Students turning to legal stimulants for exam edge

Caffeine is no longer sufficient. ADHD drugs are being illegally used as study aids, says Rita de Brun

CAFFEINE was once the stimulant of choice for students to enhance concentration. Not any more. Cognition enhancing pills, most often prescription drugs for attention deficit hyperactivity disorder (ADHD), are the new study tool.

Sixteen per cent of US students and 10% of UK students say they use enhancers to boost academic performance, according to studies led by Cambridge University psychiatrist Professor Barbara Sahakian. It happens here too.

Cathal Ronan, a student welfare officer at the University of Limerick, and UCC student Brian Houlihan, say that while most undergraduates take coffee, caffeine tablets or the stimulant drinks, Red Bull and Monster, some use drugs as study aids.

“From what I hear, they use ADHD meds, but they do so in their own homes and never on campus,” says Cathal.

“I’ve heard they buy Ritalin and Adderall (stimulants prescribed for the treatment of ADHD) online, or source them from friends who have the condition,” says Brian.

Dr John Ball, spokesperson for the Irish College of General Practitioners (ICGP), says that Irish GPs do not know the extent of the use of cognitive-enhancing drugs in Ireland. “Given their age profile, students are more likely to purchase these medications online rather than attempt to convince a GP that they have ADHD.”

Packages sent from online pharmacies don’t always reach their intended destination. According to a spokesperson for the Irish Medicines Board, 150 Adderall pills, 980 Ritalin, and 214 Modafinil were seized by Irish customs officers and Gardaí in 2011.

Buying prescription drugs over the internet is risky. Many online pharmacies are run by criminals distributing drugs that contain banned or toxic substances. Also, it’s a criminal offence to have prescription drugs without a prescription.

Students are not shy about asking for enhancers at student welfare centres, says NUI Galway lecturer, Dr Stanislava Antonijevic-Elliott: “I know of medical professionals at these clinics who are increasingly fielding requests for ADHD drugs from normal, healthy students pretending to have the condition.”

This happens more often in the US. In 2011, it was reported that each semester 100 to 150 American students approach health services at the University of Wisconsin-Madison claiming to have ADHD, but only 1% have the condition.

Some students talk freely about their illicit drug use. Shortly before Christmas, a friend told Houlihan he was considering using drugs as a study aid. “He had problems with concentration and focus, and decided that Ritalin and Adderall (stimulants used to treat ADHD) might help,” says Houlihan. “He said he could source them from friends who had ADHD, or, alternatively, from [a particular] website.”

ADHD drugs are not designed to be used as study aids.

One Dublin-based student, who didn’t want to be named, said taking Ritalin as a brain booster can backfire. “I know of one guy who, under the influence of cognitive enhancers, spent the night before an exam fastidiously rearranging his music collection, and another who spent that vital study time meticulously overhauling his social network profiles. They didn’t realise that, before taking those drugs, you need to clear everything from your study space that might distract you from your goal.”

Brain-training is more effective than enhancers, NUI lecturer and partner at Mindscapes Health, Dr Stanislava Antonijevic-Elliott, says: “Those who take pills to achieve peak performance may feel some impact, but they lose that within six to eight hours. A brain-training method makes more sense. It teaches how to work under pressure, how to focus, how to become more efficient and how to switch off. It even teaches how not to fiddle on Facebook when you should be doing something else.”

American research shows that drug users are more likely to be male undergraduates at competitive colleges, to belong to a fraternity or a sorority, and to have a GPA of 3.0 (satisfactory or lower). They are ten times more likely to have smoked marijuana in the past year and 20 times more likely to have used cocaine.

Houlihan says many of the Irish students who take enhancers are smart, from good families, and would never smoke a joint: “They take them because they fear they won’t be able to live up to their parents’ expectations without them, and because they have no faith in their own ability to deliver good grades.”

Peer pressure plays a role.

“Students who have ADHD sometimes feel obliged to give their meds to friends who come saying they need it,” says Houlihan. “When they are asked for help, they don’t like to refuse.”

“This sort of thing shouldn’t happen but we know it does,” says Stephanie Mahony, co-founder of the family support group, HADD: “It’s not good for those who take drugs prescribed for others, and it’s not good for those with ADHD, who do without their medication so that someone who doesn’t need it can have it.”

Students can become dependent on these drugs. Richard Fee was a 24-year-old student when he became addicted to the ADHD drugs prescribed for him. When the American subsequently took his own life, former friends spoke of his habit of taking Adderall pills as study aids, and his family spoke of their belief that he never had ADHD.

The over-diagnosing of ADHD is a problem in America. A 2010 study reported that when diagnosing it, 20% of doctors did not follow the guidelines of the American Association of Pediatrics.

Students looking for ADHD medications for study would not acquire them so easily from Irish GPs. “Most would be fearful to prescribe Ritalin, and other drugs which might be used as cognitive enhancers, without first referring patients to a psychologist or a psychiatrist for further screening,” says Dr Ball.

Occasionally, doctors prescribe ADHD meds for surprising reasons. Cherokee County-based paediatrician, Dr Michael Anderson told a New York Times reporter that he prescribed them for healthy children who perform poorly in badly funded schools, to improve their grades. “We’ve decided, as a society, that it’s too expensive to modify the kids’ environment. So, we have to modify the kids,” he said.

When contacted by the Irish Examiner, Dr Anderson forwarded a paper he had written on the subject. The following extract clarifies his stance: “At some level, the ratio of students-to-teacher morphs a classroom into dysfunction. Apparently, this level already has been surpassed for many. Return more teachers to their classrooms and less of our children may find they have dysfunctions, and more of them will succeed in school without help from the pharmaceutical industry.”

In 2011, 38% of respondents to an anonymous poll, conducted by Newsnight and New Scientist magazine, said they had taken cognitive-enhancing drugs and 92% said they would do so again.

Although the long-term impact of enhancers is not known, they work: a study by the University of Cambridge and the Imperial College London showed that smart drugs enabled surgeons to perform better.

As to the ethicalness of students using enhancers, Oxford University neuroethics philosopher Dr Anders Sandberg, says: “I have argued that while they are ethical to use under some conditions, further investigation is required. Right now, we do not know whether they benefit the students who use them, or whether they have harmful side-effects.”

As to whether he advocates the use of enhancers, he says:

“Cognitive enhancers can perhaps help in the teaching of knowledge and skills, but they might also mess up the role of grading in education. What is a fair grade if some students enhance and others don’t?”