Stimulant abuse in children: Questions the NYT didn't ask

While I was puzzling over how to address the front page story in Saturday's New York Times on the abuse of stimulants by students seeking better grades, I discovered that some else had already done a superb job of dissecting the article--Matthew Herper at Forbes.

The Times story, "Risky Rise of the Good-Grade Pill," by Alan Schwarz, opens with a scene of a high-school student snorting a line of Adderall on the armrest of his car in the school parking lot minutes before stepping inside to take the SAT. "At high schools across the United States, pressure over grades and competition for college admissions are encouraging students to abuse prescription stimulants," Schwarz wrote. He noted that students who share their prescriptions with their fellow students can be charged with a felony.

The same day, Herper wrote a post entitled, "The Questions About ADHD Drugs the New York Times Didn't Ask." He wrote:

 The story does a fantastic job tracking the personal stories of high school and college kids who use these medicines to get an academic edge. But it’s worth looking at the science and medicine behind this trend, because it shows how our cultural misunderstanding of what these medicines do is leading to more — and more dangerous — stimulant use.

He raised a few objections to the story. There is no evidence in the article that the problem is new, Herper wrote, with a link to 2002 survey data that showed the same thing. And the story, he wrote, "perpetuates the idea that these drugs calm kids with ADHD down, but have a different effect on [healthy] people. Actually, the drugs do exactly the same thing in people whether they are hyperactive, have problems paying attention, or are healthy. They improve focus by increasing the levels of the neurotransmitters norepinephrine and dopamine in the prefrontal cortex." He supported that, too, with a link.

Then he raised what he thinks is the crucial question: If these drugs help students, why shouldn't they use them? Concerns over safety are one reason. Another reason, perhaps, is that many of us believe that using drugs to gain an advantage is wrong.

Herper was cautious. "I worry that we’re over-using these stimulants, both as a medical treatment and as a performance enhancer. There are other ways to learn to focus. A dose of Ritalin is not the same as a cup of coffee," he wrote.

John Grohol at PsychCentral also raised questions about the Times story. But he came to a different conclusion than Herper. Adults use coffee and cigarettes to sharpen their focus, he said, and so perhaps we're wrong to criticize other stimulant use. "I now believe it’s just as 'fair' as ingesting any other ingredient into our bodies that will help our concentration, attention or energy levels." He continued:

Instead of decrying their use outright (ala Prohibition times), it might be more helpful to actually bring such use into a brighter light. If people stop hiding their use of stimulant medications, it may make it easier to monitor their use by a physician.

I'm not quite sure what to think of the story. I was surprised to see it on the front page, because we have indeed read this sort of thing before. Schwarz's story was gripping, however, and highlighted the issue in a way a less well written piece would not have.

Would I tell my kids to snort Adderall before taking an important test? Of course not. If they told me afterward they had done so--and that they were sure it helped get them into the college they were desperate to attend--what would I say then? You should have skipped the drug and gone to a college that was lower down on your wish list? I don't know how a parent could possibly weigh the pros and cons of a decision like that. So, mostly, we don't. Apparently we are leaving it to our teenagers, who are even less well equipped to make the choice.

I wish Schwarz had been a little sharper at addressing some of the questions raised by Herper and Grohol. That aside, the Times story forced me to confront a complicated question that I would rather not think about at all. And that's one of the things that good journalism does.

- Paul Raeburn