Overheard at Kenyon:

Student 1: Wait, where do you get your Adderall from?

Student 2: Chelsea, but she needs a refill soon. It’s cool, I have another hookup.

Every Kenyon student has heard conversations like this one; under-the-table Adderall (or other study drug) use has been standard practice in academia for a long time. But no one is ever sure if the stories they hear are representative or exceptional. How many Kenyon students are actually turning to Adderall to get through their classes?

I, along with psychology major Joshua Samuels, just completed a study in an attempt to quantify this anecdotal evidence that study drug use, among other forms of self-medication, are increasingly commonplace and socially acceptable as part of our college experience. Our survey was conducted online from Monday, April 22nd through Monday, April 29th and received responses from 374 students, nearly a quarter of Kenyon’s student body. We received levels of responses from various demographic groups (class standing, gender, race, etc.) that were in line with Kenyon’s student composition; given the level and nature of responses, we can be reasonably confident that our results paint a relatively accurate picture of Kenyon students’ behavior.

Attention Deficit Hyperactivity Disorder

In a recent New York Times article, it was reported that eleven percent of American children, including nearly twenty percent of high school boys, are diagnosed with ADHD. Moreover, two thirds of those who receive a diagnosis also receive a prescription for a stimulant, such as Ritalin or Adderall, in an attempt to treat the disorder’s symptoms.

And Kenyon is no exception. In our study, 11.7 percent of Kenyon students reported having a prescription for ADD/ADHD medication.

But some in the psychology community are becoming increasingly skeptical that such high levels of diagnoses are either necessary or beneficial. And given the behaviors of those who do have a prescription, their skepticism may be warranted. Only 30.5 percent of Kenyon students with a prescription for ADHD medication reported taking their medication on time; a majority reported taking their medication only up to half of the times they were supposed to and students were more likely to completely ignore their medication than to take it on schedule:

Clearly, a significant percentage of students who have medication prescribed to them consider themselves perfectly able to function day-to-day without the use of their medication. And when a large number of pills are prescribed and not taken, a surplus is created. This surplus, as you can probably imagine, is used to spur academic performance:

To put these charts in perspective, if you line up ten Kenyon students, one of them will have a prescription for ADD/ADHD medication, which they probably won’t need, and at least two others who don’t have a prescription will have used such medication for the sole purpose of writing a paper or studying for/taking a test.

While an imperfect comparison, these findings are in line with prior literature, mentioned in the Times article, which pegs the percentage of ADD/ADHD medication that goes to non-prescribed friends at about 30 percent.

ADHD has historically been estimated to affect between three and seven percent of children, but, as pediatric neurologist William Graf notes:

Mild symptoms are being diagnosed so readily, which goes well beyond the disorder and beyond the zone of ambiguity to pure enhancement of children who are otherwise healthy.

And while current levels of diagnoses are already at record highs, the number is only expected to increase. As the Times article says:

…even more teenagers are likely to be prescribed medication in the near future because the American Psychiatric Association plans to change the definition of A.D.H.D. to allow more people to receive the diagnosis and treatment.

…The final wording has not been released, but most proposed changes would lead to higher rates of diagnosis: the requirement that symptoms appeared before age 12 rather than 7; illustrations, like repeatedly losing one’s cellphone or losing focus during paperwork, that emphasize that A.D.H.D. is not just a young child’s disorder; and the requirement that symptoms merely “impact” daily activities, rather than cause “impairment.”

There is no official test used to diagnose ADHD; psychiatrists evaluate patients based on extensive conversation with the patient, their parents and teachers. It is also common practice for doctors to allow their patients to “set their own dosage” by prescribing increasingly high levels of medication until the patient finds one that “feels right.”

Given the choice, many psychiatrists would rather wrongly diagnose someone with ADD or ADHD than to turn a patient away when they really do have a disorder. While this thinking is certainly not without merit, it opens the door for pharmaceutical companies, parents and patients to push for diagnoses that are increasingly unwarranted.

Depression

While self-reports of ADD/ADHD prescriptions were high, 23.4 percent of respondents reported having a prescription for an anti-depressant, twice the rate of ADD/ADHD prescriptions.

The Center for Disease Control estimates that depression rates for Americans over the age of twelve is around eight percent.

As seems to be the case with ADD/ADHD, it could be that depression is heavily over-diagnosed. After all, one in four is an awfully high proportion for any psychological disorder, almost high enough to call the use of the word “disorder” into question. Like the third grader who doesn’t want to do their homework and winds up with a prescription for Ritalin, there’s a fine line between having an awkward phase in high school and having a persistent clinical disorder – a line that probably isn’t crossed as often as we think it is.

In conjunction with the findings related to ADD/ADHD medication, these numbers on anti-depressants could speak further to the idea that we are becoming increasingly reliant on pills and less reliant on each other when dealing with emotional stress/anxiety/hardship. While there’s no doubt that in many cases medication is, at least temporarily, necessary and does a lot of good, we may find it all-too-convenient to get a prescription instead of investing time in talking out our issues.

These sentiments aren’t new to the psychiatry community. University of New South Wales, Australia Professor Gordon Parker has spearheaded the growing concern that depression is being used to describe normal feelings of sadness, at the behest of pharmaceutical companies that have a vested interest in using depression as a “catch-all” illness. As the Guardian wrote:

[Professor Parker] said the drugs were being marketed beyond their “true utility” in cases in which people were unhappy rather than clinically depressed.

…the “over-diagnosis” of depression began in the early 80s, when the diagnostic threshold for minor mood disorders was lowered.

His 15-year study of 242 teachers found that more than three-quarters met the current criteria for depression.

Prescription anti-depressants are taken more regularly, and more responsibly, than ADD/ADHD medication. 59.8 percent of respondents with a prescription for anti-depressants take their medication on time; 19.6 percent reported never taking them:

Furthermore, only 6 percent of respondents who did not have a prescription for anti-depressants reported taking them for the purpose of coping with their environment. At Kenyon, using “happy pills” is practically nonexistent compared to the use of study drugs.

Anxiety

While our survey didn’t dive as deep into the use of anti-anxiety drugs as it could have, one interesting finding was that a higher percentage of respondents without a prescription for such drugs reported having taken them (16.0) than the percentage of respondents who reported having a prescription (12.7). Furthermore, students with a prescription for an anti-anxiety drug were even more likely to never take their medication (40 percent) than students with a prescription for ADD/ADHD medication (32.2 percent).

Perceptions

Not only are Kenyon students’ self-medicating behaviors high in volume, they’re freely discussed to the point at which Kenyon students are uncannily accurate in estimating the extent to which their peers are engaging in them. When asked what percentage of the student body they thought had used study drugs, the average estimate was 33.45 percent (actual percentage: 34). When asked to estimate the percentage of Kenyon students who take anti-depressants, the average prediction was 28.66 percent (actual: 23.4).

Perhaps the fact that study drug use is so candidly discussed is the reason that when respondents were asked to rate their favorability towards people who engaged in various activities, study drug use was barely rated unfavorably (3.41 on a scale of 1-7, with 1 being totally unfavorable, 4 being neutral and 7 being totally favorable), and was rated less unfavorably than cigarette smoking (3.25):

We are past the point at which everyone simply knows of someone who abuses study drugs, we are at a point at which everyone has a few friends who do it and find it socially acceptable to talk about it openly.

Perhaps the most shocking result of our study is that the results aren’t all that shocking. The volume, knowledge and acceptance of study drugs and anti-depressants on our campus should lead us to take a long, hard look at ourselves. Can we call ourselves a healthy community when one in three of us are taking academic performance-enhancers and one in four of us are depressed? Do we really need these drugs?

It would seem that the answer to both of these questions is: no.

For a more comprehensive look at the results of this study or to request its data, please email Jon Green at greenj@kenyon.edu, Joshua Samuels at samuelsj@kenyon.edu or the Kenyon Observer at tko@kenyon.edu.