The story could not be more awful; a downward spiral of amphetamine addiction ends in suicide. But it wasn’t Black Beauties or crystal meth, or any kind of street speed. It was so-called “study drugs” like Vyvanse and Adderall, all prescribed by a series of psychiatrists thinking they were doing good while doing harm.

When I started writing this the most emailed article at the NY Times was Alan Schwarz’s  “Drowned in a Stream of Prescriptions.” This well-told tale recounted the tragic story of Richard Fee, Fee began using “study drugs” in college. This is common. In what college mental health experts say is an out-dated underestimate, a 2009 study of college students found “60% reported knowing students who misused stimulants; and 50% agreed or strongly agreed that prescription stimulants were ‘easy to get on this campus.’” But Fee’s use did not stop with what is now the usual practice on many college campuses. His use escalated while prepping for med school admissions tests. A nasty addiction developed, one fed by psychiatrists relying on rating scales and brief evaluations. Eventually Fee killed himself. Awful. Truly awful.

The reasons for this tragedy are many. Some are general, like over-zealous pharmaceutical marketing or our culture-wide love-affair with winning at all cost. Too many today chase the American myth of unlimited potential by denying biological limitations, including performance enhancing drugs in sports, searching for self-esteem with cosmetic surgery,  or pushing the frontiers of reproductive medicine. Somehow we have lost an appreciation for the fact that a biological “good enough” really is good enough. Too many always want more.

Some reasons for this tragedy are specific to “study drugs.” The Schwarz article focussed on how medical best practices routinely get mauled by doctors trying to hold this addictive tiger by the tail. Because these drugs can be so extraordinarily helpful to people with ADHD, and because genuine ADHD is still significantly under-treated, there is a tendency to ignore how dangerous these drugs can be when used by people hoping for an edge. This must change.

And, finally, there is a reason for this tragedy I frequently encounter in my clinical practice: individual choice, the all too common and taken-for-granted decision of ambitious young people to use drugs to enhance performance.  In fact, people between 20 and 39 are the fastest growing population segment for stimulant prescriptions.

Many go to the medicine cabinet in search of an edge, wanting something to enhance cognitive functioning. And why not? The drugs must be safe, they come from the pharmacy with a doctor’s prescription!

And they can facilitate achievement. I’ve treated investment bankers who take Adderall to find a competitive edge. And sometimes it works. Medical residents (who you might think might know better) routinely take attention-deficit-disorder medication so they can keep up. And sometimes it helps. Young associates at prestigious (read extraordinarily competitive) law firms going into “trial mode” often pack a vial of Adderall along with boxes of documents, flow-charts, and a new suit. And sometimes they are the ones who make partner.

Cosmetic use by the healthy will only accelerate as more and more cognitive enhancing medications come to the marketplace. More and more people will try to do for their attention, concentration, and memory what Lance Armstrong did for his athletic endurance. But if people are going really going to “live smart” they also need to manage the risks they are taking when they take these drugs. People need to know more than horror stories about some guy dying from his Adderall addiction, because they also know about someone else who got a huge bonus from Adderall-enhanced extra hours. People need to know how to make sure that if they choose to use stimulants they do so with the best chance of avoiding addiction and other problems.  Read More…