Among college students and working professionals, the misuse of ADHD medication—like Adderall or Ritalin—goes hand-in-hand with going to school or work, according to recent reports; the unrealistic output demands that our modern institutions place upon us are fueling our need for Limitless drug variations.
From a historical perspective, this makes sense: A recent article published on the editorial arm of database JSTOR argues that the American economy and its workforce has always thrived on uppers—depended on them, in fact. The prolific prescription and non-prescription use of amphetamines is just the latest and most nefarious work of the pharmaceutical industry's pushers.
A survey by the Center on Young Adult Health and Development says that 31 percent of college students have used prescription stimulants non-medically, they speculate, to study more effectively. But, of course, some people take these same drugs—which are FDA-approved—at the suggestion of their doctors, daily, because they depend them to manage their very real ADHD symptoms. It's strange, then, that one group's daily Adderall use is sanctioned and the other's is the subject of many worried articles. And a new study suggests that the two groups may not always be distinct: Researchers at the Massachusetts General Hospital found that college students who misuse prescription stimulants are more likely to have ADHD than students who don't.
For the study, the researchers, led by Dr. Timothy Wilens, an associate professor of psychiatry at Harvard Medical School, recruited undergraduates in Boston-area colleges and universities who were ages 18 to 28. They screened each participant for various factors, including whether or not they had been diagnosed or treated for ADHD and their use of alcohol or other drugs. They also asked each participant whether they had ever misused stimulant medications, where a even one-time use of a stimulant the participant was not prescribed counted as misuse.
These interviews were conducted by researchers with a background in psychology and subsequently reviewed by a panel of child psychiatrists and licensed psychologists. Thus, the interviewers were able to clinically diagnose the participants. One surprising finding was that stimulant misusers were more likely to display ADHD symptoms. They reported having difficulty sustaining attention, not listening, and being easily distracted in childhood, as well as moderate to severe difficulty following instructions and dislike for tasks that require attention during adulthood.
Wilens concludes that it's likely that some people who take drugs like Adderall or Ritalin without a prescription are self-medicating undiagnosed ADHD. "The misusers tended to have a higher prevalence of ADHD. We also found that they had more of a tendency to self-medicate in general," he said over the phone. "In an analysis of a sub-group of these people who misused Adderall or Ritalin," he added, "we found that they were using these substances quite a bit. Most of the people in this field of research assumed they were taking it once or twice, but it turns out it's a lot more than that."
The misusers tended to have a higher prevalence of ADHD.
I asked him if he saw this as a problem. If people were effectively managing their ADHD on their own, using the same drug they would get if they went to a doctor and at a similar frequency, does this really count as misuse?
"Based on societal norms and laws, this is misuse. Every time you are given a medicine and you divert it or use it differently than prescribed, that's misuse. We used the definition of misuse that's established by authorship and by a number of investigators who are funded by the government," Wilens said. "If someone is treating their undiagnosed ADHD without a script—is that a problem? Well, it is in so much as you could be in violation of the controlled substance act and it puts you at risk."
As for the potential danger of self-mediating with ADHD drugs, Wilens noted that "the medications for ADHD are among the safest that we use." Still, he said, doctors screen patients before prescribing them drugs to make sure that they don't have substance abuse or cardiovascular problems. "There are certain conditions that you would want to look out for, and you preclude that whole process if you just jump to taking the medication," he explained. "But, to your point, if someone is using therapeutic-level dosing and it seems to work, it's probably not too terrible."
He still insists that the safest route for people with ADHD to be properly assisted and properly monitored. Indeed, the study also found that people who misused ADHD prescriptions were more likely than the control group to exhibit overall substance use disorder. "We think that some people who are misusing these prescription stimulants probably have a substance abuse problem brewing. They're falling behind academically and they need something to help them focus and get through classes," said Wilens. "There have been longitudinal studies that show it's really people in decline who tend to misuse stimulants. We found that 20 percent of our stimulant misusers had both a drug and alcohol problem."
But, in a press release, Wilens adds that substance abuse is often concurrent with undiagnosed ADHD. "We know that untreated ADHD is associated with increased risk of alcohol- and drug-use disorders, so it is not surprising that we found high rates of co-occurring ADHD and of stimulant-use and overall substance-use disorders in those misusing stimulants," he said.