“I hate that people take ADHD medications to study,” says Katie Ellston*, halfway through our first round of raspberry blondes on a late summer’s day.
She begins telling me about a side of so-called “study drugs” that I had never quite stopped to consider. “I’d give a million dollars not to have to pop a pill every day,” she says.
The tale of the student who takes ADD/ADHD medication sans prescription is, to the modern day university student, a familiar one. Alex* finds that these meds improve concentration and keep you up all night, something that is often necessary in the over-extended schedule of a student. Alex buys the medication from a friend whose ADHD prescription provides them with more pills than they need. Alex has a few sweaty, red-eyed nights, but has plans to work at Goldman Sachs and live in a nice flat downtown.
This phenomenon is so common that even students who don’t abuse prescription drugs are likely to know where to get them. An editorial last year in the Canadian Medical Association Journal published that an estimated five to 35 per cent of students abuse prescription stimulants. The editorial is titled “Time to address stimulant abuse on our campuses,” and calls for the de-normalization of their use.
But Ellston is not like Alex. During the school year, she takes a pill every day. She’s had a prescription for Concerta — Ritalin’s long-acting cousin — since she was diagnosed with ADHD at 15. “It’s a hardcore drug,” she says – something she feels that people who take the drug recreationally don’t understand. When she goes across the border to the U.S., for example, she can only take one pill for every day she is traveling, and she must carry a doctor’s note. Furthermore, she feels that casual prescription drug use trivializes her illness, something that is part of her everyday life.
Concerta, like other medications commonly used to treat ADD/ADHD, is a stimulant, meaning it increases the amount of dopamine in the user’s brain. With Concerta, Ellston experiences many of the physiological aspects of an addiction. On days when she does not take her medication, she experiences headaches, nausea, and slight depression, much like a cocaine user coming off a high or a coffee addict running too late for work to pop by Starbucks. Furthermore, if she takes it later than 10 a.m., she cannot fall asleep later that night. During the summer, Ellston chooses to go off Concerta, and she has up to a week of nausea and depression — a detox that she calls “hell”.
Concerta produces similar effects in people with ADD/ADHD as it does for people without, though the improvement in concentration is more dramatic for people who have clinically diagnosable difficulties with concentrating. Scientists aren’t exactly sure how it works: literature is littered with the words “might” and “probably.” The thinking goes that upping the amount of dopamine and norepinephrine in the brain — which ADD/ADHD medication does — improves concentration. People with ADD/ADHD may naturally have less of these neurotransmitters, the conventional wisdom goes, which is probably why taking Concerta can bring them up to the level of concentration that most people experience without the help of drugs.
To some degree, most stimulants have the effect of improving concentration. Robert Franck, the Clinical Director of McGill Mental Health Service, says that he’s had patients that turned out to be ADD/ADHD, that have been self-medicating by excessively drinking coffee. Like Ellston, he doesn’t like the fact that students casually take medication without a prescription. Though the drugs are relatively safe, they come with a suite of risks and side effects, and their use should be carefully monitored by a health professional — one who knows what other drugs you’re on, too.
Hypertension, arrhythmias, and psychotic episodes are the more extreme effects of ADD/ADHD medication. The CMAJ editorial rattles these off, and adds that, though rare, overdoses are “potentially lethal.” These are all true and valid reasons not to abuse ADD/ADHD medication, explains Franck. “But scare tactics don’t really work,” he says.
It’s not just potential physical harm that concerns him; Franck explains that taking drugs as a band-aid solution to things like school anxiety is potentially done to mask clinical anxiety or depression. Franck’s motto is, “medication when necessary, but not necessarily medication.”
When Ellston was diagnosed with ADHD, the medication was the last step of her treatment plan, and remains just one part of her regimen. In addition to taking the drug, Ellston sees a therapist every week. Through the Office for Students with Disabilities, she’s allowed four hours instead of three to complete exams, as well as a short break to walk around during an exam. She also gets to bring in a “fidgeter” — a small object that she can play with.
She also has to know her own study habits incredibly well: she doesn’t work on any one assignment for more than half an hour at a time. “The information won’t stick if I try and make myself,” she says. She describes the feeling of having ADHD as having 100 different thoughts going on in your head at once, popping around and soaring off on their own little orbits. “When I’m on the drugs, instead of 100 thoughts, I only have 50. And when one tries to go off on a tangent,” she says, moving her hand away from her head. “I can feel it being pulled back. It’s like it hits a wall.” It’s not that she’s not herself on the drug; it’s just that her thoughts behave in a different manner. “Being on the drugs is like running down a hallway, and not being on them is like running through a field.”
The fact that these are prescription drugs with a medical use hadn’t quite settled in my mind before. Perhaps it’s because of stories that have been popping up in the media, each taking the tack that study drug abuse, like hooking up, smoking pot, or using the internet, is a new trend hitting the continent’s youth; perhaps it’s because the high school I went to was filled with overachievers who went on to universities that boasted as much of a problem with ADD/ADHD medication abuse as they did with any other drug. Though I’ve never taken Ritalin or Concerta, it’s never occurred to me that I should have any qualms about doing so; not even the basic concerns that come with smoking pot now and then. It’s not even treated like a recreational drug in the crowd I run with. It’s not done for fun — it’s done to achieve.
It seems I’m not alone. Alan Desantis at the University of Kentucky has spent the past handful of years facilitating interviews with hundreds of students. He found that, for some, taking the medication sans prescription was less of a concern than drinking beer or smoking cigarettes. In his research he found that students use a number of arguments to justify their lax use of the medication: that they only take it during finals, that they are self-medicating for concentration problems, and what Desantis referred to as the “I’m-doing-it-for-the-right-reasons” argument.
“No, they’re definitely a drug!” says George Bellwood*, a McGill student who took un-prescribed Concerta several times last year. “Yes, eight, I think,” he says, counting on his fingers. “I’m thinking about this in terms of the number of major assignments.”
For Bellwood, the study drugs are a tool for long nights of working that comes free of health or moral concerns — scare tactics referencing potential death do not work on him.
Concerta allows Bellwood to work overnight. He’ll drink two or three cups of coffee in the evening, settle into the arts computer lab, and get to work on a paper. Around two a.m., when the coffee stops being enough, he’ll pop a pill. “It’s like licking iron,” he says of the metallic taste of Concerta. Soon after, he’ll feel jittery, sweaty, but then his mind will clear, he explains. And then he’ll work.
“You don’t lose track of time. You’re really aware of the next step,” he explains dispelling my notion that these drugs offer a sort of trance. “And you don’t want to be doing the work. You just are.”
He’ll continue in that robotic haze, one task, and then the next, and then the next. By four a.m., there are only two or three other students left, at least one of them asleep. “It’s so fucking bleak in that room, with those fluorescent lights.” The janitor comes in at seven, signaling that the rest of the world has moved on to the next day.
Bellwood’s normal facial expression is a sort of Cheshire-cat grin, which makes him seem at once eager and carefree. He talks about history — citing paradigms and scholars — the way other people talk about TV shows. He plans on going to grad school when he’s done at McGill: last semester, he got a 4.0 GPA, started a journal, edited a section of a campus newspaper, had a part-time job, and, though he insists his social life was cut by half, he still went out every Saturday.
In awe, I ask him how he does it all. “The drugs!” he exclaims, throwing his hands in the air — what had I thought I was interviewing him about?
The drugs are a prop he hopes to cast aside once he’s finished hopping along the stepping stones to a successful future — perhaps in grad school, perhaps working an entry level position. He’s not sure when, he just knows that there will be a time in the future when the work will pay off, a spot in life where the things on his to-do list can be accomplished without him breaking out into a chemically induced sweat, and with room left over for seven hours of sleep and a substantial social life.
Sitting in Franck’s office, I outline Bellwood’s reasoning: wanting grades and extracurricular to be a tangible currency that he can exchange for a job after graduation, and knowing meds can make him do more and do better. Shouldn’t we take a leg up in the world when we can? “I would say to those people: why do you feel you have to study so hard?” Franck says. Wanting to get ahead in life does not necessitate medication — you can be organized and reasonable about what you take on, he reasons. But it’s not just that: Franck thinks doing drugs to wend one’s way through undergrad amounts to cheating yourself out of the things that you actually enjoy in life: whether coding, reading, or playing soccer, these are activities at which you might end up being successful, and which you enjoy.
“That, that is the kind of attitude that I fucking hate,” exclaims Bellwood, when I bring up Franck’s argument. “It’s actually really harmful, that kind of faux naivete: ‘why are you studying so hard?’ Theoretically, this is the point of attending a university.”
This brings up a much larger reality: that university is a dream world of sorts, a strange pocket of society filled with bright people, 24-hour study facilities, 24-hour coffee shops, and an endless tunnel of hoops to jump through. We’re judged by our peers, by the numbers that stare back at us from our transcripts, by the test score requirements on grad school information pamphlets. Perhaps most importantly, for Bellwood and for many of us, we’re here for genuine reasons: because we love academia, because we want to be happy and prosperous. Doing well in academia can bring us those things, and drinking coffee and popping pills can bring us success in academia. It seems like such a simple transaction.
But to Franck and other outside observers, it appears that you have to learn to live within the constraints of the real world. “University is a wonderful opportunity to develop understanding,” explains Franck. “Not just academic, but how to feel good about yourself, how to manage time and to develop coping strategies.” By popping study drugs, Franck believes you set yourself up in a lifestyle that is unsustainable and potentially soul-sucking, one that’s not based on doing the things that make you happy, but on the things that you feel others want out of you. Still, he sympathizes with the plight of the George Bellwoods of the world. That’s why he thinks people like him need to work harder to educate students about the perils of study drugs, and about ways to cope without the drugs.
Ellston, who’s studying high school education, agrees with Franck. When on field experience she’ll often have an ADHD child or two in her classroom, and she feels she can effectively teach these kids in a way that teachers without ADHD can’t. “They’ll do things like stand up in the middle of class and start walking around, and their teacher will say, ‘no, no, sit down,’” she explains. Instead of becoming frustrated and disciplining them, or singling them out, Ellston can empathize: “I’ll talk to them about it, and say, ‘if you need to stand up during class, stand up. I need to do that too sometimes.’”
Right or wrong, excusable or not, the fact remains that some people, like Ellston and the kids she works with, need ADHD medication, while others — Bellwood being one — use them for other purposes. It has become part of many university cultures, but has also grown to be a public concern.
*Names have been changed.
