Diane speaks with Dr. Roger Kligler who is living with advanced stage cancer on why he's suing the state of Massachusetts for the 'Right to Die' and with Dr Jessica Vitter, and intensive care and palliative care specialist on why better communication is so needed between doctors and patients facing end-of-life issues.
In high schools and colleges across the United States, students are illegally using prescription drugs. Medications like Adderall, Ritalin and Focalin are commonly prescribed for Attention Deficit Hyperactivity Disorder. But in recent years, more kids are using these drugs non-medically in hopes of gaining an academic edge. Nicknamed the “study drug,” Adderall can result in increased energy and intense focus. The Drug Enforcement Administration has classified it as a Class 2 controlled substance -– just like cocaine and morphine — because of its addictive nature. Diane and her guests talk about Adderall abuse and what’s being done to address it.
- Doug Young community outreach director for the Lower Merion School District.
- Amelia Arria director of the Center on Young Adult Health and Development at the University of Maryland.
- Dr. Robert Dupont president of the Institute for Behavior and Health and former director of the National Institute on Drug Abuse.
- Judith Warner author of "Perfect Madness: Motherhood in the Age of Anxiety" and "We've Got Issues: Children and Parents in the Age of Medication" and a columnist for Time.com.
MS. DIANE REHMThanks for joining us. I'm Diane Rehm. Medications like Adderall and Ritalin are typically designed to treat Attention Deficit Hyperactivity Disorder, but students with no such problems are taking them for a competitive edge.
MS. DIANE REHMJoining me in the studio to talk about medication abuse and how to curb it are Amelia Arria, director of the Center on Young Adult Health and Development at the University of Maryland, Dr. Robert Dupont, president of the Institute for Behavior and Health and Judith Warner, author of "We've Got Issues: Children and Parents in the Age of Medication."
MS. DIANE REHMI'm sure many of you will want to weigh in. Do join us, 800-433-8850. Send us your email to email@example.com. Join us on Facebook or Twitter. Good morning and thank you for being here.
MS. AMELIA ARRIAGood morning, Diane.
MS. JUDITH WARNERGood morning.
DR. ROBERT DUPONTGood morning.
REHMAmelia, I'll start with you. There have been a lot of reports lately about widespread use of Adderall among high school and college students. First, tell us what Adderall is and what you are seeing.
ARRIAWell, Adderall is in the class of drugs that is used to treat ADHD, like you said. There's also Ritalin and Concerta so it's not the only one. But among college students, what we see is about 10 percent of an incoming freshman class might have had experience with non-medically using Adderall, that is without a doctor's prescription or even overusing their own prescription.
ARRIASo when we talk about whether or not it's widespread, whether you think one in ten is widespread is sort of a judgment call. One of the myths is that everyone is doing it and that's something that we want to dispel because it is fairly rare. But then when you look at college students in the middle of their career, it becomes one in five has tried to use one of these drugs non-medically.
ARRIAAnd use is typically infrequent and sporadic. It's not something people do continuously, mainly around exam time or to stay awake longer to study or to party. And then cumulatively what we find is that about a third have had the opportunity, or two-thirds have had the opportunity to use a prescription stimulant non-medically and about a third end up using it.
REHMAmelia Arria, she's director the Center on Young Adult Health and Development at the University of Maryland. Dr. Robert Dupont, it's good to see you again.
DUPONTI'm delighted to be here, Diane.
REHMTell us the legitimate uses for drugs like Adderall.
DUPONTWell, Adderall is an amphetamine. It's a brand of amphetamine and it's become extremely popular in the treatment of Attention Deficit Disorder, as you mentioned. The treatment of ADHD is a relatively new phenomenon, at least widespread treatment going back into the 1990s and increasing to the present and its use of stimulant drugs that have a long history of abuse, but particularly when they're used by young students, grade-school kind of kids.
DUPONTYou don't have any problem with non-medical use or abuse, but when it's used with high school and college and especially now increasingly with adults, there is a very substantial problem of abuse.
REHMTell me how it acts on the brain of a person who has been diagnosed as ADHD.
DUPONTIt's a stimulant...
DUPONT...that gets people's ability to organize themselves and to focus and, of course, it does those things to people who don't have ADHD as well so that it is, as Amelia was saying, there is a very substantial amount of non-medical use. So people who do not have ADHD, which is what the problem as Amelia was talking about, but it's about 5 percent of college students have their own prescription.
DUPONTAnd there's very few people, I think, in this country, including myself, that don't have family members who have used these medicines to good effect. It's been a very positive development in the country to identify ADHD and to provide the treatment. There's no doubt about that.
REHMDr. Robert Dupont, he's president of the Institute for Behavior and Health. He's former director of the National Institute on Drug Abuse. Judith Warner, turning to you, how does the use of something like Adderall when it's not been prescribed for ADHD affect a young person, a college student, a high school student? Why are they taking it?
WARNERWell, as Dr. Dupont said, the beneficial effects in terms of concentration, attention, duration of ability to study, let's say, can apply to someone who does not have ADHD as well as someone who does. From what I've been able to read, though, these effects are often pretty mild.
WARNERSometimes, in fact, there can be a paradoxical effect if someone without a prescription, let's say, is taking too high a dosage, as they very often are when they're abusing the medications in order to get the extreme effect and can actually decrease their academic performance.
WARNERSo there's a belief that these medications are perfectly benign, that it's fine to take them, that it's like having a lot of coffee or Diet Coke or in the past people smoked cigarettes to stay awake and to focus.
WARNERAnd what's lost in all of that, first of all, is the ethical issue, the fact that these are controlled substances. But beyond that, the issue that these are serious medications, that when taken as medically prescribed can be extremely beneficial, but if abused, if taken without a prescription, can be very, very dangerous.
REHMI want to read for you all an email I received this morning. "Your second hour on Adderall hits home for me. My son got addicted and had to drop out of college. He's still struggling to find a way to handle the focusing and organizational issues. He's really smart, a great reader, but that Adderall gave him such an immediate high that he wanted more and more. It led to a serious depression issue with which he's still struggling."
REHM"He's on medications for it and he has still not gone back to college." What do you make of that, Amelia?
ARRIAWell, his story is unfortunate and one of the things that...
ARRIAIt's not as common to see the dependence arise on Adderall, but the most important thing about his story is that he probably was at risk for drug dependence. And what we find among people who non-medically use is that they have a history of excessive drinking and illicit drug disorders, particularly heavy use of marijuana.
REHMSo you're saying that the predisposition was already there, but is that always the case, Dr. Dupont?
DUPONTWell, what we don't hear in that story is whether that son had a prescription or did not have a prescription and I think that makes a big difference. The way people get into trouble with it is when they take it in extreme doses.
DUPONTThey're not taking it the way it's prescribed. As long as they're taking it as it's prescribed, it's quite safe. It does not produce those negative things. But as I treat many people, including young people with substance abuse addiction problems, often times Adderall and other stimulants are gateway drugs into a serious drug addiction problem.
DUPONTWhat happens, though, is that the people find they like the dose that they have either with prescribed or taking it from somebody else and then they take more and they take more. And they add other drugs to deal with the symptoms they have from those and that becomes a life-changing experience of addiction, which is a common picture for people with drug addiction problems that Adderall and these stimulants in adolescence were a gateway into a serious drug problem.
REHMAnd, of course, the adolescence mind, brain, body, physique is not totally formed yet and therefore probably having a more difficult time absorbing all this. But the downside of what our emailer said is that having gotten off Adderall, her son is now totally depressed. How frequently does that happen? Judith.
WARNERI guess the question is what's the start point of that story? Why did he start taking the Adderall in the first place?
REHMProbably to focus, to do better in school, to get better grades which as I read it a great many of these young people are thinking that the Adderall and those stimulants are going to help them to do.
WARNERYes, but as Dr. Dupont and Amelia were saying, whether they do this because they've been diagnosed with ADHD and the stimulants are part of a plan of medical treatment, which hopefully involves some other kind of counseling or coaching, in addition as well or whether they're doing this in part out of a kind of magical thinking.
WARNERThey don't necessarily have ADHD, but are struggling, as all students do to some extent and think that this is going to help them, that it's going to change their lives or that it's going to be fun. I mean, it can be part of socializing as well.
WARNERWhen you look at the studies that talk about who takes these drugs without a prescription and why, it's funny. It's correlated with being in a fraternity or a sorority so there are all kinds of odd reasons that go into the start of this use so that then when you look at the endpoint we hear of in this story, we don't know exactly why he started taking them in the first place, whether it was for medical reasons or whether it was for other reasons.
REHMJudith Warner, she's the author of a book titled "We've Got Issues: Children and Parents in the Age of Medication." Short break here and your calls when we come back, stay with us.
REHMAnd we're back, talking about the use of prescription drugs for non-prescribed reasons. For example, here's an email from Grace who says, "Please comment on high school students using Adderall before the SATs. I remember when I was a junior in high school a few years ago, this was a common occurrence which I did not participate in, but was frustrated about it because the unfair advantage it gave people, possibly resulting in better scholarships or entrance into better schools." How do you feel about that, Dr. Dupont?
DUPONTI think that's a dangerous illusion and the idea that taking one of these drugs prior to taking an SAT test and you're going to do better is just -- there's no basis for that. And I doubt very much that if you did a study that you'd find any effect at all. It will definitely concentrate your mind. But how concentrated is your mind when you're taking an SAT test? I don't think so. And I think there's an illusion that these drugs are smart pills and they're going to make you do better on an SAT.
REHMBut somebody -- somebody has clearly passed on a rumor or an experience that says, look, I took this drug, I aced that test.
REHMIt really made me do well. I mean, and that rumor gets started and people start looking at these drugs.
DUPONTThere are people like that, but there are nine others who were the other direction…
DUPONT...who didn't make it and you're not hearing those rumors from those folks.
WARNERI just think that those of us in the media have played such a big role in promulgating this rumor. It's been decades now that we've had headlines talking about stimulants as smart pills. Brother's little helper. Words like that which have enormous sway both with parents and with kids. And I think it's wonderful to be here today with these experts who can set the story straight. And I hope that people will listen to them.
REHMWhat do you think about that, Amelia, kids taking Adderall before an SAT?
ARRIAWell, I think Dr. Dupont is right. I think a lot of this is a placebo effect, and I think the stories are there that maybe a student did well on a test. But adolescents and young adults have a hard time connecting the dots between what they do and what happens. And so they may be making false connections between those things. But we have a lot of students who stopped using Adderall for that purpose, because they either experienced a negative physical consequence or realized it wasn't working.
DUPONTIt can give them the illusion that they've got all the right answers. And they're writing down all the wrong answers. It does -- Amelia's calling it a placebo effect. It does make them feel powerful. It makes them feel smart, there's no doubt about it. But there's no evidence it's going to make them get the right answers on those tests.
REHMHere's an email from Jonathan who says, "For so many people to use Adderall, perhaps we should be looking at the societal stresses forcing people to turn to these types of drugs. Certainly from kindergarten on, kids are being told they've got to get into the best colleges. And if this talk of using these drugs is going to improve your grades right on up, kids are going to fall into it.
ARRIAI think what's been lost in this discussion is that the way to better grades and the way to successful career and college is through hard work and spending your time doing constructive activities. And I think that adolescents have a hard time understanding that there is a wide variety of these substances to take and that they have been fed that this might be a sort of shortcut so they can have it all. They can have a partying social life.
ARRIAThey can, you know, do well in school you know if they take these drugs. They can skip class because they spent time partying the night before and this will help. But I think it's just become part of the variety of the drug landscape that is available.
DUPONTDiane, when you look at the students in college who've used these drugs non-medically and compare them to the students who have not, the people who have used it have lower GPA not higher GPA. They'd skip class more, they study less. It's the exact opposite of a marker of smartness in school.
REHMTell me how these kids are getting these drugs, Judith.
WARNERMost of them are getting them from their peers. Again, we're talking about the kids who don't have prescriptions. They're getting them from their peers, the majority are. I was amazed by the statistic that fully a quarter of the kids in college with prescriptions have at some point given them away or sold them away. Sold them. The thing that then stays with me and I wonder also is why are these kids who do have legitimate prescriptions who we can assume have ADHD, why are they sharing their medication?
WARNERWhy aren't they taking it? What's their relationship to their medication that leads them on some level to reject it or prefer to share it and why aren't they understanding that rather than helping their friends, they're potentially seriously harming them? Why hasn't that message been given to them strongly enough? Where are their parents? Where are the doctors in educating them about the responsibilities that they have both to themselves and to those around them?
REHMHow often do you believe parents know that their kids are using non-prescribed drugs?
WARNERMy guess is that they don't know. I mean, parents of kids in that age range generally don't know when the kids are doing something wrong. But I do think that there is a general climate in which it's believed by both parents and kids, in a very widespread way, that everyone is doing what they can to work the system and get a leg up. And that's how you succeed in life. It isn't hard work, it isn't following the rules, it's by playing the percentages, getting whatever advantage you can. Everyone else is doing it. If you don't do it, you're going to be left behind.
REHMAre these brilliant students who are taking these drugs or are they poor grade students?
ARRIALike Dr. Dupont said, the research over and over again has shown that the people using these drugs non-medically are the ones who have lower GPAs and have a history of other alcohol and drug involvement that probably precipitated the declines in their GPAs. And so, this is a compensatory mechanism to try to make up for that and it usually does not work.
REHMAll right, we've got lots of callers. I'm going to open the phones, 800-433-8850. First to Miami, FL. Ivan, you're on the air.
IVANGood afternoon, Diane. Thank you for having me.
IVANI'm a very big fan of your show, even though I'm only 24 years old.
IVANI'm actually a Florida International University student, and I do see it very often that I have friends and acquaintances that do take the drug. Not often. It’s not -- they do not abuse it, although if it's not prescribed to them, I guess they are abusing it. But basically, it is as simple as my friend who is prescribed the drug would like to have extra money and my other friend who isn't prescribed the drug simply has $20 to give away.
IVANFor that simple arrangement one ends up -- one who isn't prescribed the drug ends up with it and the other one simply has to give away, you know, a third of what their dosage would be and they would still be fine. And that is the simplicity of how children and kids are getting it now a days. My basic thing is, now since it's such a grey area, what's the next step? How can we tell students and my peers that this is not a good idea?
IVANI also feel that it's an unfair advantage for these students. Like for me, because I have a friend who is in medical school and I personally believe that without his slight dependence on that drug he would not be getting passed most of those tests that he does get passed. So I'm kind of worried as to this could become an epidemic.
ARRIAI think you've making great points. We see that the drugs are sold for kids to make money, especially in the later years. More often they're given away for free. So I think there is a harm to the person diverting it because they're not using it the way it's prescribed.
REHMBut, you know, Dr. Dupont, Ivan feels himself at a disadvantage because he's not taking those drugs.
DUPONTAnd that feeling feeds the epidemic that he's worried about. Think how different that is than what Amelia and I were saying about the fact that it was the students with the poor GPA, not the one who got into medical school, the one who didn't get into medical school. And remember with Amelia saying this was tied up with the use of other drugs and alcohol, marijuana and other illegal drugs. The problem we have with this where people don't realize it's a felony to give away or sell drug, a prescribed controlled substance also apply to the opiates, to the analgesic drugs.
DUPONTOn college campuses and elsewhere, this is a larger -- this is a piece of a larger problem of prescription drug abuse that is becoming the defining drug problem in the United States right now.
REHMAnd we're joined now by Doug Young. He is in Lower Merion, PA, which is a suburb of Philadelphia. He is the community outreach director for the Lower Merion School District. Good morning to you, Doug.
MR. DOUG YOUNGGood morning, Diane. Thanks for having me on.
REHMCertainly. Tell us how your district is addressing the use of Adderall and other prescription drugs in your schools.
YOUNGSure. Well, first of all, thanks for discussing this issue. It's, from our perspective, awareness is critical and we can have all the, you know, great programs in the world in the schools, but it's got to be part of a larger conversation. So we really appreciate the conversation today. Our focus, you know, is really prevention K-12. And if we're getting to a place where we're only discussing this at the high school level and we're only talking about Adderall, I think we're not, you know, seeing the big picture.
YOUNGAnd, you know, we have used the kind of used the abuse of something like Adderall, you know, not as a one-off, but it's part of a larger set of issues around student health and wellness. So our programs look at, you know, supporting students K-12 and really supporting students holistically. When it comes specifically to Adderall at the high school level, you know, our curriculum certainly is a place where students are talking about these issues.
YOUNGWe have, you know, a number of parent programs as well. And, you know, we, at times, we are reacting and responding when we're hearing reports or when students are coming to the nurses office or when there's, you know, a concern by a student or a teacher in the school that there's a student who, you know, may be involved in, you know, the illicit use or the inappropriate use of a prescription drug.
YOUNGAnd there's a whole series of things that would happen in that case. But it's, you know, everything from community programs to staff development to even policy. We revised our homework policy because of, you know, issues or concerns around student stress and the pressures that students were facing, you know, in taking, you know, whether it would be multiple AP classes or SAT preparation.
YOUNGThat, you know, there's just a set of really, you know, tough things that kids are going through outside of the academics. And, you know, there was a need to change our homework policy.
REHMSo what you've had to do, I gather, is to train your health staffers then to identify what may be going on with their kids.
YOUNGNo question. And our health staff has certainly seen a rise in the use of prescription meds and prescriptions for students in our schools. And subsequently, you know, they have gone through much more extensive training around issues that may be related to the use or misuse of those drugs.
REHMI see. And you're listening to "The Diane Rehm Show." Doug, I gather, though, it's difficult to recognize when kids are actually using these drugs.
YOUNGYes, it is. And that's, you know, that's certainly, you know, an issue and a concern. And one of our strategies if there is a student or a staff member who may be concerned that this, you know, that is happening is there is, you know, an opportunity to anonymously, you know, basically put a note in a box and say, hey, you know, I'm concerned about my friend or I'm concerned about a student.
YOUNGAnd that activates a process, a student assistance process at school. But you're right, I mean, in a lot of cases it may be difficult and it may manifest itself in different ways for different students.
REHMDo you think that the young people themselves understand the consequences of giving or selling these pills to their friends as Dr. Dupont was saying earlier?
YOUNGMm-hmm. I think that there's an increasing awareness, but I certainly think that there is a, you know, there is a disconnect. And there is not a long-term view of how the drugs can impact, you know, health. You know, there was some discussion about the legality of selling these medications.
YOUNGBut, no, I think that's one of the areas of concern that there is this disconnect, that there is this lack of awareness and understanding. And, you know, the programs in Lower Merion School District can, you know, we can attempt to address it. But if it's minimized, you know, in social settings as really an issue to worry about or if parents aren't responding aggressively to concerns, then, you know, it's perpetuated.
REHMIt sounds to me as though large assemblies of kids talking about this issue among themselves perhaps generated by a school superior would certainly help to bring out not only the dangers of these drugs but to address some of the stresses that the kids feel as though they are under.
YOUNGSure, sure. We've found that the best setting is not so much the large group setting, but rather the smaller health classes. And when you have, you know, 15 students in a room and you're, you know, you're talking about, you know, how students are accessing these drugs, they're talking about you know the pressures and the stresses of family and peers and culture and media. I mean, that's when kind of these conversations really become, you know, particularly poignant for our students and that's where our teachers and health staff have found the most impact.
REHMSure. Well, good luck to you, Doug.
YOUNGThanks so much.
REHMDoug Young is the community outreach director for the Lower Merion School District. Thanks for joining us. And I want to, when we come back, talk about Doug's point with you Amelia. He said it can be kind of difficult to recognize that a kid is on these kinds of drugs. You shook your head at that, and I want to come back to it and your calls. Stay with us.
REHMAnd going to you now, Amelia, Doug Young said that most of the time you cannot really tell when a young person is using these drugs. You were shaking your head during that.
ARRIAWell, I think that rather than a school trying to figure out who's using and who's not using one of the approaches that we recommend is that when a student experiences a precipitous decline in their grades, not necessarily a benchmark like a 2.0, but a decline in their personal best like dropping a whole grade from one semester to the next. That should single an intensive assessment of what is going on in that kid's life. An individualized confidential assessment should reveal the use of this drug and other drugs.
REHMAnd what about parents do they know that these kids are using the drugs?
ARRIAI'm not sure about the high school level, but I know at the college level we have heard that parents turn a blind eye towards this particular type of drug use. And sometimes even facilitate the access of this drug.
ARRIABecause they think -- they've sort of bought into the myth that it's going to help them succeed. And they want to try at all costs to help their child succeed. But what their student is not telling them is about why they're struggling academically. Why they're having concentration difficulties which may be related to their other drug use.
REHMAnd of course, you've got even adults using drugs like Provigil to boost their energy to help them focus.
DUPONTYou know, one of the things, Diane, I think, is very important in this discussion is that a large percentage of people who are using these medicines are doing so responsibly and it's really helping them. And I'm concerned about the general direction of just focusing on the bad things about these drugs. They're often very good.
DUPONTThe issue has to do with whether they're taken under medical supervision where the doctor knows what's going on and they're used as directed where they can be very helpful. And once you get outside of that and you start taking it with other drugs, you don't have any medical supervision, you're using an entirely different dose. Often times with these drugs they're snorted or injected intravenously and at much higher doses. That's where the problem is. And that's why getting it in the channel of appropriate medical care is really important to using these drugs because they are useful and the problems they're treating are important.
REHMAnd you were saying during the break, Dr. Dupont, that, you know, lots of people are using these and using them well.
DUPONTYes, and also there's a big problem -- Doug was talking about getting the kids together to talk about this. And most of the kids who are using them non-medically, as Amelia has said, are using it very infrequently and nothing bad happens to them. So they feed back into the peer group that it's perfectly safe.
DUPONTWhat's missing from that picture is the smaller percentage who have dreadful problems, including major drug problems -- the kind of story we started out with in this program. And that -- we don't want to have that happen. That is what the problem is and the illusion that they're smart pills and that you can take them and nothing bad -- non-medically you can take them and nothing bad happens to you feeds this epidemic and the problems we're talking about.
REHMAll right, to Richmond, Va., good morning Matt.
MATTGood morning, Diane. Your show is a breath of fresh air, thank you.
MATTI didn't want to -- you sort of jumped on the wagon of talking only about the negative, as the guest had said a few minutes ago. But as a clinical social worker, I have noticed that it seems that a lot of times doctors will prescribe Adderall for children. And they'll do it as young as age two, three, four. And the reasoning behind it a lot of times is based on trying to qualify for disability and benefits like that. So I was just wondering -- I see that a lot in my practice and I was just wondering if the guests could comment on that aspect.
WARNEROnce again, I think that the prescribing of stimulants or other psychotropic medications to very young children, two year olds, is something that exists -- didn't exist before and is very upsetting to people. But it isn't that frequent. And I do worry very much about this narrative of parents trying to get a leg up, trying to get this advantage or that advantage -- these social benefits or those.
WARNEROnce again, this is something happening in a sub population of people. This is not what's happening in your average family who's seeking out some sort of mental health care for their child. So I think we do have to guard against over generalizing from these situations.
REHMAll right, to Carmel, Ind., good morning, Chris.
CHRISMorning, Diane, thanks for calling.
CHRISOnce again, as a 42-year-old adult who's been on Adderall for two years, I agree with the doctor. Using Adderall is actually part of, like, seven or ten steps as far as treating ADD goes. There's usually a psychiatrist that gives you the medication. And they usually start you at a lower dose and build it up, a therapist that observes you and helps you develop proper behavior, diet, exercise.
CHRISAnd the biggest part is building structure in your life because people with ADD can usually join the military if they get of their medication because the military has structure. And for a lot of kids it's very important to have a therapist or a doctor monitor. Because I had heart issues and my blood pressure was going high and you really, really have to have the proper structure. And as I said, all the different parts to help you.
CHRISAnd I'm even on a downer where after I take the stimulant I do a 30 mg extended release in the morning and a 10 mg in the middle of the day, immediate release. At the end of the day I take fluvoxamine to bring me down. It -- they work. I mean I can feel it. I can tell a day that I didn't take the Adderall.
REHMAnd I can hear it, Chris. Go ahead, Dr. Dupont.
DUPONTWell, I think what Chris is saying is really important. And that is it's part of a larger approach.
DUPONTNot only from the therapist, but also Chris's work himself on this. It's clear that he is doing this in a responsible way with this professional help.
REHMAll right, to Louisville, Ky., good morning, Xelia.
XELIAOh, hi. Thanks, Diane, I love what you do.
XELIAI just wanted to say that we were talking earlier about reducing and working with kids to reduce stress in high school so they don't feel they have to take Adderall and other drugs like that. But I was wondering -- so I think that might be a disconnect when they get to the collegiate level of learning. Again, undergraduate and post graduate, like, levels.
XELIAMost of the people I know that are taking the MCAT and the Bar they -- the huge, huge, majority of them feel that they have to take Adderall and cocaine to even succeed. So I was wondering how that -- if we reduce their stress as high schoolers would prepare them for their college careers.
ARRIAI think that it goes back to just good old fashioned time management skills, monitoring your, I guess, activities to fit in all that you have to do to prepare for college, to prepare for work, to prepare for your MCAT's. It's hard work.
REHMAnd especially considering the fact that there are so few jobs out there.
REHMAnd they're ending up with all this debt. So I understand the stress that these young people are under and the question becomes what can we do to reduce some of that stress so that these kids don't feel that need.
ARRIAOnce again, I do think there's a role for parents in promoting healthy attitudes and healthy behaviors. Healthy attitudes meaning you're not constantly, 22 hours a day, on a race towards success. That life has to have more than that in it. That relaxation has to play a role. That connection has to play a role. That there are various definitions of success. There's also research now showing that in terms of improving attention, concentration, performance, things like exercise, sleep, good nutrition.
ARRIAMeditation are extremely important and meaningful. And we really have to fight back against this myth that these pills make you smarter, which they don't.
REHMHere's an email from Susan in Yuma, Ariz. She says, "Why are ADHD kids sharing their meds? As a parent of an ADHD kid, I can give you two reasons. First, impulsivity is a symptom of ADHD. Given the opportunity for monetary gain why wouldn't an impulsive kid sell his meds? Second, ADHD kids have trouble making and keeping friends. So, I think they are giving it away to make other people like them." Judith.
WARNERI think -- it makes me very sad to hear that. That strikes me as a perfectly plausible explanation.
WARNERCertainly, once again, you have to think about the kids' relationship to their medication. What I've heard many times from teenagers, young adults often who reject their medication is that they didn't feel that they were involved adequately in the process in the first place of getting a prescription, of having their problems addressed.
WARNERThere are some, not all, but there are some who feel that they, sort of, had it shoved down their throat. That they were put in a box and these medicines were used to control their behaviors. And when they get to the point where they have their adolescent rebellion the first thing to go is the medication. I'm not saying all kids feel this way, but I think that there is a population who do feel this way.
WARNERAnd I think that really raises issues, again, for parenting and also in how doctors communicate with kids. And how ADHD is explained to kids in the first place, how the medication is explained to them and how much agency they're given in the whole process of dealing with their ADHD.
REHMAmelia, you ran a study focusing on college students. Tell us what you found.
ARRIAFor the ADHD, we followed a large cohort of 1,200 students over time. And now they're in their post-college years. So we've been studying their behaviors. And among the ADHD positive kids, which comprised about five percent of our sample, we found that almost two thirds diverted their medication. And, actually, one of the hypotheses was that they're trying to make friends and they're trying to share and be nice.
ARRIAAnd what we found when we looked at a whole host of variables is that the number one predictor of diversion was actually what the caller was saying that it was more related to the impulsivity and the conduct problems that these kids have. It wasn't related to being helpful. I think we did not look at whether or not they felt like it was going to increase their friendships. I think that's a really interesting thing. But it's much more related to deviance than it is to helpfulness.
REHMOkay, so if the drug enforcement agency classifies these in the same category as cocaine and heroin, are there any criminal charges being brought against these kids for selling or passing?
YOUNGThere's two problems there. That's exactly right, but they're also -- most of these kids have never been told that it's wrong. That it's illegal. The doctors don't tell them that. The school administrators don't tell them. The parents don't tell them.
REHMWell, somebody ought to tell them.
REHMWell, you just told them.
YOUNGWell, everybody who's listening to this program, I hope, is going to do it.
YOUNGBut in addition to that, there has to be a consequence. And you talk about the criminal consequence. There needs to be something so that the kids know that it's not just something casual. This is a very serious matter and that's a big change we're going to go through in this country.
REHMAnd you're listening to "The Diane Rehm Show." To Houston, Texas, Pasqual, you're on the air.
PASQUALYes, good morning. I have a question, actually, related to the -- that ADD and -- is there a link between what the kids eat today and the ADD? Any research on that that can prove that probably what we eat has an influence on the way we behave?
REHMDr. Dupont, there's been a lot of research on that.
DUPONTYes, well, because it's become so common. And it was so uncommon before. People are looking at that. I think it had to do with we didn't know about it. We didn't know what to do about it before. I do not think there's any evidence that what we eat has anything to do with it.
REHMHere is an email from Justin who says, "Is there an alternative to Adderall that can still get people that intense focus? I was a prescribed Adderall user in college. Not taking it anymore, but I still occasionally crave the high and the intense focus from it."
ARRIADr. Dupont has a lot of experience and he's taught me a lot about a drug named Concerta, which is a different form, a less abusable form that doesn't necessarily give a person the immediate reaction that Adderall does.
DUPONTAnd there's another drug called Strattera which is not a stimulant that is used to treat ADHD. And that's something that can be tried also.
REHMBut does it give that focus...
DUPONTNo, Strattera -- not so dramatic, but it's been shown to be very effective in treating ADHD and it ought to be included on this. But the word was used as high. That's not part of the treatment of ADHD.
REHMYeah, what about...
DUPONTAnd when somebody who talks about that you're worried about where that's going.
REHMWhat about Provigil? What does that do?
DUPONTIt's a -- has a very similar affect to the stimulant drugs. I think that...
REHMTo the Adderall?
DUPONTTo the Adderall and the Ritalin. Ritalin is methylphenidate and Adderall is amphetamine and it's a synthetic drug that has very similar properties in terms of stimulant effects.
REHMWow, all right. Let's take one last call to Annie in Ann Arbor, Mich. Thanks for waiting.
ANNIEYeah, hi, thanks for taking my call.
ANNIEFirst of all, about the diversion I would just add that a lot of the people who I know who've been prescribed these drugs are told by their doctors that they don't have to take them every day. That they can take them on an as needed basis, but are still prescribed a daily dose. And so I think a lot of kids are running around with extra.
ANNIEBut my primary question is I'm now a graduate student at a major university and the psychiatrist here prescribed me Adderall based on her assessment that if I tried it and responded well to it that would mean that I did have ADD, that it was essentially diagnostic if I took the Adderall and was able to concentrate, which I knew had happened because I'd taken it throughout college. But this was then confirmed by two separate therapists and social workers who I've seen. And I just can't believe that that's true given the number of people who I know who take these drugs.
REHMAll right, very quickly, Amelia.
ARRIAI think she makes excellent points. That's exactly what we've seen in terms of the diversion. And I think that that's what we've heard in terms of the doctors prescribing it on an as needed basis and, like she said, that it's, sort of -- that's how you can diagnose a person whether or not they respond. I don't know whether that's good or bad medical practice, Dr. Dupont.
REHMBut it's also a reason why they have so many extra pills.
REHMWhat an important discussion. Thank you so much and hopefully supervisors, teachers, parents will heed what you've all said. Amelia Arria, Dr. Robert Dupont, Judith Warner. Thanks again.
DUPONTThank you, Diane.
REHMAnd thanks for listening all. I'm Diane Rehm.
ANNOUNCER"The Diane Rehm Show" is produced by Sandra Pinkard, Nancy Robertson, Denise Couture, Susan Nabors, Megan Merritt, Lisa Dunn and Rebecca Kaufman. The engineer is Erin Stamper. Natalie Yuravlivker answers the phones. Visit drshow.org for audio archives, transcripts, podcasts and CD sales.
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