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"About 30 percent [of people with ADD] have it go on into adulthood with a significant impact," says Tarnow. "The disease changes its appearance. It goes underground."
Tarnow says he tells his college patients to keep mum about the medication they're taking, and suggests they keep it locked up so it doesn't get stolen. Dr. John Sargent, a professor of psychiatry and pediatrics at Baylor College of Medicine, gives similar advice to the parents of his young patients.
"I tell the parents, 'You've got to take charge of the medicine and lock it up and dole it out bit by bit,' " says Sargent, who has worked with ADD patients for 30 years. "Kids will cheek them, they'll do all kinds of weird stuff."
A few of Sargent's patients have admitted to selling their pills, and when he confronted them about it, they usually replied by telling him, "The kids wanted some, I had them."
"I tell them, 'You've got to respect yourself and me a lot more than this,' " he says. "And when a kid goes away to college, I here in Houston would not prescribe this for someone who is away. I would recommend they get a doctor at college and they have a relationship with that person. There are some doctors who will send a prescription in the mail without seeing somebody, but I don't like doing that."
Both Sargent and Tarnow know the short- and long-term effects on kids who don't have ADD abusing the drugs: anxiety, agitation, dehydration, inability to sleep and, if the drugs are seriously abused for a long time, paranoia. The drug abuse also can trigger underlying mental conditions like bipolar disorder.
To try to combat the abuse, drug manufacturers have recently developed ADD drugs such as Adderall XR, which release medication into the body slowly, making them harder to abuse (although many of the students interviewed for this article said they had abused those drugs; they just took more of them). And the DEA tries to curb the problem by requiring that doctors like Tarnow and Sargent keep complicated records -- but Tarnow doubts that helps much.
"You have to write the prescription in triplicate, you have to write special forms, the drugstore has a copy, I have a copy," explains Tarnow. "Yet even with that careful monitoring people still abuse it." The real answer in combating the problem, he says, is making sure kids with ADD don't feel like someone is just throwing a pill down their throat.
"I think there are different sectors that have different reasons for abusing the medicine," he says. For the kids who use Adderall only to study, Tarnow doubts they're any different from his college fraternity brothers who took the once popular diet drug Dexedrine to pull all-nighters -- they feel enormous pressure to perform. And for the kids who let their study aid grow into a bigger problem, Tarnow says it's a matter of discovering what underlying issues allowed that to happen.
It had been more than a year since she had first tried the Ritalin to get through her freshman-year midterms, and Laura was no longer using the pills just to study.
After discovering Adderall during final exams, Laura thought it might be interesting to see what else the drug could do. She liked how it let her stay up all night, let her have "crazy fun."
This past winter she started taking 20 to 30 milligrams of Adderall nearly every night and then sneaking out of her family's Montrose home. She would escape to the nearby bar Helios, where they had poetry readings and older kids and cigarettes she could bum and relief from her boring everyday life at school, where other kids thought she was weird for liking poetry and wanting to get dreadlocks. Sometimes she'd walk all the way over to River Oaks to visit a friend, sometimes not. On the Adderall, it was easy to stay awake all night, come home around 4:30 in the morning, change out of her smoky clothes and get ready to go to the gym with her family for her required 5 a.m. workout.
The summer after her freshman year her friends gave her a bunch of Adderall to take with her on a vacation to Europe. She snorted it for the first time and stayed awake for five days, until she started seeing spots.
"My psychiatrist told me I was a fatalist," laughs Laura. "I've always joked that because of my bad habits I'm not going to live to see 18."
Laura has not had an easy life. Her father committed suicide and her mother died of heart problems before she turned four. When she was sneaking out she was living with an older brother and his wife. She claims that her using drugs has nothing to do with her parents' deaths.
"My psychiatrist says my subconscious is affected, but I'm not affected," she says. "It was just so fun, the people at Helios were just so fun," she says, explaining why she wanted to make the trip each night. "The thrill of taking it, that's never been a thing for me. People tell me I take drugs to escape things and I'm like, 'No, that's not true.' I did it because I had fun with it. I like having fun and that was fun. So I did it."