What’s with America’s Adderall Problem?

What's with America's Adderall Problem?

America has a strange relationship with the small handful of drugs it’s collectively chosen to tolerate. Alcohol. Caffeine. Under the right circumstances, Americans tolerate and even enthusiastically embrace amphetamines, too.

That’s exactly what Adderall is — a patented amphetamine with brand-name recognition. It now appears to be an inextricable part of our culture: once an answer to “problem children” and then young adults with “attention deficit”, it’s now, just maybe, a potential panacea for our culture of chronic burnout.

What Is Adderall? How’d It Become So Popular?

Adderall is used mostly to treat the symptoms of Attention Deficit Hyperactivity Disorder (ADHD), which was first added to the D.S.M. in 1987. The condition used to be called Attention Deficit Disorder (ADD) and was almost exclusively diagnosed in children.

However, this diagnosis has become far more common in recent years — in the 1990s, physicians estimated that as many as 5 percent of American school-aged children had ADHD. By 2013, the rate was thought to have risen to 11 percent.

Adderall is the heir apparent to Ritalin and other stimulants. In 1990, 600,000 were taking stimulants. By 2013, the number had risen to 3.5 million.

So, why replace Ritalin with Adderall? First, because it was longer-lasting and more effective at tackling these conditions.

Second? Because ADD had received a rebranding, and the most visible product on the market for combating it likely required one, too. It’s all about staying relevant. And medicating (and over-medicating) for attention-related problems in children has never gone out of style. Prescription data tells us that in the first four years of its availability, Adderall had scored 5,000,000 prescriptions across the United States. By year nine, we’d hit 9,000,000 prescriptions and reached an industry-wide sales total of $2 billion.

But what are we medicating for?

Everything, it seems like. Adderall is set to become a $17.5 billion industry by 2020, and it’s because we prescribe it to people from all walks of life. For comparison, the entirety of the caffeine industry in America is worth $30 billion a year. Adderall is manifestly a mainstream product.

But between 2008 and 2012, young adults saw some of the highest rates of use, with prescriptions to this demographic increasing by 53 percent. Some people are just looking to get by, and they increasingly feel like they don’t know how to do it without ever-larger doses of drugs that, in any other sphere, would be recognized as dangerously habit-forming and rightfully illicit.

Letting this drug into the American mainstream poses a host of other problems, as well.

Adderall Is a Product, Like (And Unlike) Any Other

To understand Adderall’s unique place in American life, we need to remember it is a product. And because it’s a product, the lives of thousands of people in this country revolve around convincing people to buy it. To buy it for our children. To hear Alan Schartz tell it in his book, “ADHD Nation,” the drug’s creator’s used the phrase “ADD for All” as the impetus for its name.

And that’s exactly what happened next: everyone started taking it. Maybe this is what the rebrand was all about. ADD and Ritalin are for kids, but ADHD and Adderall are for everybody.

By the mid-2000s, the fastest growth in Adderall prescriptions was among adults. And by the year 2012, the 20-39 age bracket had reached a new milestone of 16 million prescriptions, alongside a spike in popularity — and the rise of black markets — at universities and even on primary education campuses.

So, why mention all of this? Does America’s consumption of Adderall constitute a problem? Or a public health crisis?

Many, including the director of Netflix documentary “Take Your Pills,” believe so. The film is inspired by an increasingly vocal backlash against the way the drug is distributed in America and the degree to which a wide variety of demographics appears to rely on it for self-medication amid a backdrop of economic collapse and political and civic turmoil. “Take Your Pills” and its director argue that Adderall is directly linked to the American Dream — and our abuse of the former is a criticism of the state of the latter. Here’s director Alison Klayman:

“In the political arena [in 2016] there was a lot of discussion about voters feeling anxious and feeling concern for ‘The American Dream’ and how difficult it can be … We talked to over 100 people across all breadths of life … and they all had these feelings of pressure and they wanted to use whatever they could to get ahead. That’s not to say that the drug caused these concerns. Or that the drugs are responsible for a relentless pursuit of success. Or working longer. Or even inequality. But the point is that these drugs exist on top of a system that is rife with these issues, so it really is part of the story.”

Many of the rehabilitation center representatives you can talk to will tell you there’s little difference between a “lower-class” meth addict scrambling for a fix, and an employed, working-class American who abuses Adderall to get through their workaday life. The difference, predictably, comes down to stigma — we have a caricature of the “typical meth user” thanks to the media’s portrayal of them.

But there is no “standard Adderall abuser,” so we don’t know the first thing about how to talk about it. Yet, the effects on the body and mind are terribly similar between the two. America has a long history of failing drug addicts. What happens when drug addicts can look like anybody?

Between 2005 and 2010, hospitalizations for complications from the overuse of ADHD stimulants doubled. Abuse of this drug is so widespread among students alone that, in some regions, universities are actively lobbying to have it banned.

What Are We Medicating For?

We are far from the “epidemic levels” of amphetamine salts abuse we saw in the 1960s, but America is working as hard as ever — and probably harder — for less money than ever, while having virtually no impact on public policy. This is a society practically designed to encourage the abuse of stimulants. It’s also a world swimming in its many unpleasant side effects — heart problems, the potential for stroke, irritability and other psychological disturbances such as anxiety and panic attacks.

But aren’t we taking it for stress and anxiety in the first place? To keep steady and alert in an overwhelming world?

The truth is, scientists don’t even have a firm understanding of what changes take place in the human brain after many years of abusing drugs like Adderall. But we do know that people of all ages and from all corners of the world and economy pursue this substance as though their lives depend on it. And they do — sort of. Most of us feel the pinch of unhealthy work-life balances and the curse of diminishing economic returns sometimes. The concurrent rise of economic inequality and higher rates of workplace stress, combined with relentless drug marketing, have made this a perfect storm.

When we remember that Big Pharma helps bankroll the American Psychiatric Association, and therefore has a hand on which conditions get recognized as diagnosable disorders and which do not, it becomes less of a surprise that Adderall is such a presence in our country.

Indeed, these drugs can arguably help some, but the rate at which we’re prescribing them is most certainly far beyond what’s necessary, and they’re becoming a go-to for far too many otherwise treatable medical concerns. So if you’ve come away from this with the nagging sense that we’re buying this snake oil for no discernable reason other than because it’s been marketed in our general direction — for conditions which, when they are medically detectable, are generally of society’s own making — you’re not far from the truth.


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Kate Harveston is originally from Williamsport, PA and holds a bachelor's degree in English. She enjoys writing about health and social justice issues. When she isn't writing, she can usually be found curled up reading dystopian fiction or hiking and searching for inspiration. If you like her writing, follow her blog, So Well, So Woman.

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14 thoughts on “What’s with America’s Adderall Problem?

  1. Many of the rehabilitation center representatives you can talk to will tell you there’s little difference between a “lower-class” meth addict scrambling for a fix, and an employed, working-class American who abuses Adderall to get through their workaday life. The difference, predictably, comes down to stigma — we have a caricature of the “typical meth user” thanks to the media’s portrayal of them.

    But there is no “standard Adderall abuser,” so we don’t know the first thing about how to talk about it. Yet, the effects on the body and mind are terribly similar between the two. America has a long history of failing drug addicts. What happens when drug addicts can look like anybody?

    What happens, I think, is that maybe we finally start to get somewhere.

    We accept that sufferers from anemia, depression, cancer, astigmatism, schizophrenia, or multiple sclerosis, can look like anybody. And since we don’t have much in the way of stereotypes about people suffering those diseases, we focus mostly on treating them.

    But we have aallll kinds of stereotypes about what people who suffer from addiction look like, which all seem to lead into “and therefore we should use ineffective treatment methods, or even fail to treat them at all.”

    Now we just need to extend this to people who suffer from every other kind of addiction, not just those addicted to pharmaceutically prepared racemic amphetamine drugs.

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  2. There always has been a strong cultural component to which drugs are respectable and which are stigmatized, and any given drug can shift from one category to another. We are seeing this happen right now with marijuana. Prohibition was a century-long attempt to remove alcohol from the respectable category. As for amphetamines, they entered cultural consciousness after World War II. They were dirty drugs used by low-lifes. They were pep pills that helped our boys defeat the Nazis. This is why bowls of greenies in baseball clubhouses were uncontroversial, even after they became an open secret. Compare this with steroids, which were used by Soviet bloc nations to win Olympics. Nicotine was on the way out from respectability until the advent of vaping. Now my modestly sized town has about a dozen vape shops. And hey: they are filling retail space that might otherwise go vacant. So nicotine seems to be making a comeback.

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  3. Worth noting that the difference in effect between amphetamines and methamphetamines is fairly small, as I understand it.

    The main thing is the ratio between heart rate acceleration and other physiological symptoms, versus subjective experience of stimulation and alertness. Methamphetamine has less physiological symptoms for the same subjective experience. Which is why Desoxyn (brand-name methamphetamine) is sometimes prescribed for patients who experience racing heart rates with Adderall (brand-name amphetamine).

    The biggest problem with illicit methamphetamine is the “illicit” part, not the “methamphetamine” part – it’s mostly manufactured in conditions of shockingly inept chemical engineering.

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  4. I never did it but I remember it being a thing for college-students to do Adderrall in order to help with all-nighters.

    Though my other very unpopular thought is that student all-nighters are largely unnecessary and are more about social performance and the much dreaded “virtue signalling” than anything else. People do all-nighters because they learn somewhere that it is what you do to be a serious and real student.* Perhaps if we taught project management in high school, this would change.

    I’m not a fan of Bryan Caplan. I think he is largely a crank who reveals in knee-jerk contarianism but one of his sharper observations is that the global/American economy rewards those who can sit for long periods of time and follow instructions very well. These are the kids who end up in universities (especially good ones) and then in plum white-collar jobs that seem to get most of the money. There is a perception (real or imagined) that boys are not good at this and I do think there is an uptick in middle-class parents getting their boy children diagnosed with ADHD so they can get them on drugs to calm them down and get them to sit. I was an atypical boy so I did not run around that much but this is just my view from afar.

    *I don’t know where people learn this. If I was ever taught this, I ignored it. I’ve had 24-hour exams before where you pick up an exam and need to turn it in 24 hours later. I’ve usually spent about 9-13 hours doing these exams. A long day basically. A huge number of my classmates at least said that they spent the whole time awake doing these exams and then went home to crash. I did well on these exams so I wonder where the feeling comes from.

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    • All-nighters: I always understood them to be a moral failing, necessitated by procrastination. This was my understanding especially when I was doing one. Mostly, though, I figured out that sleep provided more test-taking advantage than anything I might cram in my head at the last minute. How much sleep? I was young, then. I could go on three hours two nights in a row, so I planned it with time for makeup sleep later. I later realized that this was another way of saying I could get by for a while with just one REM cycle. Nowadays I can just barely function the next day on one REM cycle, and would slit my wrists if I had to go two.

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      • I think procrastination is probably a part of it. There are cultural components though. I’ve heard and read that Americans like the appearance of long hours at the desk, office, library but a lot of it is slack time. OTOH, Europeans do shorter hours but when you are at work, you are working. Much less joshing around the water cooler or going to get a cup of coffee.

        I also think there are a lot of people who prove their self-worth through having other people notice how overextended they are and asking them to sit down and take a break. They can’t do this for themselves so they go from project to project, meeting to meeting during the day and then eventually someone says “you need to sit down and eat something.”

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      • All-nighters to prepare for writing a test always seemed foolishly counterproductive.

        All-nighters to get a project done, at a cost of being a useless lump the next day, seemed at least like they accomplish the goal – you stumble in to class, hand in the work, and sit in the back trying to take something like coherent notes. I did a few of those myself. Having done so was more a sign I hadn’t managed my time well in the preceding week, not that I was a good and diligent student.

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      • “All-nighters: I always understood them to be a moral failing, necessitated by procrastination. This was my understanding especially when I was doing one.”

        That was my understanding of all-nighters when I did them, too.* But now that I look back, I can be more sympathetic to myself and realize I was working 30+ hours a week. Of course, I suspect some people worked 40 hours and had families, too, and never did all nighters. But this idea of it being a moral failing or even the “very unpopular thought [ ] that student all-nighters are largely unnecessary and are more about social performance…” strike me as being hasty generalizations. They’re not necessarily wrong. Perhaps they’re even right most of the time. But sometimes people really do struggle through college and the reasons aren’t always simply that they didn’t learn “project management” in high school.

        *I never took adderall or anything stronger than caffeine.

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    • “Though my other very unpopular thought is that student all-nighters are largely unnecessary and are more about social performance and the much dreaded “virtue signalling” than anything else. People do all-nighters because they learn somewhere that it is what you do to be a serious and real student.* Perhaps if we taught project management in high school, this would change.”

      Yeah,, kinda this. I never pulled all-nighters in college, partly because I DID learn time management (both from my parents: both academics, and in high school). But I heard lots of people moaning about how many they pulled and it DID seem to me sort of a “look at me, look at how Serious I am”

      I think I got better grades with my “Okay, gonna study 20 minutes a day, starting 2 weeks before the exam, and then a couple hours the night before” than the people who pulled long all nighters and crammed. I’m sure I learned the stuff better.

      I earned pretty good grades in college. Not, like, Summa Cum Laude good, but certainly plenty good: high B average.

      I also wonder – as someone who works in academia today – how much of the “ohhhhh man another 80 hour week” you hear some academics claiming to work is an outgrowth of this. While I have put in a few 14-hour days (mainly because of meetings over and above the usual – like being on a search committee), I don’t think I’ve ever worked an 80 hour week.

      Fifty-hour weeks, yeah, sure, that’s pretty regular. But not 80, and that’s NOT something sustainable over the long term.

      I also wonder how many people in academia use stimulants stronger than caffeine to keep going. I’ve never seen out-and-out evidence of it, but I’ve known a few profs I wondered about.

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  5. I can tell you one component of drug addiction: Self-medicating,

    No health insurance, no mental health insurance, or stigma against mental illness — but there are a ton of people who take illegal drugs to manage chronic conditions. Of course, when one does that you can’t be certain or dosage, potency (or even whether what you’re taking is even roughly the right drug) — so addiction is always a risk.

    I know two adults who take adderall. Both have ADHD, both spend their days calmer, less stressed, and more capable of routine socialization than without it.

    Like rising autism rates, the rising rates of adults with ADHD are mostly the result of two simple things: The realization that one does not “grow out” of ADHD (adults can generally cope with unmedicated ADHD better, because they generally have a lifetime of learning ways to work around it. And unless you have a very mild case, medication is better than any coping strategy — they tend to make you marginally function at the cost of very high stress levels) and better diagnosis.

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  6. I was diagnosed with ADHD about halfway through grad school, though seriously everybody I knew was pretty sure I had it long before them. My mom had evidently (she told me upon hearing the diagnosis) fought to keep me from being “labeled” with as having ADD when I was a kid in the ’80s, and I was able to be pretty successful academically without it.

    Until it came time to start doing actual independent research, and the need to sustain focus for longer than it would take me to get through a problem set was too much for me. Self-medication with nicotine, caffeine, and alcohol were no longer cutting it either.

    I made my way through a few drugs before ending up taking Adderall and Wellbutrin.

    Wellbutrin was kind of helpful for attention, but I credit it for about 50% of my ability to quit smoking and it helps with my mood a lot. So that’s nice.

    Adderall is fucking bullshit though. I hate that fucking shit. Oh, sure, it’s nice to keep me focused and sitting still, but it leeches the joy out of everything, makes me extremely irritable about any sort of interruption, and causes me to zero in like a laser on the world’s most irrelevant details.

    Oh, and it also makes me much more anxious. Not like I’m exactly a rock without it.

    And when I hear about people seeking it out, I always wonder why anyone would do that to themselves if they don’t absolutely have to. Grouchiness and anhedonia in pill form.

    Anyway, I don’t take it anymore. I don’t really do a good job sitting still or paying attention to things for more than five minutes at a time, but if I have something to occupy my hands I’m better, and if I have something colorful going in front of my eyes that helps too.

    So yeah, I play video games through teleconferences. It probably sounds like malingering, but in reality I spend a lot more time engaged and contributing, and a lot less time saying, “Can you repeat that?” every time anybody asks me a question.

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