ADHD stimulants often abused by college students

This article discusses how stimulant use for ADHD is often abused by college students.

Nearly one in every five college students abuses prescription stimulants, according to a new survey sponsored by the Partnership for Drug-Free Kids. The survey also found that one in seven non-students of similar age also report abusing stimulant medications.

Young adults aged 18 to 25 report using the drugs to help them stay awake, study or improve their work or school performance. The most commonly abused stimulants are those typically prescribed for attention-deficit/hyperactivity disorder (ADHD), such as Adderall,Ritalin and Vyvanse, the survey found.

"The findings shed a new and surprising light on the young adult who is abusing prescription stimulants," said Sean Clarkin, director of strategy and program management for the Partnership for Drug-Free Kids. "While there is some 'recreational' abuse, the typical misuser is a male college student whose grade point average is only slightly lower than that of non-abusers, but who is juggling a very busy schedule that includes academics, work and an active social life."

Clarkin said the findings point to the need for parents and educators to increase their efforts to help young people develop effective time-management skills to balance academics, work and social activities.

"The profile that emerges is less that of an academic 'goof-off' who abuses prescription stimulants to make up for lost study time than a stressed out multitasker who is burning the candle at both ends and trying to keep up," Clarkin said.

The nationally representative study, conducted by independent researcher Whitman Insight Strategies, surveyed more than 1,600 young adults online this past summer, including approximately 1,000 college students.

Half of the students reported they took stimulant drugs to study or improve their academic performance, the survey noted. And, the survey found that two-thirds of those students believed the drugs helped them get a better grade or be more competitive at school or work. Around 40 percent took the drugs to stay awake. About a quarter of abusers said they took the stimulants to improve their work performance, according to the study.

These are the same reasons former user Linda Stafford said she began using the drugs.

Stafford began taking Adderall and Vyvanse without any prescriptions while she was a college student in Statesboro, Ga.

"I wanted to go to school, work and party, and Adderall helped me to focus pretty well at first," Stafford said. In reality, however, she said taking the stimulant did not change her test grades much. "Then," she said, "I got hooked."

Stafford began experiencing depression, paranoia and social anxiety and became unable to communicate even with her closest loved ones, she said.

"I was totally incapable of handling life," Stafford said. "I could not manage a simple job, my class assignments or relationships. Adderall was the center of my life."

Stafford has since been through recovery and uses a support network and support groups to manage, but her story is one that Miami University staff psychiatrist Dr. Josh Hersh has heard often.

"These survey findings have confirmed a lot of the things I have seen clinically," Hersh said. "Young adults are mainly using prescription stimulants to improve academic and work performance and to stay awake."

Although Hersh said some of the students taking these drugs may feel the invulnerability of youth, others are simply desperate to juggle everything even while they know the possible risks of taking the drugs, such as anxiety or panic attacks even with occasional use.

"The fact that students often use these drugs around deadlines, when their natural adrenaline is already high, elevates the risk even more," Hersh said. "Sporadic use can lead to severe sleep deprivation and cause stimulant-induced psychosis, when a student gets paranoid and may hallucinate."

He said snorting the pills can lead to internal nasal damage and regular use can lead to addictions that are destructive and difficult to treat.

Even young adults who are legally prescribed stimulants for specific health conditions can risk becoming more addicted, as happened to the son of Kathleen Dobbs, a retiree who co-founded the grass roots coalition Parent to Parent, Inc.

Her son was diagnosed with ADHD at age 8 and began taking Ritalin at age 10, but by high school doctors switched him to various other drugs before Dobbs requested no more prescriptions. By then, however, he was seeking out Ritalin from classmates and then moved on to cocaine to "feel normal," Dobbs said.

"Children with ADHD will do anything to fit in, to be able to learn and be like other kids," said Dobbs, adding that the addiction tore their family apart. "When you have a child who is addicted, it is like a bomb goes off in your home and everyone scatters. I prayed and did all the right things, but it creeps into your life and destroys your entire family and leaves you with pain and loss."

Her son is now married, sober and in ongoing recovery, but she recommends that parents remain vigilant and educate themselves about drugs, especially those their children are prescribed.

The survey found that 28 percent of people legally prescribed stimulants have exaggerated their symptoms to get a larger dose. The same percentage reported sharing their medicine with friends. Just over half the adults surveyed said stimulants were easy to obtain, usually from friends, and most said their friends abused them as well.

Red flags that parents can watch for in their children, Hersh said, include having dilated pupils, anxiety or manic behavior, talking about not sleeping for days and "crashing" when home from college, such as sleeping often and having difficulty concentrating.

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Lifelong changes in brain caused by early life stress

A study shows that stress during early life can cause lifelong effects on the brain.

For children, stress can go a long way. A little bit provides a platform for learning, adapting and coping. But a lot of it — chronic, toxic stress like poverty, neglect and physical abuse — can have lasting negative impacts.

A team of University of Wisconsin-Madison researchers recently showed these kinds of stressors, experienced in early life, might be changing the parts of developing children’s brains responsible for learning, memory and the processing of stress and emotion. These changes may be tied to negative impacts on behavior, health, employment and even the choice of romantic partners later in life.

The study, published in the journal Biological Psychiatry, could be important for public policy leaders, economists and epidemiologists, among others, says study lead author and recent UW Ph.D. graduate Jamie Hanson.

“We haven’t really understood why things that happen when you’re 2, 3, 4 years old stay with you and have a lasting impact,” says Seth Pollak, co-leader of the study and UW-Madison professor of psychology.

Yet, early life stress has been tied before to depression, anxiety, heart disease, cancer, and a lack of educational and employment success, says Pollak, who is also director of the UW Waisman Center’s Child Emotion Research Laboratory.

“Given how costly these early stressful experiences are for society … unless we understand what part of the brain is affected, we won’t be able to tailor something to do about it,” he says.

For the study, the team recruited 128 children around age 12 who had experienced either physical abuse, neglect early in life or came from low socioeconomic status households.

Researchers conducted extensive interviews with the children and their caregivers, documenting behavioral problems and their cumulative life stress. They also took images of the children’s brains, focusing on the hippocampus and amygdala, which are involved in emotion and stress processing. They were compared to similar children from middle-class households who had not been maltreated.

Hanson and the team outlined by hand each child’s hippocampus and amygdala and calculated their volumes. Both structures are very small, especially in children (the word amygdala is Greek for almond, reflecting its size and shape in adults), and Hanson and Pollak say the automated software measurements from other studies may be prone to error.

Indeed, their hand measurements found that children who experienced any of the three types of early life stress had smaller amygdalas than children who had not. Children from low socioeconomic status households and children who had been physically abused also had smaller hippocampal volumes. Putting the same images through automated software showed no effects.

Behavioral problems and increased cumulative life stress were also linked to smaller hippocampus and amygdala volumes.

Why early life stress may lead to smaller brain structures is unknown, says Hanson, now a postdoctoral researcher at Duke University’s Laboratory for NeuroGenetics, but a smaller hippocampus is a demonstrated risk factor for negative outcomes. The amygdala is much less understood and future work will focus on the significance of these volume changes.

“For me, it’s an important reminder that as a society we need to attend to the types of experiences children are having,” Pollak says. “We are shaping the people these individuals will become.”

But the findings, Hanson and Pollak say, are just markers for neurobiological change; a display of the robustness of the human brain, the flexibility of human biology. They aren’t a crystal ball to be used to see the future.

“Just because it’s in the brain doesn’t mean it’s destiny,” says Hanson.

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Adults with ADHD report childhood abuse

30% of adults who have ADHD reported that they also were abused as children.

Thirty percent of adults with Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder (ADD/ADHD) report they were physically abused before they turned 18. This compares to seven per cent of those without ADD/ADHD who were physically abused before 18. The results were in a study published in this week's onlineJournal of Aggression, Maltreatment, and Trauma.

"This strong association between abuse and ADD/ADHD was not explained by differences in demographic characteristics or other early adversities experienced by those who had been abused," says lead author Esme Fuller-Thomson, Professor and Sandra Rotman Chair at University of Toronto's Factor-Inwentash Faculty of Social Work. "Even after adjusting for different factors, those who reported being physically abused before age 18 had seven times the odds of ADD/ADHD."

Investigators examined a representative sample of 13,054 adults aged 18 and over in the 2005 Canadian Community Health Survey including 1,020 respondents who reported childhood physical abuse and 64 respondents who reported that they had been diagnosed by a health professional with either ADHD or ADD.

"Our data do not allow us to know the direction of the association. It is possible that the behaviors of children with ADD/ADHD increase parental stress and the likelihood of abuse," says co-author Rukshan Mehta, a graduate of the University of Toronto's Masters of Social Work program. "Alternatively, some new literature suggests early childhood abuse may result in and/or exacerbate the risk of ADD/ADHD."

According to co-author Angela Valeo from Ryerson University, "This study underlines the importance of ADD/ADHD as a marker of abuse. With 30 per cent of adults with ADD/ADHD reporting childhood abuse, it is important that health professionals working with children with these disorders screen them for physical abuse."

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