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 respondents 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 chemical imbalance. 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. When we make the (correct) choice to err on the side of caution, we must acknowledge that we are still erring.
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.
It is possible that there is something inherently depressing about going to Kenyon, or about the lifestyle one must lead in order to get accepted to a college like Kenyon. But this explanation, on its face, doesn’t seem strong enough to account for a quarter of the student body. As seems to be the case with ADD/ADHD, it would appear that depression medication is, at least in part, being over-prescribed.
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 necessary and does a lot of good, we may find it all-too-convenient to get a prescription instead of investing time in developing support structures and 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 non-prescribed “happy pills” to cope is practically nonexistent compared to the use of study drugs.
While our survey didn’t dive as deeply 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).
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):
Kenyon is past the point at which everyone simply knows of someone who abuses study drugs, it is at a point at which everyone has a few friends who do it and find it socially acceptable to talk about 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 Kenyon’s campus is highly distressing. Can Kenyon call itself a healthy community when one in three of its students are taking academic performance-enhancers and one in four are depressed? Should they really need to be medicated at this level?
It isn’t absurd to think that what’s true at Kenyon is true elsewhere. I hope that those with a better understanding of psychological research will conduct studies of their own on the seemingly pervasive medication culture in our colleges. We may not like what we see, but we have to know.
*A quick note on the possibility of selection bias in our sample*
When we first publicized the survey we sent it out over the college’s “all-student” email listserv, and the first “wave” of 100-150 responses that we received showed much higher rates of medication use than we wound up with (study drug use at 50 percent, anti-depressant prescriptions between 35 and 40 percent). Then, we sent the survey to each of the college’s residential listservs (each dorm/apartment complex has its own email listing), and the next “wave” of 100-150 responses brought our numbers down to their resultant levels. The final “wave” of responses, which came after we re-publicized the survey during the final days that it was open, did not change our averages in any significant way.
It is likely that, in the first wave of responses, the kind of student who responded to our survey was the kind of student who was likely to be on medication. After all, it was a survey about medication use. But the drop, and then leveling, of responses over the course of the week, along with our demographic results being in line with Kenyon’s overall population (as mentioned in the introduction), leads me to believe that selection bias is not as big of a concern here as it often is with research of this nature. Furthermore, the one demographic group that was underrepresented in our sample, smokers, showed rates of study drug use that were significantly higher than the general population. Had a representative sample of smokers taken our survey, our results may have shown even higher rates of medication use.
An earlier version of this post appeared in the Kenyon Observer. For a more comprehensive look at the results of this study or to request its data, please email Jon Green at [email protected], Joshua Samuels at [email protected] or the Kenyon Observer at [email protected].