Anna Adler, Jackie Liu, Diana Zuckerman, National Center for Health Research
Stimulant medications, such as Adderall or Ritalin, are prescribed to treat Attention Deficit Hyperactivity Disorder (ADHD), a brain disorder that makes it difficult to concentrate and increases impulsive behavior.  The goal is to help ADHD patients focus on activities that require attention and organization, such as homework. Some high school and college students who do not have ADHD will take stimulant medications without a prescription because they hope that taking these drugs will increase their focus and ability to concentrate.  However, taking stimulant drugs without a diagnosis of ADHD has risks and may not work in the way people think they do.
People who abuse Adderall and similar drugs by taking them without a prescription tend to have several characteristics in common. Many people who use them illegally are white, in college, and belong to a fraternity or sorority.  For instance, almost 5% of white college students reported misusing prescription stimulants in the past year compared to fewer than 2% of African American students.  Because these drugs are commonly used to help students who think it will improve their school work, abusers also tend to have lower GPAs.  This article will dive into these so-called “study drugs,” the reasons students take these medications without a prescription, and why they are risky.
Why Students Misuse These Drugs
Those who misuse prescription stimulants for academic purposes usually do so to help them stay awake, focused, and study before a big exam.  Unfortunately, stimulants do not make students “smarter.” They may help students focus and stay awake, but people should not expect the drugs to help with more complex learning such as writing better papers or studying for college-level exams. 
Some young adults misuse prescription stimulants because they claim that the medications make them more talkative, better company, and reduce social anxiety.  This is more common among middle school and high school students.  Although less common, some students also report taking stimulant drugs to experiment with getting high. 
Adderall and other stimulants reduce appetite, so they also can be misused as weight loss tools. Studies on the drug Adderall have found that women are much more likely than men to take the medication without a prescription because they are trying to lose weight.  However, taking these drugs to reduce appetite is unhealthy for a number of reasons, especially since the body will not get the nutrients that it needs and taking stimulant medications comes with serious risks.
What’s the Evidence that These Stimulants Are Effective Study Drugs?
Research indicates that Adderall does not live up to its reputation for boosting academic achievement, and may even inhibit a person’s ability to perform well. For example, a small study of 18-24 year old college students evaluated six commonly used tasks to test recall, attention, attitude, and comprehension when taking Adderall compared to taking a placebo.  The results indicated that   Adderall improved focus by decreasing the number of errors made on a test that measures attention and concentration by 10%. However, Adderall worsened students’ ability to recall a set of numbers by 7%; on average, students on Adderall remembered two fewer digits compared to placebo. This indicates that Adderall worsens the ability to remember information temporarily. Adderall had no significant effect on the ability to read or recall a story. Based on this small study, researchers concluded that Adderall probably does not improve academic performance. 
Why “Study Drug” Abuse Is a Problem
Taking medication should always be considered in terms of whether the benefits are likely to outweigh the risks. Since the benefits of stimulants as a study drug are questionable, understanding the risks is especially important. Every drug comes with risks, and Adderall and other stimulants have more risks than many other commonly used medications. When physicians prescribe a patient that has ADHD a drug like Adderall, they carefully weigh the risks against the benefits it provides. When given a prescription, patients are generally required to have yearly check-ups to make sure there are no complications from taking the medication. Obviously, when a person takes stimulant drugs without a prescription, they are not being monitored for side effects by a healthcare professional.
Students who abuse these stimulants often do not consider the risks of the drug either because they are not aware of them or they assume that, as an FDA-approved drug, there are no risks. The most common side effect of Adderall and other stimulants is insomnia, which appeals to students who use it to stay awake, but can affect judgment. There are many other less well-known side effects. In the manufacturer’s short-term study of Adderall’s safety and effectiveness on 258   adolescents with ADHD ages 13 to 17, they found that the drug caused anorexia or decreased appetite (36% on Adderall compared to 2% on placebo), insomnia (12% on Adderall and 4% on placebo), abdominal pain (11% on Adderall and 2% on placebo), and weight loss (9% on Adderall and 0% on placebo).  While these effects may seem minor for most young people, if a student has a heart condition, stimulant drugs can be deadly due to these side effects. In addition, prescribed stimulants can cause hallucinations, cardiac arrest, and depression, and these risks increase if Adderall is used without a prescription and at higher than recommended dosages, as often is the case among abusers.  For example, a study of 1,200 patients ages 17 and under with ADHD were followed for 3 years to study the effects of Ritalin. The study found that approximately 1% of the children developed arrhythmias or other potentially serious cardiovascular events, and these events were more likely in the first 3 days after starting Ritalin. 
In teenagers and middle school-age students, taking Adderall and other stimulant drugs have been shown to correlate with other risky behaviors.  A study examining the association of prescribed stimulants and other substance use found that middle school and high school students who had drunk alcohol six to eight times in the past month had a two times greater odds of taking stimulants not prescribed to them in the past year.  Additionally, students who had used marijuana three to five times in the past month were 1.9 times more likely to report misusing prescription stimulant medications.  Substance abuse among young people can lead to serious health issues, including heart disease, depression, and sleep disorders. 
Students who use stimulant drugs without a prescription are often unconcerned or do not understand the potential legal consequences. In addition, anyone with a prescription for Adderall or other stimulant drugs may believe that distributing the drug is legal or a minor infraction, similar to the widespread use of alcohol on campuses.  However, these drugs are Schedule II drugs, meaning the Drug Enforcement Agency has labeled them highly addictive.  The minimum sentence for distributing a Schedule II drug like Adderall is five years in prison.  Very few students are aware of this, and although it is not often enforced, it could be. 
Other Study Drugs
Adderall and Ritalin have been the most widely researched stimulant drugs because of their potential for dependence and because their widespread use is well known. However, there are other “study drugs” on the market that students also abuse. One such “study drug” is Modafinil. This drug is not a stimulant, but is intended to increase wakefulness and focus for those who take it. That is why it is usually prescribed to people with sleep disorders, such as narcolepsy, as well as overnight workers. Modafinil has also become an alternative option for the 10-30% of people with ADHD who do not respond to stimulant drugs, and has been shown to have less adverse effects than Adderall.  While there have been few reports of Modafinil dependence or overdose , there is a lack of evidence of benefits as well.  For example, although 1 in 5 students who take Modafinil without a prescription believe it will make them smarter, a study on language performance and control while on Modafinil compared to placebo found that, on average, students on Modafinil responded 14 seconds later to test prompts than those on the placebo. In addition, Modafinil did not improve responses in a test that asked students to fill in the blanks in sentences, as a way to measure cognitive flexibility. Modafinil did not improve their test scores. 
Another type of stimulant drug is Concerta. Concerta is very similar to Ritalin. However, while Ritalin has an immediate effect and must be taken several times a day to be effective, Concerta is slow acting, and will be released into the body over a period of time.  Both are controlled substances and students are known to misuse them. In 2015, 2% of 12th graders reported misusing either Ritalin or Concerta in the previous year. 
Since Adderall, Ritalin, or other stimulants are prescribed by doctors, people believe that they are safer than illegal drugs and may take these types of medications without a prescription. However, they can have negative side effects for those misusing them. Adderall and similar medications are important for people who need them for ADHD, but should be taken by prescription only, and only when monitored carefully by an appropriate healthcare professional. If students have serious attention issues, they should see a doctor for a medical diagnosis instead of asking a friend to illegally use Adderall or other prescription stimulants. At the very least, students need to be aware of the serious risks that can occur whether they are taking medication that does not belong to them or selling prescription stimulants illegally. Parents, health care professionals, counselors, and college administrators should be sure to include Adderall and other “study drugs” in any conversation about the dangers of substance abuse.
All articles on our website have been approved by Dr. Diana Zuckerman and other senior staff.
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