March 31st, 2014

Features | September 12th, 2011
Getting by or getting high
It's easy to forget that, for many, "study drugs" are part of every day life
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“I hate that people take ADHD medications to study,” Katie Ellston* says to me. We’re halfway through our first round of raspberry blondes at Brutopia. It’s the end of summer.

“I’d give a million dollars not to have to pop a pill every day” she says. And she begins telling me about a side of so-called “study drugs” that I had never quite stopped to consider.

The tale of the student who takes ADD/ADHD medication sans prescription is, to the modern day university student, a familiar one. Mythical student Alex (a friend of a friend, or a character in a news story) is a great student, but needs more time for studying, the soccer team, and partying. Alex finds there are meds that improve concentration and keep you up all night. (“Yeah, that’s exactly the type of person who drives me nuts,” says Ellston.)

Alex buys the medication, probably the short-acting Ritalin or Dexodrin, from a friend who has both ADHD and a prescription that provides them with more pills than they need. Alex has a few sweaty, red-eyed nights, but has plans to work at Goldman Sachs and live on Park Avenue. The drug will wash in and out of Alex’s system and leave not a trace.
We know this story by now. If you don’t take concentration meds, you know how to get them, and if you don’t know how to get them, go ask your friends. I’ll bet $5 that you can find a pill in the time it would take you to read this newspaper cover to cover. A recent editorial in the Canadian Medical Association Journal explains that an estimated 5 to 35 per cent of students abuse prescription stimulants. The editorial is titled “Time to address stimulant abuse on our campuses,” and calls for the de-normalization of their use.  The adults don’t think we’re alright.

But Ellston is not like Alex. During the school year, she takes a pill every day. She’s had a prescription for Concerta – Ritalin’s long-acting cousin – since she was diagnosed with ADHD at 15. “It’s a hardcore drug,” she says. She feels that people who take “study drugs” to try to get ahead in academics don’t understand that. When she goes across the border to the U.S., she can only take so much of the drug – one pill for every day she is traveling – with her and she has to be carrying a doctor’s note. Further, she feels that people taking the medications casually trivializes her illness, which is part of her everyday life.

Concerta, like the other medications commonly used to treat ADD/ADHD – or like caffeine, or cocaine – is a stimulant. That is, it increases the amount of dopamine in the user’s brain. With Concerta, Ellston experiences many of the physiological aspects of an addiction. On days during the school year when she does not take her medication – when she forgets or wakes up after 10 a.m. (if she takes it later than this she cannot fall asleep at night) – she experiences headaches, nausea, and slight depression, much like a cocaine user coming off a high or a coffee addict running too late for work to pop by Starbucks. During the summer, Ellston chooses to go off Concerta, and she has up to a week of nausea and depression. She refers to this period of time as “detox.” “Detox is hell,” she adds. She’s going to start taking Concerta again next week, she tells me, once classes start gearing up: “I’ll basically be high for a couple of days.”

Concerta produces the same effect in people with ADD/ADHD that it does for people without, though the improvement in concentration is more dramatic for people who have a clinically diagnosable difficulty concentrating. Scientists aren’t exactly sure how it works though. The literature is a string of “might”s, and “probably”s. The thinking goes that upping the amount of dopamine and norepinephrine in the brain – which ADD/ADHD medication does – improves concentration. People with ADD/ADHD may naturally have less of these neurotransmitters, the conventional wisdom goes, which is probably why taking Concerta can bring them up to the level of concentration that most people experience without the help of drugs.

All stimulants have the effect of improving concentration to some degree. Robert Franck, the Clinical Director of McGill Mental Health Service, says that, more than once, he’s had patients come in with concentration problems that turn out to be ADD/ADHD, and has realized that they have been unconsciously self-medicating by drinking tons of coffee. (“There are lots of reasons people drink coffee,” he says, when I, in a moment of hypochondria, mention that I drink tons of coffee.) Like Ellston, he doesn’t like the fact that students take medication for concentration without a prescription. Though the drugs are relatively safe, they come with a suite of risks and side effects, and their use should be carefully monitored by a health professional – one who knows what other drugs you’re on, too.

Hypertension, arrhythmias, and psychotic episodes are at the extreme end of bad things that can happen from taking ADD/ADHD medication. The CMAJ editorial rattles these off, and adds that, though rare, overdoses are “potentially lethal.” These are all true and valid reasons not to abuse ADD/ADHD medication, explains Franck, “But scare tactics don’t really work.” Further, it’s not just potential physical harm that makes him concerned about medication being used to study. Franck explains that taking drugs as a band-aid solution to, say, anxiety about not being able to complete all your assignments during finals, is to ignore other problems and to potentially mask clinical anxiety or depression. Franck’s motto is, “medication when necessary, but not necessarily medication.”

When Ellston was diagnosed with ADHD – a process of elimination of sorts – the medication was the last step of her treatment plan, and remains just one part of her regimen. In addition to taking the drug, Ellston sees a therapist every week. Through the Office for Students with Disabilities, she’s allowed four hours instead of three to complete exams, and a short break to walk around during an exam. She also gets to bring in a fidgeter – a small object like a koosh ball or a bean bag that she can play with.

She knows her own study habits incredibly well. She doesn’t work on any one assignment for more than half an hour at a time. “The information won’t stick if I try and make myself,” she says. She has a CD-case style binder with 100s of DVDs in her apartment; she loves unwinding in front of the television on Saturdays by watching Harry Potter film after Harry Potter film. “But, see, that takes a lot of concentration. So even when I’m watching movies, which I love, I’m also painting my nails, and checking my email, and texting. I’ll take breaks to just walk around my apartment.”

She describes the feeling of having ADHD like this: it’s like having 100 different thoughts going on in your head at once, popping around and soaring off on their own little orbits. “When I’m on the drugs, instead of 100 thoughts, I only have 50. And when one tries to go off on a tangent,” she says, moving her hand away from her head, “I can feel it being pulled back. It’s like it hits a wall.” It’s not that she’s not herself on the drug, it’s just that her thoughts behave in a different manner. “Being on the drugs is like running down a hallway, and not being on them is like running through a field.”

It’s odd, but the fact that these are prescription drugs with a medical use hadn’t quite settled in my mind before now. Perhaps it’s because of stories that have been popping up in the media over the past few years – each taking the tack that study drug abuse, like hooking up, smoking pot, or using the internet, is a new trend hitting the continent’s youth. Perhaps it’s because I went to a high school filled with overachievers who went on to universities that boasted as much of a problem with ADD/ADHD medication abuse as they did with any other drug. Though I’ve never taken Ritalin or Concerta, it’s never occurred to me that I should have any qualms about doing so – not even the basic concerns that come with smoking pot now and then. It’s not even treated like a recreational drug in the crowd I run with. It’s not done for fun – it’s done to achieve.

According to Alan Desantis at the University of Kentucky, I’m not alone. He’s spent the past handful of years facilitating interviews with hundreds of students, and has found that, for some, taking the medication sans prescription was less of a concern than drinking beer or smoking cigarettes. For some, ADD/ADHD medication doesn’t carry the same weight as party drugs. In his research he found that students use a number of arguments to justify their lax use of the medication, including that they only take it during finals, that they are self-medicating for concentration problems, and what Desantis refers to as the “I’m-doing-it-for-the-right-reasons” argument.

“No, they’re definitely a drug!” says George Bellwood*, a McGill student without ADHD who took Concerta about eight times last year. “Yes, eight, I think. I’m thinking about this in terms of the number of major assignments,” he says, counting on his fingers.

For Bellwood – who has also done cocaine, pot, and MDMA – the study drugs are a tool to be used during long nights of working that come free of particular health or moral concerns. Scare tactics referencing potential death do not work on him.
Concerta is long release, so it allows Bellwood to work overnight. He’ll drink two or three cups of coffee in the evening, settle into the Arts computer lab, and get to work on a paper. Around two a.m., when the coffee stops being enough, he’ll pop a pill. The metallic taste of the Concerta hits his tounge, and will stay there in his mouth for a while (“like licking iron,” he says). He’ll feel jittery, sweaty. His mind will feel clear, he explains, making a desk-clearing gesture with his hands. And then he’ll work.

He dispels my notion that these drugs offer a sort of trance. “Is it like kicking a soccer ball around for hours? That kind of focused?” I ask.
“Oh God no. You don’t lose track of time. You’re really aware of the next step.” He drums the table with his index fingers. “And you don’t want to be doing the work. You just are.”

He’ll continue in that robotic haze, one task, and then the next, and then the next. By four a.m., there are only two or three other students left, at least one of them asleep. “It’s so fucking bleak in that room, with those fluorescent lights.” The janitor comes in at seven, signaling that the rest of the world has moved onto the next day.

Bellwood plans on going to grad school when he’s done at McGill – he explains that for his field, history, he has to. (George also asked that his real major not be used). His normal facial expression is a sort of cheshire-cat grin, which makes him seem at once eager and carefree. He talks about history – citing paradigms and scholars – the way other people talk about TV shows. Last semester he got a 4.0, started a journal, edited a section of a campus newspaper, had a part-time job, and, though he insists his social life was cut in half, still went out every Saturday or so. “What, how to you do all that?” I ask him. “The drugs!” he says, his hands flying into the air. What is it that I thought I was interviewing him about?
The drugs are a prop he hopes he will cast aside when he’s finished hopping along the stepping stones to a successful future. But he can’t say when that will be. “When you’re in grad school? When you’re working an entry-level position?” He’s not sure, he just sort of knows that there will be a time in the future when the work will pay off, a spot in life where the things on his to-do list can be accomplished without him breaking out in a chemically induced sweat, accomplished with room left over for seven hours of sleep and a substantial social life.

Sitting in Franck’s office, I outlined Bellwood’s reasoning: wanting to go to grad school, wanting grades and extracurriculars to be a tangible currency he can exchange for a job after graduation, and knowing meds can help a person do more and do better. Shouldn’t we take a leg up in the world when we can? (In fact, this was before I first talked to Bellwood – these concerns are near-universal amongst a certain kind of high-achieving McGill student.)

“I would say, to those people, why do you feel you have to study so hard?”  Franck said. Wanting to get ahead in life does not necessitate medication – you can be organized and reasonable about what you take on. But it’s not just that: Franck thinks doing drugs to wend one’s way through undergrad amounts to cheating yourself out of the things that you actually enjoy in life. These are the things – whether coding, reading, playing soccer – at which you might end up being successful, the activities you love so much you can sit and do them for hours and lose track of time.

“That, that is the kind of attitude that I fucking hate,” says Bellwood, when I bring up Franck’s argument. “It’s actually really harmful, that kind of faux naïveté. ‘Why are you studying so hard?!’ Theoretically, this is the point of attending a university.”

This brings up a much larger reality about education, especially at a school like McGill: that it’s a dream world, of sorts, a strange pocket of society filled with bright people, 24-hour study facilities, 24-hour coffee shops, and an endless tunnel of hoops to jump through. There are small, flickering lights dotting the tunnel – if I can just pass this midterm, just make it through finals, just get my diploma – that make it seem like ad hoc solutions, like one more all-nighter, or two, or eight, could be enough. We’re judged by our peers, by the numbers that stare back at us from our transcripts, by the test score requirements on grad school information pamphlets. Perhaps most importantly, for Bellwood and for many of us, we’re here because of reasons that are genuine and innocent: because we love academia, because we want to grow up and be happy and prosperous. Doing well in academia can bring us those things, and drinking coffee and popping pills can bring us success in academia. It seems like such a simple transaction, like magic.

But, to Franck, to the adults, you have to learn to live within the constraints of the real world. Franck explains “university is a wonderful opportunity to develop understanding – not just academic, but how to feel good about yourself, how to manage time, and to develop coping strategies.”  By popping study drugs, Franck believes, you set yourself up in a lifestyle that is unsustainable and potentially soul-sucking, one that’s not based on doing the things that make you happy, but on the things that you feel society – or the job market, or your parents, or your peers – want out of you. Still, he sympathizes with the plight of the George Bellwoods of the world. He knows the heat of the floodlights turned on students these days. That’s why he thinks people like him – adults, and MDs – need to work harder to educate students about the perils of study drugs, and about ways to cope without the drugs.

Ellston agrees. She’s studying high school education. When on field experience (a sort of mandatory internship for education students), she’ll often have a child or two in her classroom with ADHD. She feels she can effectively teach these kids in a way that teachers without ADHD can’t. “They’ll do things like stand up in the middle of class and start walking around, and their teacher will say, ‘no, no, sit down,’” she explains. Instead of becoming frusturated and disciplining them, or singling them out, Ellston can empathize: “I’ll talk to them about it, and say, ‘if you need to stand up during class, stand up. I need to do that too sometimes.’”

She wants to teach for a few years, and then go into educational policy, where she will design curriculums, and play with the way the classroom is structured, making it a more friendly place for kids who have different learning styles, whether they are diagnosed with a disorder or not. She loves being able to do that.

*Names have been changed.

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