Poster from Wolverine Wellness’s campaign against use of Adderall with Alcohol
The college experience is built around late nights, late nights studying, late nights partying, late nights making memories that are supposed to last a lifetime. At colleges and universities across the country, a “work hard, play hard” culture is emphasized, causing students to feel the pressure to work long, late hours and push themselves to maintain competitive grades and active, glamorous social lives. But, not everyone can manage this non-stop lifestyle, leaving students looking for anything to help them keep up. Many students chug coffee or energy drinks hoping that the caffeine will hold off their drooping eyelids through one more practice problem or late night house party. But some students like Jake*, a University of Michigan sophomore, have another drug of choice, Adderall.
Jake got a prescription for Adderall after his freshmen year of college, although he had used the drug before. He admits he does not have Attention Deficit Hyperactivity Disorder (ADHD) or medical reason to take the drug, but instead had a “ doctor [that] is pretty free to just give it out”. As a student in the competitive Ross School of Business Jake has a “mindset of drugs a tools”. With courses graded on a curve and constant pressure to outperform his classmates, Jakes sees Adderall as “a motivator to put my nose to the grindstone”.
Adderall was first approved to treat ADHD in 1996. By the early 2000s, Adderall, and other drugs to treat ADHD had become increasingly popular among stressed out students fighting to get ahead academically. Adderall use has continued to climb, and a 2015 meta analysis from the University of South Carolina reported that an estimated 17% of college students have misused Adderall or other stimulant medications. A 2015 review article published in the Journal of Postgraduate Medicine, reported that the most common reasons for misusing the drugs among college students were help with concentration (58% of respondents) and increased alertness (43%). Adderall’s efficacy comes from a combination of amphetamines that work to stimulate norepinephrine (NE) neurotransmitters and modulate attention, focus, and energy.
For people who have ADHD, Adderall and other stimulants work to stabilize a chemical imbalance within the norepinephrine system, creating normal levels of attention. But for people who don’t the flood of NE can make them feel hyper focused and energized. According to Renee*, a University of Michigan sophomore who takes Adderall to manage severe ADHD, she’s watched many of her friends abuse the drugs. When they take Adderall “it’s like they’re super powered” she exclaims. She says “a lot of people use it for the side effect…to be able to stay up, but me, I sleep, I eat”. Renee admits to being frustrated by the attitude and culture surrounding Adderall, when it is a medication she needs to function normally. But where do these supercharged students get the medication? How hard would it be to walk in to a campus health center, say you have trouble focusing and walk out with an ADHD diagnosis and prescription for Adderall?
Currently at the University of Michigan, students can receive a prescription for Adderall through Counseling and Psychological Services (CAPS) or the University Health Service (UHS). However the process is by no means quick and easy, involving multiple interviews, tests and other screening devices. Jim Dolan, clinical director of CAPS, states that his department consistently sees around 150 students per year requesting ADHD testing. However, he contends that most of these students are struggling with the transition to college life, not seeking drugs “When they [students] encounter…. difficulties concentrating the first thing they think of is “oh, I must have ADHD””, says Dolan.
UHS primarily functions to provide continuing medication programs for students who arrive at college with established and documented prescriptions. Dr. Elizabeth Cardinale, a physician lead in the UHS internal medicine department, says that in an ideal situation a “Psychiatrist can initiate [ADHD treatment] and we [UHS] will continue”. In Cardinale’s opinion the “gold standard is having students go through neuropsychiatric testing” to be diagnosed. But, she also admits that there are several different ways that and ADHD diagnosis can be made, “every clinician is going to do things slightly differently” and when it comes to prescriptions there are “a lot of indications for Adderall” and “clinicians have a lot of autonomy”. It’s this autonomy that put the drugs in wider circulation on campus.
Students like Jake who have Adderall prescriptions, but don’t need the medication daily often share unused pills with friends. Although Jake insists that he tries not to “go out exposing that I have and Adderall script”, he does admit to sharing the medication with close friends from home. To try and counter this issue departments on campus try to educate students on the effects and abuse potential of Adderall. Any student receiving the medication is given instruction to not to tell their friends that they have to drugs, and a stern reminder that selling or sharing them is illegal. Mary Jo Desprez, the director of Wolverine Wellness, a branch of UHS that handles substance abuse, thinks that “because people think that it is so normal to share, or get it to go through finals” students don’t actually realize how dangerous stimulants can be. Desprez warns, “stimulants are addictive” for students taking Adderall without the chemical imbalance related to ADHD, the drug pretty much “works like cocaine”. In addition, Wolverine Wellness started a program targeted at Greek Life students to discourage mixing the Adderall with alcohol. This campaign began after Theta Chi fraternity brother Josh Levine died by combining the drugs in 2014. For their part, Dr. Cardinale says that UHS is currently working on revising their stimulant prescription protocols, and requiring documentation of thorough neuropsychiatric testing and diagnosis before a student can refill a prescription, however those standards won’t go into effect until the 2017-18 school year.
Despite the hard work of university health officials, many of their efforts only work to regulate the distribution of these drugs within the university health system or with specifically targeted groups. The high stress culture or college still remains and Jake, and many students like him, are still using Adderall as a “coping mechanism to be able to handle that environment”.
*Only student’s first names have been used to protect their privacy