A few months ago, a friend gave me an article in the American Bar Association's Student Lawyer magazine discussing "Mental Doping" and the use of ADHD stimulant medication among students in law school. Some of these individuals legitimately have ADHD and need the medication - a situation which the article has compared to a person using glasses to correct a vision problem. In addition to this group of ADHD patients, there are also those who have both sought out an ADHD diagnosis by manipulating a screening, as well as those who have acquired the drugs through other illegitimate practices.
I interviewed ADHDCentral expert and clinical neuropsychologist Robb Mapou, Ph.D. ABPP to help me answer some questions about the prevalence of this activity.
What exactly is ADHD? How does medication help treat it?
The most recent theory about ADHD, which is supported by research, is that it is due to the dysfunction of the frontal lobes of the brain. The frontal lobes are involved with planning and looking at a goal ahead in time, figuring out how to get to that goal, and maintaining a direction toward that goal. They also enable people to inhibit responding to something that is unrelated to the goal. For people with ADHD, as Russell Barkley writes, it's disproportionately difficult to inhibit a response to something that is reinforced in the moment rather than work toward a long-term goal. For example, a student with ADHD may do anything but work on a paper that's due in three weeks. Stimulant medications help by increasing the availability of dopamine, one of the neurotransmitters in the brain which is presumed to be deficient in individuals with ADHD. The frontal lobes, especially, rely on dopamine for efficient functioning, so by taking a stimulant, more dopamine is available. The frontal lobes can then function more effectively, and people with ADHD can avoid distractions, focusing instead on what they are supposed to be doing.
What happens in a patient with ADHD when they take medication? What does this person feel when taking medication?
I must preface this by noting that I am not a physician and do not prescribe medication. Physicians who treat ADHD in adults have told me that the correct way to do a medication trial is to start with a low dose, and gradually push it up. People may then have the "a-ha" moment at the right dose, suddenly noticing that they can focus the way most people do. If the dosage is too high, however, they may feel very jittery and anxious.
Yet, even in people without ADHD, stimulants can boost cognitive performance. Consequently, it is being used by students and others without ADHD, much the way people used to use speed in the 1970s. In fact, what was called speed was amphetamine, which is what is in the drugs Adderall and Dexedrine. There was an article a year or so ago in the New Yorker about people using ADHD medications to gain an edge which explained just this issue, sometimes referred to as cognitive or neuro enhancement.
