Six hundred students live in Claflin Hall, a white, cinder-block dorm set back from Commonwealth Avenue in the heart of Boston University's raucous and social West Campus. Rooming there her freshman year, Rachel found it an ideal place for a new student to make friends. It wasn't as conducive to developing healthy study habits, however. Rachel had been a good student in high school, but in her first semester of college she earned a disappointing 2.5 grade point average–about a C. The spring semester didn't start out any better, and as the papers piled up and midterms loomed, she got desperate.
That's when a friend told her about Adderall–a drug he had gotten with a prescription and was selling to fellow stressed-out students. Used along with its cousin Ritalin to treat children diagnosed with attention deficit disorder and attention deficit hyperactivity disorder (known as ADD and AD/HD, respectively), it also can make users feel more focused and alert. Figuring she had nothing to lose, Rachel bought a 10-milligram pill for $3 and took it right away.
“That night, I ended up studying for eight hours straight,” says Rachel, who asked that her last name not be used. “I felt like the connections in my brain were faster.” She never looked back. Coached by her friend on what to say, she went to the mental health office, got a prescription for Adderall herself, and started to take it daily. When finals came, she used it to stay up for two straight days, studying late, then acing tests each morning. Her GPA shot up to 3.3.
When she returned home that summer, Rachel found it wasn't as easy to get off Adderall as it had been to get on it. Without the drug, she felt lethargic and absent-minded. She kept taking it to get through her shifts as a waitress and to motivate herself to work out at the gym.
Now a junior, Rachel lives in a quiet apartment in a Brookline brownstone with four friends. She still takes Adderall to study because now, she says, she can't concentrate without it. “It literally makes me smarter,” she says. She fidgets as she tells her story, perched cross-legged on the edge of an overstuffed couch. She talks fast, but thinks faster, often starting a new thought before finishing the last one. She's not the only one using the drug, she says. Everyone from her pre-med roommate to her boyfriend, she says, has taken it to study. “Seriously, almost everybody–and people who you would never even think–they take it or try to buy it because of schoolwork,” she says. “It's probably just as common as cigarettes.”
Today's generation of college students grew up with Adderall and Ritalin, which have been used for years to help children sit still and concentrate during school. Hailed as wonder drugs by some parents and teachers, they have been just as widely criticized by detractors who say they're overprescribed for children who don't need them. But little attention has been given to their widespread use among high school and college students who have never even been diagnosed. Studies estimate that anywhere from 4 to 36 percent of college students use one of these drugs as a study aid. On some campuses, they've become fixtures at late-night study sessions that used to be stocked with nothing more shocking to the body than Starbucks and NoDoz.
One senior at Tufts has been on Ritalin since he was in the fourth grade. Come finals time, he says, he's inundated with requests from other students to buy his pills for up to $15 for a 15-milligram dose. (He says he hasn't sold any.) “They think it's this cure-all, that if they take it, they'll get an A on this test or paper,” he says.Another student, a Boston College senior, says she's used Adderall to study since high school, even though she admits she doesn't think she has attention deficit disorder. She estimates she takes it once a week during the semester and daily during midterms and finals. “I'm probably twice as productive on Adderall as I am normally,” she says.
While most students know that Adderall and Ritalin have a dramatic effect on their studying abilities, few seem familiar with their dangers. Side effects, other than insomnia, range from anxiety and headaches to high blood pressure and sexual impotence. Rachel, for one, says she suffers from dramatic side effects when she takes Adderall in large doses or with caffeine. “Your heart beats superduper fast, and you feel like your stomach is going up, and all the blood rushes to your head, and it's just a really uncomfortable, overwhelming feeling,” she says. “You feel like you're going to have a heart attack.”
Despite the risks, many students don't hesitate to buy these drugs from friends who have prescriptions. Others use what one student calls the “barter system.” “I give my friend a gram of weed, he gives me ten 20-milligram [pills] of Adderall,” says Chris, a BU freshman.
At BU as on other campuses, it also appears relatively easy for a student to take a quick trip to the health services office and, like Rachel, snag a prescription of his or her own. Another junior at BU, who asked that her name not be used, says she got a prescription for generic Ritalin through the school after buying Ritalin and Adderall from friends for years. Suspecting she might have ADD, she went to the mental health department and walked away with a prescription after talking with a doctor.
BU maintains that there is not a problem on its campus with these drugs. “I know students do cram and use caffeine during study periods,” says spokesman Colin Riley. “I don't know of any widespread misuse of prescription drugs.”
I test this assertion with a trip to the mental health office. At my first appointment with Dr. Philip Sandler, a staff psychiatrist, I tell him truthfully that I had looked up the symptoms of attention deficit disorder on the Internet, thought I had some, and wanted to be tested. During an hour-long interview, I tell him that I sometimes have trouble paying attention in class and studying for long periods and that I could be distracted or impulsive–characteristics that are probably true of 90 percent of college students. He tells me that he thinks I have a mild case of ADD and to come back for another appointment.
The second appointment lasts half an hour. I leave with a 30-day prescription for Adderall at 10 milligrams per day. When I ask Sandler later why it seemed so easy for me to get a prescription, he says he usually gets corroborating evidence from a parent or a child psychiatrist before prescribing these drugs. He did not do this before prescribing me the Adderall, and other students interviewed believe this process also was not followed for them when they went to BU's mental health department. “I can't really tell you why I did not do that in your case,” says Sandler. “My record for doing that probably is not 100 percent. You told me what sounded like a believable story.” Sandler does say there are times when he'll refuse to prescribe medication to a student, though he does not report these students to the school. “Our impression is that most of the students who come in here are trustworthy,” he says. “Maybe we're mistaken.”
The prevailing attitude at area universities seems to be that responsibility for properly using prescription drugs lies with students. Dr. Margaret Higham, medical director of the health services department at Tufts, says she's aware that many students use drugs such as Adderall and Ritalin as study aids, despite the risks. “They're popular, they're plentiful, and they're an easy way to get speed,” she says. Tufts has no policies to deal with the problem, though Elizabeth Moore, the school's alcohol and drug treatment specialist, says the school is studying the issue.
Part of the difficulty in regulating these drugs stems from the way attention deficit and attention deficit hyperactivity disorders are diagnosed: almost solely on the basis of a patient's description of his or her own symptoms, according to Dr. Timothy Wilens, a psychiatrist at Massachusetts General Hospital who is an authority on AD/HD. At the same time, Wilens says, there are things that doctors on college campuses can do to prevent the misuse of the drugs as study aids. He says they can keep track of prescriptions to make sure students aren't selling pills on the side and encourage students to report when pills are lost or stolen. Doctors also could prescribe only the extended-release versions of these medications, which hold little appeal to abusers because they can't be used in short bursts for studying. “It's a matter of protecting college-age students from their own aggressive behavior to do well or their inclination to experiment with these medicines,” Wilens says.
“A lot of college students have gotten the message that they've got to do whatever they can to compete,” says Jeffrey Winseman, a psychiatrist at Bennington College who has complained about the overprescription of drugs on campuses. “As psychiatrists, we have an important role to play, and that is to stem the flow.” Relying on students to police themselves, says Winseman, is naive. After all, he says, this generation of children has grown up surrounded by doctors and medication. They know how to talk their way into a prescription.
The role of universities themselves, meanwhile, has been largely overlooked. “It's definitely something that goes totally unwatched by the administration,” the Tufts senior says. “It's something that's fun, it's easy to get, and it doesn't seem as serious as using a real drug,” says the student at BC.
Tell that to Rachel, who, at least for now, has accepted that she needs Adderall to function as a student. “I feel like I have to sacrifice my health a little bit to get by in school and do well,” she says. “I know I have to get off it someday–maybe the end of college.”