Like many young people, I relied for years on prescription stimulants to power me through all-nighters in college and late nights at the office, said writer Casey Schwartz. Then I tried to kick my addiction.
In thrall to Adderall
HAVE YOU EVER been to Enfield? I had never even heard of it until I was 23 and living in London for graduate school. One afternoon, I received notification that a package whose arrival I had been anticipating for days had been bogged down in customs and was now in a FedEx warehouse in Enfield, an unremarkable London suburb. I was on the train within the hour. The package in question, sent from Los Angeles, contained my monthly supply of Adderall.
The train to Enfield was hardly the greatest extreme to which I would go during the decade I was entangled with Adderall. I would open other people’s medicine cabinets, root through trash cans where I had previously disposed of pills, write friends’ college essays for barter. Once, while living in New Hampshire, I skipped a day of work to drive three hours each way to the clinic where my prescription was still on file. Never was I more resourceful or unswerving than when I was devising ways to secure more Adderall.
Adderall is prescribed to treat attention-deficit hyperactivity disorder, a neurobehavioral condition marked by inattention, hyperactivity, and impulsivity that’s predominantly seen in children. That condition, which has also been called attention deficit disorder, has been increasingly diagnosed over recent decades: In the 1990s, an estimated 3 to 5 percent of school-age American children were believed to have ADHD; by 2013, that figure was 11 percent. It continues to rise. And the increase in diagnoses has been followed by an increase in prescriptions. In 1990, 600,000 children were on stimulants, usually Ritalin. By 2013, 3.5 million children were on stimulants, and in many cases, the Ritalin had been replaced by Adderall, officially brought to market in 1996 as the new, upgraded choice for ADHD—more effective, longer lasting.
By the mid-2000s, adults were the fastestgrowing group receiving the drug. In 2012, roughly 16 million Adderall prescriptions were written for adults between ages 20 and 39. Adderall has now become ubiquitous on college campuses. Black markets have sprung up at many, if not most, schools. In fact, according to a 2012 article, the off-label use of prescription stimulants had come to represent the second most common form of illicit drug use in college by 2004. Only marijuana was more popular.
To date, there is almost no research on the long-term effects on humans of using Adderall. 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.
THE FIRST TIME I took Adderall, I was a sophomore at Brown University, lamenting to a friend the impossibility of my plight: a five-page paper due the next afternoon on a book I had only just begun reading. “Do you want an Adderall?” she asked. “I can’t stand it—it makes me want to stay up all night doing cartwheels in the hallway.”
Could there be a more enticing description? My friend pulled two blue pills out of tinfoil and handed them to me. An hour later, I was in the basement of the library in a state of ecstasy. The world fell away; it was only me, locked in a passionate embrace with the book I was reading and the thoughts I was having about it, which tumbled out of nowhere and built into what seemed an amazing pile of riches. When dawn came, I was hunched over in the grubby lounge of my dormitory, typing my last fevered perceptions, vaguely aware that outside the window, the sky was turning pink. I was alone in my new secret world, and that very aloneness was part of the great intoxication. I needed nothing and no one.
I would experience this same sensation again and again over the next two years, whenever I could get my hands on Adderall on campus, which was frequently, but not, I began to feel, frequently enough. Adderall wiped away the question of willpower. Now I could study all night, then run 10 miles, then breeze through that week’s New Yorker. It was fantastic. I lost weight. That was nice, too. I did snap at friends, though, abruptly accessing huge depths of fury I wouldn’t have thought I possessed.
By my senior year of college, my schoolwork had grown more unmanageable, not less. For the first time in my life, I wasn’t able to complete it. My Russian-history professor granted me an extension on the final term paper. One Friday evening well into December, I was alone in the Sciences Library—the one that stayed open all night—squinting down at my notes on the Russian intelligentsia. Outside, it was blizzarding. I felt dizzy and strange. It had been a particularly chemical week; several days had passed since I had slept more than a handful of hours, and I was taking more and more pills to compensate. Suddenly, when I looked up from the page, the bright room seemed to dilate around me, as if I weren’t really there but rather stuck in some strange mirage.
An hour later, I was in an ambulance, being taken through the snowstorm to the nearest hospital. I sat for hours in the ER, until I was ushered behind a curtain and a skeptical-looking doctor came in to see me. I described what I’d been taking. His diagnosis: “Anxiety, amphetamine induced.” I had had my first panic attack—an uncommon but by no means unknown reaction to taking too much Adderall.
A few days later, I drew incompletes in my classes and went back home to New York. I spent that long winter break soldiering lethargically through the essays I hadn’t been able to cope with while taking amphetamines. What I didn’t know then, what I couldn’t have known, was that the question of whether Adderall actually improves cognitive performance when taken off-label— whether or not it is a “smart drug”—was unresolved. It would be another few years before studies appeared showing that Adderall’s effect on cognitive enhancement is more than a little ambiguous. Martha Farah, a cognitive neuroscientist at the University of Pennsylvania, has conducted much of this research. She has studied the effect of Adderall on subjects taking a host of standardized tests that measure restraint, memory, and creativity. On balance, Farah and others have found very little to no improvement when their research subjects confront these tests on Adderall. Ultimately, she says, it is possible that “lower-performing people actually do improve on the drug, and higherperforming people show no improvement or actually get worse.”
My pill-free period didn’t last very long. I turned in my incomplete schoolwork and duly received my grades, but by graduation that spring, I was again locked into the familiar pattern, the blissful intensity and isolation followed by days of slow-motion comedown, when I would laze around for hours, barely able to muster the energy necessary to take a shower.
It took me exactly one year from the time of college graduation to come to the decision that would, to a great extent, shape the next phase of my life. It hit me like a revelation: It might be possible to declare my independence from the various ADHD kids who sold me their prescription pills at exorbitant markups and get a prescription all my own. The idea occurred to me as I walked among the palm trees on the campus of UCLA. By then, I was living in Los Angeles, working as a private tutor for high school kids, many of whom were themselves on Adderall, and taking summer-school classes in psychology and neuroscience in order to be able to apply for graduate school. As soon as it occurred to me that I might be able to get my own prescription, I went to the nearest campus computer and searched for “cognitive behavioral psychiatrist, Westwood, Los Angeles, California.”
The very next day, I was describing to the young psychiatrist in the chair opposite me how I had always had to develop elaborate compensatory strategies for getting through my schoolwork, how staying with any one thing was a challenge for me, how I was best at jobs that required elaborate multitasking, like waitressing. Untrue, all of it. I was a focused student and a terrible waitress. And yet these were the answers, I discovered from the briefest online research, that were characteristic of the ADHD diagnostic criteria. These were the answers they were looking for in order to pick up their pens and write down “Adderall, 20 mg, once a day” on their prescription pads. So these were the answers I gave.
Fifty minutes later, I was standing on San Vicente Boulevard in the bright California sun, prescription slip in hand. That single doctor’s assessment, granted in less than an hour, would follow me everywhere I went: through the rest of my time in Los Angeles; then to London; then to New Haven, Conn., where I would pick it up once a month at the Yale Health Center; then back to New York, where the doctor I found on my insurance plan would have no problem continuing to prescribe this medication, based only on my saying that it had been previously prescribed to me, that I’d been taking it for years.
Occasionally, I would try to get off the drug. Each attempt began the same way. Step 1: the rounding up of all the pills in my possession, including those secret stashes hidden away in drawers and closets. Debating for hours whether to keep just one, “for emergencies.” Then the leap of faith and the flushing of the pills down the toilet. Step 2: a day or two of feeling all right, as if I could manage this after all.
Step 3: a bleak slab of time when the effort needed to get through even the simple tasks of a single day felt stupendous. Panic would set in. Then, suddenly, an internal Adderall voice would take over, and I would jump up from my desk and scurry out to refill my prescription or borrow pills from a friend, if need be.
I’ve often wondered whether my inability to give it up was my deepest failing. I’ve found some comfort in seeing my own experience mirrored back to me in the dozens and dozens of disembodied voices on the internet, filling the message boards of the websites devoted to giving up this drug. One post, in particular, has stayed with me, a mother writing on QuittingAdderall.com:
I started taking Adderall in Oct. 2010. And my story isn’t much different than most.... The honeymoon period, then all downhill. I feel like I cannot remember who I was, or how it felt, to go one minute of the day not on Adderall. I look back at pictures of myself from before this began and I wonder how I was ever “happy” without it because now I am a nervous wreck if I even come close to not having my pills for the day.
I WAS 30 by the time I got off Adderall for good. This statement horrifies me even now, more than three years later, recognizing the amount of precious time I gave away to that drug.
During my first weeks of finally giving up Adderall, the fatigue was as real as it had been before, the effort required to run even a tiny errand momentous, the gym unthinkable. The cravings were a force of their own: If someone so much as said “Adderall” in my presence, I would instantly begin to scheme about how to get just one more pill. Or maybe two. I was anxious, terrified I had done something irreversible to my brain, terrified that I was going to discover that I couldn’t write at all without my special pills.
On one of those earliest days of being off the drug, I was moving slowly, more than a little daunted, trying to walk the few miles to an appointment I had in midtown Manhattan. It was a glorious summer evening, the sun just going down. As I approached Bryant Park, I heard live music and wandered in to see. A rock band was performing onstage. The singer gripped the microphone with two hands, pouring his heart into every word. Suddenly, tears were streaming down my face. I was embarrassed, but I couldn’t stop. It was as if I hadn’t heard music in years.
Excerpted from an article that originally appeared in The New York Times Magazine. Reprinted with permission.