Eight hours.

Eight hours of sitting in College Library, re-reading notes over and over again. Eight hours of desperately trying to finish an organic chemistry assignment.

Not a single problem finished.

Lauren Van Hoof, a University of Wisconsin sophomore majoring in chemistry, said she hadn’t taken her Attention Deficit/Hyperactivity Disorder medication that day. Though her prescription for Adderall helps her focus, it also makes her lose her appetite, and she wanted to eat.

When Van Hoof attempted to study, her ADHD got in the way.

“I would try to start something … and my brain just wouldn’t process it, and I couldn’t even move on,” Van Hoof said.

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Van Hoof relies on Adderall to help her concentrate. She takes it in low doses, as prescribed by her doctor.

When midterms and finals come around, Van Hoof said she sees an uptick in the amount of students asking her to illegally sell them her ADHD medication, a request she always refuses. Van Hoof said it’s frustrating some students view Adderall and other stimulants as “magical smart drugs,” without fully understanding the implications of misusing these controlled substances.

For some UW students, using stimulants to enhance academic performance is routine. Some use the drugs knowing fully well they do not have focus issues. Others use them to address their own concentration problems, though without a diagnosis.

The illegal use of prescription stimulants is something many students at UW see as an acceptable part of campus culture.

Drugs as normal part of campus culture

According to the spring 2015 National College Health Assessment survey, which contains the most recent data on prescription drug abuse, 7.9 percent of UW students surveyed said they used stimulants without a prescription in the past year.

Prescription stimulants include lisdexamfetamine, methylphenidate and amphetamine, which commonly go by the brand names Vyvanse, Ritalin and Adderall, Sarah Van Orman, University Health Services executive director, said in an email to The Badger Herald.

[In] the general population, it tends to be more opioids and things like that, but as you can see on an academic college campus the stimulants really leapfrog ahead and become the most common prescription drug that is abused.Angela Janis, director of psychiatry and interim co-director of mental health at UHS

Stimulants were used illegally more than any other prescription drug. The next most-common drug was painkillers, which 3 percent of students reported using.

Angela Janis, director of psychiatry and interim co-director of mental health at UHS, said stimulant medications are the third most abused drug category at UW, below alcohol and marijuana.

“[In] the general population, it tends to be more opioids and things like that, but as you can see on an academic college campus the stimulants really leapfrog ahead and become the most common prescription drug that is abused,” Janis said.

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While 7.9 percent of the student population may seem like a small number, UW students describe the misuse of Adderall and other stimulants as commonplace.

Mark*, a UW junior majoring in economics, doesn’t have severe focus problems but has used prescription stimulants twice to help him improve his ACT score and once for a binge study session. He said it’s “just too easy” to get Adderall on campus. Using Adderall and other stimulants for studying, he said, is widely accepted since it’s not as damaging as other drugs.

“On this campus it’s so prevalent that people don’t think anything of it,” Mark said. “The payoff is just way too good to not use it.”

A 20mg Adderall pill usually sells for around $3-$5, according to student reports. Emily Hamer/The Badger Herald

Stimulant dangers and side effects

Many students assume since prescription stimulants are safe when treating ADHD with the help of a doctor, using them illegally is automatically safe. Experts, however, agree using them without a prescription is dangerous.

Two of the most common side effects are loss of appetite and insomnia, Janis said. Other serious side effects include increases in anxiety and cardiac issues. All of these side effects are worsened when taken in high doses that would not normally be prescribed.

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When taken in high doses, prescription stimulants are more likely to cause panic attacks or even psychosis, Janis said. They can also cause your heart to race, which can be dangerous — especially for someone with a pre-existing cardiac issue.

Dr. Jacob Behrens, medical director of Envision ADHD, a clinic specializing in treating and diagnosing ADHD in adults, pointed to one study, however, that found ADHD medications were not associated with increased risk of cardiovascular events in young and middle aged adults.

All of the potential side effects are worsened when stimulants combine with alcohol, Janis said. There is also a greater danger of students getting alcohol poisoning because Adderall makes students more aware when they’re drunk, making it seem like they can drink more, she said.

Nick*, a UW student majoring in mechanical engineering, has taken Adderall about 20 times for studying and partying. Nick said combining Adderall with alcohol is a “rush,” but can also have a “scary” blackout side effect.

“You drink a lot more than you should,” Nick said. “Say you took X amount of shots, and you still remember it, so you … drink more.”

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But in the eyes of many students the benefits are worth the side effects.

ADHD: A disorder both over and underdiagnosed

To mitigate risks, some students take Adderall in low doses similar to the amounts called for in prescriptions.

In young, hyperactive middle class and above white males it’s extraordinarily highly diagnosed. It’s extremely under diagnosed in minorities, girls and women.Dr. Jacob Behrens

Jessica*, a UW junior majoring in journalism who has previously written for The Badger Herald, said she uses Adderall because of trouble focusing on subjects she’s not interested in. She was diagnosed with ADHD in high school, but didn’t get a prescription because her mom read about the dangers of Adderall.

During her first two years of college, Jessica said she used Adderall in low doses every week, around three days a week.

Based on what she has seen on campus, Jessica thinks some students, like herself, are using Adderall to self-prescribe for what may be mild forms of ADHD. She said she thinks it would be unfair if she wasn’t able to get Adderall — a drug that helps her — just because she doesn’t have a doctor who can prescribe it.

“I think a lot of people who [find] Adderall really helps them might actually have [ADHD],” Jessica said.

Katie Cooney/The Badger Herald

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To be diagnosed with ADHD at UHS and all general practitioners, someone has to have exhibited symptoms of ADHD before age 12, Janis said.

“Nowadays, most people, if they have ADHD, come to college with a diagnosis,” Janis said. “It’s rare that someone would have it missed and it only be brought about or noticed when they come to college.”

Janis said UHS has a “robust protocol” for diagnosing ADHD when a previous diagnosis doesn’t exist. This includes gathering teacher report cards and doing in-depth neuropsychic testing into memory and IQ.

Behrens said one of the challenges the medical community faces is ADHD medications being prescribed too easily, then getting out on “the black market.”

A 2011 study by the Innovations in Clinical Neuroscience found symptoms of ADHD can be easily feigned, so students can get a prescription for Adderall without actually having ADHD.

While this is a serious issue, Behrens said the fear of overdiagnosis leads some people who struggle with ADHD to be afraid to seek treatment.

“In young, hyperactive middle class and above white males it’s extraordinarily highly diagnosed,” Behrens said. “It’s extremely under diagnosed in minorities, girls and women.”

For the ADHD inattentive subtype, where hyperactivity is not present, it is less obvious someone may have ADHD because their symptoms don’t draw attention. Behrens said intelligence often masks ADHD symptoms in middle school and high school because students retain enough information to pass tests and get through high school.

This changes when students get to college because they have heavier workloads and less structure, Behrens said.

“It’s more than understandable to see why it starts to become very much unmasked when people move to college,” Behrens said.

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Janis, however, said many students who experience concentration problems assume they have ADHD and start taking Adderall, without considering other potential causes. More common causes include poor sleep habits, depression, anxiety, marijuana use or excess alcohol use, Janis said. If it’s anxiety or poor sleep habits, taking Adderall makes it worse.

Both Janis and Behrens agree students taking stimulants in an uncontrolled setting without a doctor is concerning.

Administration, UWPD rarely encounter student stimulant use

Will Chapman, assistant director of the UW Office of Student Conduct and Community Standards, said one of the most concerning aspects is the acceptance of nonmedical prescription drug use as a “normalized” or “tolerable” behavior.

Overall, Chapman said the misuse of Adderall and other prescription drugs is an underreported issue to the student conduct office, something he wishes would change.

I’m not saying that we want to expel every student that misuses prescription drugs, but we do want to have the opportunity to intervene with them to help them understand the impact.Will Chapman, assistant director of the UW Office of Student Conduct and Community Standards

Darcy Wittberger, spokesperson for the UW Division of Student Life, said in an email to The Badger Herald that there were only three cases in “the last several years” where Adderall was confiscated from a student without a prescription.

The UW Police Department comes in contact with possession of illegal stimulants infrequently, UWPD Lt. of Investigative Services Brent Plisch said. This isn’t because of inattentiveness, but because it is a hard crime to detect.

Plisch said most cases where UWPD comes into contact with a student who is using or is in possession of Adderall, Ritalin or Vyvanse occurs when something else drew officers to that location.

Anecdotally, Plisch said most cases result in probation. In the worst case scenario, since Adderall, Ritalin and Vyvanse are Schedule II narcotics, illegal possession could result in jail time or a felony. Under UW rules, possession of Adderall or other prescription drugs without a prescription falls under the nonacademic misconduct policy, and could result in expulsion.

“I’m not saying that we want to expel every student that misuses prescription drugs, but we do want to have the opportunity to intervene with them to help them understand the impact,” Chapman said.

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Students who “cheat the system” and use these academic enhancers, do a “disservice” to themselves and their peers, Chapman said. If a student knows of someone who is misusing prescription drugs, Chapman encouraged the use of the Med Drop location on Monroe Street to dispose of the substances properly.

‘Academic steroids’ put some students at disadvantage

Janis said using stimulants as study aides puts students who struggle with ADHD and students who do not want to use illegal drugs at a disadvantage. When used nonmedically, stimulants are essentially “academic steroids.”

Van Hoof said when students use ADHD medications as study drugs it trivializes her symptoms. It makes it seem like she uses Adderall to get ahead in school or that her learning disorder is “fake.”

Caleb Sindic, a UW junior majoring in biochemistry who has ADHD, said he doesn’t think other students using stimulants puts him at an academic disadvantage, but he does get frustrated with students who don’t fully understand ADHD medications. He said students don’t know about the side effects and proper dosage.

Craig Berridge, UW psychology professor and expert of neuropharmacology, said since ADHD patients have impaired cognitive function, stimulants have a greater impact on them, and it’s unclear how much of an effect stimulants would have on a healthy, well-rested UW student.

Studies show the nonmedical use of prescription stimulants doesn’t actually improve students’ GPAs, Behrens said.

Both Nick and Mark said they’re not sure if Adderall helps them focus, or if it’s a placebo effect.

Jessica, however, said Adderall helps one focus, regardless of ADHD diagnosis.

When students approach Sindic to try to get his ADHD medication, Sindic said he warns them of the side effects and pushes them to see that Adderall is a drug they don’t want to be taking.

But while Sindic doesn’t think students should misuse Adderall, he said they should have the legal right to access it. Sindic said legalization of the stimulants would lead to greater education about how the drugs work.

“When someone without ADHD is using this … fundamentally I kind of consider it to be kind of like coffee,” Sindic said. “It is kind of like caffeine … where it just kind of boosts your confidence, your focus.”

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Berridge said he thinks it’s weird society doesn’t have a problem with people using caffeine to enhance cognitive performance, but people have ethical concerns when it comes to Adderall. If stimulants were legal and didn’t carry more risks than caffeine, he doesn’t think there would be a problem.

But stimulants do carry significantly more risk than caffeine, Berridge added.

Study drugs provide ‘band-aid’ for poor study habits

The misuse of prescription stimulants is one symptom of a larger problem: the immense pressure for students to succeed.

It’s kind of putting a band-aid on it rather than figuring out a better way to get all your work done.Nick

In the spring 2015 NHCA survey, anxiety and stress impacted a student’s academic performance the most, more than alcohol use and depression. For anxiety, 22.2 percent of students said it was an impact, and 30.6 percent of students said stress was an impact.

Nick said, for him, Adderall is essentially hard work, organization and time management in a pill.

“It’s kind of putting a band-aid on it rather than figuring out a better way to get all your work done,” Nick said.

Chapman said there are a number of services to help students improve their study habits and talk about prescription drug dependency or abuse like drop-in tutoring sessions. A program through Greater University Tutoring Service targets improvements on study skills.

Student organizations like Live Free host meetings designed to help students overcome all substance abuse, including prescription drug dependency or addiction, Carter Kofman, spokesperson for Live Free, said in an email to The Badger Herald.

Janis said UHS is also a confidential place for students to come for advice on better stress management or alternatives to Adderall.

Some students still feel like the university isn’t doing enough to inform students about ADHD medications. Sindic said he thinks the university would benefit from more programs educating students about ADHD, ADHD medications and alternatives. There is currently not a program dedicated to this mission specifically.

Still, Sindic said he thinks students should re-evaluate whether or not they need stimulants.

“People aren’t learning how to manage their lives,” Sindic said. “You could go in [to UHS] and say ‘I think I have ADHD’ and then they tell you, here are a bunch of methods that you could use to mitigate these ADHD symptoms that don’t involve taking pills. … There are alternatives.”

*Names have been changed to protect the privacy of sources who have engaged in illegal activities.

Correction: A previous version of this article stated that Dr. Jacob Behrens was the assistant clinical professor of psychiatry at the UW School of Medicine and Public Health, but Behrens no longer works there. The Badger Herald regrets this error.