Brain Gain.(stimulants for work and studies)

A young man I'll call Alex recently graduated from Harvard. As a history major, Alex wrote about a dozen papers a semester. He also ran a student organization, for which he often worked more than forty hours a week; when he wasn't on the job, he had classes. Weeknights were devoted to all the schoolwork that he couldn't finish during the day, and weekend nights were spent drinking with friends and going to dance parties. "Trite as it sounds," he told me, it seemed important to "maybe appreciate my own youth." Since, in essence, this life was impossible, Alex began taking Adderall to make it possible.

Adderall, a stimulant composed of mixed amphetamine salts, is commonly prescribed for children and adults who have been given a diagnosis of attention-deficit hyperactivity disorder. But in recent years Adderall and Ritalin, another stimulant, have been adopted as cognitive enhancers: drugs that high-functioning, overcommitted people take to become higher-functioning and more overcommitted. (Such use is "off label," meaning that it does not have the approval of either the drug's manufacturer or the Food and Drug Administration.) College campuses have become laboratories for experimentation with neuroenhancement, and Alex was an ingenious experimenter. His brother had received a diagnosis of A.D.H.D., and in his freshman year Alex obtained an Adderall prescription for himself by describing to a doctor symptoms that he knew were typical of the disorder. During his college years, Alex took fifteen milligrams of Adderall most evenings, usually after dinner, guaranteeing that he would maintain intense focus while losing "any ability to sleep for approximately eight to ten hours." In his sophomore year, he persuaded the doctor to add a thirty-milligram "extended release" capsule to his daily regimen.

Alex recalled one week during his junior year when he had four term papers due. Minutes after waking on Monday morning, around seven-thirty, he swallowed some "immediate release" Adderall. The drug, along with a steady stream of caffeine, helped him to concentrate during classes and meetings, but he noticed some odd effects; at a morning tutorial, he explained to me in an e-mail, "I alternated between speaking too quickly and thoroughly on some subjects and feeling awkwardly quiet during other points of the discussion." Lunch was a blur: "It's always hard to eat much when on Adderall." That afternoon, he went to the library, where he spent "too much time researching a paper rather than actually writing it--a problem, I can assure you, that is common to all intellectually curious students on stimulants." At eight, he attended a two-hour meeting "with a group focussed on student mental-health issues." Alex then "took an extended-release Adderall" and worked productively on the paper all night. At eight the next morning, he attended a meeting of his organization; he felt like "a zombie," but "was there to insure that the semester's work didn't go to waste." After that, Alex explained, "I went back to my room to take advantage of my tired body." He fell asleep until noon, waking "in time to polish my first paper and hand it in."

I met Alex one evening last summer, at an appealingly scruffy bar in the New England city where he lives. Skinny and bearded, and wearing faded hipster jeans, he looked like the lead singer in an indie band. He was ingratiating and articulate, and smoked cigarettes with an ironic air of defiance. Alex was happy enough to talk about his frequent use of Adderall at Harvard, but he didn't want to see his name in print; he's involved with an Internet start-up, and worried that potential investors might disapprove of his habit.

After we had ordered beers, he said, "One of the most impressive features of being a student is how aware you are of a twenty-four-hour work cycle. When you conceive of what you have to do for school, it's not in terms of nine to five but in terms of what you can physically do in a week while still achieving a variety of goals in a variety of realms--social, romantic, sexual, extracurricular, resume-building, academic commitments." Alex was eager to dispel the notion that students who took Adderall were "academic automatons who are using it in order to be first in their class, or in order to be an obvious admit to law school or the first accepted at a consulting firm." In fact, he said, "it's often people"--mainly guys--"who are looking in some way to compensate for activities that are detrimental to their performance." He explained, "At Harvard, at least, most people are to some degree realistic about it. . . . I don't think people who take Adderall are aiming to be the top person in the class. I think they're aiming to be among the best. Or maybe not even among the best. At the most basic level, they aim to do better than they would have otherwise." He went on, "Everyone is aware of the fact that if you were up at 3 A.M. writing this paper it isn't going to be as good as it could have been. The fact that you were partying all weekend, or spent the last week being high, watching 'Lost'--that's going to take a toll."

Alex's sense of who uses stimulants for so-called "nonmedical" purposes is borne out by two dozen or so scientific studies. In 2005, a team led by Sean Esteban McCabe, a professor at the University of Michigan's Substance Abuse Research Center, reported that in the previous year 4.1 per cent of American undergraduates had taken prescription stimulants for off-label use; at one school, the figure was twenty-five per cent. Other researchers have found even higher rates: a 2002 study at a small college found that more than thirty-five per cent of the students had used prescription stimulants nonmedically in the previous year.

Drugs such as Adderall can cause nervousness, headaches, sleeplessness, and decreased appetite, among other side effects. An F.D.A. warning on Adderall's label notes that "amphetamines have a high potential for abuse" and can lead to dependence. (The label also mentions that adults using Adderall have reported serious cardiac problems, though the role of the drug in those cases is unknown.) Yet college students tend to consider Adderall and Ritalin benign, in part because they are likely to know peers who have taken the drugs since childhood for A.D.H.D. Indeed, McCabe reports, most students who use stimulants for cognitive enhancement obtain them from an acquaintance with a prescription. Usually, the pills are given away, but some students sell them.