The Study Drug

They call her “Addy”, and she’s become known on college campuses as the steroid of academics. She’s frequently sold to students in libraries when they just need a boost to stay up late studying for their big exam the next morning. She’s requested at college health centers by students who answer “yes” to questions about distractibility and trouble concentrating. And then she’s blamed for students’ demise when they are carted off to jail after being discovered as controlled substance dealers.

Addy is Adderall, a well-known stimulant used in the treatment of attention deficit hyperactivity disorder (ADHD). While there are many other brands and types of stimulants—such as Ritalin, Concerta, and Vyvanse—Adderall seems to be the favorite of college students who are looking for an edge in a fiercely competitive academic world.

The problem? Stimulants are not candy, or smart drugs (as they’re often referred to), and on top of being controlled substances, they can have serious effects on those who are not meant to take them. Stimulants can raise blood pressure and heart rate and can cause severe moodiness and depression in those who do not have ADHD.

I bring this up because a recent segment on NBC’s Rock Center with Brian Williams caught my eye, featuring an ambitious Columbia University student who became caught up in the Addy craze. You can watch the video here.

As a psychiatric nurse practitioner student in the student health center on ASU’s downtown campus, I am keen to the many student requests for stimulants for their supposed ADHD that is affecting their school performance. Now, I want to make it clear that many of these students actually do have ADHD, and may not have been diagnosed before due to denial on the part of their parents. Or they have been successfully treated for years and just need to continue their treatment on campus. However, I suspect that there are many others who have heard about the wonder study drug and have been coached on what to say so that they can convince the provider (sometimes me) that they have diagnosable symptoms of ADHD.

The unfortunate reality, given the current state of our neurobiology advancements, is that we cannot diagnose ADHD definitively with any type of biological data. As psychiatric providers, we essentially conduct a comprehensive psychiatric interview with a thorough history, and then may supplement with an ADHD rating scale. But savvy college students—or any patients, for that matter—will know what they need to say and fill out on the rating scales in order to win an ADHD diagnosis.

So while there is no current way to diagnose ADHD with 100% accuracy and weed out every fraudulent request, it is advantageous to at least become more aware of college students’ (and others’) tactics, while also refreshing our knowledge on the DSM-IV-TR criteria for ADHD.

The symptomatology of ADHD is split up into two categories: inattention and hyperactivity/impulsivity. Patients can be diagnosed with either ADHD combined type (meeting full criteria in both categories), ADHD inattentive type (meeting inattention criteria only), or ADHD hyperactive-impulsive type (meeting the latter criteria only). Diagnosable criteria require the patient reporting at least 6 symptoms from either or both symptom categories.

There are a few key points here. First, symptoms must have persisted for at least 6 months. Also, symptoms must be causing interference in functioning in at least two areas of life, such as socially and academically. And finally, at least some symptoms must have been present before the age of 7. That is the kicker. While some patients may be savvy enough to know about this criterion, many will not, and this may be where we can really hone in on the critical assessment.

While I see a lot of ADHD complaints as a psychiatric provider, I am well aware that all nurse practitioners encounter these complaints in a variety of settings. My advice is to be vigilant of patients seeking a “smart drug” or “study drug”, and perform a comprehensive assessment guided by the current DSM-IV-TR every time. Your license and your patients’ well being depends on it. 

[photo credit]