Dr. Hal Pickett's Thoughts on Adderall Abuse

There’s been a great deal of media buzz recently about abuse and shortages of Adderall, one of a family of pharmaceutical stimulants used to treat Attention Deficit Hyperactivity Disorder (ADHD).  Recent surveys have shown more and more high school and college students in Minnesota are faking ADHD to obtain the drug for enhanced academic performance -- following a nationwide trend. Last week alone, there were at least two local articles, one in MinnPost, the other in the Start Tribune, about this disturbing trend.

While Adderall is the focus of the current concern, similar effects and abuse happen with any and all of the other prescription stimulants. Research into how the brain functions with Ritalin showed years ago that these stimulant pharmaceuticals act on the cerebral prefrontal cortex to enhance executive functioning.  This part of the brain controls such things as attention and concentration, higher level impulse control, organization and problem solving.  It is the part of the brain that enhances organization and oversight of many of the higher level cognitive functions.  So would enhancement in this part of the brain enhance academic functioning?  Of course it would.  The NCAA has known and monitored this for years in sports, because the stimulants can also enhance sports skills.  That’s why unless you have a proven medical reason to use these stimulants, they are illegal in NCAA sports competitions.

Other things we know about brain functioning is that during periods of high stress, our brains become less efficient in higher-level cognitive functioning. At that point, more primitive, emotional, reactive parts of our brain take over more functioning.  So if you are stressed out about a test, stressed out about the ACT or SAT, the stimulant may help enhance activity in the prefrontal cortex and increase attention, concentration and organization.

But the opposite could very likely happen as well.  Stimulants also have the potential to increase agitation and anxiety.  So if a student who does not need the stimulant medication to help with attention deficit symptoms is anxious about performance, the stimulant medication could potentially make academic performance worse.  In most cases, if the student could lower his or her stress level naturally, prefrontal cortex functioning would probably be better than it would with the stimulant.

So, yes, during normal brain functioning without high levels of stress, the stimulant medication will most likely enhance attention, concentration and organization.  But it will not make the student smarter nor will it replace poor preparation or lack of studying for a test.  

Sadly it appears that we are moving toward an era where drugs are seen as the route to better academic performance, similar to the period when anabolic steroids were abused for enhanced sports performance. But it is a misperception that drugs like Adderall and Ritalin are the way to academic brilliance -- good preparation and realistic expectations are still the only way to get there. Some students do much better than others academically because of natural differences, but  for those who suffer from test anxiety, stimulant medication is the wrong treatment.  Therapy and skills development to learn how to manage stress is much more effective.

Dr. Hal Pickett is the clinical director at Headway Emotional Health Services, which provides comprehensive mental and emotional health care to adolescents, families, adults and couples.