Using Prescription Medication For An Academic Edge

MS. DIANE REHM

11:06:53
Thanks for joining us. I'm Diane Rehm. Medications like Adderall and Ritalin are typically designed to treat Attention Deficit Hyperactivity Disorder, but students with no such problems are taking them for a competitive edge.

MS. DIANE REHM

11:07:10
Joining me in the studio to talk about medication abuse and how to curb it are Amelia Arria, director of the Center on Young Adult Health and Development at the University of Maryland, Dr. Robert Dupont, president of the Institute for Behavior and Health and Judith Warner, author of "We've Got Issues: Children and Parents in the Age of Medication."

MS. DIANE REHM

11:07:40
I'm sure many of you will want to weigh in. Do join us, 800-433-8850. Send us your email to drshow@wamu.org. Join us on Facebook or Twitter. Good morning and thank you for being here.

MS. AMELIA ARRIA

11:07:59
Good morning, Diane.

MS. JUDITH WARNER

11:08:00
Good morning.

DR. ROBERT DUPONT

11:08:00
Good morning.

REHM

11:08:01
Amelia, I'll start with you. There have been a lot of reports lately about widespread use of Adderall among high school and college students. First, tell us what Adderall is and what you are seeing.

ARRIA

11:08:20
Well, Adderall is in the class of drugs that is used to treat ADHD, like you said. There's also Ritalin and Concerta so it's not the only one. But among college students, what we see is about 10 percent of an incoming freshman class might have had experience with non-medically using Adderall, that is without a doctor's prescription or even overusing their own prescription.

ARRIA

11:08:51
So when we talk about whether or not it's widespread, whether you think one in ten is widespread is sort of a judgment call. One of the myths is that everyone is doing it and that's something that we want to dispel because it is fairly rare. But then when you look at college students in the middle of their career, it becomes one in five has tried to use one of these drugs non-medically.

ARRIA

11:09:20
And use is typically infrequent and sporadic. It's not something people do continuously, mainly around exam time or to stay awake longer to study or to party. And then cumulatively what we find is that about a third have had the opportunity, or two-thirds have had the opportunity to use a prescription stimulant non-medically and about a third end up using it.

REHM

11:09:50
Amelia Arria, she's director the Center on Young Adult Health and Development at the University of Maryland. Dr. Robert Dupont, it's good to see you again.

DUPONT

11:10:05
I'm delighted to be here, Diane.

REHM

11:10:08
Tell us the legitimate uses for drugs like Adderall.

DUPONT

11:10:13
Well, Adderall is an amphetamine. It's a brand of amphetamine and it's become extremely popular in the treatment of Attention Deficit Disorder, as you mentioned. The treatment of ADHD is a relatively new phenomenon, at least widespread treatment going back into the 1990s and increasing to the present and its use of stimulant drugs that have a long history of abuse, but particularly when they're used by young students, grade-school kind of kids.

DUPONT

11:10:51
You don't have any problem with non-medical use or abuse, but when it's used with high school and college and especially now increasingly with adults, there is a very substantial problem of abuse.

REHM

11:11:03
Tell me how it acts on the brain of a person who has been diagnosed as ADHD.

DUPONT

11:11:13
It's a stimulant...

REHM

11:11:14
Yes.

DUPONT

11:11:14
...that gets people's ability to organize themselves and to focus and, of course, it does those things to people who don't have ADHD as well so that it is, as Amelia was saying, there is a very substantial amount of non-medical use. So people who do not have ADHD, which is what the problem as Amelia was talking about, but it's about 5 percent of college students have their own prescription.

DUPONT

11:11:44
And there's very few people, I think, in this country, including myself, that don't have family members who have used these medicines to good effect. It's been a very positive development in the country to identify ADHD and to provide the treatment. There's no doubt about that.

REHM

11:12:03
Dr. Robert Dupont, he's president of the Institute for Behavior and Health. He's former director of the National Institute on Drug Abuse. Judith Warner, turning to you, how does the use of something like Adderall when it's not been prescribed for ADHD affect a young person, a college student, a high school student? Why are they taking it?

WARNER

11:12:41
Well, as Dr. Dupont said, the beneficial effects in terms of concentration, attention, duration of ability to study, let's say, can apply to someone who does not have ADHD as well as someone who does. From what I've been able to read, though, these effects are often pretty mild.

WARNER

11:13:02
Sometimes, in fact, there can be a paradoxical effect if someone without a prescription, let's say, is taking too high a dosage, as they very often are when they're abusing the medications in order to get the extreme effect and can actually decrease their academic performance.

WARNER

11:13:20
So there's a belief that these medications are perfectly benign, that it's fine to take them, that it's like having a lot of coffee or Diet Coke or in the past people smoked cigarettes to stay awake and to focus.

WARNER

11:13:35
And what's lost in all of that, first of all, is the ethical issue, the fact that these are controlled substances. But beyond that, the issue that these are serious medications, that when taken as medically prescribed can be extremely beneficial, but if abused, if taken without a prescription, can be very, very dangerous.

REHM

11:13:56
And addictive.

WARNER

11:13:57
And addictive.

REHM

11:13:59
I want to read for you all an email I received this morning. "Your second hour on Adderall hits home for me. My son got addicted and had to drop out of college. He's still struggling to find a way to handle the focusing and organizational issues. He's really smart, a great reader, but that Adderall gave him such an immediate high that he wanted more and more. It led to a serious depression issue with which he's still struggling."

REHM

11:14:45
"He's on medications for it and he has still not gone back to college." What do you make of that, Amelia?

ARRIA

11:14:54
Well, his story is unfortunate and one of the things that...

REHM

11:14:58
How common…

ARRIA

11:14:59
It's not as common to see the dependence arise on Adderall, but the most important thing about his story is that he probably was at risk for drug dependence. And what we find among people who non-medically use is that they have a history of excessive drinking and illicit drug disorders, particularly heavy use of marijuana.

REHM

11:15:22
So you're saying that the predisposition was already there, but is that always the case, Dr. Dupont?

DUPONT

11:15:30
Well, what we don't hear in that story is whether that son had a prescription or did not have a prescription and I think that makes a big difference. The way people get into trouble with it is when they take it in extreme doses.

DUPONT

11:15:42
They're not taking it the way it's prescribed. As long as they're taking it as it's prescribed, it's quite safe. It does not produce those negative things. But as I treat many people, including young people with substance abuse addiction problems, often times Adderall and other stimulants are gateway drugs into a serious drug addiction problem.

DUPONT

11:16:05
What happens, though, is that the people find they like the dose that they have either with prescribed or taking it from somebody else and then they take more and they take more. And they add other drugs to deal with the symptoms they have from those and that becomes a life-changing experience of addiction, which is a common picture for people with drug addiction problems that Adderall and these stimulants in adolescence were a gateway into a serious drug problem.

REHM

11:16:33
And, of course, the adolescence mind, brain, body, physique is not totally formed yet and therefore probably having a more difficult time absorbing all this. But the downside of what our emailer said is that having gotten off Adderall, her son is now totally depressed. How frequently does that happen? Judith.

WARNER

11:17:09
I guess the question is what's the start point of that story? Why did he start taking the Adderall in the first place?

REHM

11:17:16
Probably to focus, to do better in school, to get better grades which as I read it a great many of these young people are thinking that the Adderall and those stimulants are going to help them to do.

WARNER

11:17:36
Yes, but as Dr. Dupont and Amelia were saying, whether they do this because they've been diagnosed with ADHD and the stimulants are part of a plan of medical treatment, which hopefully involves some other kind of counseling or coaching, in addition as well or whether they're doing this in part out of a kind of magical thinking.

WARNER

11:17:55
They don't necessarily have ADHD, but are struggling, as all students do to some extent and think that this is going to help them, that it's going to change their lives or that it's going to be fun. I mean, it can be part of socializing as well.

WARNER

11:18:08
When you look at the studies that talk about who takes these drugs without a prescription and why, it's funny. It's correlated with being in a fraternity or a sorority so there are all kinds of odd reasons that go into the start of this use so that then when you look at the endpoint we hear of in this story, we don't know exactly why he started taking them in the first place, whether it was for medical reasons or whether it was for other reasons.

REHM

11:18:33
Judith Warner, she's the author of a book titled "We've Got Issues: Children and Parents in the Age of Medication." Short break here and your calls when we come back, stay with us.

REHM

11:20:05
And we're back, talking about the use of prescription drugs for non-prescribed reasons. For example, here's an email from Grace who says, "Please comment on high school students using Adderall before the SATs. I remember when I was a junior in high school a few years ago, this was a common occurrence which I did not participate in, but was frustrated about it because the unfair advantage it gave people, possibly resulting in better scholarships or entrance into better schools." How do you feel about that, Dr. Dupont?

DUPONT

11:20:56
I think that's a dangerous illusion and the idea that taking one of these drugs prior to taking an SAT test and you're going to do better is just -- there's no basis for that. And I doubt very much that if you did a study that you'd find any effect at all. It will definitely concentrate your mind. But how concentrated is your mind when you're taking an SAT test? I don't think so. And I think there's an illusion that these drugs are smart pills and they're going to make you do better on an SAT.

REHM

11:21:23
But somebody -- somebody has clearly passed on a rumor or an experience that says, look, I took this drug, I aced that test.

DUPONT

11:21:38
Yes.

REHM

11:21:38
It really made me do well. I mean, and that rumor gets started and people start looking at these drugs.

DUPONT

11:21:46
There are people like that, but there are nine others who were the other direction…

REHM

11:21:50
Okay.

DUPONT

11:21:50
...who didn't make it and you're not hearing those rumors from those folks.

REHM

11:21:53
Judith.

WARNER

11:21:53
I just think that those of us in the media have played such a big role in promulgating this rumor. It's been decades now that we've had headlines talking about stimulants as smart pills. Brother's little helper. Words like that which have enormous sway both with parents and with kids. And I think it's wonderful to be here today with these experts who can set the story straight. And I hope that people will listen to them.

REHM

11:22:21
What do you think about that, Amelia, kids taking Adderall before an SAT?

ARRIA

11:22:28
Well, I think Dr. Dupont is right. I think a lot of this is a placebo effect, and I think the stories are there that maybe a student did well on a test. But adolescents and young adults have a hard time connecting the dots between what they do and what happens. And so they may be making false connections between those things. But we have a lot of students who stopped using Adderall for that purpose, because they either experienced a negative physical consequence or realized it wasn't working.

DUPONT

11:23:01
It can give them the illusion that they've got all the right answers. And they're writing down all the wrong answers. It does -- Amelia's calling it a placebo effect. It does make them feel powerful. It makes them feel smart, there's no doubt about it. But there's no evidence it's going to make them get the right answers on those tests.

REHM

11:23:17
Here's an email from Jonathan who says, "For so many people to use Adderall, perhaps we should be looking at the societal stresses forcing people to turn to these types of drugs. Certainly from kindergarten on, kids are being told they've got to get into the best colleges. And if this talk of using these drugs is going to improve your grades right on up, kids are going to fall into it.

ARRIA

11:23:56
I think what's been lost in this discussion is that the way to better grades and the way to successful career and college is through hard work and spending your time doing constructive activities. And I think that adolescents have a hard time understanding that there is a wide variety of these substances to take and that they have been fed that this might be a sort of shortcut so they can have it all. They can have a partying social life.

ARRIA

11:24:26
They can, you know, do well in school you know if they take these drugs. They can skip class because they spent time partying the night before and this will help. But I think it's just become part of the variety of the drug landscape that is available.

DUPONT

11:24:41
Diane, when you look at the students in college who've used these drugs non-medically and compare them to the students who have not, the people who have used it have lower GPA not higher GPA. They'd skip class more, they study less. It's the exact opposite of a marker of smartness in school.

REHM

11:25:04
Tell me how these kids are getting these drugs, Judith.

WARNER

11:25:08
Most of them are getting them from their peers. Again, we're talking about the kids who don't have prescriptions. They're getting them from their peers, the majority are. I was amazed by the statistic that fully a quarter of the kids in college with prescriptions have at some point given them away or sold them away. Sold them. The thing that then stays with me and I wonder also is why are these kids who do have legitimate prescriptions who we can assume have ADHD, why are they sharing their medication?

WARNER

11:25:40
Why aren't they taking it? What's their relationship to their medication that leads them on some level to reject it or prefer to share it and why aren't they understanding that rather than helping their friends, they're potentially seriously harming them? Why hasn't that message been given to them strongly enough? Where are their parents? Where are the doctors in educating them about the responsibilities that they have both to themselves and to those around them?

REHM

11:26:07
How often do you believe parents know that their kids are using non-prescribed drugs?

WARNER

11:26:17
My guess is that they don't know. I mean, parents of kids in that age range generally don't know when the kids are doing something wrong. But I do think that there is a general climate in which it's believed by both parents and kids, in a very widespread way, that everyone is doing what they can to work the system and get a leg up. And that's how you succeed in life. It isn't hard work, it isn't following the rules, it's by playing the percentages, getting whatever advantage you can. Everyone else is doing it. If you don't do it, you're going to be left behind.

REHM

11:26:49
Are these brilliant students who are taking these drugs or are they poor grade students?

ARRIA

11:26:56
Like Dr. Dupont said, the research over and over again has shown that the people using these drugs non-medically are the ones who have lower GPAs and have a history of other alcohol and drug involvement that probably precipitated the declines in their GPAs. And so, this is a compensatory mechanism to try to make up for that and it usually does not work.

REHM

11:27:21
All right, we've got lots of callers. I'm going to open the phones, 800-433-8850. First to Miami, FL. Ivan, you're on the air.

IVAN

11:27:35
Good afternoon, Diane. Thank you for having me.

REHM

11:27:37
Certainly.

IVAN

11:27:39
I'm a very big fan of your show, even though I'm only 24 years old.

REHM

11:27:42
I'm glad.

IVAN

11:27:42
I'm actually a Florida International University student, and I do see it very often that I have friends and acquaintances that do take the drug. Not often. It’s not -- they do not abuse it, although if it's not prescribed to them, I guess they are abusing it. But basically, it is as simple as my friend who is prescribed the drug would like to have extra money and my other friend who isn't prescribed the drug simply has $20 to give away.

IVAN

11:28:10
For that simple arrangement one ends up -- one who isn't prescribed the drug ends up with it and the other one simply has to give away, you know, a third of what their dosage would be and they would still be fine. And that is the simplicity of how children and kids are getting it now a days. My basic thing is, now since it's such a grey area, what's the next step? How can we tell students and my peers that this is not a good idea?

IVAN

11:28:33
I also feel that it's an unfair advantage for these students. Like for me, because I have a friend who is in medical school and I personally believe that without his slight dependence on that drug he would not be getting passed most of those tests that he does get passed. So I'm kind of worried as to this could become an epidemic.

REHM

11:28:53
Amelia.

ARRIA

11:28:54
I think you've making great points. We see that the drugs are sold for kids to make money, especially in the later years. More often they're given away for free. So I think there is a harm to the person diverting it because they're not using it the way it's prescribed.

REHM

11:29:12
But, you know, Dr. Dupont, Ivan feels himself at a disadvantage because he's not taking those drugs.

DUPONT

11:29:22
And that feeling feeds the epidemic that he's worried about. Think how different that is than what Amelia and I were saying about the fact that it was the students with the poor GPA, not the one who got into medical school, the one who didn't get into medical school. And remember with Amelia saying this was tied up with the use of other drugs and alcohol, marijuana and other illegal drugs. The problem we have with this where people don't realize it's a felony to give away or sell drug, a prescribed controlled substance also apply to the opiates, to the analgesic drugs.

DUPONT

11:29:57
On college campuses and elsewhere, this is a larger -- this is a piece of a larger problem of prescription drug abuse that is becoming the defining drug problem in the United States right now.

REHM

11:30:09
And we're joined now by Doug Young. He is in Lower Merion, PA, which is a suburb of Philadelphia. He is the community outreach director for the Lower Merion School District. Good morning to you, Doug.

MR. DOUG YOUNG

11:30:29
Good morning, Diane. Thanks for having me on.

REHM

11:30:31
Certainly. Tell us how your district is addressing the use of Adderall and other prescription drugs in your schools.

YOUNG

11:30:43
Sure. Well, first of all, thanks for discussing this issue. It's, from our perspective, awareness is critical and we can have all the, you know, great programs in the world in the schools, but it's got to be part of a larger conversation. So we really appreciate the conversation today. Our focus, you know, is really prevention K-12. And if we're getting to a place where we're only discussing this at the high school level and we're only talking about Adderall, I think we're not, you know, seeing the big picture.

YOUNG

11:31:17
And, you know, we have used the kind of used the abuse of something like Adderall, you know, not as a one-off, but it's part of a larger set of issues around student health and wellness. So our programs look at, you know, supporting students K-12 and really supporting students holistically. When it comes specifically to Adderall at the high school level, you know, our curriculum certainly is a place where students are talking about these issues.

YOUNG

11:31:44
We have, you know, a number of parent programs as well. And, you know, we, at times, we are reacting and responding when we're hearing reports or when students are coming to the nurses office or when there's, you know, a concern by a student or a teacher in the school that there's a student who, you know, may be involved in, you know, the illicit use or the inappropriate use of a prescription drug.

YOUNG

11:32:12
And there's a whole series of things that would happen in that case. But it's, you know, everything from community programs to staff development to even policy. We revised our homework policy because of, you know, issues or concerns around student stress and the pressures that students were facing, you know, in taking, you know, whether it would be multiple AP classes or SAT preparation.

YOUNG

11:32:36
That, you know, there's just a set of really, you know, tough things that kids are going through outside of the academics. And, you know, there was a need to change our homework policy.

REHM

11:32:49
So what you've had to do, I gather, is to train your health staffers then to identify what may be going on with their kids.

YOUNG

11:33:05
No question. And our health staff has certainly seen a rise in the use of prescription meds and prescriptions for students in our schools. And subsequently, you know, they have gone through much more extensive training around issues that may be related to the use or misuse of those drugs.

REHM

11:33:26
I see. And you're listening to "The Diane Rehm Show." Doug, I gather, though, it's difficult to recognize when kids are actually using these drugs.

YOUNG

11:33:41
Yes, it is. And that's, you know, that's certainly, you know, an issue and a concern. And one of our strategies if there is a student or a staff member who may be concerned that this, you know, that is happening is there is, you know, an opportunity to anonymously, you know, basically put a note in a box and say, hey, you know, I'm concerned about my friend or I'm concerned about a student.

YOUNG

11:34:09
And that activates a process, a student assistance process at school. But you're right, I mean, in a lot of cases it may be difficult and it may manifest itself in different ways for different students.

REHM

11:34:24
Do you think that the young people themselves understand the consequences of giving or selling these pills to their friends as Dr. Dupont was saying earlier?

YOUNG

11:34:40
Mm-hmm. I think that there's an increasing awareness, but I certainly think that there is a, you know, there is a disconnect. And there is not a long-term view of how the drugs can impact, you know, health. You know, there was some discussion about the legality of selling these medications.

REHM

11:35:02
Sure, right.

YOUNG

11:35:06
But, no, I think that's one of the areas of concern that there is this disconnect, that there is this lack of awareness and understanding. And, you know, the programs in Lower Merion School District can, you know, we can attempt to address it. But if it's minimized, you know, in social settings as really an issue to worry about or if parents aren't responding aggressively to concerns, then, you know, it's perpetuated.

REHM

11:35:36
It sounds to me as though large assemblies of kids talking about this issue among themselves perhaps generated by a school superior would certainly help to bring out not only the dangers of these drugs but to address some of the stresses that the kids feel as though they are under.

YOUNG

11:36:14
Sure, sure. We've found that the best setting is not so much the large group setting, but rather the smaller health classes. And when you have, you know, 15 students in a room and you're, you know, you're talking about, you know, how students are accessing these drugs, they're talking about you know the pressures and the stresses of family and peers and culture and media. I mean, that's when kind of these conversations really become, you know, particularly poignant for our students and that's where our teachers and health staff have found the most impact.

REHM

11:36:52
Sure. Well, good luck to you, Doug.

YOUNG

11:36:59
Thanks so much.

REHM

11:37:00
Doug Young is the community outreach director for the Lower Merion School District. Thanks for joining us. And I want to, when we come back, talk about Doug's point with you Amelia. He said it can be kind of difficult to recognize that a kid is on these kinds of drugs. You shook your head at that, and I want to come back to it and your calls. Stay with us.

REHM

11:40:05
And going to you now, Amelia, Doug Young said that most of the time you cannot really tell when a young person is using these drugs. You were shaking your head during that.

ARRIA

11:40:20
Well, I think that rather than a school trying to figure out who's using and who's not using one of the approaches that we recommend is that when a student experiences a precipitous decline in their grades, not necessarily a benchmark like a 2.0, but a decline in their personal best like dropping a whole grade from one semester to the next. That should single an intensive assessment of what is going on in that kid's life. An individualized confidential assessment should reveal the use of this drug and other drugs.

REHM

11:41:00
And what about parents do they know that these kids are using the drugs?

ARRIA

11:41:06
I'm not sure about the high school level, but I know at the college level we have heard that parents turn a blind eye towards this particular type of drug use. And sometimes even facilitate the access of this drug.

REHM

11:41:20
Why?

ARRIA

11:41:21
Because they think -- they've sort of bought into the myth that it's going to help them succeed. And they want to try at all costs to help their child succeed. But what their student is not telling them is about why they're struggling academically. Why they're having concentration difficulties which may be related to their other drug use.

REHM

11:41:41
And of course, you've got even adults using drugs like Provigil to boost their energy to help them focus.

DUPONT

11:41:52
You know, one of the things, Diane, I think, is very important in this discussion is that a large percentage of people who are using these medicines are doing so responsibly and it's really helping them. And I'm concerned about the general direction of just focusing on the bad things about these drugs. They're often very good.

DUPONT

11:42:10
The issue has to do with whether they're taken under medical supervision where the doctor knows what's going on and they're used as directed where they can be very helpful. And once you get outside of that and you start taking it with other drugs, you don't have any medical supervision, you're using an entirely different dose. Often times with these drugs they're snorted or injected intravenously and at much higher doses. That's where the problem is. And that's why getting it in the channel of appropriate medical care is really important to using these drugs because they are useful and the problems they're treating are important.

REHM

11:42:44
And you were saying during the break, Dr. Dupont, that, you know, lots of people are using these and using them well.

DUPONT

11:42:55
Yes, and also there's a big problem -- Doug was talking about getting the kids together to talk about this. And most of the kids who are using them non-medically, as Amelia has said, are using it very infrequently and nothing bad happens to them. So they feed back into the peer group that it's perfectly safe.

DUPONT

11:43:13
What's missing from that picture is the smaller percentage who have dreadful problems, including major drug problems -- the kind of story we started out with in this program. And that -- we don't want to have that happen. That is what the problem is and the illusion that they're smart pills and that you can take them and nothing bad -- non-medically you can take them and nothing bad happens to you feeds this epidemic and the problems we're talking about.

REHM

11:43:39
All right, to Richmond, Va., good morning Matt.

MATT

11:43:43
Good morning, Diane. Your show is a breath of fresh air, thank you.

REHM

11:43:48
Thank you.

MATT

11:43:49
I didn't want to -- you sort of jumped on the wagon of talking only about the negative, as the guest had said a few minutes ago. But as a clinical social worker, I have noticed that it seems that a lot of times doctors will prescribe Adderall for children. And they'll do it as young as age two, three, four. And the reasoning behind it a lot of times is based on trying to qualify for disability and benefits like that. So I was just wondering -- I see that a lot in my practice and I was just wondering if the guests could comment on that aspect.

REHM

11:44:33
Judith.

WARNER

11:44:35
Once again, I think that the prescribing of stimulants or other psychotropic medications to very young children, two year olds, is something that exists -- didn't exist before and is very upsetting to people. But it isn't that frequent. And I do worry very much about this narrative of parents trying to get a leg up, trying to get this advantage or that advantage -- these social benefits or those.

WARNER

11:45:00
Once again, this is something happening in a sub population of people. This is not what's happening in your average family who's seeking out some sort of mental health care for their child. So I think we do have to guard against over generalizing from these situations.

REHM

11:45:18
All right, to Carmel, Ind., good morning, Chris.

CHRIS

11:45:23
Morning, Diane, thanks for calling.

REHM

11:45:24
Sure.

CHRIS

11:45:25
Once again, as a 42-year-old adult who's been on Adderall for two years, I agree with the doctor. Using Adderall is actually part of, like, seven or ten steps as far as treating ADD goes. There's usually a psychiatrist that gives you the medication. And they usually start you at a lower dose and build it up, a therapist that observes you and helps you develop proper behavior, diet, exercise.

CHRIS

11:45:47
And the biggest part is building structure in your life because people with ADD can usually join the military if they get of their medication because the military has structure. And for a lot of kids it's very important to have a therapist or a doctor monitor. Because I had heart issues and my blood pressure was going high and you really, really have to have the proper structure. And as I said, all the different parts to help you.

CHRIS

11:46:10
And I'm even on a downer where after I take the stimulant I do a 30 mg extended release in the morning and a 10 mg in the middle of the day, immediate release. At the end of the day I take fluvoxamine to bring me down. It -- they work. I mean I can feel it. I can tell a day that I didn't take the Adderall.

REHM

11:46:27
And I can hear it, Chris. Go ahead, Dr. Dupont.

DUPONT

11:46:30
Well, I think what Chris is saying is really important. And that is it's part of a larger approach.

REHM

11:46:34
Sure.

DUPONT

11:46:35
Not only from the therapist, but also Chris's work himself on this. It's clear that he is doing this in a responsible way with this professional help.

REHM

11:46:46
All right, to Louisville, Ky., good morning, Xelia.

XELIA

11:46:50
Oh, hi. Thanks, Diane, I love what you do.

REHM

11:46:54
Thank you.

XELIA

11:46:55
I just wanted to say that we were talking earlier about reducing and working with kids to reduce stress in high school so they don't feel they have to take Adderall and other drugs like that. But I was wondering -- so I think that might be a disconnect when they get to the collegiate level of learning. Again, undergraduate and post graduate, like, levels.

XELIA

11:47:17
Most of the people I know that are taking the MCAT and the Bar they -- the huge, huge, majority of them feel that they have to take Adderall and cocaine to even succeed. So I was wondering how that -- if we reduce their stress as high schoolers would prepare them for their college careers.

REHM

11:47:35
Amelia.

ARRIA

11:47:36
I think that it goes back to just good old fashioned time management skills, monitoring your, I guess, activities to fit in all that you have to do to prepare for college, to prepare for work, to prepare for your MCAT's. It's hard work.

REHM

11:47:56
And especially considering the fact that there are so few jobs out there.

ARRIA

11:48:02
Right, right.

REHM

11:48:03
And they're ending up with all this debt. So I understand the stress that these young people are under and the question becomes what can we do to reduce some of that stress so that these kids don't feel that need.

ARRIA

11:48:25
Once again, I do think there's a role for parents in promoting healthy attitudes and healthy behaviors. Healthy attitudes meaning you're not constantly, 22 hours a day, on a race towards success. That life has to have more than that in it. That relaxation has to play a role. That connection has to play a role. That there are various definitions of success. There's also research now showing that in terms of improving attention, concentration, performance, things like exercise, sleep, good nutrition.

REHM

11:48:58
Meditation.

ARRIA

11:48:59
Meditation are extremely important and meaningful. And we really have to fight back against this myth that these pills make you smarter, which they don't.

REHM

11:49:09
Here's an email from Susan in Yuma, Ariz. She says, "Why are ADHD kids sharing their meds? As a parent of an ADHD kid, I can give you two reasons. First, impulsivity is a symptom of ADHD. Given the opportunity for monetary gain why wouldn't an impulsive kid sell his meds? Second, ADHD kids have trouble making and keeping friends. So, I think they are giving it away to make other people like them." Judith.

WARNER

11:49:55
I think -- it makes me very sad to hear that. That strikes me as a perfectly plausible explanation.

REHM

11:50:01
Yeah.

WARNER

11:50:02
Certainly, once again, you have to think about the kids' relationship to their medication. What I've heard many times from teenagers, young adults often who reject their medication is that they didn't feel that they were involved adequately in the process in the first place of getting a prescription, of having their problems addressed.

WARNER

11:50:24
There are some, not all, but there are some who feel that they, sort of, had it shoved down their throat. That they were put in a box and these medicines were used to control their behaviors. And when they get to the point where they have their adolescent rebellion the first thing to go is the medication. I'm not saying all kids feel this way, but I think that there is a population who do feel this way.

WARNER

11:50:45
And I think that really raises issues, again, for parenting and also in how doctors communicate with kids. And how ADHD is explained to kids in the first place, how the medication is explained to them and how much agency they're given in the whole process of dealing with their ADHD.

REHM

11:51:01
Amelia, you ran a study focusing on college students. Tell us what you found.

ARRIA

11:51:08
For the ADHD, we followed a large cohort of 1,200 students over time. And now they're in their post-college years. So we've been studying their behaviors. And among the ADHD positive kids, which comprised about five percent of our sample, we found that almost two thirds diverted their medication. And, actually, one of the hypotheses was that they're trying to make friends and they're trying to share and be nice.

ARRIA

11:51:37
And what we found when we looked at a whole host of variables is that the number one predictor of diversion was actually what the caller was saying that it was more related to the impulsivity and the conduct problems that these kids have. It wasn't related to being helpful. I think we did not look at whether or not they felt like it was going to increase their friendships. I think that's a really interesting thing. But it's much more related to deviance than it is to helpfulness.

REHM

11:52:10
Okay, so if the drug enforcement agency classifies these in the same category as cocaine and heroin, are there any criminal charges being brought against these kids for selling or passing?

YOUNG

11:52:32
There's two problems there. That's exactly right, but they're also -- most of these kids have never been told that it's wrong. That it's illegal. The doctors don't tell them that. The school administrators don't tell them. The parents don't tell them.

REHM

11:52:46
Well, somebody ought to tell them.

YOUNG

11:52:47
Well, that's...

REHM

11:52:49
Well, you just told them.

YOUNG

11:52:49
Well, everybody who's listening to this program, I hope, is going to do it.

REHM

11:52:52
Yeah.

YOUNG

11:52:52
But in addition to that, there has to be a consequence. And you talk about the criminal consequence. There needs to be something so that the kids know that it's not just something casual. This is a very serious matter and that's a big change we're going to go through in this country.

REHM

11:53:08
And you're listening to "The Diane Rehm Show." To Houston, Texas, Pasqual, you're on the air.

PASQUAL

11:53:16
Yes, good morning. I have a question, actually, related to the -- that ADD and -- is there a link between what the kids eat today and the ADD? Any research on that that can prove that probably what we eat has an influence on the way we behave?

REHM

11:53:35
Dr. Dupont, there's been a lot of research on that.

DUPONT

11:53:39
Yes, well, because it's become so common. And it was so uncommon before. People are looking at that. I think it had to do with we didn't know about it. We didn't know what to do about it before. I do not think there's any evidence that what we eat has anything to do with it.

REHM

11:53:53
Here is an email from Justin who says, "Is there an alternative to Adderall that can still get people that intense focus? I was a prescribed Adderall user in college. Not taking it anymore, but I still occasionally crave the high and the intense focus from it."

ARRIA

11:54:20
Dr. Dupont has a lot of experience and he's taught me a lot about a drug named Concerta, which is a different form, a less abusable form that doesn't necessarily give a person the immediate reaction that Adderall does.

DUPONT

11:54:36
And there's another drug called Strattera which is not a stimulant that is used to treat ADHD. And that's something that can be tried also.

REHM

11:54:42
But does it give that focus...

DUPONT

11:54:45
No, Strattera -- not so dramatic, but it's been shown to be very effective in treating ADHD and it ought to be included on this. But the word was used as high. That's not part of the treatment of ADHD.

REHM

11:54:56
Yeah, what about...

DUPONT

11:54:57
And when somebody who talks about that you're worried about where that's going.

REHM

11:55:00
What about Provigil? What does that do?

DUPONT

11:55:03
It's a -- has a very similar affect to the stimulant drugs. I think that...

REHM

11:55:08
To the Adderall?

DUPONT

11:55:08
To the Adderall and the Ritalin. Ritalin is methylphenidate and Adderall is amphetamine and it's a synthetic drug that has very similar properties in terms of stimulant effects.

REHM

11:55:20
Wow, all right. Let's take one last call to Annie in Ann Arbor, Mich. Thanks for waiting.

ANNIE

11:55:28
Yeah, hi, thanks for taking my call.

REHM

11:55:30
Sure.

ANNIE

11:55:31
First of all, about the diversion I would just add that a lot of the people who I know who've been prescribed these drugs are told by their doctors that they don't have to take them every day. That they can take them on an as needed basis, but are still prescribed a daily dose. And so I think a lot of kids are running around with extra.

ANNIE

11:55:48
But my primary question is I'm now a graduate student at a major university and the psychiatrist here prescribed me Adderall based on her assessment that if I tried it and responded well to it that would mean that I did have ADD, that it was essentially diagnostic if I took the Adderall and was able to concentrate, which I knew had happened because I'd taken it throughout college. But this was then confirmed by two separate therapists and social workers who I've seen. And I just can't believe that that's true given the number of people who I know who take these drugs.

REHM

11:56:24
All right, very quickly, Amelia.

ARRIA

11:56:26
I think she makes excellent points. That's exactly what we've seen in terms of the diversion. And I think that that's what we've heard in terms of the doctors prescribing it on an as needed basis and, like she said, that it's, sort of -- that's how you can diagnose a person whether or not they respond. I don't know whether that's good or bad medical practice, Dr. Dupont.

REHM

11:56:47
But it's also a reason why they have so many extra pills.

ARRIA

11:56:53
Yes.

REHM

11:56:54
What an important discussion. Thank you so much and hopefully supervisors, teachers, parents will heed what you've all said. Amelia Arria, Dr. Robert Dupont, Judith Warner. Thanks again.

DUPONT

11:57:14
Thank you, Diane.

WARNER

11:57:16
Thank you.

REHM

11:57:17
And thanks for listening all. I'm Diane Rehm.

ANNOUNCER

11:57:20
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