DR. WORNIK: When people hear the term “performance enhancement,” they often think of athletes or bodybuilders trying to get bigger and stronger. But for many teens, academic performance is a bigger worry. And with the increase in prescribed stimulants for children suffering from ADHD, many unaffected kids have started asking if those same drugs could boost their academic performance.
Often known as “study drugs,” these stimulants make teens feel like they can focus better, study longer, and master more challenging course loads… or blow off their studies until the last minute, then cram to catch up. Some teens even feel they need the drugs to compete academically with others who are using. But how big a problem is this?
Ten percent of high schoolers and more than 30% of college students use stimulants for cognitive neuroenhancement. Fifty-six percent of teens report that it is “easy” or “very easy” to obtain a stimulant like Adderall or Ritalin without a prescription.
But despite the drugs’ reputation as a study aid, they show no academic benefits for students without ADHD. In fact, non-medical stimulant use is correlated with worse grades. And teens who use these drugs are also likely to suffer from other substance use disorders.
Teens often don’t understand the serious health effects of stimulant medications. Just because a drug can be legally prescribed doesn’t make it safe. Stimulant use has many negative effects, including increased or irregular heart rate, high blood pressure, loss of appetite, headaches, insomnia, dry mouth, and anxiety.
Whenever a patient comes in with a combination of these symptoms, it’s a good idea to ask about stimulant use. Many teens who use stimulants already suffer from diagnosed or undiagnosed anxiety, which can then be exacerbated by the drugs. A referral to counseling can address that underlying problem and reduce reliance on stimulants.
As doctors, we must also be careful not to feed into prescription drug misuse. Some teens claim or fake ADHD symptoms in the hopes of obtaining a prescription, while one in four teens with a legitimate prescription admits to exaggerating symptoms to obtain additional medication for friends. We can help our patients understand that taking or sharing medicine without our oversight can be dangerous. And we can let them know that ADHD medications are Schedule II drugs, which means that selling pills -- or even possessing them without a prescription -- can mean fines or jail time. This is often a surprise to teens and their families, who don’t realize that sharing pills is no different than buying or selling other illegal drugs.
Let’s look at another case study. Ella is a 16-year-old high school sophomore whose mother brought her in after she experienced heart palpitations and had to drop out of a track meet. In the initial exam, Ella’s mother is concerned about her daughter’s drastic weight loss and insomnia. To make Ella comfortable answering personal questions, Dr. Denke has asked her mother to leave the room and give them some time alone.
Ella skipped the section about prescription medications on her screening form, but did admit to drinking with friends several times a month. She also reports an extremely high level of anxiety that interferes with her daily activities.
It’s Dr. Denke’s job to find out for sure whether Ella is using stimulants. He should ask Open-Ended Questions to encourage her to share, use Ask-Tell-Ask to share information, and help her feel accepted and validated by Reflecting and Normalizing her feelings. To keep the conversation on track, he should use Summaries to make sure that he understands what Ella is telling him. With his help, she can find a way to address her anxiety and stimulant use that is safe, legal, and effective.