What’s driving the use of Adderall as a performance-enhancing drug on college campuses?
That’s one of several questions addressed in a new Netflix documentary, “Take Your Pills.”
The film traces the history of prescription stimulants and the role that changing social norms and pressures have played in shaping their use.
“When I was in college, people did drugs to check out. Now, people do drugs to check in,” Dr. Anjan Chatterjee, chair of neurology at the University of Pennsylvania, remarks early in the film.
Along with other experts interviewed, Chatterjee draws attention to the highly competitive nature of modern society as one of the factors driving prescription drug use.
College students, professional athletes, and people in other highly competitive fields are pressured to strive for perfection and meet unrealistic standards of performance.
In some cases, they turn to Adderall or other prescription stimulants to help them focus and stay awake for longer.
But the potential benefits of using prescription stimulants to enhance performance may be more limited than many people realize.
And these drugs carry the risk of serious side effects, including addiction.
Prescription stimulants used to treat ADHD
Adderall is a type of amphetamine used to treat attention deficit hyperactivity disorder (ADHD).
According to Dr. Dan Coury, member of the developmental and behavioral pediatrics section at Nationwide Children’s Hospital in Ohio, it’s one of over a dozen prescription stimulants approved to treat ADHD.
“The stimulant medicines all effectively treat the core symptoms of ADHD, which are problems with inattention, hyperactivity, and impulsivity,” Coury told Healthline.
“Adderall is one of the most widely prescribed medications for the treatment of ADHD, and it’s a very appropriate and effective treatment,” he added.
In recent decades, rates of ADHD diagnoses and stimulant drug prescriptions have increased.
At the same time, stimulant drug misuse has become a growing issue of concern.
Misuse occurs when someone takes a drug that hasn’t been prescribed to them or uses a drug in a way that doesn’t conform to their doctor’s recommendations.
In its latest national survey on drug use and health, the Substance Abuse and Mental Health Services Administration estimated that 1.7 million people over the age of 12 misused stimulants in 2016.
It found the highest rate of misuse reported among young adults, ages 18 to 25.
More than 2 percent of young adults reportedly misused stimulants in the previous month.
The lifetime rate of misuse in young adults is likely higher.
Adderall can cause serious side effects
Prescription stimulants can help people with ADHD manage their symptoms.
But they offer fewer benefits to people without this condition.
“When we’re using these medications to treat someone with ADHD, you can see improvement in their inattentiveness, their distractibility, and their impulsivity, and that can then result in improved performance,” Coury said.
“For people who do not have ADHD, the benefits in attention and concentration are minimal,” he continued, “so they’re unlikely to see that improvement.”
The use of Adderall and other prescription stimulants also comes with risks.
“Adderall actually comes with a ‘black box warning,’ which is the FDA’s highest level of warning,” Matt Varga, PhD, an associate professor of counselor education and college student affairs of the University of West Georgia, told Healthline.
For example, Adderall can increase users’ heart rate, blood pressure, and risk of heart attack and stroke.
These risks are heightened when users combine Adderall with other stimulants, such as coffee or energy drinks.
In fact, the recent death of a University of Tennessee student has been linked to combined Adderall and caffeine use.
Over time, users can become physically and psychologically dependent on Adderall.
“You have the physical addiction but then also the psychological addiction, that you can’t complete work, or achieve, or succeed without these drugs,” Varga said.
Many users resort to illegal activities, such as purchasing prescription drugs from friends, to feed their habit.
Overdiagnosis contributes to drug abuse
To be diagnosed with ADHD, patients should demonstrate a history of specific symptoms and functional impairment in their academic, professional, or social life.
“The current recommendations for diagnosing ADHD involve taking a history of the patient’s symptoms and also gathering input from other adults who know the patient,” Coury told Healthline.
To develop an accurate diagnosis for a child, physicians should generally speak with not only their parents but also their teachers or other adults that know them, he noted.
When diagnosing an adult, physicians are less likely to interview their parents, but they should still look for evidence of symptoms and impairment in their patient’s history.
However, some physicians don’t follow all the recommended steps to develop an accurate diagnosis, Coury said.
As a result, some people receive a diagnosis of ADHD and prescription stimulants that they don’t actually need.
This contributes to the availability and use of prescription stimulants on college campuses, where it’s not uncommon for students to buy and sell prescription drugs to each other.
To help limit the availability of Adderall, Varga would like general practitioners to refer patients to psychiatric professionals, rather than diagnose them with ADHD themselves.
“They need to refer to psychiatrists that can go and do full assessments to determine whether or not somebody has ADHD,” he said.
Varga also thinks it’s important to raise awareness on college campuses of the potential signs, symptoms, and risks of prescription stimulant misuse.
This might help faculty and other community members identify students who are engaging in prescription stimulant misuse or struggling with addiction.
It might also help students understand the downsides of misusing prescription stimulants, including the health and legal risks.
To address the competitive pressures that drive a lot of Adderall misuse, wider cultural changes are needed.