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When Kari Benson was an undergraduate at the University of South Carolina doing laboratory research on attention deficit hyperactivity disorder, acquaintances often asked if she could hook them up with stimulant medications meant to treat ADHD—such as Adderall and Ritalin—to give them a study boost. “Of course I would tell them, no, that wasn’t possible,” says Benson, who is now a graduate student pursuing her Ph.D.
But the requests for study drugs inspired Benson to look into how often college students misuse stimulant medication to try to get ahead in school.
The result was a comprehensive analysis by Benson and her professor in the journal Clinical Child and Family Psychology Review, which estimated that 17 percent of college students in the U.S. misuse ADHD drugs. The research, published in 2015, “remains the most nationally representative study on this subject in terms of college students,” Benson says.
Benson says that while many young adults still use ADHD to get ahead at school, that doesn’t make it a good idea. Mounting evidence has linked the misuse of ADHD medications—which include amphetamine and dextroamphetamine (Adderall, Adderall XR, and generics), methylphenidate (Concerta, Methylin, Methylin ER, Metadate CD, Ritalin, Ritalin SR, Ritalin LA, and generics), atomoxetine (Strattera), and lisdexamfetamine (Vyvanse)—to serious harm.
The risks range from restlessness, aggression, and increased blood pressure and heart rate to stomach problems, paranoia, psychosis, seizures, heart attack, and stroke, according to the National Institute on Drug Abuse.
To make matters worse, research also suggests that while the drugs may improve concentration in people who are diagnosed with ADHD, in those without that condition the drugs may undermine mental performance.
ER Trips on the Rise
A 2016 study in the Journal of Clinical Psychiatry found that Adderall use among young adults who didn’t have ADHD jumped 67 percent in recent years and that emergency room visits related to these medications rose 156 percent.
The study also found that most of the people misusing the stimulants did not have a prescription and often got them from a friend or relative. The fact that many people are taking the medications without the supervision of a doctor could explain some of the ER visits.
“Many people think prescription opioids are the only prescription drugs used nonmedically,” says Caleb Alexander, M.D., an author of the study and co-director of the Center for Drug Safety and Effectiveness at the Johns Hopkins Bloomberg School of Public Health. “That simply isn’t true. Nonmedical use of stimulants is also very common. As with all drugs, stimulants have risks and benefits, and all too often, the balance of these is unfavorable.”
Many students, however, are unaware of the risks of misusing ADHD medications, and they overestimate the ability of the drugs to boost their performance in school.
A 2017 study in the journal Addictive Behaviors—based on survey data collected from more than 6,900 U.S. college students without ADHD—found that nearly 29 percent of students believed that using stimulants would improve their grades. And of the students who used the stimulants, nearly two-thirds believed the drugs helped them.
But medical research isn’t so sure. For example, a 2016 analysis in the journal Experimental and Clinical Psychopharmacology found that in people who haven’t been diagnosed with ADHD, prescription stimulants do not significantly improve “executive function,” which includes performing tasks that involve decision-making, planning, attention, mental flexibility, working memory, and verbal fluency. The authors suggested that whatever cognitive benefits people report when taking these drugs may be explained by a skewed perception of their work, a burst of energy caused by the stimulants, or placebo effects.
Healthy students taking an ADHD drug “do feel more alert when they take it,” says Lisa Weyandt, Ph.D., professor of psychology and interdisciplinary neuroscience at the University of Rhode Island, and the lead author of the study. “That’s a real effect. But it does not enhance their academic abilities.”
The medication may even worsen functioning in students who don’t have ADHD, according to a pilot study co-authored by Weyandt and published this year in the journal Pharmacy.
In that study, which examined the effects of Adderall on 13 healthy college students, neither the researchers nor the participants knew who received the medication and who received the placebo. “We expected that because students think [the medication] is improving their neurocognition that we would find improvements in reading, comprehension, reading fluency, and working memory,” Weyandt says. But students taking the ADHD drug didn’t perform better than those taking a placebo on any measure, she says, and performed worse on the working memory test.
Why? Weyandt explains that in people with ADHD—who often have less activity in the regions of the brain that govern executive function—stimulant medication can indeed normalize neural functioning and improve performance. “But for people who don’t have a deficit in their functioning, the medication won’t enhance it and may do harm,” she says.
Weyandt likens the phenomenon to using corrective glasses that aren’t prescribed. “If you need glasses to see far away but your best friend doesn’t, when she puts on your glasses that’s not going to make her vision super vision; it’s going to impair her vision,” Weyandt says. “Things are going to be all blurry. That’s what I suspect is going on with ADHD medication in healthy adults.”
What’s more, students who take ADHD drugs without the supervision of a doctor are more likely to develop dependency on the medication and, when they try to stop, experience withdrawal symptoms, such as fatigue, depression, and sleep problems.
Because of the health risks, and the lack of benefit, the American Medical Association says Adderall and other so-called smart drugs should not be used in healthy people seeking to improve studying. “While prescription stimulants carry real risks, they do not make people smarter,” the AMA said in a statement.
Smarter, Safer Study Strategies
If you have persistent difficulty studying or concentrating, consider seeing a doctor. Your symptoms could stem from undiagnosed ADHD (and you might benefit from supervised treatment). Or you may be dealing with another medical condition, such as insomnia, depression, anemia, or a thyroid disorder.
Certain medications can also cloud thinking. These include antihistamines, such as diphenhydramine (Benadryl and various over-the-counter sleep aids); cough and congestion medications, such as dextromethorphan (Robitussin and other products) and pseudoephedrine (Sudafed and generic); and tricyclic antidepressants, including amitriptyline (Elavil and generic).
Before seeking out drugs to improve school performance, evaluate your study habits. “We know from the research that the students who are more likely to misuse stimulant medications are also the students who are more likely to skip class, study less, and struggle with organization,” Benson says. “Lifestyle changes may be more effective than medication in having an impact on their academics.”
Unsure of how to make a change on your own? “There are a lot of resources readily available to students on campus, so turn to those rather than turning to Adderall,” Weyandt says.
Here are some specific tips:
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- Get study assistance. “Go to the academic skills center—every campus has one—where they have tutors who proofread papers and teach study skills,” Weyandt says. “Those offices are there for support."
- Visit the health center. Students who misuse medications are often under psychological distress and could benefit from counseling or therapy.
- Stop multitasking. Doing several tasks at once can cause confusion, and it can take longer to complete each task that way rather than doing them sequentially.
- Spread out your studying. Instead of cramming the night before a test, schedule study sessions over several nights, Benson says. That will improve your ability to retain information over the long term and help you get enough sleep, especially on nights before exams.
- Limit social media. It can be distracting and anxiety-provoking. And recent research has found an association between a high use of social media and ADHD in adolescents. "So put your phone away while you’re studying. “Use social media as a reward instead of something you’re doing while trying to study,” Weyandt says.
- Address your stress and sleep. People who are under stress or are tired perform worse than those who are calm and well-rested. So try to incorporate relaxation strategies, such as exercise and meditation, into your life, and stick to a regular sleep routine so that you can get adequate shut-eye.
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