By Craig Malisow
By Jeff Balke
By Angelica Leicht
By Jeff Balke
By Sean Pendergast
By Sean Pendergast
By Jeff Balke
By Ben DuBose
It started with her freshman-year midterms.
Laura, a student at one of Houston's toniest private high schools, suddenly realized that her grades, in a word, sucked. It was her fault; she knew that. Because her school allows students to use laptops to take notes, and because it can afford to provide wireless Internet access, she had spent most of her class time exploring the Internet and Instant Messaging her friends.
"I was doing lots and lots of that," she admits. "I didn't pay attention at all."
Laura had heard about people taking prescription drugs such as Ritalin and Adderall to help them focus. She was aware, of course, that the people she knew who took those pills had been diagnosed with attention deficit disorder, and doctors had prescribed the pills. No one had ever labeled her ADD. But still, she figured, if it worked for them, it might work for her.
She scored some free Ritalin from a classmate, and when it came time to buckle down and start studying, she closed herself off in her room and swallowed 15 milligrams.
It wasn't like coffee, and it wasn't like No-Doz pills. It was so, so much better than that.
"I thought, 'Wow, this is great. I don't have to sleep,' " says the coltish, fair-skinned girl with a rapid-fire, sweet-as-sugar voice. "I studied for eight hours at a time. I studied and actually learned the stuff."
She swallowed a pill every three to four hours, and soon she became the master of the index card. She scribbled on card after card, filling each one with equations and vocabulary words and French grammar rules. Whereas before after just an hour or so of studying Laura would have found herself staring into space or goofing off in her bedroom, that didn't happen on Ritalin. After she got good grades on her midterms, she stopped taking the drug.
That's when she crashed.
"I could tell when I came off it, because I got tired and really distracted, more than usual," she says. "And I was like, 'This is bad, I need to take more.' " So when finals rolled around, Laura discovered a different ADD drug, Adderall -- one she says worked even better for her than the Ritalin did.
"That's how I studied for finals, and I did really, really well on my finals," she says.
Laura and the other students in this article didn't want their real names used. None of them is particularly unique among high school and college students these days. The twist is that instead of using drugs illegally for recreation, these kids are using drugs to score higher grades. They're not cheating. But without a prescription, what they're doing is illegal.
"Adderall was like the staple," explains 18-year-old Jack, reflecting on his recent public high school career in an outlying suburb of Houston. "Like, if you couldn't afford crystal meth you could get the Adderall from someone in your class. Just look for the kid that can't pay attention."
Jack, who used Adderall through high school but claims to be clean now, remembers one friend who had put off a physics project involving the construction of a bridge made out of dry spaghetti that had to be able to hold a certain amount of weight.
"He had postponed this three-week project, and the last night he decided he was going to work on it, it was like 12 o'clock, and he had like four things of spaghetti," says Jack. "So he took a whole bunch of Adderall, maybe like 95 milligrams or something, and he just worked through the night. I saw him in second period the next day and he was like, 'Hey, Jack, I just did a full night on Adderall building a spaghetti bridge!' "
The bridge ended up breaking under the weight, says Jack, but only because the glue was still wet. And anyway, the guy got a passing grade for trying.
Ever since ADD became an almost fashionable diagnosis in the mid-'90s, there have been reports from across the country of high school and college kids selling their pills or giving them away to kids who want to get high or just study harder. Although data from the National Institute on Drug Abuse shows that abuse of the stimulants Ritalin and Adderall has leveled off in the last few years, it's still a source of concern. In May 2000, Terrance Woodworth of the Drug Enforcement Administration offered congressional testimony that noted the dramatic increase in prescriptions for the two drugs in the past ten years -- hence the wider availability of the pills. In the early '90s, Ritalin was one of the most stolen drugs in the country. There were even reports of "attention deficit scams," where a parent or other adult would get medication for their ADD child and then use it or sell it instead.
It's hard to say if arrests for illegal use of the drugs have gone up -- the Harris County District Attorney's office doesn't track them specifically. And police from the Houston, Fort Bend and Spring school districts say their biggest problem is still the old standby: marijuana. Then again, a pill that was legitimately prescribed to nearly six million American schoolchildren in 2001 might be a lot easier to conceal in a classroom than a joint -- although kids are sometimes found out.
"When I was a sophomore or junior, a freshman was caught with a whole bunch of Adderall," remembers Jack. "A whole pill bottle. And this was a pretty good kid; he wasn't even ADD, he just brought them to school to sell after he bought them from some ADD kids. Two months after that there was some big school assembly talking about the dangers of Adderall, basically. It was the first time I'd ever heard an administrator talk about it being used illicitly instead of as a miracle drug that makes bad kids work better."
But the pills are not popular just in high schools. Although area university health departments have tight restrictions on prescribing the drugs -- in fact, most refer students with ADD symptoms to outside specialists -- that doesn't mean the kids can't get ahold of them. With more ADD students than ever staying on their medication while in college, the pills are widely available as a study aid to students who aren't supposed to be taking them. At exam time it's a seller's market, explains 20-year-old Mike, a Houston native who now studies at the University of Texas in Austin. Where a pill might go for $2 during the rest of the school year, it could go for as high as $6 during finals week.
"Everyone buys it," says Mike. "You'd be surprised how many straight-A students will come up to you and ask you for it.
"If you take 15 milligrams, you really won't feel that much," he says. "If you're studying, 15 milligrams is really good. You're relaxed, you can pay attention to things for longer. You can work for six hours straight and you don't have to get up and do anything except get a drink of water."
Mike has used Adderall to prepare for tests in American government and history; he aced both exams. Although he normally hates reading, Mike discovered that on Adderall he actually enjoyed being productive.
"I hated government class," he says. "It wasn't any interesting policies or interesting topics. It was just, you know, what happened in Plessy v. Ferguson, all these different facts. [But] on Adderall I could sit there for hours and read and get everything done. I would go to places where normally I wouldn't go to study, and I could study there."
Both Jack and Mike have experimented heavily with other drugs besides Adderall, but they don't view the ADD drugs as a big problem, for either them or other kids. If you're doing it to study, reasons Mike, "you're probably fine."
It's that kind of thinking that worries John Will, a licensed chemical dependency counselor and program director for the Palmer Drug Abuse Program, a nonprofit support program for teenage drug addicts and their families that has operated in Houston since 1971.
"A lot of times what you will see with the young person is they make justifications for the drug that they do," says Will. "They think, 'Well, a doctor prescribed it to Joe Bob, who is my friend who looks like me and acts like me, and if it's good enough for Joe Bob, it's good enough for me.' "
Will says he can't give a profile of the average Adderall user, although he theorizes that there may be more of them in the suburbs than in the city.
"You get out into suburbia and they are a lot more body-conscious," he says, noting that he's known young women who have taken the drug to suppress appetite. "There's more pressure to be perfect, there's more pressure to be upbeat and active and all of that."
And of course, there's pressure to get good grades.
The desire for an A on an organic chemistry test was Julie's motivation for taking a friend's Adderall the night before the exam. A student at Texas A&M, Julie shuns coffee because it upsets her stomach and makes her sweaty and clammy. A straitlaced student who drinks alcohol but has never tried any other drugs, Julie found herself worrying about the upcoming big test. Although she was in a regular study group, she knew that as the hours wore on everyone wouldn't exactly want to study.
"They would all get really silly toward the end of it," she says. "Jumping around, making coffee, talking, not really studying or anything."
With pages and pages of information about molecules and synthesis and electrons that she knew needed to be conquered before the break of dawn, Julie accepted the offer of some free Adderall from her friend who had a prescription for it. By the time her study partners entered the giddy phase of studying, Julie was busy memorizing facts and equations without being distracted.
"When I took it, the thought of stopping, even when they were playing around and being silly ," she says. "I could study. I could sit there and read the book while they were jumping around."
Julie, who has since taken the drug once more to prepare for another exam, says she didn't worry about what she was taking or about the fact that it's illegal to use someone else's prescription drugs.
"I don't do it often enough to be worried about being hooked on it," she explains. "I see it as in another category" from other drugs. "It's something that's prescribed to people and it's something that's been approved."
She got 35 minutes of sleep the night before the exam, but she ended up scoring the second-highest grade in the class. When Julie graduates from college she hopes to become a pharmacist.
When 19-year-old Joe, then a student at Southwestern University, needed to finish a book in one night for an English course he was taking, he welcomed the offer of some free Adderall from a friend.
"It was the equivalent of drinking a pot of coffee, basically," he says. "It was like I was just born to plow through Pride and Prejudice. It was like I was made for it. There was nothing but these stupid characters I'm sorry, but I hate that fucking book."
Joe says the friend who gave him the pills had a prescription for the drug, but he rarely took the pills himself. Instead, he gave them away to people he liked and charged about $5 a pill to the people he didn't.
"He was supposed to take it every day, maybe twice a day," says Joe. "But he only took it himself maybe three times a week, when he had a lot of reading to do or a big assignment. He figured maybe he's got ADD a little bit, but, like, that it wasn't really necessary. It was more the parents and doctors freaking out, like, 'You need this stuff.' "
Dr. Jay Tarnow of Houston's Tarnow Center for Self Management has worked in the field of ADD for more than 30 years. He's heard that kind of thinking about the disorder before, and it troubles him. For many teenagers and young adults with ADD, taking the pills is a downer, not an upper.
"When we take a stimulant, it stimulates," says Tarnow. "So why is it paradoxical? Why does it calm people with ADD down?" The answer, explains Tarnow, is that drugs like Ritalin and Adderall stimulate the part of an ADD brain that increases certain neurotransmitters. It's that lack of those neurotransmitters that causes some of the hallmark symptoms of an ADD child: hyperactivity, difficulty organizing and focusing, trouble reading social cues and problems curbing impulsive behavior.
So while the ADD drugs might cause a normal brain to get hyped up, they actually help the ADD child slow down -- therefore, they often don't want to take their pills.
"That's why kids who have ADD almost never, and I'm saying 99.9 percent, almost never abuse these stimulants," says Tarnow. "They don't like the effect. They like being hyper. The most common thing we hear is 'Gosh, everything is so much more boring on this medicine.' That's why they sell it."
Tarnow says that's why doctors who work with ADD patients must take the time to explain to their patients why the medication can help them. It starts with a proper diagnosis, an extensive process that Tarnow says should involve a battery of tests and in-depth discussions with both parents and teachers. And that's not easy to do.
"ADD is considered, research shows, to be the most overdiagnosed and the most underdiagnosed disease in childhood," says Tarnow. The disorder can be missed when managed care companies insist it should be pinned down in one 15-minute session with a pediatrician, something Tarnow says is just not possible. And sometimes the disease is overdiagnosed because of parental pressure.
"There are some people, some parents, they want something to be fixed right away," says Tarnow. "Where does it get overdiagnosed? With parents who are very concerned about school, who are upwardly mobile, who put a lot of pressure on their children to accomplish and do well, and who have them in schools that may not be the best environment." Tarnow notes that children with anxiety or depression problems may have symptoms that mimic those of ADD.
But, says Tarnow, for kids who truly have the disorder -- about 3 to 5 percent of the general population -- the medication in conjunction with therapy can do a world of good. Studies have shown that kids with untreated ADD have a higher incidence of drug abuse, suicide, dropping out of school and reckless behavior.
"I just don't believe that all you do is put the child on medicine and say good-bye to the parent," he says. "Anytime I put a child on medicine there's always psychotherapy. I'm always working with the parents, teaching the parents how to teach the child to self-manage." That combination will ensure that kids will realize how useful the drugs can be to them and make them less likely to give away their pills, says Tarnow.
And, he adds, that realization will hopefully stay with the teenager when he or she goes on to college. More and more college students are remaining on their medication into their twenties and beyond, which wasn't the case ten years ago. Tarnow explains that as students get older, the hyperactivity that is so often seen with ADD usually goes away. Therefore many people think they've outgrown the disease. But problems with organizing and focusing remain.
"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."
The late-night excursions made her a walking zombie during her days at school, where she slept through all her courses and opened her eyes only to navigate her way from class to class. She developed black moons under her eyes that didn't go away, no matter how much she crashed on Saturday and Sunday afternoons. She started getting paranoid and thought her teachers were looking at her in the hallways for an unusually long period of time. Her Helios friends told her they were worried about her, that it wasn't good to be so dependent on something. One night, when Laura ran out of her Adderall, she freaked out so badly about crashing the next morning that a girlfriend at Helios gave her an "all-natural" diet pill to help her stay awake.
So about a month ago she quit the Adderall abruptly, and for days she shook furiously from the withdrawal effects, so much so that she says she'd have to lie down on the back porch at Helios just to chill out. She tried to sneak out while not on the drug, but she got too sleepy. It didn't matter anyway -- her brother and his wife had caught her leaving the house one too many times, and they told Laura she had to leave Montrose and move in with her grandfather out by Highway 6.
"They kicked me out of the house," she says. "They were like, 'We're tired of dealing with you. You don't trust us and you don't respect us.' "
Laura doesn't have a driver's license, which she considers to be a good thing. Since she can't travel into the city, she doesn't sneak out anymore.
"If I were still there, I would still sneak out," she says matter-of-factly, "because I have no self-control."
Her sensibility is a strange mix of an old person's world-weariness and the immortal naïveté of a teenager. She admits she feels a definite sense of relief that she isn't on Adderall every day anymore. But then a moment later she's guessing she would probably take the drug once more if she had the opportunity.
This time, however, things would be different.
"I might take it again," she says. "But if I did, I would be really aware of how much I was taking, and I would make sure I didn't get dependent on it again."