It's a delicate balance, the life of a college student. Too many classes. Too many exams. Too many pages to read. Too few hours in a day.
Trapped.
If an escape comes in a little pill, it may be hard to say no.
To a Miami University sophomore, Adderall use is nothing out of the ordinary.
"It's almost expected when you walk into King Library during finals that everyone is on Adderall," she said. "Everyone looks like zombies."
Sophomore John Siami said Adderall usage is fairly common.
"It's really, really common-like everyone does it," Siami said. "I have my own prescription, but I have a ton of people asking for it. During exam week, almost ten people a day will ask."
Siami, a pre-med zoology major, is diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). According to the National Institute on Drug Abuse (NIDA) 2005 Research Report Series on prescription drugs, Adderall is often prescribed to people like Siami to increase alertness, attention and energy.
Adderall is a dextroamphetamine that works to enhance the effect of neurotransmitters called monoamines. Stimulants such as Adderall increase blood pressure and heart rate, constrict blood vessels, increase blood glucose, open up the pathways of the respiratory system and increase dopamine levels, which may create a sense of euphoria.
When used under a physician's supervision, NIDA's research report states that stimulants are appropriate and helpful.
When used without a prescription to study for longer periods of time or to achieve a greater level of focus, serious dangers are possible.
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Dangers aside, said a Miami sophomore, Adderall has an addictive effect.
"Once one person takes it, soon others will follow to be able to keep up and compete," she said. "It's all about having an advantage."
Working against the clock
As a zoology and psychology double major, sophomore Jon Turpin said he doesn't have a lot of extra time on his hands. He said Adderall has helped him meet time demands.
"I've used Adderall when I have a lot of studying to do in a condensed amount of time," Turpin said.
He described his experience with mixed results.
"As far as use, for me, it's not like a caffeine rush," Turpin said. "It's not really that I'm so awake, it's like I'm really focused. I can read uninterrupted without being distracted for a lot more time."
Turpin said in one instance, he studied for four hours then proceeded to clean his room for three more. For Turpin, the high following Adderall usage lasts about eight hours, however the withdrawal can be even worse.
"It sounds stupid saying you have to be smart about taking a drug," Turpin said. "After the eight hours, as much help as it gave you, it hurts you that much more."
This withdrawal, Turpin said, includes exhaustion.
"For me, I'm really tired," Turpin said. "It's probably just the fact that I've been studying for eight hours. I don't want to do anything anymore. I want to go to bed. You are definitely exhausted after it, but with any kind of high, there is some amount of withdrawal after the fact. That's why coke users cry and alcoholics get hungover."
Turpin is not diagnosed with a learning disorder like Attention Deficit Disorder (ADD) or ADHD. A Miami sophomore said she has used Adderall in the past to help her study.
"The first time I tried it, I tweaked out in a calculus exam," she said. "My mind just went blank."
However, she said Adderall is helpful in completing long reading assignments.
"Teachers assign unreal amounts of reading," she said. "It always seems like everything falls on the same day. Especially when the reading is for a Miami Plan class that you have no interest in, Adderall is a stimulant so you are guaranteed not to fall asleep."
Anna Perkins, a sophomore diagnosed with ADD, said she feels that people underestimate the aftereffects of Adderall.
"A lot of people get it because they want it," Perkins said. "People take it to get A's, but they neglect the effect on the body. They don't think how it will hurt them."
While Perkins' diagnosis is not severe, she is hesitant to tell people about her prescription, because she said she does not wish to be hounded for pills nor does she feel a diagnosis of ADD is something people need to know about.
"It's not something I like to broadcast, just like if I took antidepressants," Perkins said. "You wouldn't ever hear a person be like, 'Hey, I just took Tylenol.'"
For people like Perkins and Siami who have prescriptions, being asked for pills is a constant nuisance.
One sophomore said she knows of several people who are willing to sell pills from their prescriptions.
"I have at least five people close to me who I have no problem asking," she said.
Turpin also said there was a high level of availability to students.
"As far as accessibility, it's extremely accessible," Turpin said. "It's when you really need it, you can't get it."
On a scale from one to ten, with ten being the easiest, Turpin said obtaining Adderall is usually a 10, but plunges to a three during busy times like exam week.
"I could get truckloads of it if I wanted it right now," Turpin said. "(During) exam week, people will pay six to nine bucks a pill, depending on what type or dosage of pill you are getting. Usually it's people buying it from their friends anyways."
Partying, not studying
According to Amelia M. Arria, deputy director of research at the Center for Substance Abuse Research, Adderall abuse by nonprescription users is nothing new.
"Attention to stimulant abuse has become common, but drugs such as Adderall have always been something students turn to to succeed," Arria said.
Arria, along with five other physicians and researchers, released a study in February 2008 titled, "Nonmedical Use of Prescription Stimulants Among College Students."
The study stated that, "Nonmedical users had significantly lower grade point averages in high school as compared with nonusers; in college they skipped classes more often, spent more time socializing, and spent less time studying."
Those who abuse Adderall also comprise a risk group for academic problems in college, according to the study.
More than 1,200 college students between the ages of 17-20 were sampled in the study, and prescription stimulants like Adderall were used at least once by 13.3 percent of the sample population for a nonmedical purpose.
Additionally, during the first year of college, students who used stimulants nonmedically at least once earned a significantly lower GPA than nonusers.
In general, the study found "being white, residing in fraternities or sororities, attending more competitive colleges and using other illicit drugs" to be linked with stimulant abuse.
To Arria, students who abuse Adderall do so in a misinformed manner.
"The biggest risk is the misperception and overconfidence which makes students think this will help them in the long run," Arria said. "They think this is a safe thing."
Studying the results of the study, Arria found little evidence that Adderall abuse was truly helpful to college students.
"Over time, we noticed decreased academic performance among users," Arria said. "Students engaged in other behaviors like drug use and skipping class used stimulants to stay awake longer or to drink more."
In the study, Arria and the other experts formulated conclusions as to why students resort to Adderall.
"One possible interpretation of these findings is that students who engage in nonmedical use of prescription stimulants could be using these drugs in a compensatory fashion to 'catch-up' with their studying because of the classes they missed as a result of drinking more or socializing more during the week," the study revealed.
The study continued to refute the idea that students who abuse Adderall do so with strictly academic motives. It explained that students who use Adderall are not simply preoccupied with academic achievement, rather they used prescription stimulants to make their few study hours more efficient due to significant time spent socializing. The study consistently emphasized that lower grades have been associated with nonmedical uses of Adderall.
Perkins said she is aware of students taking Adderall for reasons other than cramming in a study session.
"I've heard stories that girls will take Adderall to curb their appetite," Perkins said. "A bunch of guys call them 'party pills'. If you have pulled an all-nighter then take an Adderall, you can drink more and not get drowsy."
Turpin agreed that Adderall can be used for other purposes, but maintained that most users turn to it for studying purposes.
"I know one guy from high school who crushes them up and snorts them for a high," Turpin said. "Certainly there are people who abuse it as a drug, but with Adderall, I would say mostly people use it as a study aid."
Regardless of the reason for its usage, Arria said not enough information is available on how risky Adderall actually is without a prescription.
According to the NIDA "Research Update on Prescription Drug Abuse," high levels of availability and misperceptions about their safety make prescription drugs an easy candidate for abuse. NIDA also said that stimulants are incorrectly perceived as safe study and weight loss aids, are highly addictive and have potentially harmful effects such as high body temperature, seizures and cardiovascular complications. Other side effects include fatigue, depression, disturbance of sleep patterns, hostility, paranoia and irregular heartbeats.
Arria said she and her coworkers, along with NIDA, are working to increase awareness of the potential threats of stimulant abuse.
"We are trying to develop policies (for prescription regulation) based on evidence from research and conversations with physicians," Arria said. "We want to pass on the risks so people will understand what they are putting in their bodies. We don't want anyone else taken in by the myth that this will help them."
From a local perspective, Sgt. Jim Squance of the Oxford Police Department said the recently formed Directed Patrol Unit has been investigating all forms of drug use, including prescription pills like Adderall.
"I was quite a bit taken aback by the amount of Adderall we've found," Squance said. "We run across several instances of Adderall in addition to marijuana, other prescription drugs and mushrooms."
Squance said that tracking down illegal prescription drug users is not more difficult than other drugs.
"Adderall is no different," Squance said. "Most of the arrests we've made lately come from information from our patrol officers and undercover officers. When we get information, we execute a search warrant and take action."
After reviewing reports on recent arrests regarding illegal Adderall use, Squance expressed surprise.
"From the information I am receiving, it seems students are also mixing Adderall with energy drinks," Squance said. "It's an energy thing used for studying and exercising. It's very surprising."
Exploring other options
While Adderall can have serious consequences for those who take it without a prescription, it is important to point out that Adderall can positively affect those with learning disorders.
For Siami, Adderall is a backup plan for coping with his ADHD.
"Every year I try not to take it, but I always fall back on it," Siami said. "I exercise every day and when I feel like I can't do work, I lift for 30 minutes and then come back."
There are other options as well. Miami students like Siami who may suffer from various learning disorders can receive counseling help at the Bernard B. Rinella, Jr. Learning Center or Student Counseling Services.
According to Christina Carrubba-Whetstine, assistant director at the Rinella Learning Center, students can receive help developing alternate methods of organization without depending solely on medication.
"In general, we help with developing organizational skills, better time management skills and developing structure to get projects and papers done," Carrubba-Whetstine said.
Programs, such as academic coaching, work directly with students to keep them on track and help them stay accountable, Carrubba-Whetstine said.
"Many students once have struggled with their disabilities, but now know how to better manage their time," Carrubba-Whetstine said. "They can be very successful at Miami and later on in the workforce."
Turpin said he would agree that with appropriate time management, the need for Adderall would go down.
Carrubba-Whetstine explained if a medical prescription is needed, students can seek help from a psychiatrist at Student Counseling Services.
At the counseling center, learning disorders like ADHD are treated using the biopsychological model, which includes behavioral modification, environmental changes and medication as treatment options. If a prescription stimulant is given to students, medical evaluation and monthly appointments follow to ensure that the student is properly adjusting to and taking the drug.
To minimize abuse, lost prescriptions are not replaced by Student Counseling Services.
Perkins said her prescription can be refilled one a month with strict rules to ensure she is not overusing or misusing her prescription.
"We're always encouraging responsibility," Carrubba-Whetstine said. "We're not looking at a prescription as an easy way out, not a 'I take one pill and everything is miraculously changed' attitude."
Carrubba-Whetstine emphasized the legal implications of abusing stimulants in addition to the psychological and physical risks.
"For people who are not diagnosed, not only is it illegal to abuse a prescription but it's very dangerous," Carrubba-Whetstine said.
As Carrubba-Whetstine said, improving study skills and organization helped Siami, who is preparing to take the MCAT in May, fight his need for Adderall to succeed.
"I actually make better grades without it by starting to study two weeks ahead of time for my exams," Siami said. "I crashed and burned when I took it from the get-go. When I would resort back to Adderall as a means of an emergency, it became a bad habit that was not rewarding GPA-wise."