Do Ritalin and Adderall Make the Grade?

A recent op-ed article in the New York Times brought to the forefront an important and often under-discussed topic, medicating children for attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD).

Several months ago CNN reported on the off-label use of medications normally prescribed for ADD or ADHD as “study drugs” in college. Furthermore, as the number of prescriptions of Ritalin or Adderall continues to increase, people are becoming concerned about the long-term side effects of these drugs, something the FDA has not tested.

Others are concerned that we, as a society, are medicating for what is normal childhood behavior.

Pharmacology

Ritalin, otherwise known as methylphenidate, has a very similar chemical structure to amphetamines, but the body tends to respond to it in a way that is more similar to low-dosage cocaine.

Both Ritalin and cocaine affect the dopamine receptors in the brain, but Ritalin is less addictive than cocaine, mainly because it is ingested rather than snorted or injected.

Adderall is a combination of two amphetamine salts. The body responds to Adderall as it would to any amphetamine. Like Ritalin, Adderall affects the dopamine and norepinephrine receptors in the brain. Some children no longer respond to Ritalin, so they will often be put on Adderall, which is thought to be a stronger drug in lower dosages.

Adderall is only legal in the U.S. and Canada. The NCAA has ruled that amphetamines, including Adderall (a Schedule II drug), are not permitted, and recently reported on the prevalence of the illegitimate use of stimulants on college campuses.

Several pharmacological issues are cause for concern.

First, Ritalin and Adderall will cause anyone to be able to focus better and pay attention. They are, therefore, not specifically addressing the underlying causes of ADHD or ADD, if they have the same effects on everyone. Also, if a person stops taking the drugs, then symptoms reappear at similar levels as before (unless cognitive or neurofeedback therapy is coupled with the use of stimulants). This means the drugs themselves are not efficacious in treating the underlying problem; they are merely masking the symptoms.

Lastly, the appropriate dosage of Ritalin or Adderall is determined by behavioral responses even though, at least in the case of ADHD, this is a neurological issue. Behavior is a much more subjective criterion and may change based on environmental factors.

The New York Times article points out that there is no statistical correlation between better academic performance and the use of Ritalin in children. Furthermore, the effects of Ritalin tend to decrease over time:

Attention-deficit drugs increase concentration in the short term, which is why they work so well for college students cramming for exams. But when given to children over long periods of time, they neither improve school achievement nor reduce behavior problems. The drugs can also have serious side effects, including stunting growth.

While college students say that pscyhostimulants help them concentrate and perform better in school, the correlation between good performance and Ritalin and Adderall use is sketchy. Reportedly, students who party more and blow off most of the semester are more likely to take Ritalin or Adderall to help them get through finals. However, there is no indication that their performance is significantly better than if they had just crammed for finals, and there are several indicators that they would have performed significantly better had they actually gone to class and studied throughout the semester.

One student talked to me about his experience after taking one of his friend’s “ADD drugs.”  He said that he took them the night before a calculus test to help him study. He ended up spending several hours that night trying over and over to work this one calculus problem that he apparently could not do. He described it as obsessing over this one problem and not being able to move on from it. Obviously, this is not conducive to good study skills. Knowing when to cut a problem loose and move on is just as important in test-taking and succeeding in school as knowing how to bull through a difficult problem. Unfortunately, that important life lesson is lost in the stimulant-induced state.

From Recreation to Enhancement

For many years, the most commonly abused drugs were deemed “recreational drugs.” Drugs like Ecstasy, LSD, and marijuana were used for escaping.

Now, drugs are used more often for performance enhancement. The athlete and the nerd (and everyone in between) have a lot more in common than one may think. Anabolic steroids and amphetamines are both performance-enhancing drugs that people take to help them be someone or something that they want to be. Oftentimes, these drugs are a way to shirk one’s physical limitations and go beyond what he or she was designed to do. In The Case against Perfection, Michael Sandel, former member of President Bush’s Council on Bioethics, states:

. . . the debate over Ritalin reveals the cultural distance we have traveled since the debate over drugs (such as marijuana and LSD) a generation ago. Unlike the drugs of the sixties and seventies, Ritalin and Adderall are not for checking out but for buckling down, not for beholding the world and taking it in, but in molding the world and fitting in. We used to speak of nonmedical drug use as “recreational.” That term no longer applies. The steroids and stimulants that figure in the enhancement debate are not a source of recreation but a bid for compliance, a way of answering a competitive society’s demand to improve our performance and perfect our nature. This demand for performance and perfection animates the impulse to rail against the given. It is the deepest source of the moral trouble with enhancement.(1)

To put this in a larger context, Carl Elliot, in his book Better than Well: American Medicine Meets the American Dream, says that Americans are in the business of identity-crafting, and the enhancement choices they make are all about crafting an identity in hopes of finding some kind of odd form of happiness or fulfillment. His thesis ties everything from sex-change-surgery to enhancement to real estate together in an effort to describe a culture that lives by the notion that happiness is found in being the smartest, fastest, and best.

The college student is hardly doing himself a favor by taking psychostimulants. College graduates are a dime a dozen, and information is cheap. No longer are companies looking for people who can memorize a bunch of facts in an insomnia-induced state. They are looking for creativity, productivity, and resourcefulness. The advent of Google means that the facts are readily available. As Sroufe points out in the New York Times article:

Stimulants generally have the same effects for all children and adults. They enhance the ability to concentrate, especially on tasks that are not inherently interesting or when one is fatigued or bored, but they don’t improve broader learning abilities. . . . To date, no study has found any long-term benefit of attention-deficit medication on academic performance, peer relationships or behavior problems, the very things we would most want to improve.

What companies need is someone who is able to sift through the wheat and the chaff in order to present solutions to complex problems. They are looking for creativity and innovation.

Unfortunately, the college graduates who took stimulants to perform well in college come out of school knowing when to take a pill and how to store just enough facts in their short-term memories to pass the next test.

See also: Human Nature Watch 6: Ritalin Gone Wrong

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(1) Michael J. Sandel, The Case against Perfection (Harvard UP, 2007); pp. 60–61.