Earlier this month, The New York Times ran an article about high school students’ routinely abusing stimulants like Adderall and Ritalin. According to the report, some teens obtain the drug by faking symptoms of Attention Deficit Hyperactivity Disorder (ADHD), while others receive the medication from their friends. Lying to a physician to get a prescription for a controlled substance is criminal conduct, as is sharing prescribed drugs with someone for whom the drugs were not prescribed.
The Times story suggests a growing problem among today’s teens. The general problem of high school students’ using illicit drugs is, of course, anything but news. What makes the use of these stimulant medications different is the motivation behind the decision to indulge: academic performance enhancement.
The students using the drugs are not seeking to drown their sorrows, to achieve euphoria, or to ease their comfort level in social situations. They are looking instead to fortify their capacity to concentrate hard on their schoolwork and thereby enable themselves to do well on exams. In other words, they are taking drugs to help them achieve goals that will please the authority figures in their lives—their parents and teachers.
In this column, I will consider what might be wrong with teens using stimulant drugs to enhance academic performance.
The Fuzzy Line Between Having and Not Having ADHD
The New York Times article suggests that stimulants like Adderall and Ritalin work paradoxically on sufferers of ADHD. Someone who has the disorder, according to the Times, will become calm and relaxed when she takes the drug, while someone who is not suffering from the disorder will experience a stimulant effect upon using it. If this account were accurate, then distinguishing between a person who suffers from ADHD, and a person who does not, would be simple. One could just give a particular person a dose of Adderall or Ritalin and see whether the result is relaxation or stimulation. We could say with confidence that everyone falls into one of two categories: ADHD-positive and ADHD-negative, in the same way as we can say that all people are currently either HIV-positive or HIV-negative.
In reality, though, a stimulant drug will have a stimulating effect on virtually anyone who takes it. For a person who is hyperactive, easily bored, and under-stimulated, the sudden ability to concentrate and calmly work hard on a difficult task for an extended period of time may look, from the outside, like a tranquilizing effect. A truly tranquilized person, however, will feel sleepy or sedated. A person taking a therapeutic dose of a stimulant—whether or not she has ADHD—will, by contrast, feel energized, motivated, and able to take on otherwise daunting assignments.
Consider the way in which many people use coffee, which contains caffeine—another stimulant. An ad from years ago touted the supposed phenomenon of “coffee achievers” and observed that coffee provides “the calm moment that lets you think.”
For a person who might otherwise struggle to focus on her work or other tedious commitments, caffeine can help motivate her to settle down and engage in the mental processes necessary to carrying out daily responsibilities. If that person had previously felt anxiety about her work, the feelings of control and focus could also help alleviate that anxiety. This is not because caffeine “paradoxically” works as an anti-anxiety medication. It is because experiencing confidence in one’s ability to meet one’s obligations can relieve anxiety (much in the way that a colleague’s taking on some of your responsibilities at work might alleviate your anxiety).
Why does it matter that everyone’s performance can “benefit” from stimulant drugs? It matters because it means that receiving a diagnosis of ADHD enables some schoolchildren to measurably enhance their ability to do their work and achieve better grades than they otherwise could. Other children without the diagnosis might also have difficulty concentrating and focusing on a difficult task, in the way that many people do, from time to time, especially if they do not enjoy their work. But their difficulty may not reach the level that triggers an ADHD diagnosis—a somewhat arbitrary and subjective threshold. These children could understandably feel that they have been unfairly treated, wondering whether perhaps, if they could take Adderall or Ritalin, they would get an A or an A- instead of the B- grades that they consistently bring home.
If stimulants were effective only for people with ADHD, there would be no reason for non-ADHD students aiming to improve their grades to abuse the drug. Likewise, if stimulants improved performance only for those without ADHD, then no one would perceive an unfair advantage when one child, but not another, receives a prescription to address behavioral problems. Because a stimulant can in fact be useful for anyone, though, its use by some students creates a powerful incentive for others to get their hands on it, too, whether by faking or exaggerating symptoms or by borrowing pills from a friend. While the difference between a child with a mild case of ADHD and another child who falls just short of this diagnosis may be miniscule or even nonexistent, the difference between the respective performance of the two students, when one but not the other is taking Ritalin, may be dramatic.
What, Exactly, Is Wrong With “Doping”?
The Times article draws a useful analogy between professional athletes’ use of anabolic steroids, and high school students’ use of stimulants. Examining this analogy may help us determine what exactly troubles us about the phenomenon of high-school stimulant abuse.
One important difference between steroids and stimulants is that all professional sports organizations ban steroid use by athletes. If a person is not sufficiently fast or muscular or agile to compete in a professional sport without steroids, then he is simply (at least, officially) unwelcome in professional sports. Children with ADHD, by contrast, may permissibly use stimulants like Ritalin. In fact, their use may even be legally protected as part of a disabled patient’s right against discrimination.
With the apparent blessing of the school and the law, then, some children—but not others—are taking performance-enhancing drugs in a competitive environment.
As we have learned by now, the use of steroids by some competitors in professional athletics can make it difficult for others to compete without relying on steroids. Furthermore, because we are social creatures, as more professional athletes use performance-enhancing drugs, the stigma associated with their use within the profession may diminish. In his new book, The Honest Truth About Dishonesty, Dan Ariely demonstrates that cheating and other forms of dishonesty noticeably increase when people come to regard the behavior in question as normal and accepted among their peers.
To put it another way, people flexibly adjust to the new normal, on Wall Street and in the classroom. This may be why, according to some experts, the use of steroids has now become epidemic in professional sports. Once a large number of people stop following the rules, it no longer seems accurate to characterize them as being “the rules.” If people wish to “crack down” on doping in sports, of course, there could be a zero-tolerance policy, at least for detectable drugs, because performance-enhancing medications are prohibited to everyone, without exception.
Teens in high school who are seeking to excel, or merely to get a passing grade, may adopt the mentality that currently drives steroid use in sports: Everyone else seems to be doing it; why shouldn’t I? A teen may thus reason as follows: “I need to take the drugs or I will be at an unfair competitive disadvantage, relative to my classmates who do take them.” Add to this dynamic the fact that providers are prescribing the drugs for a large (and increasing) number of high school students, and the incentives become even more powerful.
Unlike in professional sports, the inability to compete in an academic environment without stimulants may count as a legitimate reason to take them. And it would be highly unusual for a school to announce that any teens who cannot complete their studies without Ritalin should just drop out of school. Unlike in competitive athletics, schools have an additional goal: to effectively educate all of the children in their care. High school is not just an arena for competition in which winners and losers are selected, even if it may sometimes feel that way to students.
The Adverse Health Effects of Stimulants
If stimulants were harmless, then we might not be especially concerned about their use by high school students. People could use them and perform better in their studies. The problem, however, is that the drugs do not appear to be harmless. They reportedly carry side-effects and serious risks, and they are considered very addicting as well. As a result, according to an opinion piece in The New York Times, though Ritalin and other stimulants can improve behavior, academic performance, and peer relationships of children diagnosed with ADHD, they do so only in the short term.
After the initial boost, patients seem to return to their pre-drug behavior and may need stimulants just to maintain that old baseline level of performance. And we still do not know all of the long-term effects of the drugs on the growing brains and bodies of children. What we do know already—that the drugs may stunt children’s growth—is disturbing.
Because stimulants can cause health problems, their widespread use by high school students (and younger children) may ultimately usher in a serious public health problem. And to the extent that many children who do not even fit the diagnostic category feel pressured to use the drugs just to keep up, the consequences could be even greater. For these reasons, “doping” by children to enhance school performance is a matter of greater urgency than is steroid use by the far more limited number of adults in professional athletics.
What Should We Do About It?
It may be time for us to rethink the competitive model of high school studying. When I watch my own children learning in school, I observe that they and their classmates seem to be the most eager and interested in working when they feel supported in doing the best they can do, without having to worry about whether their performance measures up to that of their classmates. My children attend a school that awards almost no grades and that provides an atmosphere of cooperative learning and mutual support. The whole idea of a curve—where there must be winners and losers in the game of learning—would, I think, strike the children there as bizarre and profoundly unappealing.
I suspect that the use of stimulants to enhance performance might drop if schools were to promote cooperative learning and pay less attention to how students rank relative to one another. The sense that one’s worth turns on outperforming classmates makes winning come to occupy a more important place in children’s minds than does actually learning or mastering an area of study. In my own teen years, I can think of at least one elective course that I decided not to take because I worried that my grade point average might suffer if I took it. Somewhere between kindergarten and ninth grade, the joy of learning can morph into a quest for competitive advantage.
Children who are in high school now appear to feel so pressured to outperform their peers that even some of the “good kids,” who would otherwise have no interest in abusing drugs, fake ADHD to get their hands on stimulants. This suggests that something is wrong with the way we are teaching our children. If high schools were better able to prioritize student wellbeing and learning over the destructive process of separating the supposed wheat from the supposed chaff, then students might be motivated to learn the many fascinating things that high school has to teach, without feeling the need to take a pill to pay attention.
There seems to be a bit of tension between the idea that the instruction schools intend to accomplish is important and the claim that students ought not care so much about it that they should be motivated to enhance their performance. If learning cooperatively is important, why should being better at learning cooperatively be less important than besting one’s peers in a more competitive environment?
Mostly, I like the message that school doesn’t matter enough to risk one’s health, but there’s a disturbing undertone that it doesn’t matter as much as other things we routinely risk our health for, like sports, viagra, or eating red meat. This is particularly problematic because the risks are small, and we tend to reason poorly about low probabilities. So the part of the message about health risks is likely to be largely dismissed, and what’s left is the “school isn’t important” part and some vague moralizing about fairness which seems to apply poorly if a substantial number of peers are known to be using such drugs.
I mentioned in a paper I wrote 6 tears ago the growing concern on the misuse of ADHD diagnosis and drugs in suburbia High Schools. It is not a relatively knew issue and has been around for at least a decade now.
It is true that in small doses stimulants medication will have that calming, focusing effect on just about everyone. But to high a de can make you jittery, unfocused
etc, like having way to much caffeine.
Of course, we need to examine the doctor’s who are prescribing these medications to kids and teens who do not meet the DSM IV criteria. There is more to the diagnosis then parent say so! It is those that abuse the diagnosis and the drugs that make life for those with ADHD and their parents so much harder. I dread the day people start to accused us of drugging our children for an academic advantage. It is already had enough that people think ADHD is about bad parents, lazy parents or kids, or that the drugs turn the kids into zombies.