Stimulants Prescribed For Attention Disorders Find New Unapproved Use

By NICHOLAS ZAMISKA November 8, 2004; Page A1 — BETHESDA, Md. — On the morning he was to take the SAT last March, a 17-year-old senior at Bethesda-Chevy Chase High School in suburban Washington went looking for a bottle of pills. His score on practice tests had been too low and, with his sights set on an Ivy League college, he needed a miracle. Or, friends suggested, Adderall.

He grabbed a tiny blue pill from his little brother’s prescription stash and swallowed it two hours before the test. Despite some jitters when he took the test that he attributes to the drug — a stimulant prescribed for attention deficit hyperactivity disorder, or ADHD — he scored 200 points better than he had on a previous test.

In an interview recently, he credited the drug with keeping him alert and confident: “It just felt like I was on top of my game. I knew I was going to get the questions right.”

Students have long taken stimulants — ranging from caffeine to cocaine — to help them stay up all night writing papers and cramming for exams. Now, some high-school and college kids are using prescription drugs in hopes of improving their performance on the standardized admissions tests for college and graduate school, according to interviews with students, parents, test tutors and doctors.

“It used to be on the fringes completely, but now it’s seeping into the mainstream,” says Steven Roy Goodman, a college and graduate-school admissions consultant in Washington. “If you’re one of hundreds of kids fighting for one of 10 spots, you’ll do everything you can to get the extra edge.”

William Pollack, a psychologist and director of the Centers for Men and Young Men at Harvard University’s McLean Hospital, says he has spoken with more than 50 students who say they’ve used stimulants to raise their test scores. “I’ve seen it become a trend,” Dr. Pollack says.

Chul Yim, 24, a graduate of the University of Nevada, Reno who has a job in Washington, on Capitol Hill, says he’s wrestling with whether to use a stimulant before he takes the Law School Admission Test next year. “I really can’t fail,” he says, “because it’s not just me that’s failing. I fail for my parents and my entire family. Even if it bumps my score up an extra point, it’s worth it.”

On high-stakes admissions tests where minor swings in scores — let alone a 200-point improvement on a 1,600-point test — can be very important in getting into the right school, many students have become desperate to ace the exam, turning to everything from hypnosis to herbal supplements for an extra edge.

The current drug of choice for many students is Adderall, a fast-acting mixture of amphetamines made by Shire Pharmaceuticals Group, of the United Kingdom, that is one of a handful of stimulants prescribed for ADHD. Shire says Adderall isn’t intended to enhance test scores and should only be used under medical supervision. Some students also have used Ritalin, a stimulant approved by the Food and Drug Administration in 1955 that became popular in the 1990s for treatment of ADHD. Ritalin is frequently prescribed for children.

Amphetamines act on the brain by mimicking the neurotransmitter dopamine, which increases alertness and concentration. Studies conducted by the National Institutes of Health in the late 1970s found that low-dose stimulants increase concentration and alertness in everyone, not just people with attention disorders.

Side effects of Adderall can include loss of appetite, insomnia and weight loss. “One pill won’t kill you, but we also know that with adolescents, I take one pill, I’m more likely to take a second pill,” says Westley Clark, a physician and director of the Center for Substance Abuse Treatment in the federal Substance Abuse and Mental Health Services Administration.

Today, with so many young people taking the drugs for attention-deficit disorder, it isn’t hard to scrounge a pill from a sibling or schoolmate, or even to get a prescription of your own. Overall, prescriptions for stimulants have risen to 2.6 million a month in 2004, from 1.6 million in 2000, says IMS Health Inc., a consulting firm in Fairfield, Conn. According to those sales figures, Adderall XR, an extended-release form of the drug, is the leader in its class, capturing around a third of the market.

Some kids who take stimulants before tests have valid prescriptions, but not all. Under federal law, it’s illegal to knowingly possess a “schedule II” drug, such as Adderall, without a prescription. But prosecutions for possession are rare.

Hyla Swesnik, an SAT tutor in the Dallas area, says she has had three mothers call her this year to ask whether drugs might increase their children’s scores. Dan Alemar, a guidance counselor at Bethesda-Chevy Chase High School, says, “It’s becoming a more common problem, kids using Adderall and that type of drug to try and boost their score.” The school suspends students caught using marijuana and other street drugs. It has never suspended or otherwise punished a student for using a prescription drug to help on an SAT, he says.

Elizabeth, 17, a high-school senior in the Washington area, credits Adderall with helping her post her best-ever score on the March SAT. “Why work harder to get a 1260 when you can take something …?” she says. She recalls feeling the drug’s effects just before her test started and says, “It’s a crazy kind of feeling of confidence, looking at a problem and saying I can do this in five seconds.” (Last names and some identifying details have been omitted in the case of minors.)

Shortly before taking the Oct. 2 Law School Admission Test at the University of Colorado in Boulder, Carrie, a college senior, downed an Adderall with her breakfast of eggs and toast. “I’m nervous because I’m taking a test that will determine the rest of my life,” she said in an interview as she stood outside the testing center. She had no prescription but bought 10 of the pills for $2 each from a friend’s roommate. She took practice tests with and without pills before deciding that Adderall would help improve her score.

One 17-year-old senior at the private Greenhill School in Addison, Texas, says she thinks Adderall hurt her performance on the ACT, another national college admissions exam. “I ended up focusing on the texture of my pencil and the desk,” she recalls. Susan, 18, a senior at a high school in suburban Dallas, says her mother insisted she take a stimulant before the June SAT. But her score on Adderall was only 10 points better than she got on her practice test. “It made me feel much more jittery and 10 times more nervous than I would have been,” she says. She retook the test last month without the amphetamine.

The College Board, the nonprofit administrator of the SAT, a national college admissions test, isn’t aware of students using drugs illegally to help with tests, spokeswoman Chiara Coletti says. The board has no rules explicitly prohibiting drug use, but “we certainly do not recommend that students take any drugs or stimulants in hopes of affecting their scores,” she says.

An online discussion group for people preparing for the law-school admissions test was recently abuzz with stories of students popping pills to improve scores. An argument broke out over whether that is proper. “Are you looking for a … easy way out, or what?” wrote someone with the screen name lilmeangreenone. “And am I the only one that feels that taking prescription drugs that are unnecessary for your health and the doctors that write these scrips are very unethical?”

Questions of right and wrong also come up with parents. A 17-year-old senior at the Episcopal School of Dallas says she asked her mother to get her a stimulant for the SAT she planned to take Oct. 9. Her mother at first refused but, after reading up on Adderall, got the drug from a doctor friend. “I don’t believe in cheating,” the mother says. “I’m mainly doing this to calm her.”

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