Artificial attention: The consequences of study drugs

It’s the end of the semester, crunch time for every class, and you’ve fallen behind on your schoolwork. The Georgetown culture, in which classes, social life, and extracurriculars fight for every minute of your schedule, is starting to take its toll, and you find yourself scraping to find enough time and energy for every aspect of your busy student life.

It takes a special kind of person to pull of such a balancing act with ease. But 36 milligrams of Concerta later, that balancing act becomes a lot easier.

Concerta is the extended-release version of Ritalin, which has been a popular medication to treat attention disorders and other conditions for years. The active ingredient in both medications, methylphenidate, is a central nervous system stimulant which focuses activity in certain regions of the brain. Georgetown psychology Prof. Chandan Vaidya has worked extensively with magnetic brain imaging to observe the effects of this type of drug.

“What it changes in the brain, it acts on two neurotransmitters,” she said. “One is dopamine and one is norepinephrine, and both of these have to do with our attention, cognition, and frontal lobes that are very important.”

Methylphenidate blocks the reuptake of dopamine and norepinephrine into brain cells. The resulting excess of these neurotransmitters in the blood boosts energy and focus. Users of such drugs report feeling confident in themselves and their work, allowing them to accomplish monumental assignments without anxiety or fatigue.

“It’s not something that you want to take,” said John*, Georgetown student and recreational user of Adderall, another cognitive enhancing drug. “It doesn’t make you feel good. But I usually take it when either I have a free day and could use it to get a lot of work done or I have a lot of work backed up. It’s usually for utility and necessity…I use it whenever I feel like I need to.”

Cognitive enhancers—Adderall, Concerta, and Ritalin, to name some popular ones—may help students focus on a given task, but the drugs hold unpredictable risks for recreational users. Even if the dosage is appropriate and side-effects are negligible, working with an unauthorized study aid treads into problematic moral territory.

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Prof. Vaidya conducted research on the effects of psychostimulants in school-age children, and found the drugs were nondiscriminatory in their positive effects. rew“Kids in the study were doing a task that is an attentional task. And what we saw was that Ritalin increased activation in the ADHD kids,” she said. “So the idea is that, in those regions, if they have an attentional deficit, the drug compensates for it. … [I]n control children, we saw a change such that activation actually decreased. But the most intriguing and interesting finding was that both groups improved performance on the attentional task.”

Because an attention deficit can exist with or without the hyperactivity component in ADHD, the predominant criterion for diagnosis is an individual’s ability to remain focused. “Attention is a continuum. There is no objective marker between who is affected, who does have ADHD, and who doesn’t. You are just at the lower end of something that is a continuous variable,” Prof. Vaidya said.

Patrick Kilcarr, Ph.D., Director of the Student Health Center’s Center for Personal Development, counsels students facing personal and academic stress. Through his encounters with students who have prescriptions and those in need of them, he acknowledges the advantages psychostimulants can have in achieving one’s potential.

“I actually, as a therapist, believe ADHD is underdiagnosed, especially in women,” Dr. Kilcarr said. “Because they are bright and compliant, people push them along without really looking more closely at what may be underlying their inattentiveness. I also do think that there are moments of misdiagnosis or a rush to judgment about a child and based on some over activity, they are placed on medication.

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Half an hour after you wash the little white pills down with the remnants of your coffee, they start to kick in. The people around you become less exciting, Facebook becomes less distracting. Regardless of your typical work ethic, feel how effortlessly your eyes graze the black and white pages now. Notice how the page looks different than before. The white is brighter, the black richer, and the letters paint even the most abstract ideas with ease. You tear through the pages, free from distraction. Anxiety has almost completely disappeared. You know you do not want to make a habit of this, but you start to think about investing in a small supply, just in case of emergency.

Jeremy*, a Georgetown student, is diagnosed with ADHD, and has been taking medication for a few years.

“It was originally my parents’ suggestion,” he said. “I was definitely exposed to it a lot more when I was growing up, because my siblings were given it and so I was given it. It was just assumed that I was going to take ADHD drugs to ensure academic success.”

This type of pressure placed on children at an early age can alter their perceptions of these drugs from treatments for a disorder to artificial tools for scholastic achievement. “I think there is something wrong with our society,” Prof. Vaidya said. “It kind of is a reflection on the competition. Everyone wants to excel and everyone wants to get into the best of everything, so whatever gives you an edge.

Time for a break from all this reading. Go for a walk through the library. Try and talk to people in a crowded room. Feel the difference in the surroundings. Grapple with the unfamiliarity of a familiar place. Notice your other senses have dimmed: your brain wants to think, not see or hear. Your peripheral vision is blurred, and you can only focus on the person speaking directly in front of you. You are fully engaged, but social interaction has never been this difficult.

If a person is not attention impaired, enhancing cognition with drugs can inhibit other important skills. “I would feel more socially reserved. In face to face social interaction, I would be more irritable and feel a lot less like talking to people,” Jeremy said. “There is a certain extent to which you lose spontaneous creativity and it makes it difficult to interact with other people. Natural conversation is improvising.”

Right before college, Jeremy stopped taking his medication as prescribed and began to accumulate a stockpile. He charges $5 to $10, depending on how well he knows the buyer. But, like many students who sell study drugs, he does not see himself as an actual “drug dealer.”

“Because it was not in any way an actual source of my income,” he said. “And also, I would never try to find customers. I would only deal to people as they came to me. I really wasn’t trying to make money off of it. It was something I barely thought about at all.”

Sales increase around exam time, and he notices a trend in customer type. “It’s always a friend of a friend who had bought something before, who is extremely stressed in school, and thought that they needed something beyond their own abilities to help them get through it,” he said. “It’s a response to anxiety that drives people to want that kind of thing.”

Medications which prove useful to individuals with and without actual prescriptions are the most prone to misuse. As diagnoses increase among college students and students nearing college, availability increases as well. This convenience and, more importantly, the reputation of effectiveness contribute to a growing trend of the use of these stimulants as study aids on college campuses.

“Behaviorally, it is not surprising,” Prof. Vaidya said. “If you have a deficit or a disorder versus if you were normal, nonetheless, behaviorally, it was helpful. So it’s findings like this that actually support the use, so it is no surprise that they are effective. That’s the reason students would take them before an exam when they are studying. It focuses you. And in many ways, they are safe. There’s no danger of abuse or addiction when taken at very low dosage.”

You feel some pressure now in your forehead and temples, but it isn’t distracting because of how focused you are on your schoolwork. But your heartbeat is accelerated, your appetite is gone, you’re starting to feel anxious, and you have no desire to sleep, despite that you’ve been awake for an unnaturally long time. It’s different, and because it’s not your drug, you can’t tell if it’s normal or not. But you’re studying like a machine, and you have no intention of slowing down.

“The problem with taking other peoples’ prescriptions is that people do not know how [a drug] will react to their system and body,” Dr. Kilcarr said. “I have had multiple situations where someone being prescribed the medication has a negative side effect, such as heart racing or feeling over-caffeinated, and we need to adjust the medication. This occurs under supervision. When someone takes someone else’s prescription, there is no monitoring.”

The owner of the pills knows what it does to him, but satisfaction is not a guarantee in the market for prescription drugs. “My body is really used to it so it affects me in a different way,” Jeremy said. “Some people did report really negative effects when they used it. They say they felt too anxious and shaky and nervous.”

***

You begin to think that perhaps testing this drug for the first time the night before an important final was not the best idea. Luckily, the side effects that you feel right now are not too intense to inhibit your studying. A Concerta overdose is messy, but you looked up the symptoms on Wikipedia—you have no fever, aggression, or hallucinations, so you’re just fine. You don’t worry about the risk of side effects after the rug wears off; you’re too far in the zone for that.

“Maybe it does nothing, but there is equal chance that it does something bad on how it’s changing your neurotransmitters’ functioning,” Prof. Vaidya said. “So repeated usage over a long term may be bad for you. Definitely, developmentally, there are many more risks because the brain is growing. Even college kids, a person in their early twenties, your brain is still developing. The more we know now tells us that maturation goes on into the early 20s in terms of frontal lobe development. So, from that point of view, it’s better not to subject it to substances that one doesn’t really need.”

Yet the prevalence of recreational use of cognitive enhancers is staggering. In 2010, 60 Minutes reported that 50 to 60 percent of college juniors and seniors have abused psychostimulants, either by stealing them, falsely reporting symptoms to obtain a prescription, buying them from another student, or trading them for other drugs. Students increasingly view these drugs as a means to academic success, raising the question of whether the illegal use of an enhancer without demonstrated medical need is academically dishonest.

“All it does really is change my attitude,” John said. “I’m not proud of the fact or happy with the idea that I use it for those purposes, but it’s still for the sake of utility. And the only person that’s going to have a problem with me using it is me.”

Under the Georgetown University honor code, “cheating is the use or attempted use of unauthorized materials, information, study aids, or unauthorized collaboration on in-class examinations, take-home examinations, or other academic exercises.” This definition does not explicitly state that drug use qualifies as cheating.

However, cognitive enhancers could be understood as an unauthorized study aid. The key distinction is that the student in question retaining information using a tool which is not readily available to other students.

Because the definition in the Honor Code is ambiguous, students take it upon themselves to formulate their own opinions.

“The effects on academic integrity are negligible,” Jeremy said. “Because, ultimately, anything you did, you still did. You’re not taking credit for anything someone else did. That’s the basis behind academic honesty. You’re not presenting someone else’s work as your own. And I don’t think the effects are strong enough that you could say that something you did while under the influence was so different it can’t even be counted as your work. The ideas came from your head. The medicine just helped you focus a little bit more and get it out.”

For now, the University can, at most, reprimand students for the illegal purchase of prescription medications. However, the trend has not existed long enough for there to be a codified standard for punishment.

“These drugs are good in the sense that they help people work on those kinds of virtues—diligence as a virtue, concentration, commitment, things like that,” John said. “But at the same time, they are morally problematic because instead of a person developing from their own will, they have to use a drug to make sure that they do that.”

As with other drugs taken to enhance performance, the physical advantages are tightly woven in with a placebo effect.

“It really doesn’t do anything more than drinking a lot of coffee,” Prof. Vaidya said. “But think about what coffee does for you—it doesn’t make you smarter, it makes you stay awake longer and focus a little bit better. Just multiply that fivefold. It’s different than coffee because the effect is stronger. It narrows your tunnel of focus so you’re able to keep out distractions and stay on task. But in terms of the stuff you would learn and all the effort you would use to learn the information, store it in your mind and retrieve it appropriately, that is all work you are still going to have to do.”

Some doctors and informed, prescribed users argue that the effects of the drug for non-prescription users would not be as satisfying if those users knew how the drug works in the brain. “If other people knew about it, it would be sort of disenchanting … if they realized that it was just increasing the blood in my brain,” Jeremy said. “And so I think people would respond differently if they knew.”

After a sleepless night in the library, you go straight to your exam and take it. You pass with flying colors. You wonder how much was because of the drug, and how well you could have done without it. You wonder if you should take it again for your next exam.

“You can look at yourself and say, ‘I’m satisfied with my character, I’m satisfied with how I act and how I behave and for what purpose I do things. I’m satisfied with my functioning as a human being as of now.’ And people that would be quick to deny [their drug use] see in themselves and see in their actions something that’s wrong,” John said.

“Everyone has to make their own decisions emerging from their value set and ethical standings,” Dr. Kilcarr said. “Every student on this campus has the capacity to fully engage their subjects and have the success they want without using someone else’s prescription medication.  It requires being organized, a bit of discipline, and certainly planning.  Learning to tap into your own mind during these four years is the essence of the college experience.  Taking shortcuts or doing what seems to be the easy way only develops bad habits or reinforces behavior that is taking the person farther from their potential.”

*Note: Names have been changed.

Additional reporting by Connor Jones