Richard is a fourth-year arts student at the University of Toronto. Like most students, he’s had his share of extremely stressful academic periods, times when he found it difficult to cope with the workload he was expected to complete.
Toward the end of his third year he had a particularly severe “oh shit, I haven’t done anything all semester” moment — a feeling most humble undergrads can relate to. He remembers thinking that even if he studied for 10 hours a day for three weeks, he probably wouldn’t be able to do all the work he needed to finish.
The overwhelming feeling of academic stress compelled Richard to use a prescription psychostimulant to help him focus and get more work done in a shorter period of time. Although it wasn’t prescribed to him, he had access to the drug Adderall through a friend. Richard continued using Adderall, along with similar psychostimulants, nearly every day for three weeks.
Adderall is a brand name medication composed of four amphetamine salts. Like other brand name stimulants including Ritalin and Concerta, Adderall is prescribed to treat a variety of conditions in both children and adults; the most common is attention deficit hyperactivity disorder. However, on university campuses, particularly in Canada and the United States, psychostimulant use has become prevalent for non-medical reasons. The drugs not only extend periods of wakefulness but also significantly enhance the user’s ability to focus.
A widely cited University of Michigan study from 2005 found that approximately 7 per cent of American undergraduate students had taken a prescription stimulant for a non-medical purpose. Some 4.1 per cent reported use in the past year. Considering these single-digit rates, this may not appear to be a serious problem. But Bernard Le Foll, a professor at the University of Toronto’s Department of Pharmacology and Toxicology calls non-medical use of these psychostimulants a “growing issue.”
As with any mind-altering substance, psychostimulants cause a variety of unwanted side effects. They can also be dangerous depending on the dosage and the user’s sensitivity to the chemicals.
One of the side effects Richard noticed when he began his self-described “three-week binge” was the desire to speak incessantly to anyone willing to listen. “After studying for two hours on Adderall, I went outside the library for a cigarette and ended up sitting down and had a conversation with these two girls I knew for about an hour,” he recalls.
“When you’re on Adderall, you have a lot to say and you never feel as if what you have to say isn’t important.”
Of course, those who aren’t in a similar state of mind might not be so enthralled by your exuberant monologue. “I may have bored them,” he adds. “I didn’t really notice.”
Richard didn’t immediately experience any of the negative effects associated with non-medical psychostimulant use, of which the most common is the inability to sleep.
“My friend told me to do it earlier in the day or else you wouldn’t be able to sleep at night. So I think it was around 1:00 in the afternoon when I took it for the first time. That night was okay,” he says.
But after three weeks of taking stimulants almost every day, the negative effects became more apparent.
“I wasn’t sleeping at proper times. I would just be on Adderall and be up all night, then up all day. It was like, when you’re off Adderall, when you’re done studying, then you can go to sleep,” he explains. “On the days when I took it too late, like after one o’ clock, I found that I would be lying in bed and my brain just wouldn’t shut up.”
Ryan, a recent graduate, has also used prescription stimulants — chiefly Adderall — during his time at U of T. Despite his efforts to monitor his Adderall intake during intense study sessions, there were a few times, especially in his final year, when he lost track of how much he’d taken.
“If you take too much, you won’t be able to sleep,” Ryan explains. “You’ll want to take more the next day to stay awake and continue getting work done, and that will make it even more difficult to get any good sleep.”
“What really sucked,” he recalls, echoing Richard’s sentiment, “was the frustration of wanting to sleep but being unable to, and just watching the hours tick away and then seeing the sunrise. That’s the worst feeling. It’s a cycle that you can break out of if you’re smart about it, but it can be dangerous,” he concludes.
But was it worth it? Did the ability to devour chapter after chapter for hours without losing focus, while taking copious, detailed notes win out over the exasperation they felt as they lay awake, unable to fall asleep?
During Richard’s three-week binge, he wrote essays, did research, studied, and wrote an exam. “The studying worked well [on Adderall] because it was just memorization and learning concepts,” he says.
“I wrote an exam on Adderall, but I ran out of time and ended up getting probably the same mark I would have gotten had I not taken it. It was like a 76 per cent or 77 per cent. That’s below my standards, but it was decent. There was no awesome mark boost though.
“The paper was tougher to do because Adderall is almost like a single-track kind of drug,” he continues. “A thought process will go very far in one direction, but it’s really rigid. With essay writing, you can’t think like that.”
Ryan also describes having difficulty writing essays while on Adderall. “My research was a little more thorough, but it really inhibits the writing process in a weird way. It can jam you up because it makes it more difficult to be creative. That can include trying to come up with a sentence structure that doesn’t sound completely robotic.”
Although it robbed him of his ability to be creative, Ryan believes it allowed him to accomplish more in a shorter period of time. “[Adderall] has a really weird way of making you enjoy the work you’re doing,” he says. “The entire task goes from seeming impossible to surmount to something you’ll actually enjoy.”
While Ryan and Richard knew the potential negative effects before they took Adderall, at least at the time, they both thought it would be worth the risks just to be able to accomplish their schoolwork.
But it’s likely that they didn’t fully grasp all the possible negatives, mainly because no one can paint a comprehensive picture of the effects of psychostimulants when they’re used off-label.
“The use of them ‘off-label’ is a behaviour that’s not sufficiently studied,” explains Dr. Roger McIntyre, associate professor of the Department of Psychiatry and Pharmacology at U of T. “We have assumptions built into this that if they are beneficial in ADHD, wherein cognitive disturbances are the defining feature, they must be helpful for people who don’t have ADHD.”
According to McIntyre, this assumption is completely inaccurate. “Commentary about their effectiveness is one largely based not on the available evidence but one based on impressions and anecdotes,” he says. “Keep in mind that several anecdotes don’t make data.”
I am sitting on a bench outside Robarts Library on a cloudy October afternoon with a fourth-year political science student who would prefer to be called Stephen. It’s that time of the year — students are in the midst of the first stream of assignments and tests.
Even though a fairly intense academic period is fast approaching, Stephen isn’t trying to pull off a miraculous 11th hour cram session. He took Concerta a few hours earlier to boost his focus and confidence, but his attitude toward the drug seems more casual than what Richard and Ryan described. Stephen’s on a break from studying and has agreed to an interview with the requirement that I keep my questions brief. The peak period of productivity when you’re on Concerta is fleeting, and he wants to make the most of it.
“I don’t look up from my table. I just focus on what’s in front of me and I’m enthusiastic about it too,” he explains.
With an assignment and midterm in two and a half weeks, it certainly seems like Stephen has enough time to work on both without worrying. But as he puts it, the work is more enjoyable and he studies more effectively when he takes Concerta.
“It’s definitely fun. I enjoy the work and I feel like I’m making progress,” he says. “Not only do I feel confident in what I’m doing, but I’m experiencing the same ‘in the zone-ness’ when I’m doing any activity that requires focus like a high-intensity game.”
Stephen’s relatively casual attitude toward Concerta may be surprising considering the common image of a desperate student using a study drug to cram the night before an exam.
However, according to Dr. Roger McIntyre, the idea of a study drug making work more pleasurable isn’t so strange. In his mind there are three potential explanations that aren’t mutually exclusive.
“People have pressures; they have assignments to get done. And simply the process of getting the work done effectively and efficiently would itself be stress-reducing, and that could be experienced as pleasurable,” he explains.
This isn’t the entire story though. McIntyre’s second theory centres around the stimulant’s effect on the neurotransmitter dopamine. “It’s possible that these medications are emboldening people’s capacity for pleasure,” he begins. “Dopamine is a classic neurotransmitter that’s targeted by each of these agents and it’s well known in science as the pleasure chemical. Whether you have a piece of dark chocolate or you make love or read your favourite book — all these acts of pleasure we engage in are engaging the dopamine system.”
McIntyre’s third theory is a bit darker, and is rooted in the prevalence of undiagnosed psychiatric disorders on university campuses.
“We do know that the rate of depression, whether it’s mild, moderate or severe, is significant on college campuses,” he explains. Many people don’t know they have depression and have come to the conclusion that they’re depressed because they’re stressed and so on, but don’t realize the seriousness of the situation they’re in.
“They take a stimulant because their cognition is impaired and they’re feeling fatigued and motivation is not quite what it should be. That’s all part of depression. The medication offers them benefits. They say their cognition has improved and they come to the erroneous conclusion that the medication simply mitigated the cognitive problems, when in fact, the psychostimulant may have offered them an antidepressant effect. This improves mood, but it also improves cognition. That then begs the question: are psychostimulants antidepressants?”
There is no consensus yet from the medical community, chiefly due to the fact that it hasn’t been sufficiently studied. However, McIntyre does believe that “they would not be considered by the psychiatric community as robust in their overall effect” though some individuals might do “quite well with the medication.”
There seems to be little debate as to whether a student should use a prescription stimulant for non-medical purposes, but dissuading students from using them is a more difficult task.
The stereotypical view of university students is that they have a propensity for recklessness and don’t consider the negative effects of binge drinking or recreational drug use. Of course, this isn’t categorically true, but it’s definitely an important consideration for those working to discourage prescription drug abuse amongst university students. How far can preventative initiatives go when other unhealthy, drug-related activities are so pervasive on campus?
“I don’t think anyone is unaware of the fact that smoking cigarettes is bad for you, yet people still do it,” says Dr. McIntyre. “Many people are able to trick themselves into thinking that they’re not going to develop any consequences from smoking. The way you get people to discontinue smoking is to have them become appreciative of the consequences — not the general consequences, but the consequences to them.”
McIntyre knows most university students are more likely to rely on a testimonial from a friend than look up a research study before taking a psychostimulant. Nevertheless, he believes that educating students about the consequences of such behaviour is the key to prevention. He also emphasizes that there are alternative methods that are helpful for enhancing cognition.
“It’s turning out that one of the more effective cognitive enhancing strategies for people who have difficulty is aerobic exercise. I think we would all agree that that’s a very healthy endeavour and it’s actually one of the better ways to go,” he explains.
But for some, the unpleasant side effects are enough to deter further use of the drugs. Richard hasn’t taken Adderall since his three-week binge last year, and he doesn’t plan on using it again.
“It wasn’t worth the physical side effects,” he says emphatically. “Now I’ve realized I should stay on top of my shit. I don’t want to put myself in that position again.”
Whatever the medical community’s view of non-medical psychostimulant use may be, and regardless of the potential side effects, there’s little doubt that there will always be a market for substances like Adderall, just as there will always be a demand for coffee and energy drinks. You don’t get through university unless you’re awake and focused, but some students will go to greater lengths than others to stay that way, making themselves psychostimulant guinea pigs in the process.
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