Some consider it the academic equivalent of performance-enhancing sports steroids; to others, it’s just a mental booster on par with a large jolt of caffeine. Adderall, legally prescribed for patients with attention deficit disorders, is more commonly found on college campuses not with prescription holders, but with an increasing number of healthy students who use the medicine as a “study drug” to boost focus and energy while studying.

Many students are fully aware that using another person’s prescription is a crime, but apart from that, abusing cognitive stimulants like Adderall and Ritalin carries little negative stigma because of their FDA approval and their widespread presence on campus. These qualities, in turn, make obtaining the drugs a simple task and make enforcing their abuse extremely difficult.

At Stanford, rising rates of Adderall abuse are beginning to raise troubling questions: what makes a student likely to use study drugs, and could it be considered cheating when used as an academic enhancer?

A Growing Concern

Surveys on study drugs in college have failed to come to a consensus about an average rate of use, with results running the gamut from two percent to 34 percent of students having ever used cognitive stimulants without a prescription. While inconclusive, the results have certainly been considered at Stanford.

A University of Kentucky study of 1600 students found that more than A-students aiming for A-plusses, most of the users were C-students avoiding Ds, said law Prof. Hank Greely. To him, that means that an academically driven school like Stanford might be less likely to have as many users.

“To get here, you have to be smart, but you also have to have your act together,” Greely said. “It’s not to say there isn’t anyone here like that, but it’s a consideration.”

“We don’t necessarily have a very good handle on use at Stanford,” said Ralph Castro, director of the Substance Abuse Prevention program at Vaden Health Center.

In 2008, Vaden’s general health survey included a question on study drugs: “Have you ever used a stimulant medication to enhance academic performance?” According to Castro, only about two or three percent of responses said yes, but he said the return was lower than the accurate count.

“Some students also use drugs like Adderall just to get high, so they may not have answered,” he said. “I think the number we got was a little small, but I also don’t think it’s as rampant as some people fear. It’s not 20 percent, like some surveys are reporting.”

Greely, who specializes in the ethics of enhancements, has attracted widespread attention for his published journal articles and other interviews in which he defends prescribed use of cognitive enhancers against negative social stigma.

“There’s nothing inherently wrong with cognitive enhancement through drugs or other methods,” he said. “I’m a teacher; my job is cognitive enhancement. Caffeine is a cognitive enhancement. I don’t think there’s anything special about enhancing with drugs that makes it morally different.”

Greely does concede, however, that the same flexibility cannot apply to illegal use of Adderall by students without prescriptions. But, he said, despite the illegal nature of Adderall abuse, rates have been growing quickly because of high availability on American campuses — where, he says, prescriptions of Adderall are eight or nine times as common as prescriptions of Ritalin, and much more widely available than other, perhaps safer, mental stimulants.

He pointed out that in the University of Kentucky study, use was incredibly widespread: four percent had a prescription, and 34 percent had used it. In juniors and seniors, the use rate was over half; in fraternity and sorority members, over 70 percent of surveyed students said they’d ever used Adderall.

“I don’t think anyone is going out and meeting dealers in dark corners,” Greely said. “It’s being used because there are so many pills on campus legally.”

Student Perspectives

(All student names have been changed to grant anonymity for a legally sensitive subject.)

“It is about the pressure,” said Jason, a junior Earth Systems major, who uses Adderall on a regular basis. “It’s about catching up with other students. I don’t feel like I can study as much as other Stanford students do.”

Jason said he uses about three or four times a quarter — usually to finish schoolwork in one block and to prepare for midterms and finals.

“I’m sure to leave two weeks between each time I use it because I know it can be addictive,” he said. “I know I’m walking a thin line because I see the very real possibility that I can only do work while using it.”

Jason, who has been using Adderall without a prescription since junior year of high school, used to find it at high school for five dollars a pill. Now, he says, his younger sister has a prescription, and he takes part of her dosage.

“When I’m planning to take Adderall, I schedule it,” he said. “I’ll wait for a Sunday when I’m free from obligations, and set aside 12 hours and take 30 milligrams.”

When he’s taking it, he said, he makes “tons of lists” and spends the first couple hours orienting himself, then focuses for hours on a specific project or task, although he can sometimes “get sidetracked.”
“Mostly, it makes you love the work — the feeling of accomplishment is incredible,” he said, and he considers it an important part of his study schedule. “I don’t think I’d be where I am without it,” he added.

For Jessica, a sophomore English major, Adderall was something she and her friends experimented with in high school, “mostly for the fun of doing something against the rules, rather than for studying. But [at Stanford], I know a bunch of people who take it mostly to stay up all night.”

Since coming to Stanford, Jessica has only used Adderall once, during last quarter’s finals, but the experience was “not a positive thing.”

“I had already been up for a long time, and I took one in the morning to stay awake,” she said. “I stayed up, but I was already stressed and it backfired.”

For her, the physical side effects outweighed any kind of academic help the drug gave her.

“I was expecting brilliance, and instead, I wrote the worst paper I’ve written in a long time,” she said. “I got work done, sure, but it was at the expense of feeling good.”

While many of the students who use Adderall do so to increase focus and attention for academic purposes, the drug’s chemical similarities to speed and other amphetamines have also led to some students using it for recreational use.

“A friend of mine from [Arizona State University] brought some to a party on campus, and we crushed it and snorted some,” said Peter, a senior English major. “It was an immediate high — like I could do anything or go on a crazy adventure.”

For Peter, who has only used Adderall for recreational purposes, the stigma against using it for academic purposes is low — and he claims use is “pretty common.”

“Of the fifty or so guys in my [fraternity] house, I’d say the number of users is under 10,” he said. “It’s a pretty common college thing, especially at somewhere like Stanford where we have a lot of work to do and the mentality is pretty easygoing about doing drugs in general.”

Health Considerations

“Study drugs are very powerful stimulants, Adderall especially,” Castro said. “It’s an amphetamine mix, which works similarly to cocaine and affects the midbrain like other methamphetamines. It has the potential to be highly addictive over a period of time.”

Although Greely said users should consider the risks involved with Adderall, he didn’t consider the overall problems to be a complete deterrent.

“One of the problems is, we have very little research about either the effectiveness or the safety of Adderall in a healthy population,” Greely said. “But it doesn’t appear to be enormously risky, and it doesn’t appear to be enormously helpful, either. It’s sort of like mega-caffeine, as far as I can tell, not having used it myself.”

Jason noted feeling significant side effects while on Adderall, such as cold extremities, loss of appetite and a skewed sense of time. He was aware of the risk of physical addiction and tried to space out use to avoid dependence, but he noted that he “could see becoming psychologically dependent” — a worry that Castro also echoed.

“Once you get used to [study drugs] aiding you in school, you’re more likely to want to use it again, regardless of physical dependence,” Castro said.

Is It Cheating?

Aside from the illegal nature of using another’s prescription, academic use of Adderall on school assignments begs the question of academic violation within University rules. Although Stanford has no specific rules regarding cognitive enhancement drugs, Castro believes that the future of study drug abuse enforcement may lie with Judicial Affairs on campus.

“The way I’ve been framing this is: is it ethical for someone to take a stimulant that gives them an edge over others doing the same assignment?” he said.

“I think, yes, Judicial Affairs would look at this as cheating, just as in sports,” Castro added, saying that it might be even more probable in disciplines that emphasize quantity-based work.

Greely, however, disagrees, saying that without a specific rule regarding study drug use, the University cannot try to enforce abuse as an academic violation.

“It’s only cheating if it’s against the rules,” he said. “I wouldn’t read the Fundamental Standard to make it clear that [using Adderall] is cheating any more than drinking a double espresso is cheating.”

He added that if the University wanted to consider study drug use as cheating, they first need a clear and effective rule, which would be challenging to devise due to the difficulty of enforcement.

“What are you going to do — make everyone pee in a cup before every organic chemistry test?” he said. “How do you tell if someone’s roommate gave them Adderall when they were studying?”

For students, even those who find the drug to be extremely helpful in academics, few considered the idea that study drugs could be considered cheating.

“Taking Adderall lets me put in the work that I would do anyway, just in a shorter amount of time,” Jason said. “It’s not making me smarter.”

While the potential future for the drug in academic violations, as well as its effects and repercussions, remain uncertain, students are clear-headed about how they perceive their own use.

“You’re not suddenly Superman when you’re using Adderall,” Jessica said. “You can just stare at a computer screen longer.”