The other drug epidemic

The drug problem in the US has historically focused on marijuana and heroin and the like and it is relatively recently that people have realized the extent of other dependencies such as on pain-killers. The New York Times has a long article by a young, ambitious, hard-striving woman who attended an elite college about how she got hooked on a commonly prescribed prescription for Adderall, a drug that started out being used to treat ADHD (Attention Deficit Hyperactive Disorder) for young children but now has become used by many adults to power their way through the day. About 16 million prescriptions were written in 2012 for adults between the ages of 20 and 39 and very little known about the long term effects of its use.

The article is frightening in the way she describes how she first got the taste of it while in college from a friend to whom she had complained about having a deadline for a paper, the way it helped her meet that deadline, how easy it was later to get the drug either prescribed for herself or to buy it from others who had prescriptions, and how hard it was to let go. She felt that the drug was indispensable to her functioning at all and only managed to shed her dependence on it at the age of 30.

She describes the history of the drug.

Adderall as we know it today owes its origins to accident. In the late 1920s, an American chemist named Gordon Alles, searching for a treatment for asthma, synthesized a substance related to adrenaline, which was known to aid bronchial relaxation. Alles had created beta-phenyl-isopropylamine, the chemical now known as amphetamine. Injecting himself to test the results, he noted a “feeling of well being,” followed by a “rather sleepless night,” according to “On Speed: The Many Lives of Amphetamine,” by Nicolas Rasmussen. By the 1930s, the drug Benzedrine, a brand-name amphetamine, was being taken to elevate mood, boost energy and increase vigilance. The American military dispensed Benzedrine tablets, also known as “go pills,” to soldiers during World War II. After the war, with slight modification, an amphetamine called Dexedrine was prescribed to treat depression. Many people, especially women, loved amphetamines for their appetite-suppressing side effects and took them to stay thin, often in the form of the diet drug Obetrol. But in the early 1970s, with around 10 million adults using amphetamines, the Food and Drug Administration stepped in with strict regulations, and the drug fell out of such common use. More than 20 years later, a pharmaceutical executive named Roger Griggs thought to revisit the now largely forgotten Obetrol. Tweaking the formula, he named it Adderall and brought it to market aimed at the millions of children and teenagers who doctors said had A.D.H.D. A time-release version of Adderall came out a few years later, which prolonged the delivery of the drug to the bloodstream and which was said to be less addictive — and therefore easier to walk away from. In theory.

In a sense, then, we are the walking experiment, those of us around my age who first got involved with this drug in high school or college when it was suddenly everywhere and then did not manage to get off it for years afterward — if we got off it at all. We are living out what it might mean, both psychologically and neurologically, to take a powerful drug we do not need over long stretches of time. Sometimes I think of us as Generation Adderall.

How the drug works its magic is well known.

Any basic neuroscience textbook will explain how Adderall works in the brain — and why it’s so hard to break the habit. For years, the predominant explanation of addiction, promulgated by researchers like Nora Volkow, director of the National Institute on Drug Abuse, has revolved around the neurotransmitter dopamine. Amphetamines unleash dopamine along with norepinephrine, which rush through the brain’s synapses and increase levels of arousal, attention, vigilance and motivation. Dopamine, in fact, tends to feature in every experience that feels especially great, be it having sex or eating chocolate cake. It’s for this reason that dopamine is so heavily implicated in current models of addiction. As a person begins to overuse a substance, the brain — which craves homeostasis and fights for it — tries to compensate for all the extra dopamine by stripping out its own dopamine receptors. With the reduction of dopamine receptors, the person needs more and more of her favored substance to produce the euphoria it once offered her. The vanishing dopamine receptors also help explain the agony of withdrawal: Without that favored substance, a person is suddenly left with a brain whose capacity to experience reward is well below its natural levels. It is an open question whether every brain returns to its original settings once off the drug.

The article is long but well-written.

For those of us who have been fortunate enough to avoid becoming addicted to various forms of drugs, it is difficult to imagine what takes some people along that road and what it must be like to live with the drugs and to try to get off it. It seems so unreal. But it would be wrong to blame it on weakness of character. It seems like it would be so easy for anyone to slip into that kind of life based purely on the events that impinge on one’s life. What such addicts need is help, not condemnation.


  1. NYC atheist says

    I never cared for amphetamines, so I dodged the adderall bullet. I got caught up in the other plague of our generation, Oxycontin. I was way out there from ’06 to ’11.

    And re the time delay: we all got around that by crushing the pills and snorting them.

  2. lorn says

    I never had much use for stimulants, outside of coffee. While I’d like to be able to say it is because of my iron will and moral superiority I suspect that it is simply a quirk of my biochemistry. You see I have ADHD and speed, including cocaine, doesn’t work well at getting me high. It tends to calm me down. Doses that have others bouncing off walls are restful. I fell asleep after a doctor injected some of it. I woke up to a cluster of doctors talking about how this was a clear case of what they were calling a ‘paradoxical reaction’. I was young at the time and it didn’t make a lot of sense, and they didn’t explain.

    In college people thought I was a coke-head because normal doses didn’t phase me. They assumed that I’d done so much that I had developed a resistance. There was lots of speed and coke around and it never did much for me.

    On the other hand opiates seem to work really, really well on me. An anesthesiologist said he could wave the syringe in my direction and I’d be out for two hours. Every time I go under they use Narcan to bring me back because it takes so long for me to pop back up naturally.

    I tend to be careful around opiates and use the bare minimum necessary, and transition to OTC products ASAP, even if I still have some pain.

    I got lucky. Lots of friends didn’t enjoy my luck. A few died, lots of others have had their lives mangled by addictions.

  3. says

    I’ve only ever done the basic amphetamines, once -- and it was so intense it scared me away from them for the rest of my life.

    As an undergrad, having just taken a semester of abnormal psych (including a unit on the effects of drugs on brains) I knew that amphetamines jacked short-term memory and recall. So I got 2 hits of speed from a classmate and crammed for my stats final on speed. It was amazing, I hit the second just as I was going into the exam, and completely crushed the test, then I left and found out I couldn’t relax -- I bicycled all around Baltimore setting the high scores on all the Battlezone machines at the theaters, then went home and slept a couple days. When I woke up, I had forgotten most of the exam. But I set the curve for everyone else. I could see how that would become something to depend on.

    When my jaw was broken in 2013 they sent me home with 1l of liquid roxicet to keep my pain levels manageable. Again, I could see how someone can get addicted to that. I have mostly steered clear of opiates since then, though I came to appreciate them a lot. Just to give those of you who haven’t experienced it an idea: merely the thought of a nice big squirt of “nurse roxy” makes me start salivating like one of Dr Pavlov’s dogs. It was such good stuff, I spent a month watching “Glee” re-runs and actually enjoyed them.

  4. says

    The other thing that really worries me is that there are a lot of people growing up on amphetamines. One of a friends’ kids are both on Ritalin. I don’t see any way that being on a maintenance dose of amphetamines for years isn’t going to have some kind of long-term effect.

    I understand that some of these drugs are necessary for many people to function. But I suspect that some day people will look back at contemporary neuropsychology with the same kind of horror we currently reserve for bleeding and leeches.

  5. trollofreason says

    I grew up on Ritalin, and took Adderall up to my 17th year. I was basically on amphetamines from my 7th year and ten years onward for misdiagnosed ADHD. It is likely that it’s affected me, as I don’t… I don’t really seem to experience things the way others do now that I’m practically drug free. Joy eludes me, the easy comfort of a lover is more an act for their benefit than my own enjoyment. I am comfortable enough, but just that.

    Iunno, there are very few highs in my emotions, but I remember them when I was younger.

  6. says

    I grew up on amphetamines, and ended up going off them as an adult because… because… I can’t even remember why, now! I don’t miss the side effects (speed doesn’t mix well with anxiety disorders — go figure!), but I really do miss having an attention span longer than, like, ten minutes. And it’s been close to twenty years since I’ve managed anything more than a half-assed doodle, so… I miss being able to focus and produce artwork.

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