Psychology/Psychiatry

The Horror of Drug-Boosted Grades and SAT Scores

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The New York Times reports that "abuse" of "study drugs" (stimulants prescribed for attention deficit hyperactivity disorder) is on the rise among high school students. A couple of problems with this story: There is no evidence that consumption of such drugs has increased among teenagers in recent years, and what the Times calls "abuse"—taking the stimulants to boost grades and SAT scores by making it easier to focus on studying and tests—would more accurately be described  as "use." The story's headline ("Risky Rise of the Good-Grade Pill") and opening paragraphs create the impression that students anxious to improve their academic performance are popping pills like never before:

At high schools across the United States, pressure over grades and competition for college admissions are encouraging students to abuse prescription stimulants, according to interviews with students, parents and doctors. Pills that have been a staple in some college and graduate school circles are going from rare to routine in many academically competitive high schools, where teenagers say they get them from friends, buy them from student dealers or fake symptoms to their parents and doctors to get prescriptions….

"It's throughout all the private schools here," said DeAnsin Parker, a New York psychologist who treats many adolescents from affluent neighborhoods like the Upper East Side. "It's not as if there is one school where this is the culture. This is the culture."

Not until the 15th paragraph do we learn that "there is no reliable research on how many high school students take stimulants as a study aid." Nine paragraphs later, the Times reveals that "a respected annual survey financed by the National Institute on Drug Abuse, 'Monitoring the Future,' reports that abuse of prescription amphetamines by 10th and 12th graders nationally has actually dipped from the 1990s and is remaining relatively steady at about 10 percent." Even here the Times is fudging. According to the Monitoring the Future Study, the share of 12th-graders reporting nonmedical use of amphetamines in the previous year peaked at 11.1 percent in 2002; last year it was 8.2 percent. Among 10th-graders, this number fell from 11.7 percent in 2001 to 6.6 percent last year. The patterns for Ritalin are similar. In short, the Times, through the magic of anecdotes and obfuscation, has transformed a decrease into an increase.

As for the consequences of the nonexistent trend decried by the Times, here is one example of what can happen when a student "abuses" stimulants such as Adderall or Ritalin:

Madeleine surveyed her schedule of five Advanced Placement classes, field hockey and several other extracurricular activities and knew she could not handle it all. The first physics test of the year — inclines, friction, drag — loomed ominously over her college prospects. A star senior at her Roman Catholic school in Bethesda, Md., Madeleine knew a friend whose grades had gone from B's to A's after being prescribed Ritalin, so she asked her for a pill.

She got a 95. Thereafter, Madeleine recalled, she got Adderall and Vyvanse capsules the rest of the year from various classmates — not in exchange for money, she said, but for tutoring them in calculus or proofreading their English papers.

"Can I get a drink of water?" Madeleine said she would ask the teacher in one class, before excusing herself and heading to the water fountain. Making sure no one was watching, she would remove a 40-milligram Vyvanse capsule from her purse and swallow it. After 30 minutes, the buzz began, she said: laser focus, instant recall and the fortitude to crush any test in her path.

"People would have never looked at me and thought I used drugs like that — I wasn't that kid," said Madeleine, who has just completed her freshman year at an Ivy League college and continues to use stimulants occasionally. "It wasn't that hard of a decision. Do I want only four hours of sleep and be a mess, and then underperform on the test and then in field hockey? Or make the teachers happy and the coach happy and get good grades, get into a good college and make my parents happy?"

The horror? The Times does describe a few less happy outcomes, including one boy who "later became addicted to the painkiller Percocet and eventually heroin" and another who escalated to 400 milligrams of Adderall a day, "was rushed to the emergency room" after he "began hallucinating and then convulsing," and "wound up spending seven months at a drug rehabilitation center." How common are the Madeleines compared to the convulsing, hallucinating addicts? The Times does not even raise the question.

Underlying the whole article is the dubious premise that using stimulants to do better in school is perfectly legitimate when you are properly diagnosed with ADHD but alarming, disturbing, and vaguely anti-social when you fib to your psychiatrist or find one who is less than diligent in applying the criteria laid out in the Diagnostic and Statistical Manual of Mental Disorders: inattentiveness, hyperactivity, or lack of impulse control causing "clinically significant impairment" in at least two settings, signs of which were apparent by age 7. "It's one thing if you have a real deficiency," a family therapist tells the Times. "The medicine is really important to those people. But not if your deficiency is not getting into Brown." For the Times this is the sort of distinction that justifies arresting people; to me it seems like a moral judgment masquerading as medical advice.