By Katie Koschalk, Will Taylor, Elizabeth Poeschl, Leticia Rodriguez, Jessa Squellati, Nikol Schiller and Katie McIntyre
NOTE: This is part two in a two-part series. For part one, click here.
It was Friday night, a week before dead week. The flashing cursor on Kate’s blank Word document mocked her inability to begin her 10 to 15 page research paper. A friend with an Adderall prescription offered her a pill, and Kate decided to try the ADD/ADHD drug for the first time in hopes of enhancing her productivity during the chaotic week.
Kate felt effects similar to what her friend had described: high levels of concentration and the ability to stay awake easily, which she did, all night long.
“I would say my cutoff time is going to be 2 (a.m.), and then I said 3:30 (a.m.), but then all of a sudden it was 7 (a.m.) and the sun was coming up,” said Kate, a journalism sophomore. “Time went by so fast.”
Kate’s Adderall use is indicative of a trend not only at Cal Poly but on campuses across the United States. Non-prescription use of prescription amphetamines is rising dramatically. Studies show that between 4 and 35 percent of college students have used illegal stimulants as study aids, and the highest rates of use are at the most academically rigorous schools with highly competitive admissions.
Pressure to perform
With a freshmen acceptance rate of 36 percent in Fall 2009, getting admitted to Cal Poly takes hard work, determination and a competitive edge. Naturally, the workload at this school is not a walk in the park. An array of challenges, deadlines and scantrons to bubble in loom around every corner, pressuring students to enhance their study skills by any means.
If a recent online survey conducted by the Mustang Daily is any indication, Cal Poly ranks near the top of the national range for stimulant abuse. More than one in three respondents said they have used Adderall, Ritalin or Concerta illegally.
Daniel DiZoglio, a electrical engineer junior and physics minor, said he feels the stress and competition to do as well as he can, and consequently the pressure to take study-enhancing drugs, though he hasn’t yet.
“I know a lot of people who cheat on labs, homework, quizzes and tests and they throw off the curve,” he said. “They get perfect scores and I’m over here trying to do it on my own and getting Cs. It hurts my GPA and my chances of getting a job. I figure it’s just time to even the playing field.”
The Rx factor
Another element influencing the trend may be the increased diagnoses of ADD and ADHD in the 1990s, which directly correlates with the recent spike in off-prescription Adderall use, according to Dr. Anjan Chatterjee, a professor of neurology at the University of Pennsylvania.
The Food and Drug Administration only allows a drug to be marketed for its intended purpose. Once the FDA approves a drug, however, doctors can prescribe it for whatever purpose they deem appropriate. This, along with patients who are legitimately prescribed Adderall and simply have extra, may be fueling the rise in stimulants on college campuses.
“It’s potentially a huge market if people without diseases start taking these medications,” Chatterjee said. “There’s a clear incentive for them to have people take it.”
Prescription protocol
Despite their increased availability through doctors, getting legal access to these drugs isn’t necessarily easy.
“Students at Cal Poly cannot just walk into the Health Center, give the symptoms for Adderall and get a prescription,” head of Cal Poly Health Center Medical Services Dr. David Harris said. “That’s just a fairytale.”
“We take strict measures with Adderall and other amphetamines because it’s our license that’s on the line,” Harris said.
In order to be prescribed Adderall or any other medication for ADHD or ADD from Cal Poly’s Health Center, students must go through a series of nationally established criteria. In-depth medical and psychological evaluations must be conducted by the Health Center to ensure that students are correctly diagnosed.
Although doctors, nurse practitioners and physician assistants at the Health Center can write prescriptions, students cannot fill them on campus since the Health Center’s pharmacy does not carry Adderall. After a prescription for Adderall is written, students must then get the drug filled at an outside pharmacy. Once an Adderall dosage is appropriately prescribed, the Health Center or a local psychiatrist must conduct mandatory evaluations every three years.
Cal Poly’s Health Center offers no automatic refills for Adderall prescriptions. Thus, students who receive a prescription from Cal Poly must pick up a new prescription from the Health Center every month and then have a nearby pharmacy fill it.
In fact, the Cal Poly Health Center pharmacy has never offered Adderall. Harris explained that the Health Center’s pharmacy has a very low number of controlled substances they are even allowed to carry.
Even though the use of Adderall for those with a diagnosed concentration problem can be beneficial, the recreational use of Adderall can have negative side effects, Harris said.
“Adderall is a classic two-edge sword drug,” Harris said. “It has wonderful benefits but misused, it can be lethal.”
Adderall, like all other ADHD and ADD prescription drugs, is a central nervous system stimulant. It allows users’ brains to concentrate more efficiently because it increases the levels of dopamine and norepinephrine.
“There is a place in the brain, the nucleus accumbens, that generates reward through a neurotransmitter, dopamine. The more dopamine you have, the better you feel. The baseline level is about 300 units, but when a person takes an amphetamine, the level goes to 1,200 units,” said Dr. Dane Howalt, an addiction specialist at the San Luis Obispo Addiction Recovery Center (SLOARC).
Although methamphetamines, commonly referred to as meth, glass and ice, are stronger than their parent drug, amphetamines, including Adderall. Many people underestimate the potential for Adderall addiction. When properly prescribed by a doctor and used at the recommended dosage, addiction to the drug isn’t generally an issue since patients use the drug in regulated quantities. However, when an individual begins to abuse Adderall, addiction can occur fairly quickly.
“The issue at hand is that people are not taking it as prescribed. If they took one pill in the morning and one at night like they should, we wouldn’t have a problem. But they are crushing it up and snorting it and selling it on the streets and that is a problem,” said Janie Stuart, a licensed family therapist at the SLO County Drugs and Alcohol Services.
Addiction
Use, abuse and addiction are three different things, according to Howalt. Not every college student who crushes and snorts Adderall to enhance study skills is an addict. The differentiation between a user, abuser and addict comes down to whether a given person does or does not have an addictive personality, or a predisposition to become addicted.
“There is a severe physic conflict over using a drug, like having two separate people inside of you. It’s as if (addicts) are possessed or inhabited by another person who doesn’t care about anything, their job, their family, their health, anything,” Howalt said.
Genetics also play a significant role in addiction, making it about 25 percent more likely for a user to become addicted to a substance if one of their parents is an addict. In addition, being previously addicted to a drug greatly increases the likelihood of becoming addicted to another drug.
Whereas a non-addict who experiments with Adderall will be able to stop at any given time through self-control, an addict who experiments with Adderall will develop an undying need to take the drug frequently in large quantities
“An addict has a compulsion to use, a loss of control and continues to use the drug despite adverse consequences. Addicts who use amphetamines have their reward system hijacked so that they are incapable of pushing the addict out of the way,” Howalt said.
Amphetamines are a very dangerous category of drug because of the high potential for addiction. According to Howalt, if somebody was on the “maybe path” of becoming a full-blown addict, using an amphetamine, which increases dopamine levels in the brain by about 300 percent, would be the drug that tips them over the edge.
The environment also has a large impact on whether a person uses, abuses or becomes addicted to a drug. According to Stuart, the use of Adderall in the San Luis Obispo community is a big problem, especially among college students.
“Students are juggling so many pressures every day — school, work, so many responsibilities and pressures. The people you hang around with on campus, your use of alcohol and other stimulants, definitely plays into your potential for addiction,” Stuart said.
Help for addicts
However, many college students who become addicted to Adderall will not receive help. Based on his experiences with treating drug-addicted patients, Howalt claims that addicts who take Adderall see their behavior as less evident of being addicted. Especially in the college environment, the use of Adderall is seen as socially acceptable, similar to binge drinking on the weekends. In Howalt’s opinion, snorting Adderall is about as accepted as smoking marijuana in a college environment.
“I think that we don’t see many college students in recovery because there are not as many legal consequences as there may be with other drugs. We usually see students coming in here to get help for drugs that got them in legal trouble,” Stuart said.
Cal Poly counseling services does not have students coming in to address Adderall abuse, said Mary Peracca, Cal Poly’s Drug and Alcohol specialist and counselor, adding that students may not report the amphetamine as a drug when counselors meet with them.
Although there may be a limited number of people who volunteer themselves for recovery, those who do are in for a difficult and often lengthy process. According to Howalt, there is no known treatment that has been successful in treating amphetamine addiction. While there have been records of several different medications that appear to help, nobody has scientifically been able to demonstrate this.
The most important first step in recovery from amphetamines is treating a person for their physical symptoms. Typically that involves tranquilizers, which makes it easier for the patients to sleep. Unlike the potentially life-threatening withdrawal symptoms associated with alcohol and opiates, Adderall withdrawal is not physically dangerous, mostly just unpleasant.
“To be using a substance such as Adderall, which brings your dopamine levels to 1,200 units, and then crashing down to 300, doesn’t feel good. I don’t tell people that things will be as good or better than when they were using the drugs because they won’t,” Howalt said.
According to SLOARC, the best chance for long-term recovery from substance abuse involves individual counseling and active participation in 12-Step Programs. The changes that have occurred in an addict’s brain are far to complex to overcome alone.
The SLO County Drug and Alcohol Services uses a process called MATRIX, which involves relapse prevention groups, education groups, individual counseling and random drug testing. The individual counseling is used for the first four months only, but the entire program lasts a year.
Cal Poly offers two forms of therapy for drug abuse problems: Peer counseling and professional counseling. The student peer counseling team, Thoughtful Lifestyle Choices, helps students apply healthy decisions to their lives. The professional counseling team assists students in eliminating drug use and tolerating high stress levels.
Leaving it behind
Many students who use illegal stimulants to study say they plan to quit before they enter the professional world. Among them is a graduating senior who asked to be referred to as “K.”
K started taking Adderall last spring to help him study for finals. From there his use progressed to when he needed to stay focused for long, tedious homework assignments and sometimes before tests.
“I had a really hard time sitting down when I had a six-hour project to get done. Thirty minutes in I’d start playing with my pencil,” he said. “(Adderall) helped me zone other things out. I don’t consider myself smarter from when I had it, but now I can go more in-depth on problems.”
K said he hasn’t used it since finals last quarter and “for the most part” he’s done taking Adderall. He said he doesn’t want to use Adderall in the professional field because he wants to be able to do his own work without an illegal advantage.
After taking it approximately 20 to 30 times over the course of a year, K said he no longer really feels the need for it to focus. “I didn’t really want to become dependent on it to do work. Now I can sit down and do work without being on it,” he said.
“A part of it is the placebo effect: I thought I needed it to do well so I did. It’s the mindset,” he said. “If you think taking a pill will make you sit down and study longer, you do. What the mind wants, it does.”
— Brittany McKinney contributed to this report.