A note to readers: The intent of this story was to talk about stimulants from the perspective of stimulant addicts. It’s a common conversation in addiction communities, especially the ones our team has a close connection to. But we failed to tell the full story, and we’re sorry. We heard from hundreds of readers about how one-sided coverage of recreational Adderall abuse can be harmful to people with ADHD by perpetuating stigmas around diagnosis and treatment — making life harder for people who can’t easily get the vital medications they need. This problem is persistent and real, and we apologize for minimizing their perspective in our reporting.
Other readers put it better: We whiffed on a chance to “contextualize verifiable data and research in a way that can actually help solve many of the systemic and social problems regarding ADHD and ADHD meds.” To that end, we’re reevaluating our editorial guidelines around reporting on stories like this, and we’re commissioning additional pieces from experts on the topic. We promise to do better, and we’re grateful you shared your feedback.
— Josh Schollmeyer, editor-in-chief ([email protected])
When Alex was prescribed the psychostimulant Adderall in 2011 while studying for the grueling Chartered Financial Analyst (CFA) exam, he never imagined it would lead to him jumping from a 20-foot bridge and shattering his leg while fleeing an Airbnb scam gone wrong.
Adderall is prescribed to treat Attention Deficit Hyperactivity Disorder (ADHD), a neurobehavioral condition predominantly diagnosed in white or otherwise affluent children, marked by inattention, hyperactivity and impulsivity that was first included in the Diagnostic and Statistical Manual of Mental Disorders in 1987. There aren’t clear-cut boundaries to the condition, so determining who to treat becomes fuzzy; some doctors insist there is no definitive measure for ADHD, others require extensive neuropsychological testing. Such tests, however, are time-consuming and not always covered by insurance, so an increasing number of unscrupulous physicians are willing to write a prescription for Adderall after a brief interview, often only relying on the Conners Clinical Index Test, a series of 25 questions that can easily be manipulated by anyone seeking a prescription, like Alex, who believed it essential for his studies.
Four years later, Alex had switched from 60 milligrams of Adderall a day to smoking crystal methamphetamine, a far more potent amphetamine that’s virtually indistinguishable to the brain. If opiate painkillers are small doses of heroin in a pill, Adderall is a small dose of crystal meth, and the transition was seamless. “Long-term Adderall use created a body condition in me where I could control the meth,” says Alex, a pseudonym.
Until he couldn’t.
In February 2017, the then 34-year-old Navy brat purchased someone’s Airbnb login information on the Dark Web for $2.50 in Bitcoin, and booked a luxury unit at the Mosaic Apartments and Condominiums in Houston. It was the latest in an 18-month string of credit-card force authorization scams he committed with a gang of enterprising, tweaked-out meth heads, including fraudulent purchases of dozens of iPhones, joy rides in luxury cars and flights to Vegas on a Gulfstream G650 while snacking on chicken cordon bleu and Dom Perignon. Alex didn’t book the Airbnb with the intention of ripping off the owner, but when he stepped into the bathroom and discovered an unlocked closet filled with laptops, golf clubs and an authentic Air Force Two jacket, he said, “Fuck it, we’re taking this.”
A cadence of authoritative knocks on the door interrupted the plunder, however. Alex reminded everyone to remember the alibi and prepared to open the door, but before he could, the owner burst in, phone raised to record everything. Hector, Alex’s accomplice and also a pseudonym, instinctively knocked him to the ground and sprinted out of the apartment, with Alex chasing close behind. Rather than wait for the elevator, bolstered by amphetamines and feeling “bionic,” Alex instead leapt down the stairwell and into a parking garage. Looking left, then right, he spotted a small bridge that appeared to be about eight feet above the ground. In reality, it was more like 20 — a two-story drop — and he recalls the sensation of his hand brushing against the side of the concrete wall lasting “way longer than it should have.”
Then, everything went black. He attempted to stand, but a searing pain sent him to the ground as he glanced at his broken left leg, its foot dangling in the wrong direction.
“There he is!” Houston’s finest shouted from above.
It’s over, Alex thought. It’s finally all over.
While obviously not directly responsible for Alex’s felonious shopping spree, for him, Adderall paved a perilous path toward drug addiction. It’s a common progression according to addiction experts. “For so long, people have talked about marijuana as a gateway drug, but Adderall is even more of one now,” says Mark Shandrow of Asana Recovery in Southern California. “Many of our younger clients’ stories begin with a psychological dependence on Adderall,” agrees Matthew Kinoshita, clinical director at True Recovery in Newport Beach. “Which often leads to alcohol abuse, cocaine abuse and crystal meth addiction. The unwarranted confidence is fascinating. They feel like Superman.”
Adderall and medications like it — e.g., Ritalin, Vyvanse, Strattera, Dexedrine — treat ADHD by boosting levels of dopamine and norepinephrine in the brain to impact arousal, attentiveness and assurance. The amphetamine stimulants have a paradoxical effect for those with ADHD, explains adolescent psychologist Liz Jorgensen, calming their minds and reducing impulsive behavior. But for those who don’t have ADHD, Adderall overflows the brain with dopamine, causing euphoria and overconfidence. “Your ego tells you that you’re the smartest person that’s ever lived,” she says.
I definitely can offer some firsthand experience in this regard. As a young writer, I was hired to adapt a comic book series about lawyers representing supernatural clients into a TV show. Fearing I couldn’t meet the deadline, I consulted a life coach to work on time management. After two sessions, she recommended Adderall and wrote a note to my physician saying as much. To be clear, I don’t have ADHD and was never screened for the condition. Nevertheless, I was prescribed 60 milligrams of Adderall XR (“extended release,” as opposed to IR, or “immediate release”) a day.
The immediate results were undeniably positive. Weeks before the deadline, I submitted multiple versions of a Moonlighting-inspired one-hour pilot, along with season-long arcs for the legal duo and their clients, some of whom I imagined to be supernatural wife beaters, sex traffickers and rapists. I was promptly fired and castigated by the author for turning his wholesome protagonists into egomaniacal sociopaths. “You put them all on speed, dude!!!” Jorgensen explains.
The explosion of ADHD diagnoses and subsequent prescriptions for stimulants in the late 1990s coincided with a successful two-decade campaign by pharmaceutical companies to publicize the condition. In the late 1990s, the FDA allowed the advertising of controlled substances directly to consumers, and pharmaceutical companies jumped at the opportunity to market medication to treat ADHD, explains Alan Schwarz in A.D.H.D. Nation: Children, Doctors, Big Pharma and the Making of an American Epidemic. At that time, one in seven high school students in the U.S. had been told they had ADHD, Schwarz says, and experts worried parents were being pressured by pharmaceutical marketing campaigns to act.
Aaron Kesselheim, a Harvard professor who studies pharmaceutical marketing and ethics, shared with Schwarz what makes ADHD ads so effective: “You see a perfectly balanced child who is both academically and athletically gifted, with words like ‘potential’ jumping out at you, and neurons in the background to look like there is some science behind it. Quotations play on common fears and concerns that parents have about their children — they’re not socialized enough, they’re not doing their homework. But there really aren’t many 8-year-olds who look forward to doing their homework.”
“The ads played on parents’ concerns that sometimes their kids could be monsters,” Kesselheim continues, “and you want to be interacting with that lovable kid inside rather than the monster that your 8-year-old son can sometimes be.”
But the ads made no reference to potentially lifelong psychological consequences, as described by Jean Piacenza, a family therapist and licensed clinical social worker with 25 years’ experience treating ADHD. “My concern is the learned helplessness,” she tells me. “I always hear, ‘I can’t do it if I don’t take my meds.’ There’s a sense of not having agency over your own thinking until, or unless, you’ve taken your meds. That’s destructive and dangerous.“
A dose of amphetamine will make anyone more deliberate and methodical in what they’re doing — whether it’s separating laundry or variables in a quadratic equation, explains behavioral pediatrician Lawrence Diller, among the first to speak out against the country’s mass diagnoses of ADHD in a 1998 cautionary book, Running on Ritalin: A Physician Reflects on Children, Society and Performance in a Pill. In it, Diller investigated the explosion of ADHD diagnoses and prescribed stimulants, which he partially attributed to a declining standard of living in the U.S. since the 1970s. “Any performance enhancer is going to be attractive,” he tells me. “By cloaking it in something as ambiguous as ADHD, drug companies took the ball and ran with it.”
In fairness, academia handed it to them. Namely, Harvard psychiatrist Edward Hallowell, the world’s leading expert on ADHD, whose groundbreaking 1995 book, Driven to Distraction: Recognizing and Coping with Attention Deficit Disorder from Childhood Through Adulthood has served as a quasi ADD bible ever since. “I was trying to call people’s attention to a virtually unknown, unrecognized and misunderstood syndrome,” Hallowell tells me. “No one had heard of ADD, so I wanted to demystify and de-stigmatize it as the fascinating condition that it is: a race car brain with bicycle brakes. If you don’t strengthen the brakes, you can crash and burn. But if you do, you can become a champion.”
Again, many of the symptoms could describe a typical child, particularly one growing up with heightened technology, yet the overwhelming impulse was to fix the kid instead of the culture he or she was raised in. Jorgensen, an adolescent psychologist with more than 30 years experience, remembers the onslaught of clients looking to medicate their hyperactive children. “Dr. Hallowell was regularly on Oprah, Good Morning America and The Today Show, warning parents about the train wreck of untreated ADHD approaching,” she recalls.
Not surprisingly, Hallowell disagrees and fiercely defends his work today. “Russell Barkley, one of the great researchers in the field, concluded that due to everything that happens to people with untreated ADHD — drug addiction, gambling addiction, sex addiction, unemployment, accident prone, multiple divorces — an average of 13 years are wiped off your life, more than cigarette smoking,” he argues.
There’s no denying, however, that the use of “study drugs” has exploded ever since. From 2002 to 2012, the manufacturing of prescription stimulants increased by a whopping 9 million percent. And by 2018, 16 million American adults used the medication, with 5 million misusing it and 400,000 having a stimulant use disorder. “The number is much higher today,” Diller says.
That said, for people who say they struggle with bad cases of ADHD, the drugs are a lifesaver — not something that puts them in jeopardy. “It’s not dissimilar to a person with diabetes needing to take insulin,” explains Kyle, a 39-year-old marketing director in San Francisco. (Like with all the others who use ADHD medication in this piece, Kyle is a pseudonym to protect his anonymity.) A better analogy, Hallowell says, is nearsightedness — i.e., patients do much better with glasses than without them, and ADHD patients do much better with stimulant medication than without.
Douglas, a screenwriter in L.A. with ADHD, has taken 60 milligrams of Adderall as directed for 15 years and says he wouldn’t have a career without it because he’d never finish anything. Attentional ability is on a spectrum, confirms neuroscientist Anjan Chatterjee, and those at the farthest ends of distractibility require stimulants to function. “It’s unfair to these people that Adderall has become stigmatized,” he tells me.
The stigma was almost entirely born from the ubiquity of ADHD medication on college campuses over the past 20 years. “It’s everywhere,” reports Chris, a 24-year-old chemical engineering graduate student who regularly sees people snorting lines of crushed Adderall off desks in the Science and Engineering Library. “There’s so much competition to ace the test, get into grad school, land a job, whatever it is. If you know everyone else is taking Adderall, you think, Fuck, I need to be on the same level. It’s just part of the college lifestyle.”
And yet, if drugs are taken in double and triple doses, the psychological effects of stimulants rise dramatically, Schwarz explains. “So to hand Adderall out to any college undergrad who says he’s having trouble is to abet disaster, particularly among a population notorious for experimenting with mind-altering substances.” Still, he points out, the first article about college students abusing amphetamines to study was in Time magazine in 1937. “This ain’t new,” he says.
The original amphetamine epidemic in the U.S. from the 1940s through the 1960s was likewise generated by the pharmaceutical industry as a byproduct of commercial drug development and competition. Searching for a decongestant and bronchodilator to substitute for ephedrine, in 1929, biochemist Gordon Alles discovered the physiological activity of beta-phenylisopropylamine, soon to be known as amphetamine. “He took quite a big dose, 50 milligrams, before he gave it to patients,” explains Nicolas Rasmussen, a professor at the University of New South Wales and an expert on the history of drug abuse and pharmaceuticals in the U.S. since 1900. Shortly after, Alles wrote in his notebook he had “a feeling of wellbeing” and his thoughts seemed to be quicker. “There’s really nothing fundamentally new about Adderall over Alles’ discovery,” Rasmussen tells me.
Two years later, the American pharmaceutical company Smith, Kline & French announced it was releasing Alles’ new drug as the Benzedrine inhaler, a volatile 300-milligram amphetamine base in a tube. Vapors would cause the nasal mucosa to shrink and relieve congestion, but if you just wanted to get high, the bottom of the tube could be unscrewed and the wad of amphetamine dropped in a cup of hot coffee or Coke. The inhaler was ubiquitous, available in most gas stations and five-and-ten-cent stores as an over-the-counter cold remedy, and became a staple of bebop jazz culture — beat writers like Jack Kerouac fashioned their writing style after the spontaneous rush of sound it often inspired. Truck drivers, prisoners and World War II pilots were likewise drawn to Benzedrine for the same reason: quicker thoughts and Alles’ “feeling of wellbeing.”
By the early 1960s, legions of middle-aged, middle-class patients received low-dose prescriptions from family doctors to help them cope with their daily “duties,” resulting in a quasi-medical amphetamine gray market. To help maintain his youthful vigor, JFK received regular injections containing 15 milligrams of methamphetamine from German-trained physician Max Jacobson, nicknamed “Doctor Feelgood,” who also treated Cecil B. DeMille, Truman Capote, Tennessee Williams and the Rolling Stones.
But concern mounted about widespread amphetamine abuse, and in 1969, a congressional hearing was devoted to the theme, “Crime in America — Why 8 Billion Amphetamines?” The legislation that emerged, the 1970 Comprehensive Drug Abuse Prevention and Control Act, established the modern set of controlled substance schedules. “When a drug is treated as a virtually harmless legal medicine, it’s difficult to make a convincing case that the same drug is terribly harmful if used nonmedically,” Rasmussen concludes. “This is what happened in the 1960s, and is presumably happening again today.”
Chris, for example, a 24-year-old in the Mid-Atlantic, began taking Ritalin in high school and continued throughout college, which he calls the most successful years of his life. “I felt like fucking Albert Einstein and could solve any differential equation and calculus problem in a heartbeat,” he says with glee. To obtain a prescription, Chris Googled symptoms for ADHD and recited them to his doctor. “I bullshitted, and it spiraled from there,” he says. The doctor allowed him to titrate his dose, beginning with 10 milligrams a day, then 20 and eventually working up to 50.
Christy, a 31-year-old copy director in New York, has been taking Adderall daily since 2009 and recalls a similarly questionable diagnostic process that included rating statements like “I have difficulty with task completion,” and “I often walk away from my workspace,” which she knew exactly how to answer if she wanted a prescription. “The doctor barely looked at me, and after four minutes, wrote a prescription for 40 milligrams of Adderall XR daily.”
A decade before Alex shattered his leg beneath a luxury apartment building in Houston, he was an ambitious pre-med student at a liberal arts university struggling to keep up. He couldn’t understand how everyone in the library was able to just sit there, for hours, studying. He switched majors to business, figuring it would be easier, but the real revelation came sophomore year when a study partner gave him a 20-milligram tablet of Adderall IR. “It was such a profound moment,” he recalls, his voice growing softer. “I was like, This is how they do it.”
Soon, Alex, too, was rating statements like, “I have trouble completing tasks that need to get done,” on a 10-point scale. The doctor explained that Alex had scored a 26 on the test, and “anything over a 20 is ADHD.” He wrote a prescription for 60 milligrams of Adderall per day, despite 30 milligrams a day being the most Alex had ever taken before. The price: $17 for a three-month supply, with insurance. “I was like, Holy shit! Score!!!” he tells me.
“When I was in school in the 1970s, people did drugs to check out. Now, they’re doing drugs to check in,” Chatterjee says, noting heightened competition to be the primary distinction, with people feeling a need to be cognitively enhanced just to keep up. John, for example, an economics major at Columbia University, justified his Adderall use to the New York Times in 2005, explaining, “If you don’t take them, you’ll be at a disadvantage to everyone else.”
Asked if he thinks a student who is not diagnosed with ADHD should have access to psychostimulants to improve performance, Hallowell, the ADHD OG, is conflicted. “You can’t, because it’s against the rules. Do I think the rules are fair? No, because many people who do better on stimulant medication don’t have ADHD.”
Upon graduating, Alex was hired by a Fortune 500 company in Texas, one of the most reputable wealth-management organizations in the country. He used Adderall to study and easily pass the Certified Financial Planner Board of Standards exam before setting his sights on the more challenging and demanding CFA qualification. The goal not only justified Adderall, he says, but demanded it.
Every morning when his alarm went off at 5:30 a.m., he would immediately pop 30 milligrams and smoke weed to stimulate his appetite so he wouldn’t be tweaked out by noon on an empty stomach. The weed/speed combo also served to pump him up before daily morning study sessions. “I would drive to work blasting Eminem, thinking, I’m about to go kill this exam.” In the office cafeteria, over scrambled eggs and bacon, he silently studied with another young advisor in his group, Daniel, who wasn’t medicated.
“I envied the fuck out of him,” Alex says. “I wanted so bad to be able to sit there without the help of drugs and study the way he did. He’s now in his 15th year with the same company, in a dream role we both aspired to get at the time. Probably a millionaire.”
At 8:30 a.m., when the first pale orange missile was beginning to fizzle, Alex would take another 30 milligrams before advising high net-worth clients on their financial problems. Oil and gas executives sought him out for advice; promotions were routine. Delighted by the early morning study sessions and glowing reviews from customers, management saw Alex as an intelligent go-getter. In two years, he’d quadrupled his entry-level salary of $42,000.
“A big part of the stimulant story is what people use to come down from them,” Alex says. “I drank a ton of booze.” The off ramp would begin shortly after lunch in a private bathroom 15 minutes away from his desk, where he could snort lines of OxyContin, which negated the dreaded stimulant comedown. Alex cheerfully fluttered about the office for the rest of the afternoon, helping co-workers and making them laugh. On the way home, he’d slam a $15 bottle of Crown Royal, followed by three or four beers and a perpetual cloud of marijuana. If he’d taken too much Adderall, he’d add 200 milligrams of over-the-counter sleep medication to the mix to catch some Zs.
Recovery professionals say people with Adderall problems often present with attending “downer” addictions used to offset the medication. “In this line of work, you always have to read between the lines,” says Michael Ahearn, a recovery coach at Mountainside Treatment Center in Connecticut and an expert on substance abuse among millennials. “Whenever someone presents with a drinking problem, I always look for a history of stimulant use. Especially within millennials, because we were raised with the idea that there’s a pill for however you’re feeling. We’re an exceedingly medicated generation.”
Brook McKenzie, admissions director at New Method Wellness in Southern California and a recovering Adderall addict himself, says his go-to downer was five capfuls of NyQuil. For many others, it’s benzodiazepines like Xanax, or prescription drugs like Lunesta. But Adderall and alcohol is the most common pairing, McKenzie says, since both are more or less legal. “Many rationalize these substances in their lives more readily because they don’t have the moniker of an illegal narcotic from a cartel, so they’re a little more palatable.”
Another potentially fatal characteristic of stimulants is a heightened ability to consume large quantities of alcohol without feeling intoxicated, Jorgensen says. “There are a lot of complex liver reasons why people tend to fall asleep when they drink too much, but that’s all out the window when you’re on stimulants. And that’s extremely dangerous.”
One in seven people entering New Method Wellness has been prescribed Adderall, McKenzie says, and for clients under 24, it’s three out of seven. But few, if any, mention an Adderall abuse disorder. “If someone participates in abstinence-based 12 steps programs like Alcoholics Anonymous, are they able to raise their hand and claim they are 90 days’ sober if they’ve been taking 90 milligrams of Adderall every day?” he wonders. Last week, a client graduated after 45 days and called McKenzie, explaining he had checked in with Adderall and was hoping he could now ship it back to him. “It’s the most difficult substance for clients to overcome, because it’s psychological dependence in addition to physical,” McKenzie says.
Dependent or not, Alex was feeling like “a winner all around” at work, consistently exceeding management’s expectations. He passed the CFA exam and was relocated to Houston to open a new office, but the Adderall consumption persisted despite having an “obscene” amount of free time with nothing to study for. So he’d finish his work before noon and head to the strip club for lunch. One time, while reaching into his pocket, a couple of pills fell on the floor. The stripper shot him a knowing glance and asked if he liked speed. Alex nodded. “What about ice?” she queried next, summoning him to her car.
Alex recalls the first hit as being similar to Adderall, but much stronger. “Steady and consistent, like nonstop shots of dopamine to the brain.” Over the course of a year, the crystal meth addiction slowly consumed his career, his marriage and everything else he cared about. He eventually divorced and quit his job, telling himself that he’d find something else but really just intending to get high. He opened up an underground game room in south Houston (i.e., a small parlor filled with electronic slot machines popular with crystal meth users because it’s open 24/7.) He began dealing meth to support his habit, and in the course of doing so, met Hector and his associates who were planning their next credit-card force authorization scam and asked if he could offer some financial advice.
As for me, I’ve been tempted over the years to give Adderall another shot, particularly when I find myself up against a seemingly insurmountable amount of work that requires the smartest version of myself to complete. But then I found out that stimulants don’t actually make you any smarter, they just make you think you are. “We shouldn’t be talking about Adderall as a ‘smart pill,’ but rather a ‘drive pill’ that enhances one’s motivation to sit through otherwise mundane tasks,” says Chatterjee, who conducted a study with his University of Pennsylvania colleague Martha Farah of college students taking either stimulants or a placebo. They found no significant difference between Adderall and placebo, except for one question: “Do you feel that the pill you took today enhanced your cognition?”
The perception that you’re doing better in your tasks is really the only contribution to actual improved performance. It’s an addiction to aspiration; people feel they’re doing better, and therefore, perform at least a little better in reality, yet not as well as they think. “I suppose the question is what’s lost if we all were in an Adderall world,” posits Wendy Brown, a political theorist at the University of California, Berkeley. “What we might say is lost is what we do when we reflect and allow our thoughts to wander. Out of that comes creativity, art, intense pain and grief and extraordinary moments of connection. I would describe them as the experience of being human itself.”
“Nonsense,” Hallowell says. “[ADHD] medication should change you as much as and no more so than eyeglasses — improved focus, plan better, more access to a sense of humor and creativity because you can organize and plan it.”
But it’s undoubtedly mood-changing, I counter, citing two people I interviewed who use the drug exclusively in social situations. Hallowell, though, insists the only mood-altering component of the medication is related to depression. “Very often, depression and anxiety are a component of ADHD, and most of the time, it’s related to underachieving, which is a bummer. When you get focused, your performance goes up, so what appeared to be depression goes away. That’s not mood-altering. That’s an appropriate adjustment of your feeling tone in relation to improved performance and reduced anxiety.”
For some Adderall addicts, the question of what’s lost is more fundamental, however. My stimulant habit blossomed into a full-blown intravenous cocaine addiction, leading to a traumatic brain injury that left permanent cognitive and physical deficits. I hit lots of deadlines, of course, but it wasn’t worth it.
The same obviously for Alex. The Houston Fire Department had to lower a crane into the bayou to retrieve him. He was then handcuffed to a gurney and transferred to the hospital, where he spent three days undergoing surgery, a uniformed Houston cop in the room at all times. After spending six months in jail, he was broke and in debt, owing the IRS roughly 40 grand due to having cashed out a $200,000 401k early.
“Maybe it would’ve been better for me to fail out of finance and be forced into a more fulfilling occupation that better fits my personality,” he says now in hindsight. “Something more creative, perhaps.”
This is music to Diller’s ears, who keeps a children’s sorting toy in his office with a triangle, a circle and a square and corresponding pegs. “I tell teens and their parents, ‘You’re this pyramid, and you’re trying to fit into a square educational hole, which hurts! There are two other holes here. Why don’t you try the circle? Why are you at Harvard if you’re having to use Adderall?”
For now, Alex is taking things one day at a time, as they say, living with his parents. He’s a 38-year-old with a criminal record and walks with a limp, reminded daily of everything he’s lost. He wishes he’d come across more stories of people crashing and failing as he did on Adderall, so he created Alphatweaker.com to share some experience, strength and hope.
More than any prescription medication, he blames Western society for his stimulant addiction, and a constant barrage of movies, music and ads equating money to happiness. Or as he put it, “I got a bunch of money and still had this strange void, despite swallowing a pill to train my unwavering attention on materialism and overabundance. It’s the American way, and it’s dangerous.”
Correction: A previous version of this story misstated a statistic about ADHD diagnoses. It’s now been removed.