From time to time, we encounter a long-form piece that touches on a number of our longstanding interests. The best of these pieces feature powerful firsthand testimony illustrating the ways in which multiple trends in our common life come into focus when we pay sustained attention to the example of a single life or community.
This week, we bring you one such piece, Casey Schwartz’s “Generation Adderall” from the New York Times Magazine. In it, Schwartz chronicles her own dependence on Adderall, which began during her second year of college, included at least one significant Adderall-induced panic attack, and persisted throughout her 20s. Toward the end of her addiction, she describes the drug’s effect on her in vivid terms:
I had long been telling myself that by taking Adderall, I was exerting total control over my fallible self, but in truth it was the opposite: The Adderall made my life unpredictable, blowing black storm systems over my horizon with no warning at all. Still, I couldn’t give it up.
While the details of her story are compelling in their own right, allowing the emphasis to fall on the first word of Schwartz’s title is important. Schwartz begins her piece by putting her own struggle into a broader context:
Adderall is prescribed to treat Attention Deficit Hyperactivity Disorder, a neurobehavioral condition marked by inattention, hyperactivity and impulsivity that was first included in the D.S.M. in 1987 and predominantly seen in children. That condition, which has also been called Attention Deficit Disorder, has been increasingly diagnosed over recent decades: In the 1990s, an estimated 3 to 5 percent of school-age American children were believed to have A.D.H.D., according to the Centers for Disease Control and Prevention; by 2013, that figure was 11 percent. It continues to rise. And the increase in diagnoses has been followed by an increase in prescriptions. In 1990, 600,000 children were on stimulants, usually Ritalin, an older medication that often had to be taken multiple times a day. By 2013, 3.5 million children were on stimulants, and in many cases, the Ritalin had been replaced by Adderall, officially brought to market in 1996 as the new, upgraded choice for A.D.H.D.—more effective, longer lasting.
Crucially, however, as A.D.H.D has become more broadly recognized within the medical community and society as a whole, a growing number of prescriptions are written for adults who were not diagnosed as children. In fact, Schwartz reports that “in 2012, roughly 16 million Adderall prescriptions were written for adults between ages 20 and 39.” In this way, medications that were mostly prescribed to counteract signs of hyperactivity in children in order to assist them in their schooling and maturation are now widely used by emerging adults and young professionals, particularly among elites in the creative class.
Schwartz’s own struggle personalizes this broader cultural shift. She describes her first encounter with Adderall as a state of “peerless ecstasy,” language that could just as easily describe the kind of high produced by recreational drugs. But the occasion for her bliss was not a party or social gathering. It was her need to produce a five-page paper in less than 24 hours, on a book she had not read. After successfully completing that assignment (with the vague awareness that “outside the window the sky was turning pink”), Schwartz came to depend upon Adderall at crucial moments of her (elite) college education. “My Adderall hours became the most precious hours of my life,” she says. On Adderall, the “humming campus life going on outside” lost its luster. “Instead,” she says, “what mattered, what compelled, were the hours I spent in isolation, poring over, for instance, Immanuel Kant’s thoughts on ‘the sublime.’”
While her interest in Kant faded with time, Schwartz’s dependence on Adderall persisted throughout her 20s, and deepened dramatically when she was able to procure her own prescription for the drug after lying her way through a psychiatric appointment. “That single doctor’s assessment, granted in less than an hour,” she says, “would follow me everywhere I went: through the rest of my time in Los Angeles; then off to London, with the help of FedEx; then to New Haven, where I would pick it up once a month at the Yale Health Center; then back to New York, where the doctor I found on my insurance plan would have no problem continuing to prescribe this medication, based only on my saying that it had been previously prescribed to me, that I’d been taking it for years.”
What are we to make of stories like this and the broader cultural trends they represent?
In the first place, we should recognize that the facts of over-medicalization do not negate the very real benefits A.D.H.D patients receive from treatment. The antidote to abuse is wise use, not abandonment. For the many patients (both adults and children) for whom medications like Adderall make life possible, presenting Schwartz’s story as representative of all such stories is misleading and unfair.
Furthermore, we should historicize this trend by recognizing the degree to which America’s workforce has often “run on amphetamines.” Whether it be New Orleans dockworkers working cocaine-fueled 70-hour work weeks in the 1880s, Benzedrine abuse in post-WWI America, or amphetamine dependence for long-haul truck drivers in midcentury America, we should recognize that it has long been true that, as Katie Bielamowicz puts it in an essay for JSTOR Daily, “uppers provide a willing, able, and happy workforce, eager and pepped, with a powdered Protestant work ethic running through its veins.”
But recognizing these facts should not distract us from the reality of the predicament we face. Given our shared obsession with productivity and creativity (Cameron Herold has recently argued that A.D.H.D gives entrepreneurs an edge on “MBA types”), the proliferation of direct-to-consumer advertising, the establishment of black markets on college campuses in particular, and perhaps most importantly, the dearth of research on the long-term effects of medications like Adderall, this is not a problem to ignore. But, as Casey Schwartz makes plain, we can only address the problem indirectly. We have to see not just what drugs like Adderall enable us to accomplish; we must also think seriously about what our need for Adderall says about who we have become. For Schwartz and many others, abusing medications like Adderall is the price of continued success upon what David Brooks has dubbed the “Achievatron.” But, in the end, Schwartz has come to recognize amphetamine dependency as a strategy of avoidance, a “state of false intensity, always wondering if I should be somewhere else, working harder, achieving more.”