptions, including dosages, should be noted by physicians at each patient visit.[4]
After emerging in 1918 in New York State to monitor cocaine, morphine, and heroin, Prescription Drug Monitoring Programs (PDMPs) grew in popularity and widespread use between 1960 and 1989.[5] When pharmacists dispense controlled substances, they are required to enter prescription details into their state PDMP databases. The databases are integrated into hospital electronic health systems and are accessible by physicians as well as physician assistants and nurse practitioners. The theory behind databases of this nature is to keep information regarding dispensing and prescribing controlled substances well organized and known to those who may need it.
Though monitoring usage and tracking prescriptions are positive steps to combat this epidemic, the mental state of the current American college student plays a large role in the continuing abuse of stimulants. The American College Health Association Survey from spring 2018 compiled data from 88,178 students at 140 institutions and found that at any given point over the 12 months prior to survey completion 22.3% of students “felt overwhelming anxiety”. Over this same time-period 24.7% “felt very sad” and 18.8% “felt so depressed that it was difficult to function”.[6] It is well accepted that students in higher education increasingly experience anxiety, depression, and general pressure academically, socially, and professionally. Given the great numbers of students who are prescribed Adderall by a physician and subsequently asked to deal, the increasingly easy access to smaller and less expensive doses, as well as the increase in abuse of the stimulant, is no surprise.
While this is a new field, and one into which professors and doctors are treading carefully, it is increasingly clear that there is an issue in abusing stimulant medication. Furthermore, if the societal discourse turns its attention to stimulant abuse, the conversation must also grow to include the stressors and factors that are pushing students and young adults towards self-medication, recreational or otherwise, instead of, or in addition to, therapy or physician prescriptions.
[1]. Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. (2016). [ebook] Substance Abuse and Mental Health Services Administration, p.17. Available at: https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2016/NSDUH-FFR1-2016.pdf [Accessed 18 Nov. 2019].
[2]. McCabe SE, Knight JR, et al. “Non-medical use of prescription stimulants among US college students: prevalence and correlates from a national survey.” Society for the Study of Addiction 2005. 99:96-106.
[3]. Aubrey, Allison. “Misuse Of ADHD Drugs By Young Adults Drives Rise In ER Visits.” NPR. NPR, February 16, 2016. https://www.npr.org/sections/health-shots/2016/02/16/466947829/of-adhd-drugs-linked-to-increased-er-hospital-visits-study-finds.
[4]. Benham, Barbara, and JH Bloomberg School of Public Health. “Adderall Misuse Rising Among Young Adults.” Johns Hopkins Bloomberg School of Public Health. Johns Hopkins Bloomberg School of Public Health, February 17, 2016. https://www.jhsph.edu/news/news-releases/2016/adderall-misuse-rising-among-young-adults.html.
[5]. “What States Need to Know about PDMPs.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, October 3, 2017. https://www.cdc.gov/drugoverdose/pdmp/states.html.
[6]. American College Health Association National College Health Assessment Spring 2018 Reference Group Executive Summary. (2019). [ebook] American College Health Association, p.14. Available at: https://www.acha.org/NCHA/ACHA-NCHA_Data/Publications_and_Reports/NCHA/Data/Reports_ACHA-NCHAIIc.aspx [Accessed 18 Nov. 2019].