On Saturday, the New York Times’ Alan Schwarz told us about the rising tide of teens and young adults who turn to stimulants — specifically medications used to treat attention deficit hyperactivity disorder (ADHD) — to help their school performance. The next day, Matthew Herper over at Forbes asked where the news was in this story, given that there’s no significant rise in the use of these medications by teens and young adults over the past decade.
He also called out the myth perpetrated by Schwarz — that ADHD medications like Adderall and Ritalin work one way in people with ADHD, but in a different way in people without ADHD. This is not true, and you’d think a NY Times writer (or his editors) would catch that.
But I wonder — why do we find it surprising people make use of something that will improve their school (or work) performance? And is this a problem, or an enhancement we should all embrace?
First, let’s take care of the myth that stimulants magically work different in normal brains versus ADHD brains. As Herper quoted from a Neuropsychopharmacology study:
For years, it was assumed that stimulants had paradoxical calming effects in ADHD patients, whereas stimulating ‘normal’ individuals and producing locomotor activation in rats. It is now known that low doses of stimulants focus attention and improve executive function in both normal and ADHD subjects. Furthermore, the seminal work of Kuczenski and Segal showed that low, oral doses of methylphenidate reduce locomotor activity in rats as well.
Now, let’s put this use into some sort of perspective.
Adults consume copious amounts of caffeine in order to stay focused and increase their energy levels. Nobody blinks an eye at this sort of use. I suspect this is largely due to the fact that caffeine is a non-regulated ingredient (in everything except, ironically enough, alcoholic beverages).
In earlier times, this is one of the reasons people inhaled nicotine too. This ingredient was more regulated, but nobody ever thought, “Geez, Mary sure smokes a lot and gets good grades. It’s not fair that she uses cigarettes to keep her energy levels up so much!”
Yet when we turn to an ingredient that happens to be a prescription (for now; government can un-regulate drugs whenever they want), suddenly it becomes some sort of moral or ethical question. Is it right that people are using this particular ingredient to help a person be better at the things they try and do in their lives?
While at one time I would’ve said, “No, it’s not really fair,” I’ve come to rethink that position. I now believe it’s just as “fair” as ingesting any other ingredient into our bodies that will help our concentration, attention or energy levels.
The only difference is that, for now, these ingredients are still regulated as prescriptions, and carry a slightly higher risk than ingesting large amounts of caffeine (but likely a much lower risk that other things readily available, such as alcohol).
Are there long-term negative effects of taking a stimulant like Adderall? We don’t really know (studies like this one in the New England Journal of Medicine suggest there’s not much serious cardiovascular risk).
And we have to put any negative effects into perspective. Because research also demonstrates the negative effects of over-use of perfectly legal substances like caffeine, or if you’re at least 21, alcohol, to name just two.
Instead of decrying their use outright (ala Prohibition times), it might be more helpful to actually bring such use into a brighter light. If people stop hiding their use of stimulant medications, it may make it easier to monitor their use by a physician.
We need to get over our fear of the misuse of such medications and accept that their use will continue to grow. Because there’s little to stop their use in this unintended manner, to help a person’s cognitive performance.
Read the NY Times article: Seeking Academic Edge, Teenagers Abuse Stimulants
Read the Forbes article: The Questions About ADHD Drugs The New York Times Didn’t Ask