Over the Limit?
Americans young and old crave high-octane fuel, and doctors are jittery
All stimulant medications work by increasing the amount of dopamine in the brain, a neurotransmitter that's a major player in the pleasure response to food, say, or sex. Cocaine and methamphetamine, a powerful (and illegal) cousin of the amphetamine in Adderall, create sharp upward spikes in dopamine, causing an intensely pleasurable rush. The equally quick crash, and the memory of the euphoric high, are powerful spurs to addiction. Prescription amphetamines raise dopamine levels slowly and lose their effect gradually. Thus, they're less likely to prompt a high and crash and be addictive.
But the reality is that people can become addicted to prescription stimulants, and repeated overuse can lead to hostility, paranoia, confusion, hallucinations, psychotic episodes, depression, and seizures. "There's an optimal level of dopamine in your brain," says NIDA's Volkow, who studies how drugs of abuse remodel the brain. Go beyond that level, and the brain, in effect, gets stuck.
These days, the impetus on campus is often less the urge for a high than the desire to get more done. "I saw no point in sleeping," says Derek Simeone, now 22, who was prescribed stimulant medication while in high school-and took it more often as a freshman at Syracuse University. "Adderall allows me to do more with my life in a certain amount of time." Beyond studying, the medication helped him stay up and play video games, party, and hang out. He finally cut back after a week without sleep left him hot, pale, and sweaty, and he eventually gave up Adderall altogether. Now a programmer in New Jersey, Simeone relies on coffee.
Heart risks. Stimulant drugs also increase the chance of heart attacks and strokes, a risk that's well documented in abuse of drugs like cocaine and methamphetamine. In February 2006, after studies revealed 25 cases of fatal strokes or heart attacks in children and adults taking stimulant medication for ADHD, the FDA ordered manufacturers to put warnings on all prescription stimulants, including Ritalin, Adderall, and Concerta. Those complications are rare. But Steven Nissen, chairman of the department of cardiovascular medicine at the Cleveland Clinic, thinks the agency should go further, particularly since so many people are taking stimulants to treat only mild symptoms of ADHD.
"Can it possibly be that 10 percent of all the sixth-grade boys in America have a disease that requires amphetamines?" Nissen asks. "I'm unwilling to accept that that's an appropriate use of a psychotropic agent, particularly one that has well-known cardiovascular risks." He also worries about the rapidly increasing use of ADHD drugs by adults. "Ten percent of them are over age 55," Nissen says. "That's a potential disaster."
The popularity of stimulants on campus has not escaped the notice of university health officials. Although they are far more concerned about the dangers of binge drinking-a much more widespread problem-schools are becoming considerably more cautious about handing out stimulant medications. Two years ago, Indiana University initiated a screening process for students claiming to need stimulants that includes standardized tests, evaluation of a student's records as far back as elementary school, and a survey sent to parents, according to Hugh Jessop, director of the IU Health Center. Of the 283 students who scheduled appointments to get medication at Indiana in the past couple years, only 47 completed the process. The University of Wisconsin no longer even fills prescriptions from family doctors back home.