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Four years ago, a former director of the National Institute on Drug Abuse (NIDA), Dr. Robert Dupont, predicted the next wave of the addiction crisis would be stimulants. There were two main factors contributing to his prediction. First, is U.S. history: Dating back to the early 1900s, every heroin crisis has been followed by a stimulant crisis. Second, is the uptick in doctors prescribing stimulant medications for young people, such as Adderall, Concerta, Vyvanse, or Ritalin.
Unfortunately, it seems he was correct. Johns Hopkins reports that 18 to 25-year-olds comprise 60 percent of all non-medical stimulant use. 55 percent of stimulant prescriptions are written for people over the age of 19 who have been given a clinical diagnosis of ADD or ADHD. Two-thirds of young adults who have tried a stimulant without their own prescription are currently college students or recent graduates. In fact, most stimulant users – with or without a prescription – are college students and young professionals taking them for performance enhancement.
The pressure to perform
I evaluate many teenagers, college students, and young professionals, and most tell me the same thing: Everybody’s using stimulants. I can’t compete without it. I need it to stay up late and study and work the long, grueling hours required of me.
A recent survey by Harris Poll and Caron found that schoolwork is the leading cause of stress for teens, and 71 percent reported not feeling equipped to handle the extreme pressure they face in their lives. 63 percent say they feel pressure from social media to be competitive, and overwhelmingly teen respondents said their parents are the most significant source of external pressure. On college campuses, student health centers say anxiety is a top health condition. Today’s 24/7 culture has created unrealistic expectations and triggered a generation of students to seek substances to keep up.
The stimulant crisis is taking shape
Unfortunately, incorrect diagnoses of ADD or ADHD or a push to take medication unnecessarily, the accessibility of these drugs without a prescription, and a common lack of understanding of the addictive nature of stimulants is creating another public health crisis in America. There are individuals who truly have ADD or ADHD and they do benefit from a combination of medicine and therapy. However, many people taking these medications do NOT have these diagnoses. Just as with the opioid epidemic - it appears we are heading in the same direction with the current rate of prescribed stimulants.
Additionally, the overprescribing of stimulants has started to bolster the use of drugs like methamphetamine and cocaine. In its design, Ritalin is a methylphenidate, a stimulant that works on the brain like cocaine. Similarly, Adderall works like methamphetamine. I see this come full circle in my work: People who prefer Ritalin, prefer Cocaine; those who prefer Adderall, prefer methamphetamines. It’s very scary to see that the brain is not capable of distinguishing between the illicit drug versus the prescription drug.
An onslaught of incorrect diagnoses
Before a young person is diagnosed with ADD or ADHD and prescribed medication, I think it’s important to rule out other illnesses or conditions that could present with similar symptoms or lead an individual to seek stimulants for non-medical reasons. These are factors that must be taken into consideration:
- Marijuana use could be to blame. When a teenager begins to exhibit the symptoms of ADD or ADHD (such as inability to concentrate or focus), they should be drug tested for marijuana use. Marijuana can cause a sudden change in motivation, difficulty with concentration, and issues with impaired memory. I’ve learned from experience that the late onset of these “ADD or ADHD symptoms” almost always occur around the time the patient was first using marijuana. The American Psychiatric Association reports about 4 percent of American’s have this diagnosis, most often they are boys and usually they are diagnosed by the age of 7.
- It’s anxiety. The most common condition we see being mistakenly diagnosed as ADD or ADHD is severe anxiety. Going back to Caron’s poll that found teens are more likely to experience pressure from their family, school, and community, we know many experience anxiety on a regular basis. In fact, recent research shows that an increased number of teens now suffer from anxiety. A study published in June by the Journal of Developmental and Behavioral Pediatrics found a 20 percent increase in diagnoses of anxiety between 2007 and 2012.
- Whoever wrote their prescription isn’t trained to recognize ADD or ADHD. I’m concerned that most of the scripts for stimulants are written by family practice doctors and any other individual not trained in assessing ADD or ADHD. It’s a difficult diagnosis to make, and self-reporting is not enough to determine it. Using a Quantitative Electroencephalogram (QEEG) or brain map is one of the more effective ways, and that can only be done in a practice with the right equipment and professionals trained in using it. Too often, a student reports inability to concentrate and their family doctor prescribes a stimulant.
- Friends and family can’t make a diagnosis. Early experiences with stimulants often come from friends or loved ones. Word of mouth has led to misinformation that stimulants can improve one’s ability to compete at a high level without any negative consequences. Young people are seeking it out in different ways – whether people they know give it to them for free or they buy it. As a controlled substance, any way of obtaining or taking an addictive stimulant not prescribed and monitored by a trained physician is illegal.
These are not benign drugs – even for those with a valid prescription and diagnosis
ADD and ADHD do require treatment and support with coping strategies. However, medications like Ritalin and Adderall shouldn’t necessarily be the first choice for treatment. Whether you need it or not, the medications can cause seizures, heart disease, heart attacks, high blood pressure, interrupted sleep, and decreased appetite at first that can later lead to weight gain.
There are a range of other protocols for ADD and ADHD, such as behavioral interventions at home and in school which can be very successful. Unfortunately, we are not a society that readily accepts the need for lifestyle changes – we want a pill to make it all better. In some cases, that substance can do more harm than good.
The best approach is for families, schools, and communities to educate and support teens and young adults to have realistic expectations and not pursue achievement in a potentially dangerous way. By helping them develop strong coping skills and feel empowered to practice self-care – we can begin to shift the perfectionist paradigm and help them lead healthy and productive lives.