Adderall use and college students

All About Addiction has profiled stories of college addiction in the past, but most have centered on illegal drugs and the rampant problem of alcohol abuse. Education blogger Valerie Harris joins the community today to talk about a very disturbing new trend: the rise of “study aid” dependencies, usually in the form of prescription ADHD meds like Adderall. Valerie writes a student resource website for those looking into different college and grad school options, and is an expert in many of the issues modern students face.  As prescription drug abuse is a major problem in our society, a specific focus on prescriptions relevant to college studentsis noteworthy.Study Drug Addiction Plagues Students From Masters Programs to Community College Illicit Adderall usage on college campuses has been on the rise in recent years, mostly stemming from its use as a study aid. The amphetamine salts that make up Adderall accelerate the heart rate and increase alertness, enabling students to put in long hours of continuous and focused study. However, due to its amphetamine base, Adderall can also be addictive, leading some students to use the drug as a crutch, causing long term issues both academic and social.

Increasing Use
A 2009 article in the Cornell Sun stated that Adderall was estimated to be used by 6% of college students, while a 2011 survey in the journal Addiction reported that on some campuses, as many as 25% of students were abusing the drug. A study conducted by the National Survey on Drug Use and Health found that 15% of college students have illegally ingested Adderall, Ritalin or another stimulant in the past year, while only 2% of these hold a prescription for the drug. This suggests that there might be an overall increase in Adderall abuse although longitudinal data from single sources is relatively scarce.

Campus Responses

In light of this possible increase, and the problems associated with it, universities are beginning to fight back. Recently, Duke University added “the unauthorized use of prescription medication to enhance academic performance” to its student conduct policies that equate to academic dishonesty. Wesleyan and Dartmouth have also amended their policies to include a ban on prescription drug abuse, while students with ADHD prescriptions at George Washington University are told to purchase a safe for their dorm. Other schools more aggressively target potential dealers.

The Illusion of Safety

Due to its prescription drug status, many college students believe Adderall to be safe and non-addictive. It’s true that when used with a prescription and with the supervision of a doctor, Adderall can be safe. However, when used without a prescription Adderall use  is essentially akin to unregulated speed abuse. As an amphetamine drug, Adderall is listed by the Drug Enforcement Agency as a Schedule II Controlled Substance, meaning anyone caught with pills not prescribed by a doctor is subjected to the same criminal charges as those possessing opiates or methamphetamine. Schedule II drugs involve an extremely high risk of addiction and overdose, as well as a potential to lead to depression or heart failure.

A University of Pittsburgh newspaper notes that side effects can include irregular heart rate, increased blood pressure, headaches, sleep deprivation, and loss of appetite, among others. When abused, the adverse effects of the drug can be substantially exacerbated. Instances of acute exhaustion or psychosis during withdrawal have been documented, and when it’s mixed with alcohol, Adderall can even cause death. Among young people with developing prefrontal cortexes, the effects can be even more pronounced and long-term, essentially changing the chemistry of the brain.

Safer Solutions
Perhaps the biggest hurdle schools and medical professionals face in weaning students away from prescription drug addiction in their genuine effectiveness. Still, statistics show that students using Adderall illicitly are often far from the highest achieving, with an average GPA among abusers of less than 3.0. The fact that the vast majority of students who take Adderall use it legally and likely suffer with learning disabilities clearly affects these performance numbers, but it is clear that Adderall is not a panacea. Students who truly achieve long term success usually do so by disciplining themselves and utilizing time effective time management skills. “The most important thing to have for time management is some kind of system” says Kelci Lynn Lucier, author of The College Parent Handbook. “Some students use the calendars are their phones: others use things like Google Calendar; others still use the classic paper-calendar model.”Lucier also asserts the importance of maintaining a regular and appropriate sleep schedule. “While it may be common among college students, a lack of sleep is more detrimental than you might think,” says Lucier. “It can throw everything out of whack: your mental health, your physical health, your stress level, and, of course, your schedule.”There is no doubt that Adderall offers a short-term solution for students that are behind in their studies, their sleep, or generally overwhelmed by their many burdens. However, the adverse effects of continued use on one’s mental and physical health, as well as the potential risks towards one’s education and future success, can prove devastating. Students who are genuinely invested their academics and career training are often best served by taking the time to study while maintaining a disciplined and manageable lifestyle.

About Addiction: Addiction Recovery, Alcohol, and Drug Legalization

Yes, you’ve got it, it’s your 30 seconds of news about addiction from around the world (wide web). Enjoy the reading – you can claim you learned your “new thing of the day.”

Addiction recovery- Inpatient and Outpatient treatment plans

Addiction Recovery-Recovering from addiction is hard, no matter what type of addiction it is. In order to complete a successful recovery from addiction, a positive attitude helps. Holding a positive attitude increases the chances that the recovery attempt will be a successful one. We’ve written often about addiction treatment and tips to increase sucess.

Recovery Now– What are the stages to inpatient addiction treatment? According to Recovery Now, the stages of inpatient treatment include:  intake, detox, stabilization, and long term recovery. Though I don’t necessarily agree with every aspect of this article, it contains some good information about addiction treatment that every reader should know. This additional piece from Recovery Now discusses the appropriateness of inpatient versus outpatient addiction treatment for specific patients.

Alcohol use

Science Daily– We’ve talked about the link that has been found between family history of alcoholism and an individual’s obesity risk.  In this study a family history of alcoholism produced an increased risk for obesity, though the environment also played a large role in this link. Environmental factors include the types of foods that are eaten- foods that are typically high in calories from sugars, salt and fat.

Desert News– Everyone knows at least one person whose life has been affected by alcohol abuse in some form or another. Here is a story of how alcohol negatively affected a woman’s life and how it overtook her life ultimately leading to her death.

The Sydney Morning Herald– Drunk Driving is not just a problem in the United States, driving under the influence of alcohol appears to be a problem in other countries as well.  In Australia almost 1,400 people were arrested for alcohol-related offenses.

AOL Health-There is a multitude of information found on billboards and in TV commercials which explains the risks of drunk and drugged driving. Despite this information 30 million Americans are driving drunk each year and 10 million are driving while they are under the influence of drugs. This problem is very serious and is most problematic among drivers who are aged 16-25. Although there has been a drop in the overall number of individuals who are driving while they are under the influence, one in three car accidents still occur from drunk driving.

Drugs- The dangers of legal drugs, Marijuana, Adderall, and Methadone

Belfast TelegraphAlcohol and legal drugs are okay in small doses and can even be helpful in medical settings and for overall health. However it is important to note that there have been many more alcohol related deaths than deaths from illegal substances such as heroin and crystal meth. By far alcohol is the greatest perpetrator followed by prescription drugs including amphetamines, benzodiazepines and antidepressants. In Ireland in 2009 alone there were 283 alcohol-related deaths were registered in the north and 276 the previous year.

NIH News- There has been a recent increase in marijuana use among 8th graders according to NIDA’s monitoring the future survey. It was reported that the rate of eighth-graders who are using illicit drugs is 16 percent, a 2.5 increase from the previous year’s use of 14.5 percent. Among high school seniors cigarette use has declined but marijuana, ecstasy and prescription drug use has increased. Marijuana use among adolescents is so problematic because it affects the brains development as well as a person’s learning, judgment, and motor skills. Additionally 1 in 6 people who start using it as adolescents become addicted. The spike in the drug use may be attributed to the debate on legalization which may give a false impression that the drug has no negative effects or consequences.

‘WisconsinWatch.org– Use of Adderall, a medication for ADHD, is on the rise and in demand on many college campuses. Adderall is increasing in popularity and is easily accessible on college campuses because it helps individuals study.  The drug is particularly popular in the University of Wisconsin and many students are taking it despite the negative side effects it may bring. School officials are not educating the university population of the ill effects of Adderall so it continues to be used as a study aid. At least part of the worry has to do with the potential for such students to move on to even stronger versions of amphetamines such as crystal meth, so maybe the efforts should focus on teaching students about addiction to amphetamines and the associated risks.

Scotsman NewsMethadone a drug which is used to prevent withdrawal symptoms in individuals who were addicted to opiate drugs (and as a replacement medication in heroin addiction treatment) is going to be in high demand after nearly £2 million worth of the heroin was discovered on a raid in Scotland.  Police hope that by working with healthcare professionals they can help these drug users seek addiction treatment. Anyone who was effected by the drug raid are offered the support and care they need

Victimization and Drug Legalization

Physorg.com– A potential link has been found between victimization (and hence trauma) and the prevalence of substance use disorders. This was most evident for homosexual and bisexual men and women than it was for heterosexual men and women. Both gay men and women reported high prevalence rates of victimization some point in their lifetime with lesbian women twice as likely to report victimization experiences. Men and women who reported two or more victimization experiences were found to have higher odds of alcohol and other drug dependence.

London Evening Standard– Should drugs be legalized? That is the question that is popping up in many states across the United States.  Is marijuana safer if it is regulated by the state?  The argument for legalizing drugs goes a little something like this: Despite drugs being illegal there will always be a demand for them so if drugs are legalized then governments will be able to control drug quality before they are sold on the streets. Tax income from drug sales can then to educate individuals about drugs and to aid individuals who need addiction treatment

North West Evening Mail– Paul Brown, the director of Cumbria Alcohol and Drug Advisory Service spoke out after former drugs policy minister Bob Ainsworth and he called for the decriminalization of all banned substances. Brown informed attendees that only Portugal has decriminalized drugs and since that occurred crime rates have fallen and more individuals are willing to seek treatment for drug problems. Many substances that are legal such as alcohol and tobacco are bigger killers than drugs that are criminalized. Alcohol and tobacco kill an average 40,000 people a year this is 10 times more than any illegal drug.

A new candidate for ADHD medication: Amantadine and the rise of non-stimulants

It is well known that ADHD diagnoses and substance abuse problems are closely associated. It is estimated that substance abuse problems including dependence are up to twice as common among individuals with ADHD, which is not surprising given the impulsivity factor involved in ADHD. The problem is that until recently, most medications for ADHD have belonged to the stimulant category and as many, including us, have written before it is probably not the best idea ever to give drugs that have a relatively large abuse probability to people who are relatively likely to develop substance abuse problems. Right?

We’ve already written about atomoxetine and bupropion, two drugs with relatively low abuse potential (since patients don’t actually feel “high” from them) that are being successfully used in treating ADHD. But there is little doubt that the type of effect seen among patients who are using stimulants (like adderall, ritalin, etc.) isn’t being observed among patients taking non-stimulant medications. All of this means that patients on non-stimulants are getting less bang but with less risk. A dopamine agonist by the name of amantadine might change all of that according to a recent study.

Amantadine versus stimulants for ADHD treatment

Fourty children between the ages of 6 and 14 were enrolled in the study conducted in a psychiatric hospital in Iran. The kids were randomized into two groups a methylphenidate (ritalin) and amantadine group. Over a six week period the kids were assessed four times – at intake and then every two weeks -using an instrument that parents and teachers (who didn’t know what medication the kids were getting) would use to rate the child’s behavior on the 18 ADHD symptoms listed in the DSM-IV.

Amantadine may soon offer a new non-stimulant medication option for ADHD treatmentThe final findings were very encouraging (see picture): The kids in both conditions improved greatly over the 6 weeks of the study and no difference was found between the two medications. the children in the amantadine condition actually suffered less side effects and significantly so when looking at side effects common to stimulant medication such as decrease in appetite and restlessness. While more studies are obviously needed, this randomized trial shows that amantadine is not only safe, but it may be safer than at least some stimulant medications while also providing the same effect on ADHD symptoms. Given that approximately 30% of patients don’t respond well to stimulants and that some families are afraid of giving stimulant medications to their children, at least partially because of the risk of substance abuse issues, non-stimulant medications can be an attractive alternative, and it seems like amantadine can deliver.

Final thoughts from Dr. Jaffe on ADHD medications and amantadine

One of the main reservations I have about the notion of using this medication for ADHD is that NMDA receptors are very important in learning, so it may be that we’re helping to resolve attention problems but making it more difficult to actually create memories that are crucial for learning. More research is necessary to see if these decreases in impulsivity are accompannied by improvements, and not reductions, in learning ability.

So, if you’re considering medicating a child who has been diagnosed with ADHD, I strongly support the notion given the difference that medication has made in my own life. However, I urge you to be educated and to consider non-stimulant options, especially as more are researched and as that treatment option becomes more available, less costly, and less likely to lead to abuse of the drug. With prescription drug abuse one of the fastest growing problems in the U.S., being careful is just sound advice.

Citation:

Mohammad-Reza Mohammadi, Mohammad-Reza Kazemi, Ebtehal Zia, Shams-Ali Rezazadeh, Mina Tabrizi, Shahin Akhondzadeh (2010) Amantadine versus methylphenidate in children and adolescents with attention deficit/hyperactivity disorder: a randomized, double-blind trial. Human Psychopharmacology.

Some parkinson work showing effect of amantadine: http://www.springerlink.com/content/76r5wxux8wn52rq5/fulltext.pdf

ADD and ADHD medications: Lessons from a crystal meth experiment

I’ve recently completed a study that I presented at the Society For Neuroscience (SFN) meeting in DC. The study was actually aimed at looking at the usefulness of two medications in interfering with the rewarding qualities of methamphetamine. The thinking was the if we could figure out a way to interfere with crystal meth being perceived as rewarding by the brain, we may be able to help addicts from continued use after a relapse.

Two prescription stones but only one hits crystal meth

The two medications are atomoxetine and bupropion, though you may know them as Strattera and Wellbutrin or Zyban. Their mechanisms of action are similar, but distinct enough that we wanted to test them both. The results of the study, in one sentence, were that atomoxetine (or Strattera), but not bupropion (or Zyban) succeeded in eliminating animals’ preference for meth if given along with it. The implication is that in the future, these, or other, similar, medications, may be given to newly recovering addicts. The hope would be that by taking the drug, they may be somewhat protected in the case of a relapse. If they don’t enjoy the drug during the relapse, they may have a better chance of staying in treatment.

More to these medications than meets the eye

I learned some other interesting things while preparing, and then carrying out, the study. While Zyban could, by itself, be liked by the animals, Strattera did not seem to produce any sort of preference. Given the common use of these drugs in the treatment of ADHD, the difference may be very important. As you may recall, I’ve talked before about the connection between impulse control problems and being predisposed to developing addiction. Given this relationship, it would seem that we’d want to be especially careful about using drugs that can cause abuse with this population. Many of the stimulants used to treat ADD and ADHD can indeed lead to abuse, as their effects are very similar to speed, or crystal meth (Adderall and Ritalin come to mind). Zyban’s abuse liability is definitely lower, given the greatly reduced preference animals develop for it. Still, it seems that Strattera’s abuse potential is almost zero. In trial after trial, animals given atomoxetine fail to show a preference for the drug.

To my mind, this means that as long as it’s successful in treating the attention problems, atomoxetine is the better candidate. All in all, I’d think the first choice should be the one that helps the symptoms of ADHD while having a reduced likelihood of dependence. Obviously, if the drug is not able to treat the problem, other options should be selected, but it seems to me that given the known relationship between attention deficit problems and addiction, the question of abuse liability should play a significant role in the selection of medication.

Once again, this doesn’t mean that all users of Adderall, Ritalin, or the other stimulant ADHD medications will develop an addiction to their prescription. In fact, we know that rates of addiction to prescriptions are generally relatively low. Nevertheless, I’d consider ADHD patients a vulnerable population when it comes to substance abuse so I say better safe than sorry.

Addiction causes – Learned self regulation and its possible benefits for drug use problems

In the first part of this little series on addiction cause and self-regulation I talked about some of the genetic influence on impulsivity that have been shown to also be related to drug use.

In this next part, I want to drive home some recent ideas regarding learning related to self-regulation.

It’s no secret that diagnoses like ADD and ADHD have been seen with much greater frequency in the last decade or so. Slight variations on the same theme, both of these disorders have to do with a person’s (usually a child) inability to appropriately control their impulses and behave appropriately.

The debate about the sources of the large increase in these diagnoses is still ongoing. Some think that they are nothing but an inflated push for pharmaceutical treatment by those who stand to profit from the sale of Adderall, Ritalin, and the likes.

However, if you talk to the parents of the children being diagnosed with these disorders, they’ll be the first to tell you that even though they can’t put their fingers on it, something’s up with their kids…

Tin Can PhoneA recent educational program in New Jersey (at the Geraldyn O. Foster Early Childhood Center) tries to instill in children the concept of internal regulation by making pretend play rules explicit. Children talk to their teachers before embarking on their next imaginary adventure in order to lay out everybody’s role. The idea is that by the generation of internal rules, the children become more aware of how social rules regarding behavior are dependent on their specific role in a given environment.

The creators of the program believe that children’s play in the recent past has become more and more structured. They believe that video-games, explicit toys, and constant oversight have reduced children’s ability to take on roles and depend on their own mind for the rules of behavior.

Adele Diamond, a researcher at the University of British Columbia, has found that children in the program performed much better (up to 35% better) than other children in tests of executive function. It should be noted that the program doesn’t claim, and hasn’t been shown to, get rid of attention-deficit problems in kids that have been diagnosed. Rather overall cognitive function for kids in the program seems improved.

More research on this program is ongoing, but the initial results seem to indicate that educational and developmental aspects of a child’s life can impact their ability to have internal oversight. This is obviously promising and upsetting all at once.

No parent intentionally places their child at a disadvantage, but it seems that the most recent trends of “electronic babysitting” we’ve become so accustomed to may in fact be impacting children in unintended, discouraging ways.

The connection to addiction again has to do with general impulse control problems. Less executive control leaves children generally more vulnerable to behaviors that can be detrimental to their future. As I’d mentioned in one of my earlier posts, most of the negative impact of drug use on the lives of users is not related to long term addictive use. Instead, it is the acute (as in quick and short lasting) negative impact of things like unintended pregnancy, motor accidents, and legal troubles and arrest, that end up impacting adolescent drug users.

Maybe by making our children better able to control their actions, we can protect them from a host of possible problems, including drug use…

Question of the day:
How much of your childhood was spent in relatively free play and how much of it was structured?
How, if at all, do you feel that these different activities have affected the kind of self-control you can, or can’t exert?