It’s midterm season, LET’S ROLL! (No, not like that.)

Midterms are fast-approaching here at Berkeley, and with the changing leaves and cool winter air comes the thick scent of crippling anxiety and stress for the students. While some of those students will prepare for their upcoming midterms by studying rigorously, others may take a less…savory route by abusing a well-known drug designed to treat patients of attention deficit/hyperactivity disorder: The infamous Adderall.

Adderall is a highly addictive amphetamine that was originally designed to treat attention deficit/hyperactivity disorder (ADHD) and narcolepsy [1]. It’s comprised of two stimulants, amphetamine and dextroamphetamine [1], but shares a huge number of similarities with drugs like meth and cocaine. The figure to the left shows you the chemical structure of Adderall compared to meth, and you can immediately see that their chemical structures are almost identical, the only difference being a single methyl group. Unsurprisingly, their biological effects are very similar as well. Like meth, Adderall is incredibly addictive, and often abused by young adults who use it either recreationally, or to enhance their focus and productivity. It’s relatively easy to obtain, either from a friend or family member with a valid prescription, or from a street dealer. Students are particularly prone to Adderall abuse, and studies show that students in college are twice as likely to use “study drugs” like Adderall to boost their attention and concentration in school, as opposed to students in high school or below [3]. The students obtain Adderall through various social networks, like friends or sorority/fraternity members, in order to increase their cognitive function while studying, thereby (theoretically) improving their studying habits and ultimately, their grades. But what are the risks?

As a central nervous system stimulant, Adderall’s mechanism of action is very similar to that of cocaine, and creates a very high potential for addiction. The figure below shows the biological effects of Adderall on neurons. Amphetamines like cocaine and Adderall inhibit dopamine, serotonin, and norepinephrine uptake by inhibiting their transporters [1]. With inhibited transporters, a build-up of dopamine takes place and causes hyper-stimulation of the receptors. This neurotransmitter build-up enhances awareness and mental function, but also gives users a sense of euphoria (a “high”) as dopamine continues to accumulate at neuron synapses…and therein lies the problem. Over time, the elevated dopamine levels will desensitize the dopamine receptors, and users will have to take more and more of the drug to reach the same level of “high” they achieved previously. It’s a classic reinforcement of behavior, where the users are conditioned to continue taking the drug to be rewarded with a high. College students who are abusing Adderall often aren’t aware of how high of a risk there is to becoming addicted, and use the drug habitually to study, unknowingly increasing their addiction risk.

Using stimulants also has more immediate side effects aside from developing addiction. Those who take Adderall will often experience fight-or-flight responses characteristic of a central nervous system stimulant, such as increased heart and respiratory rates, repetitive muscle contractions (twitching), and even overdose [1]. Tachycardia, hypertension, pulmonary edemas, and cerebral hemorrhaging are all possible overdose effects of stimulatory amphetamines like Adderall and cocaine [1], but even worse is the possibility that students in college are taking Adderall while also consuming alcohol. In general, alcohol should not be consumed while you’re on medication, especially with a strong drug like Adderall. Students buying Adderall illegally, however, don’t exactly get the medical warning labels with their under-the-table purchase. Instead, they think that they’re young and invincible, and drink while on Adderall, risking alcohol poisoning and/or heart issues.

If it’s so addictive and potentially dangerous, why is it still around? The short answer is because there are patients who actually need it. When properly prescribed by a doctor, Adderall’s effects can reduce symptoms of ADHD patients. Adderall’s mechanism of increasing neurotransmitter levels, as mentioned earlier, actually has on-target effects intended for treating ADHD, because the hyper-stimulation of the dopamine neurotransmitter receptors at the neuron synapses increases patients’ attention. In other words, although this mechanism sounds “bad” because it could lead to addiction in abusers, this mode of action is exactly what needs to happen in ADHD patients in order for their symptoms to improve. The build-up of dopamine is an intentional effect of Adderall, and can really improve mental cognition, increase focus, and help patients with legitimate ADHD when prescribed by a doctor.

As a student, I can personally attest to knowing about how easy it is to obtain “study drugs.” They’re virtually everywhere, and circulate in networks in every university, in every college, and in every department (Homeland Security, if you’re reading this, I have no involvement whatsoever and all my friends are clean, I swear). The increasing usage is definitely a problem, but my biggest concern is that students are using Adderall on a regular basis without understanding the long-term risks. Students are taking the drug irresponsibly, firstly by not having a medical reason to take the drug, and secondly by consuming alcohol while using the drug. Additionally, I’m also very curious to know about whether Adderall usage has an association to the Yerkes-Dodson phenomenon – for those of you who are unfamiliar with this concept, the Yerkes-Dodson law describes a direct relationship between performance level with level of arousal [2] as illustrated in the graph above.  I suspect that the enhanced cognitive function and faster internalization of concepts for students on Adderall is somewhat related to the “high” they experience while on the drug, which is consistent with what the Yerkes-Dodson law predicts. Maybe some new research while come up to definitively show whether or not the law supports the effects of study drugs. Maybe the research will be completed by someone who will be fueled by the high of the drug itself. And maybe I’m writing this blog post also fueled by the very same high…

*Homeland Security, seriously, I’m 100% joking. Good luck on midterms, everyone!

 

References:

1. Robert L. Findling, Elizabeth J. Short, Michael J. Manos, Short-Term Cardiovascular Effects of Methylphenidate and Adderall, In Journal of the American Academy of Child & Adolescent Psychiatry, Volume 40, Issue 5, 2001, Pages 525-529.
2. Cohen, Ronald. “Yerkes–Dodson Law.” Springer, Springer New York, 1 Jan. 1970, link.springer.com/referenceworkentry/10.1007%2F978-0-387-79948-3_1340.
3. Johnston LD, O’Malley PM, Miech RA, Bachman JG, Schulenberg JE. Monitoring the Future National Results on Drug Use: 1975-2013: Volume 2, College students and adults ages 19-55. Ann Arbor, MI: Institute for Social Research, The University of Michigan; 2014.