Stimulants can help with focus, but beware

Issue June 2011

Q. I am halfway through law school, and, because I'm not anywhere near the top of my class, have been told not to expect interest from major law firms upon graduating. In high school, it was suggested that I might have ADHD. Even if not, many of my fellow students routinely use Adderall to enhance their academic functioning. I have been philosophically opposed to using a chemical boost, and did quite well in college on regular brain power, but that position has certainly worked against me.

A. We of course invite you to come to Lawyers Concerned for Lawyers for a more thorough evaluation or your situation, state of mind and options.

But we would like to take this opportunity to address the issue of Adderall. As you indicate, we are hearing more and more reports suggesting that Adderall (or its newer siblings, such as Vyvanse) is being used regularly (by some, just at academic crunch times, but by others on an ongoing, daily basis), not only by those who have Attention Deficit Hyperactivity Disorder (or at least claim to have it), but by students with normal attention spans who want to augment their studying capacity, and also by young professionals seeking to be more productive or competitive in their work.

Stimulants (originally Ritalin) have been used to treat ADHD for many years, especially for children otherwise unable to settle down in class. Many parents of these kids have opposed medications, arguing that what is needed is to restructure the schools to be able to accommodate the common behavior patterns of youngsters who happen to be less contained by nature. But there is no question that the medications are very often effective, producing the "paradoxical" effect (since they are stimulants) of increased composure and focus.

Since the "discovery," perhaps 25 years ago, that ADHD often persists into adulthood, use of Ritalin and its successors (such as Concerta and Adderall) have increased astronomically among adults. Indeed, we have seen a number of lawyers who complained of chronic errors and disorganization and who saw clear benefits from such medications. We respect your philosophical opposition to ingesting drugs that are essentially optional, if helpful, but, if you truly have ADHD, using something like Adderall would be considered appropriate.

However, use of heavy-duty stimulants to lift performance from normal to supernormal is another matter. At one time, experts maintained that people without ADHD would not get the beneficial, "paradoxical" effect, and that these medications were rarely abused. Those contentions seem to have turned out to be false. Using stimulants (years ago, much more commonly caffeine, in such products as No-Doz) at exam time is certainly not a novel phenomenon. But there is, indeed, something highly unsettling, especially about unimpaired individuals chronically revving up their nervous systems by using "speed."

This old street term is not an overstatement. Adderall is an amphetamine, just like the pills that became something of a scandal when used in the 1960s by many Americans for weight loss and depression (or to seek euphoria), leading to their removal from the market.

While the benefits of amphetamine use may well outweigh its risks for those who otherwise cannot accomplish important tasks, elective use of these drugs (whether purchased illicitly or obtained by describing the right symptoms to a psychiatrist) should be balanced with awareness of the potential cumulative side effects. These include: severe increases in blood pressure; irregular heart rhythm or heart attack; stroke; respiratory difficulty; seizures; hyperthermia; internal bleeding; and liver/kidney damage.

If also taking antidepressants or decongestants, the dosages may need to be changed. All of these dangers are increased when one uses Adderall or other amphetamines by crushing and snorting (which can also injure sinuses, nostrils and lungs) or when exceeding the recommended dosage. Amphetamine use is subject to abuse (especially by those who develop tolerance and find the need to take more and more in order to get an effect) and dependence (users may become virtually unable to function without the drug, and may develop withdrawal symptoms if unable to obtain the pills).

It seems that our society becomes more Darwinian every day, but let us all balance our immediate professional survival strivings with an eye toward long-term survival. Adderall may be an absolute boon to those with attention deficits, but the decision to use it (as in the case of any psychoactive or potentially addictive medication) is not a casual one. n

Questions quoted are either actual letters/e-mails or paraphrased and disguised concerns expressed by individuals seeking assistance from Lawyers Concerned for Lawyers.

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