Have you ever been to Enfield? I had never even heard of it until I was 23 and living in London for graduate school. One afternoon, I received notification that a package whose arrival I had been anticipating for days had been bogged down in customs and was now in a FedEx warehouse in Enfield, an unremarkable London suburb. I was outside my flat within minutes of receiving this news and on the train to Enfield within the hour, staring through the window at the gray sky. The package in question, sent from Los Angeles, contained my monthly supply of Adderall.
Adderall, the brand name for a mixture of amphetamine salts, is more strictly regulated in Britain than in the United States, where, the year before, in 2005, I became one of the millions of Americans to be prescribed a stimulant medication.
The train to Enfield was hardly the greatest extreme to which I would go during the decade I was entangled with Adderall. I would open other people’s medicine cabinets, root through trash cans where I had previously disposed of pills, write friends’ college essays for barter. Once, while living in New Hampshire, I skipped a day of work to drive three hours each way to the health clinic where my prescription was still on file. Never was I more resourceful or unswerving than when I was devising ways to secure more Adderall.
Adderall is prescribed to treat Attention Deficit Hyperactivity Disorder, a neurobehavioral condition marked by inattention, hyperactivity and impulsivity that was first included in the D.S.M. in 1987 and predominantly seen in children. That condition, which has also been called Attention Deficit Disorder, has been increasingly diagnosed over recent decades: In the 1990s, an estimated 3 to 5 percent of school-age American children were believed to have A.D.H.D., according to the Centers for Disease Control and Prevention; by 2013, that figure was 11 percent. It continues to rise. And the increase in diagnoses has been followed by an increase in prescriptions. In 1990, 600,000 children were on stimulants, usually Ritalin, an older medication that often had to be taken multiple times a day. By 2013, 3.5 million children were on stimulants, and in many cases, the Ritalin had been replaced by Adderall, officially brought to market in 1996 as the new, upgraded choice for A.D.H.D. — more effective, longer lasting.
Continue reading the main storyAdderall’s very name reflects its makers’ hopes for an expanding customer base: “A.D.D. for all” is the phrase that inspired it, Alan Schwarz writes in his new book, “A.D.H.D. Nation.” And in fact, by the time I arrived at college in 2000, four years after Adderall hit the market, nearly five million prescriptions were written; in 2005, the year after I graduated, that number was just under nine million. By then, sales of A.D.H.D. medication in the United States totaled more than $2 billion.
By the mid-2000s, adults were the fastest-growing group receiving the drug. In 2012, roughly 16 million Adderall prescriptions were written for adults between ages 20 and 39, according to QuintilesIMS, an information-and-technology-services company that gathers health-care-related data. Adderall has now become ubiquitous on college campuses, widely taken by students both with and without a prescription. Black markets have sprung up at many, if not most, schools. In fact, according to a review published in 2012 in the journal Brain and Behavior, the off-label use of prescription stimulants had come to represent the second-most-common form of illicit drug use in college by 2004. Only marijuana was more popular.
We know very little about what Adderall does over years of use, in and out of college, throughout all the experiences that constitute early adulthood. To date, there is almost no research on the long-term effects on humans of using Adderall. In a sense, then, we are the walking experiment, those of us around my age who first got involved with this drug in high school or college when it was suddenly everywhere and then did not manage to get off it for years afterward — if we got off it at all. We are living out what it might mean, both psychologically and neurologically, to take a powerful drug we do not need over long stretches of time. Sometimes I think of us as Generation Adderall.
Adderall as we know it today owes its origins to accident. In the late 1920s, an American chemist named Gordon Alles, searching for a treatment for asthma, synthesized a substance related to adrenaline, which was known to aid bronchial relaxation. Alles had created beta-phenyl-isopropylamine, the chemical now known as amphetamine. Injecting himself to test the results, he noted a “feeling of well being,” followed by a “rather sleepless night,” according to “On Speed: The Many Lives of Amphetamine,” by Nicolas Rasmussen. By the 1930s, the drug Benzedrine, a brand-name amphetamine, was being taken to elevate mood, boost energy and increase vigilance. The American military dispensed Benzedrine tablets, also known as “go pills,” to soldiers during World War II. After the war, with slight modification, an amphetamine called Dexedrine was prescribed to treat depression. Many people, especially women, loved amphetamines for their appetite-suppressing side effects and took them to stay thin, often in the form of the diet drug Obetrol. But in the early 1970s, with around 10 million adults using amphetamines, the Food and Drug Administration stepped in with strict regulations, and the drug fell out of such common use. More than 20 years later, a pharmaceutical executive named Roger Griggs thought to revisit the now largely forgotten Obetrol. Tweaking the formula, he named it Adderall and brought it to market aimed at the millions of children and teenagers who doctors said had A.D.H.D. A time-release version of Adderall came out a few years later, which prolonged the delivery of the drug to the bloodstream and which was said to be less addictive — and therefore easier to walk away from. In theory.
The first time I took Adderall, I was a sophomore at Brown University, lamenting to a friend the impossibility of my plight: a five-page paper due the next afternoon on a book I had only just begun reading. “Do you want an Adderall?” she asked. “I can’t stand it — it makes me want to stay up all night doing cartwheels in the hallway.”
Could there be a more enticing description? My friend pulled two blue pills out of tinfoil and handed them to me. An hour later, I was in the basement of the library, hunkered down in the Absolute Quiet Room, in a state of peerless ecstasy. The world fell away; it was only me, locked in a passionate embrace with the book I was reading and the thoughts I was having about it, which tumbled out of nowhere and built into what seemed an amazing pile of riches. When dawn came to Providence, R.I., I was hunched over in the grubby lounge of my dormitory, typing my last fevered perceptions, vaguely aware that outside the window, the sky was turning pink. I was alone in my new secret world, and that very aloneness was part of the great intoxication. I needed nothing and no one.
I would experience this same sensation again and again over the next two years, whenever I could get my hands on Adderall on campus, which was frequently, but not, I began to feel, frequently enough. My Adderall hours became the most precious hours of my life, far too precious for the Absolute Quiet Room. I now needed to locate the most remote desk in the darkest, most neglected corner of the upper-level stacks, tucked farthest from the humming campus life going on outside. That life was no longer the life that interested me. Instead, what mattered, what compelled, were the hours I spent in isolation, poring over, for instance, Immanuel Kant’s thoughts on “the sublime.”
It was fitting: This was sublime, these afternoons I spent in untrammeled focus, absorbing the complicated ideas in the texts in front of me, mastering them, covering their every surface with my razor-like comprehension, devouring them, making them a part of myself. Or rather, of what I now thought of as my self, which is to say, the steely, undistractable person whom I vastly preferred to the lazier, glitchier person I knew my actual self to be, the one who was subject to fits of lassitude and a tendency to eat too many Swedish Fish.
Adderall wiped away the question of willpower. Now I could study all night, then run 10 miles, then breeze through that week’s New Yorker, all without pausing to consider whether I might prefer to chat with classmates or go to the movies. It was fantastic. I lost weight. That was nice, too. Though I did snap at friends, abruptly accessing huge depths of fury I wouldn’t have thought I possessed. When a roommate went home one weekend and forgot to turn off her alarm clock so that it beeped behind her locked door for 48 hours, I entirely lost control, calling her in New York to berate her. I didn’t know how long it had been since I’d slept more than five hours. Why bother?
By my senior year of college, my school work had grown more unmanageable, not less. For the first time in my life, I wasn’t able to complete it. My droll, aristocratic Russian-history professor granted me an extension on the final term paper. One Friday evening well into December, when the idyllic New England campus had already begun to empty out for winter break, I was alone in the Sciences Library — the one that stayed open all night — squinting down at my notes on the Russian intelligentsia. Outside, it was blizzarding. Inside, the fluorescent lights beat down on the empty basement-level room. I felt dizzy and strange. It had been a particularly chemical week; several days had passed since I had slept more than a handful of hours, and I was taking more and more pills to compensate. Suddenly, when I looked up from the page, the bright room seemed to dilate around me, as if I weren’t really there but rather stuck in some strange mirage. I seized with panic — what was happening? I tried to breathe, to snap myself back into reality, but I couldn’t. Shakily, I stood and made my way toward the phones. I dialed my friend Dave in his dorm room. “I’m having some kind of problem in the Sci Li,” I told him. My own voice sounded as if it belonged to someone else.
An hour later, I was in an ambulance, being taken through the snowstorm to the nearest hospital. The volunteer E.M.T. was a Brown student I’d met once or twice. He held my hand the whole way. “Am I going to die?” I kept asking him. Dave and I sat for hours in the emergency room, until I was ushered behind a curtain and a skeptical-looking doctor came in to see me. I wasn’t used to being looked at the way he was looking at me, which is to say, as if I were potentially insane, certifiable even. By then, I was feeling a little better, no longer so sure I was dying, and as I lay down on the examination table, I joked to him, “I will recline, like the Romans!” His expression remained unamused. I described what I’d been taking. His diagnosis: “Anxiety, amphetamine induced.” I had had my first panic attack — an uncommon but by no means unknown reaction to taking too much Adderall. When I left the hospital, I left behind the canister of blue pills that I had painstakingly scrounged together. I still remember the sight of it sitting next to the examination bed.
A few days later, I drew incompletes in my classes and went back home to New York. My father knew about the hospital incident, but I promised him I would stop taking the drug. And I fully intended to. I spent that long winter break at the public library on 42nd Street, soldiering lethargically through the essays I hadn’t been able to cope with while taking amphetamines. What I didn’t know then, what I couldn’t have known, was that the question of whether Adderall actually improves cognitive performance when taken off-label — whether or not it is a “smart drug” — was unresolved. It would be another few years before studies appeared showing that Adderall’s effect on cognitive enhancement is more than a little ambiguous. Martha Farah, a cognitive neuroscientist at the University of Pennsylvania, has conducted much of this research. She has studied the effect of Adderall on subjects taking a host of standardized tests that measure restraint, memory and creativity. On balance, Farah and others have found very little to no improvement when their research subjects confront these tests on Adderall. Ultimately, she says, it is possible that “lower-performing people actually do improve on the drug, and higher-performing people show no improvement or actually get worse.”
My pill-free period didn’t last very long. I turned in my incomplete school work and duly received my grades, but by graduation that spring, I was again locked into the familiar pattern, the blissful intensity and isolation followed by days of slow-motion comedown, when I would laze around for hours, eating spoonfuls of ice cream from the carton, desperate for the sugar rush, barely able to muster the energy necessary to take a shower.
It took me exactly one year from the time of college graduation to come to the decision that would, to a great extent, shape the next phase of my life. It hit me like a revelation: It might be possible to declare my independence from the various A.D.H.D. kids who sold me their prescription pills at exorbitant markups and get a prescription all my own. The idea occurred to me as I walked among the palm trees on the campus of U.C.L.A. By then, I was living in Los Angeles, working as a private tutor for high-school kids, many of whom were themselves on Adderall, and taking summer-school classes in psychology and neuroscience in order to be able to apply for graduate school. I had decided I wanted to be a psychologist — infinitely more manageable than my secret ambition of being a writer, I thought. Infinitely more realistic. Like many 20-somethings, my decisions were informed by panic and haste, but also, of course, by whatever short-lived supply of the pills I happened to be in possession of.
I was now surrounded — or had surrounded myself — by others caught up in the Adderall web. Together with two of my closest friends in Los Angeles that year, we traversed the city in a state of perpetual, hyped-up intensity, exchanging confidences that later we would not recall. Adderall was the currency of our friendship; when one of us ran short of pills, another would cover the deficit. Driving through Los Angeles in a sun-drenched trance, weaving in and out of traffic, I found it all too easy to lose track of exactly how many pills I had swallowed that day.
As soon as it occurred to me that I might be able to get my own prescription, I went to the nearest campus computer and searched for “cognitive behavioral psychiatrist, Westwood, Los Angeles, California.” I knew enough about psychology by then to avoid the psychoanalysts, who would want to go deep and talk to me for weeks or maybe months about why I felt I needed chemical enhancement. No, I couldn’t turn to them — I needed a therapist with an M.D., a focus on concrete “results” and an office within a 10-minute drive of U.C.L.A.
The very next day, I was sitting in exactly the kind of place I had envisioned, an impersonal room with gray walls and black leather furniture, describing to the attractive young psychiatrist in the chair opposite me how I had always had to develop elaborate compensatory strategies for getting through my school work, how staying with any one thing was a challenge for me, how I was best at jobs that required elaborate multitasking, like waitressing. Untrue, all of it. I was a focused student and a terrible waitress. And yet these were the answers that I discovered from the briefest online research were characteristic of the A.D.H.D. diagnostic criteria. These were the answers they were looking for in order to pick up their pens and write down “Adderall, 20 mg, once a day” on their prescription pads. So these were the answers I gave.
Fifty minutes later, I was standing on San Vicente Boulevard in the bright California sun, prescription slip in hand. That single doctor’s assessment, granted in less than an hour, would follow me everywhere I went: through the rest of my time in Los Angeles; then off to London, with the help of FedEx; then to New Haven, where I would pick it up once a month at the Yale Health Center; then back to New York, where the doctor I found on my insurance plan would have no problem continuing to prescribe this medication, based only on my saying that it had been previously prescribed to me, that I’d been taking it for years.
Any basic neuroscience textbook will explain how Adderall works in the brain — and why it’s so hard to break the habit. For years, the predominant explanation of addiction, promulgated by researchers like Nora Volkow, director of the National Institute on Drug Abuse, has revolved around the neurotransmitter dopamine. Amphetamines unleash dopamine along with norepinephrine, which rush through the brain’s synapses and increase levels of arousal, attention, vigilance and motivation. Dopamine, in fact, tends to feature in every experience that feels especially great, be it having sex or eating chocolate cake. It’s for this reason that dopamine is so heavily implicated in current models of addiction. As a person begins to overuse a substance, the brain — which craves homeostasis and fights for it — tries to compensate for all the extra dopamine by stripping out its own dopamine receptors. With the reduction of dopamine receptors, the person needs more and more of her favored substance to produce the euphoria it once offered her. The vanishing dopamine receptors also help explain the agony of withdrawal: Without that favored substance, a person is suddenly left with a brain whose capacity to experience reward is well below its natural levels. It is an open question whether every brain returns to its original settings once off the drug.
Nearly three years after getting the prescription, in 2008, I found myself sobbing in a psychiatrist’s office in New Haven, where I was finishing graduate school, explaining to him that my life was no longer my own. I had long been telling myself that by taking Adderall, I was exerting total control over my fallible self, but in truth, it was the opposite: The Adderall made my life unpredictable, blowing black storm systems over my horizon with no warning at all. Still, I couldn’t give it up. The psychiatrist was a kind Serbian man with an unflappable expression. He observed my distress calmly and prescribed Wellbutrin, an antidepressant with a slightly speedy quality that could cushion the blow of withdrawal and make it less painful to get off the Adderall. His theory was sound. But soon enough, I was simply taking both medications.
Through my Adderall years, I lived a paradox, believing that the drug was indispensable to my very survival while also knowing that it was nothing short of toxic, poisonous to art, love and life. By 2009, I had a contract to write a book about psychoanalysis and neuroscience; shortly after, I took a day job as a reporter for a news website. What was required of me there was the constant filing of short, catchy pieces: to be quick and glib and move on to the next one. It was the kind of rhythm perfect for an Adderall-head like me — and the kind of writing at odds with the effort to think slowly and carefully, at book length. The goal of slow and careful thinking came to feel more and more anachronistic with each passing week. It didn’t escape me that just as Adderall was surging onto the market in the 1990s, so, too, was the internet, that the two have ascended within American life in perfect lock-step.
Occasionally, I would try to get off the drug. Each attempt began the same way. Step 1: the rounding up of all the pills in my possession, including those secret stashes hidden away in drawers and closets. Debating for hours whether to keep just one, “for emergencies.” Then the leap of faith and the flushing of the pills down the toilet. Step 2: a day or two of feeling all right, as if I could manage this after all. Step 3: a bleak slab of time when the effort needed to get through even the simple tasks of a single day felt stupendous, where the future stretched out before me like a grim series of obligations I was far too tired to carry out. All work on my book would stop. Panic would set in. Then, suddenly, an internal Adderall voice would take over, and I would jump up from my desk and scurry out to refill my prescription — almost always a simple thing to achieve — or borrow pills from a friend, if need be. And the cycle would begin again. Those moments were all shrouded in secrecy and shame. Very few people in my life knew the extent to which the drug had come to define me.
Over the years, I’ve been told by various experts on the subject that it should not have been so hard to get off Adderall. The drug is supposed to be relatively quick and painless to relinquish. I’ve often wondered whether my inability to give it up was my deepest failing. I’ve found some comfort in seeing my own experience mirrored back to me in the dozens and dozens of disembodied voices on the internet, filling the message boards of the websites devoted to giving up this drug. One post, in particular, has stayed with me, a mother writing on QuittingAdderall.com:
I started taking Adderall in OCT 2010. And my story isn’t much different than most. ... The honeymoon period, then all downhill. I feel like I cannot remember who I was, or how it felt, to go one minute of the day not on Adderall. I look back at pictures of myself from before this began and I wonder how I was ever “happy” without it because now I am a nervous wreck if I even come close to not having my pills for the day. There have been nights I have cried laying my daughter down to sleep because I was so ashamed that the time she spent with her mommy that day wasn’t real.
“Nobody starts off by saying, I’m going to go develop a drug problem,” said Jeanette Friedman, a social worker with a specialty in addiction, when I met her in August at her Upper East Side office. “No one means to get addicted. But there’s such a casual use of something like Adderall nowadays — because it’s seen as benign, or a help to becoming more productive. And in our culture, to be productive is kind of everything. There’s a tremendous pressure not just to do well but to excel.”
When she is face to face with an addicted patient, Friedman explains, what is at stake is that patient’s very ability “to become a full person without the shadow of always needing something.” Adderall complicates the usual dynamic of drug addiction by being squarely associated with productivity, achievement and success. “It’s very hard to think about going off it, because you don’t know if you’re going to be able to produce,” she says. “Plenty of people have gone off of it and have been able to tell the story, that yes, they definitely can produce. But the fear of not being able to is what keeps people still using.”
I remember that fear, in school and, later, at work, and it’s palpable in those message-board pleas:
The way I feel now is way worse than my A.D.D. ever was before I went on this stuff. I no longer feel, at this present time, able to get a Ph.D. I don’t feel able to do coursework, I don’t feel interested and passionate about the things I loved. I need to know from you, dear readers, that this will be temporary.
Harris Stratyner, a psychologist and addiction specialist at the Caron Treatment Center in Manhattan, told me that each year he’s in practice, he sees more people desperate to get off Adderall. Stratyner estimates that he has treated more than 50 patients trying to stop using the drug; currently, they range in age from 24 to 40. His Adderall patients are overwhelmingly creative people who wanted to work in the arts — yet, he says, many have chosen other paths, safer paths, resigning themselves before they’ve even really tried to achieve what they hoped for. “They often give in to practicality,” he says. “Then they feel they missed out. And when they take Adderall, it makes them feel good, so they don’t focus on the fact that they feel like they sold out.” Many people are using Adderall to mask a sense of disappointment in themselves, Stratyner says, because it narrows their focus down to simply getting through each day, instead of the larger context of what they’re trying to build with their lives. “It becomes extremely psychologically and physiologically addictive,” he says. “It’s really a tough drug to get off of.” The side effects of Adderall withdrawal that his patients report include nausea, chills, diarrhea, body aches and pains, even seizures. Occasionally, it is necessary for him to hospitalize his patients as they come down off Adderall.
In the end, I did not get off Adderall alone. I had a brilliant psychiatrist. I believe she saved my life. On the wall of her office, she had a single image: a framed print of an Henri Matisse painting. Through our time together, Matisse came to stand for the creative process. You start one place, go through hell and wind up somewhere else, somewhere that surprises you. Adderall, we both agreed, was a perversion of that journey. Gradually, her words entered my inner dialogue and sustained me. I was 30 by the time I got off Adderall for good. This statement horrifies me even now, more than three years later, recognizing the amount of precious time I gave away to that drug.
During the first weeks of finally giving up Adderall, the fatigue was as real as it had been before, the effort required to run even a tiny errand momentous, the gym unthinkable. The cravings were a force of their own: If someone so much as said “Adderall” in my presence, I would instantly begin to scheme about how to get just one more pill. Or maybe two. I was anxious, terrified I had done something irreversible to my brain, terrified that I was going to discover that I couldn’t write at all without my special pills. I didn’t yet know that it would only be in the amphetamine-free years to follow that my book would finally come together.
Even in those first faltering weeks, there were consolations. Simple pleasures were available to me again. I laughed more in conversation with my friends, and I noticed that they did, too. I had spent years of my life in a state of false intensity, always wondering if I should be somewhere else, working harder, achieving more. In the deep lethargy of withdrawal, I could shed that chemical urgency that kept me at a subtle distance from everyone around me — and from myself.
On one of those earliest days of being off the drug, I was moving slowly, more than a little daunted, trying to walk the few miles to an appointment I had in Midtown Manhattan. It was a glorious summer evening, the sun just going down. As I approached Bryant Park, I heard live music and wandered in to see. A rock band was performing onstage. I hovered at the back of the crowd. The singer, muscular and bearded, gripped the microphone in front of him with two hands, pouring his heart into every word that left his mouth. His voice soared into that summer night. Suddenly, tears were streaming down my face. I was embarrassed, but I couldn’t stop. It was as if I hadn’t heard music in years.
Continue reading the main story
906 Comments
Readers shared their thoughts on this article.
The comments section is closed. To submit a letter to the editor for publication, write to letters@nytimes.com.
Wcdessert Girl
is a trusted commenter Queens, NY October 12, 2016I admire the author for writing such an honest confessional piece about her addiction to Adderall. Although we are about the same age, I have always been against the permissiveness with which medications have been prescribed for ADD and ADHD. For one, I believe that some of the diagnoses are bogus, especially for very young children, whose have always had difficulty sitting still and paying attention in school, but are not given the chance to grow out of it naturally as children often will. Parents, but especially schools have gotten very comfortable with using drugs to modify behavior.
They say marijuana is a gateway drug, but I have personally seen in my work which involves reading peoples medical records that drugs like Ritalin and Adderall are even more of a gateway because since they are prescribed, excessive use of these medications is not looked down on the same way as occasional recreational drug use or alcohol use. And yet the behavior the author and other people describe engaging in to get Adderall and the deteriorating effect on their lives and living in a fog of drugs is not so different from what hard core drug addicts using cocaine, heroin, or crystal meth experience. The scheming to get drugs and lying, and the desperation of trying to kick the habit only to fail a few days later and go back to scheming to get drugs.
Mood/behavioral altering drugs are no less dangerous because you get them from a pharmacy rather than some guy on the street.
peter. ufo
NY, NY October 12, 2016It's unfortunate Casey Schwartz had a bad experience taking the prescription drug Adderall illegally (scoring the pills from friends or lying about her symptoms to a psychiatrist.) I resent the way this story is hyped in the Times as “Generation Adderall” as if her experience is universal. It is one anecdotal account of a person who experimented with Adderall without a genuine diagnosis or proper medical supervision, supported by other random accounts from forums or individual doctors. I recall a similar story about a boy who abused stimulants published in the Times Magazine a few years ago.
For people with ADD/HD, which manifests itself in early childhood and should only be diagnosed through an extensive psychoeducational evaluation, stimulant medication can make the difference between life success or failure. Let me tell you about Brett, a boy so severely hyperactive that he could not attend elementary school without medication. Or Anna, who before treatment was tearing her hair out from stress. With meds, my daughter graduated from college, unlike her untreated father and aunt. (Once in the workforce she went off meds without problems, as did her cousin, who completed two master’s degrees.) My son was expelled from school before starting treatment for ADD, and is now successful in a top 10 college program for his major.
How about reporting on the numerous people with genuine ADD diagnoses who benefit from appropriate medical treatment with stimulants?
Matt
New York, NY October 12, 2016The brilliant mathematician Paul Erdős was a regular user of amphetamines. A friend of his became concerned and bet him $500 that he could not stop taking the drug for a month. Erdős abstained for a month and won the bet, but complained that mathematics had been set back for a month: "Before, when I looked at a piece of blank paper my mind was filled with ideas. Now all I see is a blank piece of paper."
People can develop problematic relationships with drugs, but we should also remember that it's possible to have positive relationships with drugs as well. Why are we so afraid of drug dependency? Why is it so bad to need something? My parents "need" coffee every morning or they'll get headaches... are they addicts in need of help? When someone breaks up with a partner, they go through severe emotional withdrawals, weeping about how much they "need" that person... should we avoid romantic relationships?
So much of life is getting involved in relationships with people and things that become difficult to break. Why do we shake our heads in disapproval when the relationship is between a person and a chemical? Why can't we live symbiotically with the substances available to us?
After 31 years on this planet, I've come to realize that even a secular population has its religious beliefs: the idea that drugs are "spiritually bankrupt" in some vague, impossible to define way. We need to critically examine this belief.
Jane
MI October 12, 2016I was diagnosed in childhood with ADD and used Adderall and other strong stimulants for 12-ish years.
Never was I chasing supernatural motivation, merely the ability to do a worksheet without staring out the window, getting up 17 times, snapping paper clips to keep my hands busy, and then somehow losing the piece of paper. The transition off in college was a bit odd, although not difficult, per se. It has made it harder to manage my weight, I think, since I was not used to a full appetite. My grades fell slightly, but that may have been due to a myriad of other factors including very severe depression (something I have struggled with on and off).
In any case, my point is that I used stimulants as prescribed (very high doses) for years, and did not become addicted. I absolutely never chased another pill, never had any sort of craving. If I forgot to take them one day, I merely felt distracted, impulsive, unfocused and somewhat more energetic.
Only people who are diagnosed (preferably by multiple professionals) with ADD have any business taking prescription stimulants. For anybody else, it is playing with fire. I am very glad I had ready and appropriate access to this medication.
Jule P. Miller III MD
Biloxi MS October 12, 2016I am a psychiatrist. Part of the problem with stimulants is that the doses prescribed are often too high and too frequent. If you use the lowest effective dose and limit the number per day, it is possible to get the benefits with less chance of problems. They should only be used when you are already sleeping well and exercising regularly, because then they can work at low doses. If you are using them to overcome a lack of sleep, it takes a much higher dose, which is more likely to induce receptor down-regulation. Further, it is good to have breaks where you can make sure your brain is not becoming adapted to the stimulant. Even with these qualifications, however, for some people these medications are not a good idea. In general if a little of something helps, it is not automatically true that a little more will help more.
Anna R
Somerville, MA October 12, 2016This is a problem that arises directly from privilege. First and foremost, being a white and relatively affluent student at a university. Additionally, the advantage of not legitimately having the serious disorder that necessitates such potent drugs. This addiction is the result of a selfish desire to gain an unnecessary edge. Although Casey is part of a popular trend amongst college students, that does not negate the self-infliction of her addiction. I have absolutely no sympathy for someone who unfairly attempted to advance themselves and blames their following failure to do so on a drug with real problem solving capability. Adderall is not to blame here. When used as intended under professional care, it helps people. Ms. Schwartz must recognize that she is responsible for the choices she made. She consciously disregarded the serious potential that comes with abusing a Schedule II controlled substance. The problem at hand is not a drug that actively helps lots of people in need, but a subset of a generation who believes they are entitled to enhancing their already privileged position by any means, regardless of if they are illegal or potentially life threatening.
alex
indiana October 12, 2016An important and well written article.
There is little doubt but that ADHD is over-diagnosed in the US, and that stimulant medications are greatly overused, to the detriment of many. This is largely a result of abusive marketing and corporate greed by some big pharmaceutical firms. I am generally a fan of the mainstream drug industry, but these drugs are a glaring exception.
Secondary gain likely contributes to overuse; including the fact that adolescents with a diagnosis of ADHD often get double time on standardized tests. Testing companies fear lawsuits under the ADA if they don’t allow double time.
Stimulant use in children is especially concerning. A child or teenager’s brain is still developing, and the long term sequelae are simply not known.
Like many addicting drugs, there is an initial “honeymoon” when one feels good and all is well. But then, all too often, things go downhill, often tragically so. In many countries, drugs such as these are far more heavily regulated than in the US, or even illegal (e.g., Japan).
Most likely, these drugs should not be illegal in the United States, some people clearly benefit. But they should be much better regulated than today; oresently, they are greatly overused. It may be appropriate to restrict prescriptions to specially trained and certified physicians. And secondary gain – double time on standardized tests, for example – should probably be eliminated through legislation.
Carol
California October 12, 2016This article was an eye-opener for me. I knew ADD drugs were addictive but I did not realize how bad the addiction could be.
When my son was in the second grade, his public school tried to force my husband and me to put my son on ADD drugs for "behavior problems in the classroom." We (actually me) said no. I am so glad I did. My son showed no signs of ADD at home. I correctly diagnosed my son's behavior was because, though in the second grade, he could not read and he had dyslexia. ADD drugs would not have taught him how to read nor corrected his dyslexia. I hired a special education tutor for my son. By the end of second grade he was reading above grade level. The school never again suggested ADD drugs for my son.
This article has confirmed my belief that ADD drugs are not good for most children. The criteria used by my son's school to diagnose and urge parents to put kids on these drugs was too loose and not rigorous enough. I really wonder how many kids are misdiagnosed at school with ADD when what they really have is a learning disability that could be addressed by tutoring. I was fortunate that my husband and I, combined, earned enough to be able to afford the cost of private tutoring tailored to address his learning disabilities. (My son also has dysgraphia.)
Paula O
Modesto CA October 12, 2016This is the account of a person who abused medication, and then presents that abuse as is it were an inevitable result and the fault of the medication itself, abetted by the complicity of the medical profession. It's another tale in the long running narrative of psychoactive drugs as being bad and scary for their ability to make you spin out of control. This idea has been promulgated about any substance you can think of; remember "Reefer Madness" and Prohibition? It continues today most notably in the overwrought response to the epidemic of inappropriate hydrocodone use.
I feel the essay was irresponsible for not pointing that the vast majority of people use these types of medication appropriately. I was diagnosed with ADD in my 30's and have been using Dexedrine for 35 years. It's a help, not a panacea, and has to be used in combination with monitoring and behavioral techniques to manage ADD most effectively.
I don't want to minimize the pain of those who find their lives have been hijacked by any particular substance or imply that theirs is a moral failing. But better to research why some have a particular vulnerability rather than demonize substances that are helpful to the majority.
Liz
Austin October 12, 2016I had untreated ADD throughout childhood (still do) and it was just called laziness. When my kids started to exhibit it, I took them to a behavioural psychologist who performed two days of testing, screened for anxiety and depression, pored over pages of evaluations from multiple teachers, and diagnosed them with ADHD. Low levels of medication have been a godsend for both. They don't take them on weekends, holidays or over the summer. They show no personality changes whether they are on them or not. They don't "come down" from them in the afternoon or evening. They have never once asked for them for anything other than a school day. They are my same amazing kids, finally able to ignore every little sight and sound that used to pull them away from the teacher or their school work. Comparing a college student's illegal drug use and then her lying to get an RX with a doctor that did not screen her at all, to proper diagnosis, treatment and evaluation is apples and oranges. This is not a decision that most parents make lightly, and the tone of many of these comments is insulting.
SG
Ithaca, NY October 12, 2016Lots of comments here criticizing Ms. Schwartz' account due to her lack of ADD/ADHD symptoms. Many commenters note that this piece is a hit piece against the drug itself, when it is actually portraying the (illegal) addiction of a privileged person. These points are astute, but as a recent college graduate, I believe that stories like this must be told. The competitive college environment is only alluded to here, but for every Casey Schwartz, there are thousands (anecdotally - likely millions in reality) of students dealing with similar issues. The environment, not the drug itself, should be critiqued. People and students who cannot drive a car or focus on work or do any of the things our society demands should be given this drug. Students at prestigious (honestly, or any) universities, some wealthy and some decidedly not, should read this article. Many of my friends took this stuff. I'm sure many of them still do, and that is a topic that should be explored. Just because white, wealthy students in the Ivy League are taking "study drugs" illegally doesn't mean the phenomenon is restricted to that demographic. I commend Ms. Schwartz for writing a brilliant essay and I implore others to continue to critique this trend for our generation. It is important that the discussion continue.
hen3ry
is a trusted commenter New York October 12, 2016I'm torn about this story. On the one hand I'm glad the author conquered her addiction. On the other hand, I'm very upset that she abused a drug that is useful for people who have ADHD and wrote a story about that without emphasizing that she was the one who got herself into this situation. No one held a gun to her head and told her she had to take drugs. She made the decision to take Adderall without a prescription and for no good reason. She is lucky that she was able to get it legally because without that prescription (which she lied to get) she would have had to turn to other drugs, perhaps illegal ones.
I have to take the generic version of Zoloft for my depression. When I don't take it I start to experience truly awful feelings, ones that I haven't experienced since I started taking it many years ago. I'd like to stop taking it but, like a diabetic needs insulin, I need the Zoloft. It keeps me functional. I don't get high from it. I feel like myself. I can hold down a job, control my self destructive urges. When I was faced with the loss of my job my biggest fear after 4 months on unemployment was what I would do to continue to get the Zoloft since America doesn't have socialized medicine and doesn't consider it a human right to have access to affordable health care. This writer never faced that dilemma. Perhaps she should in order to understand that some of us really need the meds we're on to live.
Gary Warstadt, MD
Needham MA October 12, 2016I am a psychiatrist who has treated many people who legitimately have ADHD, and who's lives have been changed for the better. Sometimes dramatically so.
And yet, I'm sure I've been fooled by many into feeding their addiction, as have my colleagues. I'm sure, despite sincere efforts to avoid it , I've misdiagnosed people and put patients without ADHD on stimulants. This is both a difficult diagnosis to make, and an easy one to fake.
The drug seems to have two aspects that overlap, perhaps even two different mechanisms of action. It has a speedy aspect that is addictive (tolerance, withdrawal and cravings), plus a attention, focus, organizing aspect which (at least in patients with ADHD), does not seem to require ever higher doses to get the same effect. The problem is that, ADHD or not, almost everyone will return for their second visit and say they're getting more done; some because they focus better, some because they're now on speed, and some because of both.
I'm usually much reassured when they report a "paradoxical reaction". They feel more tired or relaxed, yet focus better. But they can look that up too on the internet and just lie about it.
I don't think of ADHD as a classically pathological state. I think it's a mismatch between the way some people pay attention and the modern demands for attention nature never anticipated.
Fortunately, addiction to the degree this brave young woman reports, is uncommon, though one life ruined by addiction is one too many.
Stephen Spelman
East Longmeadow, MA October 12, 2016I'm a 60-year old attorney. I learned at age 48 that I had ADD, after going through the analysis on why my daughter's junior high grades had gone in the tank. The exact same thing had happened to me in junior high. A few years in the Army had given me enough discipline to partially deal with it, but unless some work task really gripped me, completing office tasks was always a struggle.
When my career shifted from frequent criminal trial work to office work, I'd often look up at 5 pm and find I'd accomplished nothing. Because Adderall had worked so well for my daughter, I talked to my physician about it. I've now been taking it for about 5 years. It's amazing - it allows me to accomplish the daily routine tasks that were always a struggle. I take it I frequently - usually once a week, sometimes more, sometimes less. Also - my daughter has done quite well as a journalist thanks in part to Adderall, and in fact has written about her own struggles with ADD.
As other commenters have pointed out, I'm not sure why the Times has recently begun to run these "personal experience" articles (on many topics) as if they were dispassionate news articles or analysis, but such "posts" or "blogs" are a service to no one, if disguised as news. What inform (and hopefully help) are facts - after which, readers can draw their own conclusions.
Andrea
Washington DC October 12, 2016Like the author of this piece, I am an Adderall addict (or Adderallic, as we like to say). Although my addiction began with a legal prescription at age 16, I began abusing amphetamines my freshman year at an elite university. Today, I am 24 years old and 57 days sober thanks to the support of my family, friends, and Narcotics Anonymous.
I agree with the sentiment many here have voiced: Adderall is not the problematic element of this story, addiction is. Ms. Schwartz seems shirk personal responsibility in her article and mistakenly assumes that most Adderall users suffer from her same addictive affliction. They do not. Most who take this drug respect it and benefit from it. Most who take this drug are not addicts.
Amphetamine addiction is tricky. Like myself, many Adderallics come from privileged homes, and as a group, we sport much lower mortality rates than opiate addicts. But the dopamine reward system that plagues heroin addicts is nearly identical to the one that we experience, and the disease of addiction does not discriminate based on socioeconomic status.
My advice to parents who are considering giving stimulants to their children: it is of paramount importance that you monitor addictive behavior in your child. Studies have shown that those with ADD/ADHD can be more prone to addictive behavior. Stimlants can be a medically necessary Godsend for some, but If not taken responsibly,can cause serious wreckage in the lives of others. Be careful.
Dave Oedel
Macon, Georgia October 17, 2016As a law professor who lost my eldest son at age 19 to a meth overdose, I've been keenly interested for several years in how laws might help reduce drug addiction and related deaths. One interesting concept that many states have been experimenting with involves the creation and sharing with other states of drug prescriptions through registries to flag problem situations. But as with other well-intentioned attempts to solve complex problems, the supposed success of the drug registries is questionable. They have tended to push addicted users into heroin and illicit sources of controlled substances. Although law reforms can help, their unintended side-effects can also hurt. Complex problems like these require very sophisticated responses that raw law is not especially well-equipped to perform.
906 Comments
Readers shared their thoughts on this article.
The comments section is closed. To submit a letter to the editor for publication, write to letters@nytimes.com.