The Drugs of Work-Performance Enhancement

A step beyond caffeine, Adderall and other common ADHD medications can improve productivity and focus—even when medical necessity remains debatable.
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(Saad Faruque/flickr)

My morning writer’s ritual is as predictable as it is contemporary: Walk the dog. Down a cup of coffee. Eat my shredded wheat. And, twice a week—sometimes three times—I flip open my vial of Adderall, tip out one of the 15-milligram peach tabs, and break it in half. For a moment the bitterness burns my tongue, and then down it goes.

The Adderall addition to my routine started three years ago, after I happened upon 60 Minutes one evening and caught a segment titled “Boosting Brain Power.” It was an examination of the Adderall epidemic on college campuses nationwide, and I found myself quickly drawn into it.

By the end of the story, the conclusion was inescapable: Adderall makes everything easier to understand; it makes you more alert and focused. Some college students scarf them like M&Ms and think they’re more effective at cognitive enhancement than energy drinks and safer than a smoke or a beer. A Harvard professor admitted he regularly devoured Adderall to help make a book deadline.

Prior to watching, I had some close friends and relatives with ADHD whose doctors prescribed the amphetamine for completely legitimate reasons. I called them “closet users” since they all seemed ashamed of their diagnosis, not to mention their prescription. Why they felt this stigma I’m not entirely sure. According to the National Institutes of Mental Health, 4.4 percent of the adult U.S. population has ADHD, which if left untreated is associated with significant morbidity, divorce, employment, and substance abuse.

Like all prescription medications, Adderall has risks that are crucial to understand. Buried in the middle of that 60 Minutes segment was a too-short riff on amphetamine’s side effects, which include addiction, psychosis, and cardiovascular problems. I’ve read many of the horrific news stories about lives, especially young people’s lives, destroyed by this drug. Most notably, the tragic tale of Richard Fee, “an athletic, personable college class president and aspiring medical student,” as The New York Times reported earlier this year, who developed a full-fledged addiction, abetted by his doctors who routinely signed off on more meds. He was 24 when he hung himself at home.

Nonetheless, for untold healthy adults (those whom researchers refer to as “mentally competent”) the cognitive-enhancing drug has led to positive changes in their lives. Not surprisingly, the many Adderall “success” stories often go unnoticed in the current debate and climate. Explained one young woman, in her late 20s, on a public bulletin board: “[Adderall] makes me so happy I can be at a family function or out socializing and not get too distracted by other events/conversations around me. I can hear them, but am not taken in by them.”

And this testimonial from an anonymous poster: “Since being on Adderall, I have been insanely productive… I have paid all my outstanding bills and parking tickets (and even renewed my car's registration before it was due). I'm not late for things anymore… I have not spent a single day lying around my house doing nothing in the past few months. I have a budget, and a scheduler that I actually use.”

The authors of a study published in the journal Nature argue in favor of moderate use: “Cognitive enhancement has more to offer individuals and society, and a proper societal response will involve making enhancements available while managing their risks.”

That spring when I watched the 60 Minutes broadcast I was on a deadline to finish a 400-plus-page book. After viewing the segment, I had a moment of insight. Jumping online, I took a few ADHD screening quizzes and was told I had “possible ADHD.” Such a diagnosis doesn’t place me among the 4.1 percent of U.S. adults with ADHD but it did lead me to promptly make an appointment with my primary care physician. When she asked me why I needed it, I replied just as the college kids had on 60 Minutes: “For focus.”  

The first morning I swallowed the whole pill (as prescribed), and within 30 minutes thought I was going to have a stroke. My heart and head were pounding, and I felt as if I were, well, on speed. Which I was—Adderall is, after all, an aggregation of amphetamines. I cut the tabs in half after that and completed my book manuscript by the deadline, with about half my 60-day supply left.

Did it make me smarter? No. Did it make me a faster writer? Yes. Previously, when I’d sit down at my desk, I felt adrift at sea. It was as though my MacBook and research materials, piled high, swayed from left to right and then back again. It was dizzying; I just couldn’t get a grip.  

For me, Adderall was like putting my foot on the ground to stop the drunken whirlies. I had a connection. I had control. My metaphoric double vision snapped to mono and I could see and think as clearly as if I’d stepped out of a fog. I’d never had such concentration and it showed in the number of well-written pages I produced daily.

Which isn’t to say that I didn’t experience some side effects. Amphetamines suppress appetite, so I easily lost weight. While the medication did wonders in prompting me to write, it inexplicably interfered with my ability to speak, scrambling my thoughts before they’d come out of my mouth. (I learned never to take a dose if I were to be out in the world anytime in the next four to six hours, otherwise I either spoke too quickly or too garbled.)

From time to time, I witnessed the shadows of depression, which I’ve read that others on the drug sometimes succumb to. Fortunately, I had the wherewithal to know this was a chemically induced darkness—one that reminded me of the sharp mood swings associated with Decadron, a corticosteroid once prescribed to me for a subdural hematoma resulting from a head injury. After two weeks of usage with this steroid, I felt suicidal. My physician had not warned me of this side effect. But with Adderall, I had knowledge aplenty and knew that once I stopped it, my depression would quickly lift. I also know that not everyone has that kind of previous experience or perspective, which is when folks get into deep trouble.

I take other meds, too, which also have their known side effects. The Lexapro I consume daily for anxiety can decrease sex drive; the Lipitor for high cholesterol can cause muscle and liver problems; and the Niaspan, also for cholesterol, can bring flushing and double vision. I’ve read about these side effects, recognize them when they occur, and understand that with the promised benefits of these meds comes risk.

But it’s different when it comes to Adderall; the most notable distinction is the “Black Box” warning on all amphetamines:

“AMPHETAMINES HAVE A HIGH POTENTIAL FOR ABUSE. ADMINISTRATION OF AMPHETAMINES FOR PROLONGED PERIODS OF TIME MAY LEAD TO DRUG DEPENDENCE AND MUST BE AVOIDED. MISUSE OF AMPHETAMINE MAY CAUSE SUDDEN DEATH AND SERIOUS CARDIOVASCULAR ADVERSE EVENTS.”

Still, according to the National Institutes of Health: “Under medical supervision, stimulant medications are considered safe.” I’d add, as the Nature authors did, especially for “mentally competent adults.”

I know some will say I’m lacking in discipline or that I’m abusing. I don’t think that’s the case, a belief that is buttressed every time I approach my desk to see the swaying stacks of research materials or my laptop levitating. On Adderall I function better and get immediate relief from the chaos—not to mention meet my deadlines. Certainly, like anything and everything in life, it’s not for everybody and the risk for abuse is very real. But as an educated patient, who measures risks and benefits every time a doctor hands me a prescription, I feel confident I’m making an informed choice for myself. And on those mornings when my routine includes half a peach tab, I know it will be a good work day.

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Steven Petrow is a contributor to The New York Times, Parade, and Everyday Health. He is the author of Steven Petrow’s Complete Gay and Lesbian Manners

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