View attachment 43778 Fading fast at 11 p.m., Elizabeth texted her dealer and waited just 30 minutes for him to reach her third-floor New York apartment. She handed him a wad of twenties and fifties, received a tattered envelope of pills, and returned to her computer.
Her PowerPoint needed another four hours. Investors in her health-technology start-up wanted re-crunched numbers, a presentation begged for bullet points and emails from global developers would keep arriving well past midnight. She gulped down one — pale orange, like baby aspirin — and then, reconsidering, took one of the pinks, too.
“O.K., now I can work,” Elizabeth exhaled. Several minutes later, she felt her brain snap to attention. She pushed her glasses up her nose and churned until 7 a.m. Only then did she sleep for 90 minutes, before arriving at her office at 9.
The pills were versions of the drug Adderall, an amphetamine-based stimulant prescribed for attention deficit hyperactivity disorder that many college students have long used illicitly while studying. Now, experts say, stimulant abuse is graduating into the work force.
Reliable data to qualify how many American workers misuse stimulants does not exist, several experts said. But in interviews, dozens of people in a wide spectrum of professions said they and co-workers misused stimulants like Adderall, Vyvanse and Concerta to improve work performance. Most spoke on the condition of anonymity for fear of losing their jobs or access to the medication. Doctors and medical ethicists expressed concern for misusers’ health, as stimulants can cause anxiety, addiction and hallucinations when taken in high doses. But they also worried about added pressure in the workplace — where the use by some pressures more to join the trend.
“You’d see addiction in students, but it was pretty rare to see it in an adult,” said Dr. Kimberly Dennis, the medical director of Timberline Knolls, a substance-abuse treatment facility for women outside Chicago. We are definitely seeing more than one year ago, more than two years ago, especially in the age range of 25 to 45,” she said.
Elizabeth, a Long Island native in her late 20s, said that to not take Adderall while competitors did would be like playing tennis with a wood racket. “It is necessary — necessary for survival of the best and the smartest and highest-achieving people,” Elizabeth said. She spoke on the condition that she be identified only by her middle name. Most users who were interviewed said they got pills by feigning symptoms of A.D.H.D., a disorder marked by severe impulsivity and inattention, to physicians who casually write prescriptions without proper evaluations. Others got them from friends or dealers.
Obtaining or distributing stimulants without a prescription is a federal crime, but the starkest risks of abuse appear to be overdose and addiction. A 2013 report by the federal Substance Abuse and Mental Health Services Administration found that emergency room visits related to nonmedical use of prescription stimulants A 2013 report by the federal Substance Abuse and Mental Health Services Administration found that emergency room visits related to nonmedical use of prescription stimulants among adults 18 to 34 tripled from 2005 to 2011, to almost 23,000.
The agency also reported that from 2010 to 2012, people entering substance rehabilitation centers cited stimulants as their primary substance of abuse 15 percent more often than in the previous three-year period. Just how stimulants like Adderall might improve work performance, and to what extent, remains a matter of scientific debate. But many young workers insist that using the drugs to increase productivity is on the rise — and that these are drugs used not to get high, but hired.
“Given the increase in rates of abuse in college students over the last decade, it is essential that we understand the outcomes as they leave college and assume adult roles,” Dr. Wilson Compton, the deputy director of the National Institute on Drug Abuse, said in an interview.
Elizabeth’s sleep tracker was confused. Her nightly rests were so brief, the iPhone software thought they were just naps. It recorded her average sleep over nine months: from 4:17 a.m. until 7:42. After founding her own health technology company, Elizabeth soon decided that working hard was not enough; she had to work harder, longer. Sleep went from an indulgence to an obstacle. So she went to a psychiatrist and complained that she could not concentrate on work. She received a diagnosis of A.D.H.D. and a prescription for Adderall in about 10 minutes, she said.
“Friends of mine in finance, on Wall Street, were traders and had to start at 5 in the morning on top of their games — most of them were taking Adderall,” Elizabeth said. “You can’t be the one who is the sluggish one.”
Researchers in the field are quick to caution that, despite stimulants’ reputation as “smart pills,” few studies suggest that they improve a person’s ability to learn or understand. But they often improve attention and motivation, particularly for tedious tasks, which can increase productivity — or at least the appearance of it. Some industries have banned the use of stimulants for reasons of safety or fairness. The Federal Aviation Administration forbids pilots to use the medications under any circumstances. Major League Baseball players and other athletes had long abused amphetamines to increase focus and endure exhausting travel schedules, but the drugs are now considered performance-enhancers allowed only with a confirmed A.D.H.D. diagnosis.
Interviews with people who have misused the pills showed them to be a diverse group. A dentist in eastern Pennsylvania prescribed herself Adderall and other stimulants for years because, she said in a telephone interview, she could see 15 patients a day rather than 12. Lisa Deese of Fishers, Ind., said she had abused Adderall as a stay-at-home mother of three for years. The pills, she said, “were like mommy crack.”
“I got so much more done during the day,” she added. “I was hooked by my first pill.”
While many studies have assessed the prevalence of misuse among college students, no doctor or researcher contacted for this article could cite a formal assessment of misuse among adults to improve job performance. But Dr. Anjan K. Chatterjee, the chairman of neurology at Pennsylvania Hospital in Philadelphia and an expert in the field of cognitive enhancement, said that even without conclusive data, misuse was undoubtedly rising. “Kids who have been using it in high school and college, this is normalized for them,” Dr. Chatterjee said. “It’s not a big deal as they enter the work force.”
A Slow Realization
Sitting in a conference room at Timberline Knolls, the treatment facility, and hearing the details of Elizabeth’s professed harmless misuse of Adderall, a New York native in her mid-20s said pointedly, “That was me 17 days ago.” The woman said her road to addiction had begun at her East Coast college, where Adderall was readily available from classmates for $5 or $10 a pill, she said. When her postgraduate job involved extensive early-morning driving and detailed paperwork, she began taking more. She said friends in accounting and teaching were doing the same thing.
“Everything was just —” she said, snapping her fingers loudly. “I did my job faster than anybody. I was on a mission, and I was not going to stop until I succeeded and got what I wanted.”
When she became too wired to relax or sleep, she added the tranquilizer Xanax to calm herself. She tried to stop taking Adderall, she said, but “became terrified that I couldn’t perform without it.” She turned to alcohol, then cigarettes and other prescription drugs to modulate her intensifying mood swings, before entering Timberline for five weeks.
The number of stimulant misusers who become addicted is unclear. But supply has risen sharply: About 2.6 million American adults received A.D.H.D. medication in 2012, a rise of 53 percent in only four years, according to Express Scripts, the nation’s largest prescription-drug manager. Use among adults 26 to 34 almost doubled. Most experts say a proper evaluation for the disorder typically requires an extensive inquiry into a patient’s history of impulsivity and inattention. Yet misusers routinely described brief chats with doctors to get a prescription. Two lawyers in Houston said wearing a suit to their appointments guaranteed no scrutiny.
Those lawyers said they and dozens of young colleagues at their firms had casually traded pills to work into the night and billed hundreds of extra hours a year in the race for partnerships. One said he had originally taken 20 milligrams of Adderall a day, moving up to 100 milligrams — almost double the highest dose recommended by the Food and Drug Administration — by getting prescriptions from multiple doctors, a felony in Texas. His productivity, he said, thrilled his unquestioning bosses and clients.
Then came the downside: rapid heartbeat, profuse sweating and acute anxiety due to sleep loss. These overwhelmed any positive effects on his work performance, he said, and transformed his personality to the point that his wife divorced him. After he lost his job, he spent six weeks at a drug treatment center.
“It’s a crutch, and it becomes a crutch immediately,” said the lawyer, who recently joined a smaller firm in Texas. In her New York apartment, where floor-to-ceiling white boards were scribbled with nascent projects, Elizabeth considered what her generation appears willing to swallow for success.
“It’s like this at most of the companies I know with driven young people — there’s a certain expectation of performance,” she said, banging away on that PowerPoint presentation as her own pills kicked in. “And if you don’t meet it, and I’m not really worried how, someone else will.”
By Alan Schwarz - The NY Times/April 18, 2015
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