Raging Adderall
My Night Out With Prescription Amphetamines
Bret has just returned from an aerobics class when I arrive at his apartment in lower Manhattan. Despite the high-intensity, one-hour workout (that came with a DJ), he is far from winded. Bret is a 27-year-old manager at a start-up based in Chicago. Fit, handsome, and clean-cut, he has an intense, bursting-at-the-seams, conquer-the-world approach to life that is infectious. Whenever I see him, I’m half convinced we’re about to climb Mt. Kilimanjaro, or getting ready to ski black diamonds, while being chased by a gang of James Bond villains. While I suspect Bret is naturally energetic, I also wonder if the 20 milligrams of extended-release Adderall he takes Monday through Friday amps it up.
A combination of amphetamine and dextroamphetamine, Adderall is primarily used to treat ADHD (in 2013, 3.5 million ADHD-diagnosed children were on medication for it), but increasingly it’s being given to non-diagnosed kids to boost their grades. While studies have shown that Adderall won’t make you smarter, it can keep you awake longer and provide energy to stay focused. Long-term health effects (including how they affect developing brains) are still unknown, but there are documented side effects: growth suppression, insomnia, increased blood pressure, dizziness, depression, anxiety, and other cardiovascular and psychiatric problems, including, in rare cases, psychotic episodes (like the ones that led to Richard Fee’s suicide at age 24).
Between 2005 and 2010 the number of emergency room visits involving ADHD stimulants increased from 13,379 to 31,244 — 50 percent of those for non-medical use.
With nearly 14 million monthly prescriptions written in 2011 for Americans ages 20–39 — clearly not all of them for ADHD — I was curious about stimulants’ appeal, and just how dependent on them (or not) younger people are becoming.
Bret started taking Ritalin off and on at age 12. His first Adderall prescription was in college, where he took it sporadically, replacing it for six months with cocaine. He takes it now primarily for work and when he feels responsible for entertaining a client. Euphoria is not uncommon. While he normally takes 10 to 20 milligrams of instant, 30 puts him “in the tunnel. I want to put on Phil Collins’s ‘Sussudio’ and clean the apartment!” he says with a thousand-watt smile.
In New York, he initially bartered stimulants through friends. Then an online review describing a doctor as “basically a glorified drug dealer” caught his eye. During his appointment, no test or physical examination was required; he was simply asked what stimulant he’d taken before and a prescription was written. While not worried about addiction, Bret is concerned about tolerance and long-term health effects. He would consider quitting, “if I got another job that was less stressful and I had a month break beforehand.” But given the New York work culture, he doesn’t see that happening any time soon. On average, he sleeps between 5 ½ to 6 hours per night.
Bret crushes 10 milligrams of instant-release Adderall, rolls the powder into a piece of paper towel, and swallows it with a Gatorade-vodka mix — a common practice called “parachuting.” (More instantaneous in powder form, users also snort it like cocaine.) Shortly thereafter, we walk to a hole-in-the-wall dance club in the East Village — a dirty, dilapidated, pretension-free standby that plays decent 80s music, serves cheap drinks, and offers space for dancing. We’ve already been drinking so zipping past the bar we dive into the music, pogo-ing along to Madonna’s ‘Holiday’. Bret and I are madcap dancers. No halfhearted swaying while surreptitiously scoping the scene for us. We are here for the music and we tear up the dance floor like a couple of Jennifer Beals ‘Flashdance’ maniacs.
And pretty quickly our dancing does start to feel like a preliminary workout for a dance school audition. Is it the Adderall? Is Bret’s chemically induced enthusiasm rubbing off on me? In trying to keep up with him, I feel myself crossing over the line of joyful, exuberant dancing into manic, fat-burning aerobics, or maybe next-level Dancing with the Stars. When we aren’t shredding the dance floor, we’re monopolizing the DJ’s song request book and making the occasional pit stop at the bar. Bret is the Energizer Bunny on speed (literally: amphetamine and methamphetamine are “about equipotent” and “produce qualitatively similar behavioral responses” according to a study in The Journal of Neuroscience). Even an hour into dancing, it’s apparent the party is just starting for him. I can see the appeal of a stimulant-backed night out. More energy means more time doing what you want to do, and humans will always want more of a good thing even when our bodies are begging us to quit: more dancing, food, alcohol, sex… But maybe our bodies know best. Maybe there’s a reason too much of a good thing can start to hurt.
Not everyone uses stimulants recreationally. Jesse, 26, a counselor finishing his Masters degree in social work, takes Adderall strictly for school, cutting up a half dose of 30 milligrams instant release for studying and writing papers, and a quarter for class discussion. Jesse radiates an open, easy going nature, the sort of warm and inviting personality you would expect from a therapist.
Like Bret, his parents suggested he take Ritalin when he was a teenager. Ritalin made Jesse feel “spacey and out of body,” so he switched to Adderall, which made him more focused and alert. He says he couldn’t complete his school work without it, crediting Adderall for teaching him how to resist the endless loop of rereading. The drug, he explains, is better for detail-oriented, straightforward tasks, as opposed to complex human interactions. “I tend to ignore or not seek out communication when I’m on it. If I’m focused on homework and my girlfriend’s in the next room being sexy, I’m just not going to be interested. I’ll be distant, kind of emotionally detached, and afterwards I’m stressed out, tired, and a little more irritable.”
Jesse sleeps between 4 to 6 ½ hours a night during the school week and 8 hours on weekends. He gets his prescription through a primary care physician who assured him the instant release is not addictive (studies show otherwise, and the DEA classifies these medications as Schedule II Controlled Substances, the same category as cocaine, because they are particularly addictive). Jesse is also concerned about long-term health effects, and eventually he’d like to stop using, but only after finishing school and establishing a career.
He says it takes a responsible person to use it appropriately. Once tasked with writing three papers in three days, he took an Adderall dose every five hours. “I wrote down the times I took it and when I could re-dose, because you start to lose track, and that’s how people overdose. Combined with sleep deprivation it can get dangerous.” He’s trying to teach mindfulness to his patients who use stimulants so they can avoid an overdose scenario, but says it’s difficult.
Kyle, a 25-year-old marketing strategist for a start-up, agrees that Adderall is a powerful and scary drug compared to others like weed or ecstasy. “Stimulants increase output more than anything should. It’s the intensity of Adderall that’s unnerving.” He has seen others go without sleep for days after taking it for the first time. “There are real dangers of which people should be aware.”
Kyle strikes me as a no-nonsense, goal-oriented type of guy. While friendly, he is level-headed and to the point, and it’s immediately clear that he values his time. He started taking Ritalin at age 10 twice a day when he was diagnosed as borderline ADHD. He recently switched from 20 milligrams of extended-release Adderall to Vyvanse at about an equivalent dosage, which he takes once a day with a prescription. He takes it now for work — specifically for focus, organization, and planning. “If I don’t take it, I feel like a noodle.”
Kyle says the stimulant definitely makes him short-fused, more temperamental, and less understanding. “I get into this mindset of ‘I don’t understand why others don’t understand what I understand.’” He has no plans to stop using, though he may when he starts a family as he’s concerned about losing his temper with his future children. He says the stimulant environment is probably not a good one for kids, adding, “I don’t want to be that Dad.”
Like Bret and Jesse, he also sleeps remarkably few hours per night: 4 to 6. He also knew plenty of people in college who used Adderall recreationally. It was either Adderall or cocaine. “If you look at the chemical breakdown between Ritalin and cocaine, they’re very similar drugs.”
Back in the East Village it’s 2AM and I am beat. But ‘Sussudio’ just came blasting onto the dance floor prompting me and Bret to go completely insane. I am in the final stretch of a marathon, the Rocky movie theme in my head doing battle with Phil Collins. By 2:30 I am destroyed. Somehow I manage to drag Bret outside. As I wobble and he bounces along the street, the sounds of Aretha Franklin stream from a nearby bar. We stop to dance on the sidewalk to ‘Respect’ — Bret doing an impossibly low limbo to an imaginary limbo bar, while I feebly wave my 100-pound arms in a placating motion that could be vaguely interpreted as dancing. There is the terrifying feeling in the air that on Bret’s schedule, far from nearing closing time, we are merely gaining ground on the apex of the night. Two blocks past the Aretha Franklin bar, Bret shouts, “Wait!” and calls my name. He’s making friends with strangers now, talking to a pack of guys outside a pub. I wave good-bye until he releases himself from their gravitational pull, concedes a pragmatic defeat, and walks me to my subway stop.
While I haven’t taken Adderall, it’s easier now to understand its appeal. Focus, energy, increased productivity, and confidence: these are strong enticements. Toss these easy-to-obtain superhero powers into a depressed, hyper-competitive economy with no rise in median wages in over 15 years and it’s no wonder young people are seeking an edge with their parents’ blessing. The flip side, though, is that in addition to the health risks, we are enabling dependency and risk instilling in children and young adults the belief that they cannot be successful, productive members of society without the aid of a pill. (We should also consider the damage pharmaceuticals are wreaking on the environment).
In 2013, the DSM-V loosened its criteria for ADHD, despite the fact that 1 in 5 high school boys and 11% of school-age children overall have received a diagnosis. In 2012, stimulant sales were at $9 billion, with young women the fastest growing demographic. And it’s a business we’re exporting.
Much has been written about the failed war on drugs and the benefits of legalization (abuse has shown to drop when criminalization is replaced with treatment); but Alexander Zaitchik nails it when he writes that the problem with stimulant abuse begins “when socially sanctioned corporate dealers are allowed to dishonestly market these drugs through a sophisticated network permeating the medical establishment, backed by the power of modern advertising.” In other words, with all its ‘FDA-approved, ask-your-doctor’ spiel, big pharma has the leverage and resources to cause just as much damage as (if not more than) any street dealer peddling addiction to kids.
Aggressive advertising, a depressed economy with no safety net, the normalization of psychotropic meds, and America’s approach to treating behavioral issues as a biological dysfunction: all of these likely contribute to the continued spike in ADHD diagnoses. There have also been studies like Rat Park on the role environment plays in addiction when there is a lack of healthy stimulation and connection, and more recent studies on the way ADHD children self-medicate online. Video games in particular provide stimulation “for a dopamine surge — a brain chemical involved in focus and reward pathways.” The kind of rewards children are getting while concentrating on video games and TV is not “sustained attention in the absence of rewards” — the kind of attention and focus they need to thrive in school and in real life — but “sustained attention with frequent intermittent rewards.” When they come down from those intense screen-time highs, ADHD kids are left feeling underwhelmed and bored with the slower pace of real life. And while there is no proof that screen time causes ADHD, studies have shown that eventually, over time, gaming has a negative effect on attention — not just in ADHD children.
The more one gets accustomed to a heightened, artificial level of stimulation, the more stimulation is required to focus.
Years ago, shortly after getting internet at home, I noticed a decline in my ability to concentrate while watching DVDs. Fidgety midway through a movie, I started taking internet breaks — checking my laptop to see what was “happening online.” Now the internet’s demand for my attention is constant, the easy stimulation of social media, news, email, and cute cat videos vying for time when I should be concentrating on something else. If my deteriorating ability to stay focused for extended periods of time doesn’t yet mean I have ADHD, screen time has undeniably messed with my attention span, and I’m not alone.
The day after my epic dance-a-thon with Bret, I feel cranky and antisocial, and as I move around my apartment at a snail’s pace, I recall what Jesse said about the post-Adderall crash: fatigue, irritability, not wanting to be around others. In keeping with my own mindfulness practice, I close my laptop and put away my phone, resisting the siren call of breaking headlines, text messages, and interspecies friendship videos. Rather than give in to a thousand distracting online stimuli, I choose instead to be still, to do nothing, to disengage — or rather, to engage with the stillness of the room.
I sit in the ensuing silence, remembering that most of what beckons from my electronic devices is not important. And as the quiet surrounds me, enveloping me in a reassuring calm, I remember that this moment in real space and time, free from the ceaseless chatter of electronic stimuli, is enough — more than enough, better.
Curious how Adderall might make you feel? Check out your brain on Adderall.
