What if a pill really could render you limitless? The use of so-called “smart drugs” – or cognitive enhancers – and the unauthorized use of prescription stimulant medications are characterized by growing trends amongst students. From stimulants such as modafinil to amphetamines (often prescribed under the name Adderall) and methylphenidate (also known as Ritalin), reports suggest usage is widespread. Researchers at the University of Michigan found that up to a quarter of college students on any given campus had used stimulant medication without a prescription (McCabe, Knight, Teter & Wechsler, 2005). Rates were highest in colleges with more competitive admission criteria. Furthermore, students using these medications were more likely to engage in other substance abuse.
College students partaking in cram revision sessions – previously aided by a mild caffeine shot – are increasingly fuelled by medicated stimulants instead.
Shockingly, total prescription stimulant-use in the United States doubled in the last decade (Piper et al., 2018). Consider the following; the United States has less than 5% of the world’s total Attention Deficit Hyperactivity Disorder (ADHD) burden, yet is responsible for 83.1% of the world-wide volume of ADHD medications prescribed (Scheffler, Hinshaw, Modrek & Levine, 2007). This dramatic increase in stimulant prescriptions has in turn led to greater availability and misuse. Prescription stimulants are perceived by many to be generally safe and effective. But the non-medical use of these drugs has been identified as a cause for concern.
The brain on stimulants
In order to understand why so many college students use stimulants as a crutch in order to get them through their academic careers, it is important to recognise the effects these substances have on the brain.
Stimulants excite and speed-up the central nervous system (CNS), and are generally used for their ability to increase alertness, attention and endurance. They therefore can keep people awake and active for a long period of time. Stimulants can promote wakefulness by raising the levels of key chemicals in the brain. Dextroamphetamine with our without amphetamine (Adderall and Dexedrine respectively) and methylphenidate (Ritalin and Concerta) act to increase such neurotransmitters in the brain, namely norepinephrine and dopamine (Kuczenski & Segal, 1997).
Increased levels of dopamine can induce euphoria when stimulants are taken non-medically. More importantly, dopamine also plays a role in addiction to, and dependence on, a substance (Volkow, Fowler & Wang, 2002). Drug withdrawal, causing psychological and physical symptoms, is also possible if tolerance develops (Sussman, Pentz, Spruijt-Metz & Miller, 2006).
Whilst these drugs are being used to bolster performance, research is failing to provide robust evidence in order to suggest that grades can actually improve with prescription stimulants. Arria et al. (2017) demonstrated that students who engaged in non-medical use of prescription stimulants showed no increases in their GPAs, commenting that “the promise of academic benefits…is likely illusory” (p. 249).
Rather, these drugs may have unpleasant and lasting side effects. Typical adverse drug reactions include fatigue, insomnia, anorexia, abdominal pain, jitteriness, nausea and dizziness (Greydanus & Strasburger, 2006). According to Lakhan & Kirchgessner (2012), these drugs are also associated with multiple cardiovascular complications, including hypertension (high blood pressure), tachycardia (fast heart rate), myocardial infarction (heart attack) and cardiomyopathy (disease of the heart muscle). Psychosis can also occur, particularly at high doses.
Addressing the problem
As already mentioned, increased accessibility is a huge problem. Most people obtain prescription stimulants from either a friend or relative who already has access to a prescription.
Attitudes about drug use have the potential to change, secondary to beliefs about the risks of drug use and peer norms against drug use (Hohman, Crano, Siegel & Alvaro, 2015). Improvements are surely not inevitable; and when they occur, they should not be taken for granted. Any drug problem cannot be extinguished head-on. It is a recurring problem which must be contained, and one that takes into account the differing generational attitudes as well as the stream of new substances threatening to lure young people into involvement with drugs.
Part of recovery is recognizing the symptoms of someone using prescription stimulants, followed by admission of the problem.
Potential negative consequences are outlined by Sussman, Pentz, Spruijt-Metz & Miller (2006) and may include any of the following signs or symptoms:
- Exhaustion and fatigue with bloodshot eyes
- Insomnia or hypersomnia (sleeping too little or too much)
- Irritability or emotional lability
- Loss of appetite with or without loss of weight
- Dizziness or blurred vision
- Dryness of mouth and eyes
- Complaints of hallucinations or reports bizarre delusions
In the long-term, treatment is an essential component of the recovery process. Drug addiction treatment involves a number of components. Recovery from a substance and managing potential symptoms of withdrawal is best done with the help of professionals. When looking for a treatment program, find out if the program itself is equipped to treat someone with this specific type of addiction.
Since this is a relatively emerging field of drug abuse, it requires a specialized, academically-focused team. Encouragement is needed to push the addict’s boundaries on what they think they can achieve, while providing help building robust coping mechanisms in the face of daily stressors. At the end of the day, the goal should be to revive passion as well as the motivation to succeed and achieve on one’s own merit.
Ultimately, dependency on prescription stimulants is a complex field. It deserves more research, and aggressive targeting of at-risk populations is needed. Youth using these substances are likely to be using other drugs, making them an important demographic; one that should not be missed. Peers may also be using drugs, making it a perceived norm, but also admitting to a substance misuse is problematic if the individual doesn’t perceive anything wrong with their behaviour. If attitudes towards certain drugs are benign, those views have to be continually challenged, making education key.
Arria, A. M., Caldeira, K. M., Vincent, K. B., O’Grady, K. E., Cimini, M. D., Geisner, I. M., Fossos-Wong, N., Kilmer, J. R., Larimer, M. E. (2016). Do college students improve their grades by using prescription stimulants nonmedically? Addictive Behaviors, 65, 245-249.
Greydanus, D.E. & Strasburger, V.C. (2006). Adolescent medicine. Prim. Care, 33:xiii–xviii.
Hohman, Z. P., Crano, W. D., Siegel, J. T., & Alvaro, E. M. (2014). Attitude ambivalence, friend norms, and adolescent drug use. Prevention Science, 15(1), 65-74.
Kuczenski, R., & Segal. D.S. (1997). Effects of methylphenidate on extracellular dopamine, serotonin, and norepinephrine: comparison with amphetamine. J Neurochem, 68(5): 2032-7.
Lakhan, S.E., & Kirchgessner, A. (2012). Prescription stimulants in individuals with and without attention deficit hyperactivity disorder: misuse, cognitive impact, and adverse effects. Brain Behav, 2(5):661-77.
McCabe, S.E., Knight, J.R., Teter, C.J., & Wechsler, H. (2005). Non-medical use of prescription stimulants among US college students: prevalence and correlates from a national survey. Addiction, 100(1):96-106.
Piper, B. J., Ogden, C. L., Simoyan, O. M., Chung, D. Y., Caggiano, J. F., Nichols, S. D., & McCall, K. L. (2018). Trends in use of prescription stimulants in the United States and Territories, 2006 to 2016. PloS one, 13(11), e0206100. doi:10.1371/journal.pone.0206100.
Scheffler, R.M., Hinshaw, S.P., Modrek, S., & Levine, P. (2007) The global market for ADHD medications. Health Affairs. 26:450–457.
Sussman, S., Pentz, M. A., Spruijt-Metz, D., & Miller, T. (2006). Misuse of “study drugs:” prevalence, consequences, and implications for policy. Substance Abuse Treatment, 1, 15. doi:10.1186/1747-597X-1-15
Volkow, N.D., Fowler, J.S., & Wang, G.J. (2002). Role of dopamine in drug reinforcement and addiction in humans: results from imaging studies. Behav Pharmacol, 13(5-6):355-66.