Can Adderall Save the Boomers?
In the beginning of this article, I wrote that Adderall is “thought to” work by increasing dopamine levels. Fact is, nobody understands exactly how the drug does what it does. “The data is really unclear,” says Anjan Chatterjee, a professor of cognitive neuroscience at Penn’s medical school. “Does it work differently in people with ADHD than in those who don’t have it? We don’t know.” What studies have shown is that taking Adderall increases executive functions in those with ADHD and most people without it, improving focus and problem-solving.
Chatterjee has never taken Adderall, but he did coin the term “cosmetic neurology” in a paper he wrote a decade ago that compared the evolution of cosmetic surgery to that of “cognitive enhancers,” as scientists call drugs that make you smarter. “In cosmetic surgery, you have procedures that involve medical intervention that enhance appearance but not health,” he says. Such procedures used to be scandalous and rare. “But in the United States in 2012, there were 14 million cosmetic medical procedures. You can work out how many that is per day. It’s been quite normalized.”
How did that happen? “I traced a shift from it being regarded as frivolous to being regarded as a rational choice based on economics and psychology,” Chatterjee explains. The same forces, he predicts, will apply to Adderall and other cognitive enhancers. As students now in high school and college who are taking such drugs get older, “it won’t feel weird” to keep on taking them.
Caffeine and nicotine have both been shown to increase alertness and improve cognition. No one thinks it’s cheating to drink a grande latte before a test. So, I ask the college professor, is it cheating for a college kid to use Adderall? “I have no idea,” Chatterjee says. “That’s a societal question.” He does point out that the American Academy of Neurology recently declared prescribing ADHD drugs for those who don’t have the disorder “not justifiable” and “inadvisable,” and called their off-label use an “ethics issue.” The NCAA bans nonprescription use of Adderall for college athletes. Should students be tested for it before they take their SATs?
Chatterjee sees a whole minefield of such ethical issues when it comes to Adderall, noting that it carries a black-box warning regarding its potential for abuse. A New York Times story in February told of a young, healthy pre-med student whose life spiraled into psychosis and suicide at age 24 because of an addiction to the drug—one of a number of media tales about harrowing experiences with Adderall. It’s classified by the government as a Schedule II controlled substance—in the same category as coke, morphine, opium and oxycodone. It’s heavily restricted in New Zealand, and banned completely in South Korea and Japan.
There’s also proof that for some people, it doesn’t work. Adderall improves performance most, Chatterjee says, for those who score lowest at executive-function tasks; those at the high end of the curve show less improvement or do worse. I tell him about a young friend who took Adderall once, to write a paper. While he was writing it, he thought his work was brilliant. Once he came down, he realized it was terrible. “My intuition is that students self-select, like your friend,” Chatterjee says. “If it doesn’t work for them, they don’t do it again.” His colleague at Penn’s Center for Cognitive Neuroscience, Martha Farah, has said that cognitive enhancers like Adderall are typically used by “a white male frat brother with a B average.” I’m not sure what that means for me and my giddy high.
But like a lot of scientists, Chatterjee doesn’t want such substances banned. “We need public discussions about what all this means,” he says. In 2008, Nature magazine ran a commentary signed by seven of the world’s foremost neuroscientists, including Farah, arguing that college students are simply “early adopters” of cognitive enhancement. “We should welcome new methods of improving our brain function,” they wrote, rejecting the notion that such enhancement is unnatural or cheating or drug abuse. It should be viewed, they said, “in the same general category as education, good health habits, and information technology”—all ways through which the human race seeks to better itself. After all, smarter people “could lead to substantive improvements in the world.”
Neuroscientists also generally agree that since these drugs exist, people are going to use them. As Farah has put it, “The genie is out of the bottle.” They worry less about those who take the drugs than those who might one day choose, against society’s tide, not to take them. Chatterjee brings up a common ethical concern among his peers: “What about the forces of coercion, both explicit and implied? What if you’re told that if you’re over 40, or 50, or 60, and you want to work for the New York Times, you have to take the stuff?”
I eventually score more pills from a Gen Xer, a woman in her 40s who was recently diagnosed with ADHD. And I discover that doing Adderall at work is just as much fun as doing it at home. In meetings, I feel sharper, more witty. I’m less inhibited. The self-consciousness that drapes me every moment of the day is lifted. I compliment a male intern on his “beautiful curly hair”—something I’d never ordinarily do. “Do you realize how fast you’re talking?” a fellow editor asks as we chat in her office. When people speak, I zero in on them like a laser, with none of my usual concerns about holding eye contact too long or mispronouncing words or having salad in my teeth.
Of course, there isn’t salad in my teeth, because I don’t eat on Adderall—not even the cupcakes at a Best of Philly tasting. For me, it’s one of the drug’s premier side effects.
It’s hard to judge whether Adderall improves my work, though. It takes me a while, when I’m on it, to settle down at my desk. I’m impatient with my usual morning routine of checking email and news websites and scanning the daily papers. On the other hand, I whip through a dense article in the journal Pharmacology Biochemistry and Behavior that I don’t think I could have read without the drug. (Sample sentence: “While there is no reason to think that the agonists for steroid ((etc.)) receptors will affect the moment-to-moment operations of elaborate cortical networks, modulators of glutamatergic transmission certainly will.”)
What I notice most is that I feel good.
A mom I know swallowed her kid’s Ritalin one morning thinking it was her own medicine. “I said, ‘Oh shit’ and went to work,” she reports. “It was fabulous. I got so much done!” She tried it a few more times, but found the crash when she came down wasn’t worth the high. Her daughter didn’t do well on it, either: “It made her crazy. She got in fights. She wrote death poetry. But I’ll tell you something—and I’ve never even told her this. The first time she took it, in fourth grade? That was the day she learned to read. She just needed one day where it all came together for her. Like riding a bicycle, you know?”
Another friend has a son who has taken ADHD drugs since he was in first grade, when his teacher told his parents he was “lost” in class. He’s 24 now. He was on the drugs all through elementary school, middle school, high school and college. He’s on them now at his first job. He’s in good company. Eleven percent of school-age children are currently diagnosed with ADHD; among high-school boys, it’s one in five. Twenty percent. When ADHD drugs were first developed, Anjan Chatterjee says, the big concern was that they’d be used in overcrowded, underfunded urban schools to create “chemical classrooms,” with kids doped up so they’d be docile. “What’s happened instead is that they’re used most commonly in affluent upper- and upper-middle-class schools,” he says. “It’s part of a general phenomenon where these kids lead incredibly complicated, over-scheduled lives.”
Ironically, a pediatrician from Georgia ignited a fuss not long ago by proposing that ADHD meds be given to low-income schoolchildren with academic problems whether or not they’ve been diagnosed with the disorder, to even out the social-justice scales. “We may not know the long-term effects” of taking such drugs, the doctor told the New York Times, “but we do know the short-term costs of school failure, which are real.” (The Times article featured a dad who gives his 12-year-old daughter Adderall because, he said, she’s “a little blah.”)
In a 2012 op-ed in the New York Times, L. Alan Sroufe, an emeritus professor of psychology at the University of Minnesota’s Institute of Child Development, stated that “when given to children over long periods of time,” ADHD drugs “neither improve school achievement nor reduce behavior problems.” Since identification and treatment of the disorder broadened in the ’70s, rates of depression in adolescents have shot up, their rate of suicide has doubled, and dropout rates haven’t budged. Adderall can induce psychosis and is linked to earlier onsets of bipolar disorder and schizophrenia—and more severe courses of both. Ned Hallowell, a renowned doctor who has written best-selling books on ADHD, used to tell parents the drug was “safer than aspirin.” He recently announced that he regretted his analogy and “won’t be saying that again.”