Stimulant use is alarmingly high
What student doesn’t love Ritalin?
The first time Jan, a master student from Germany, took Ritalin, it was out of curiosity. He had heard that it might help him study, and it was easy to come by. He had a friend who had been diagnosed with attention deficit hyperactivity disorder (ADHD) who was happy to share a couple of pills.
Suddenly, the whole experience of studying changed. ‘It didn’t enhance my cognitive abilities and it didn’t give me twenty extra IQ points’, he says. ‘But it did make studying a pleasurable endeavour.’ For three hours on end he was motivated and focused. He felt a real drive to work more, study more.
Taking Ritalin became a habit for him. When he was doing his bachelor’s degree he used the drug quite a lot, he says. Now, during his master, he’s cut back. ‘The last time I took it was a couple of weeks ago.’ He also decreased the dosage: instead of 10 milligrams, he’ll take 5 milligrams. ‘Because of the side effects’, he says. ‘Those are quite strong.’
It’s no surprise UG students are taking Ritalin without a prescription to help them study. Studies in North America have shown that up to 15 percent of students use ADHD medication without having been diagnosed with a disorder. Another study showed that 26 percent of students who do have a prescription give pills away or sell them.
It made studying a pleasurable endeavour
Much less is known about usage in the Netherlands, which is why UG psychologist Anselm Fuermaier decided to do a study. ‘We know that when people are being assessed for ADHD, a substantial number show non-credible behaviour’, he says. That’s a scientific way of saying the symptoms these people report are sometimes so severe that it’s hard to believe they’re even able to function. ‘In performance tests they are so inattentive, slow, or forgetful, that it’s suspicious.’
Fuermaier wants to know what is going on here. It might be that it’s a cry for help from people who actually do suffer from ADHD. ‘They’ve been on a waiting list for months, for example, and are afraid the doctors checking them won’t take them seriously.’ But it’s also possible that they’re feigning the symptoms because they want an ADHD diagnosis.
‘Students work under pressure’, Fuermaier explains. ‘And then they hear that methylphenidate can help them study. A diagnosis may also earn them more time during exams, or a quiet workspace.’ In times of corona, it might even get them a coveted study spot at the university library.
It can also serve as an excuse. I failed my test because of my ADHD, not because I didn’t work hard enough. I dropped out because of my ADHD, not because I partied too much.
We know little about what these drugs do to a healthy brain
So are people abusing an ADHD diagnosis? And if so, how can we tackle that problem? Because it is a problem, Fuermaier says. ‘People who have ADHD can really struggle. Some can’t finish their education, they can’t hold a job, have drug problems or their relationships may fail. But at the same time there’s a heated discussion in society on whether ADHD is even a real thing at all.’
His mission is to find a better way to test for ADHD. Currently, a doctor might just go over a checklist. Is the patient forgetful? Check. Does the patient complain about having problems concentrating? Check. ‘But everybody is forgetful’, Fuermaier says. ‘We’re all tired of using Zoom, we all have problems concentrating. But we don’t all have ADHD.’
To weed out the people who are feigning the disorder, he has to know how people perceive ADHD, how they feel about taking non-prescribed drugs, and how many people actually take these drugs without needing them.
What he found, after surveying 1,071 mostly first-year social sciences students at the UG, is that a staggering 16 percent had taken methylphenidate – the active ingredient in Ritalin – at least once. Almost 60 percent of these users said they use it ‘occasionally’, while about 1 percent use it ‘regularly’.
Even though hardly any of these students had considered feigning ADHD themselves, over half of them thought it would be easy to do so. Almost 17 percent said they knew someone who faked it. Over 50 percent thought it was beneficial to do so, especially in an academic context.
These results worry Fuermaier. ‘Students take it way too lightly. These are psychostimulants that have an effect on our central nervous system. Most students wouldn’t take antidepressants this easily, and we know little of what these drugs do to a healthy brain when you use them for a longer period of time.’
Dutch PhD student Jesse didn’t think about the dangers either, the one time he used Ritalin to study. ‘I felt more focused and energetic’, he says. ‘But mostly I felt kind of euphoric. It made me like what I was doing.’
The come-down left me feeling depressed
The fact that his sister, who called her doctor to ask about the problems she had focusing, was immediately prescribed Ritalin – without the doctor even having seen her in person – also made it seem safe.
Jan didn’t think it was dangerous either. He’s had to deal with strong side effects, though. ‘The come-down would leave me feeling depressed and anxious’, he says. ‘I also heard of people having suicidal thoughts after using too much of it.’
It isn’t as bad as it used to be, he says, now that he has reduced his dosage. But he does feel how much energy he used up while on Ritalin. ‘I feel exhausted, like coming down from cocaine.’
No ethical concerns
Neither Jan or Jesse had to feign ADHD to get their study drug: they had friends who were prescribed Ritalin and who were happy to share. That is in line with what Fuermaier found in his study. Only 30 percent of students who used Ritalin got their pills through the black market. Over 80 percent mentioned peers or family as a source.
Fuermaier also noted a lack of ethical concern about taking these drugs. ‘If students didn’t take methylphenidate, it was because they didn’t think it necessary, or because they were concerned for their health.’ Less than 20 percent of the students mentioned the fact that it is illegal, unfair to others, or might give you an undeserved advantage as a consideration.
All this bothers the psychologist. Students who use prescription drugs in this way are more likely to have neuropsychological dysfunction, and are more prone to misuse of other drugs and alcohol. They more often have a psychiatric illness, or suffer psychological distress. ‘The results reveal that Dutch university students have a liberal view towards feigning ADHD, and misuse stimulants at an alarmingly high rate’, he says. ‘So a careful exploration of how credible their symptoms are is warranted before you give them drugs.’