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.