[media-credit name=’DEREK MONTGOMERY/Herald photo’ align=’alignnone’ width=’648′][/media-credit]With exam week on the frontier and study time mounting for University of Wisconsin students, some will be relying on more than soda and coffee to get them through long nights at the library.

UW students are among the growing population of young adults using prescription attention deficit disorder medications to aid in all-night study sessions, regardless of whether they have a prescription.

While the intended use for the drug is to increase attentiveness, some say using the medication for exam-week cram sessions can only hurt students who are already at very high stress and anxiety levels.

"[Misusing the medication] is the wrong direction," Robert McGrath, director of counseling and consultation services at University Health Services, said. "The things people are taking are on the stimulant end of things; it compounds their anxiety. They're creating stress rather than calming themselves and staying focused."

But more and more students are finding ADD medications are just the ticket to hours of focused study time without fatigue, especially considering the ease with which they can be obtained from fellow prescription-holding students.

Joe, a UW junior who asked his last name be kept from print, reported using prescription attention deficit disorder drugs for studying purposes, saying two of his friends doled out their medication for friends with a lot of work and little time.

While Joe said he used the drugs only twice, he said other friends use them "all of the time," and that popping pills before heading to the library is not an uncommon practice among classmates.

"I've only done it twice, but I still get calls from people who want to know where I got [the medication] from and if I could get some for them," Joe said. "The problem is schools have put focus on grades instead of learning."

Eric Heiligenstein, psychiatrist at UHS, said a school's academic competitiveness is a factor in the use of study drugs among college students, along with the school's size and other socio-economic factors.

And while the trend in misuse is by no means limited to young adults, students do have a unique intention in taking them.

"Drugs are in the hands of people who are not supervised," Heiligenstein said. "And that's combined with an environment where there is a possible advantage in taking them."

Because the medications can give healthy people extraordinary concentration abilities for long periods of time, students like Joe turn to them for a completive edge during crunch time.

About the drugs
As the number of people diagnosed with ADD and ADHD rises, so does the availability of the medications intended to calm the disorders' common symptoms.

ADD is characterized by inability to concentrate and a short attention span; ADHD has similar symptoms, but includes hyperactivity and impulsiveness.

Stimulants including Ritalin and Adderall are designed to combat the symptoms of attention disorders by activating areas in the brain controlling task performance, increasing energy and productivity.

The military, according to Heiligenstein, had been taking advantage of the medication's effects for decades, using them to facilitate awakening and delay fatigue. College students who use the medications crave exactly those effects come exam time.

And a perceived added benefit for students popping pills comes in the newest version of a traditional attention disorder drug — Adderall XR. This newer form, approved by the FDA in 2001, has extended release, rather than instant release, which allows for up to nine hours or more of focus and concentration — leading some students to rely on the medication as a study buddy when facing hours of cramming.

Six years ago Heiligenstein aided in an informal study at UW that focused on the use and misuse of prescription attention disorder drugs, as health officials began to notice increased reports of the drugs' misuse and diversion.

"But the numbers never seem to match up," he said, noting people who do misuse the drug are oftentimes not likely to report it.

Heiligenstein referred to a study recently completed by Tim Wilens, a psychopharmacologist at Massachusetts General Hospital, which yielded results similar to those found in the UW study.

"Basically 11 percent of [prescription holders] reported selling them, and 22 percent reported misusing them," Heiligenstein said.

But these numbers are likely lower than a reflection of realistic use, he said, not only because respondents are hesitant to admit misuse, but also because police and other agencies have more trouble tracking these drugs than other substances.

"Johnny Student who uses it two times a semester," Heiligenstein said, "how are you going to track that?"

While studies tracking abuse of the prescription medications are few, monitoring and treatment of those who react negatively to the drugs is consistent, including on the UW campus.

"We definitely see students every semester who have developed physical addiction to the medication and require supervised medical care," Heiligenstein said.

But physical addiction is only one side of the coin, he added. UHS also sees a fair share of psychological addiction, where the drug user believes his or her performance depends on the use of the medication.

"That's when students say, 'Gosh, I got an A on that last test, and if I don't take the pills again I won't do as well,'" Heiligenstein said.

Pill problems
While Adderall XR is currently the most prescribed ADHD treatment in the country, it and other medications like it do not come without their downfalls.

In fact, the Food and Drug Administration recently mandated Adderall include a "black box warning" in its packaging, the highest warning indicator possible.

The warning states misuse of stimulant medications may cause sudden death or cardiac abnormalities, although Heiligenstein said those complications typically occur at a very low frequency.

The drugs are certified prescribable medications, Heiligenstein said, so they are not "evil incarnate."

But the risk is still there.

"It's roulette," he said. "If you're that one in a thousand person who has a cardiac [affliction], you're dead. If you're not cleared medically, you're at your own risk."

According to Matt Cabrey, spokesperson for Shire Pharmaceuticals — the company that makes Adderall XR — the drug company already had the warning label on its product before the FDA mandate.

In addition, Cabrey said, Shire participates in various awareness-promoting efforts, including making "tool kits" available to health care providers on college campuses.

While warnings about cardiac abnormalities and possible death cover part of the medication's possible effects, other more commonplace consequences of misusing the drug can also plague non-prescription holders.

Healthy people who pop the pills are susceptible to hyperactivity and paranoia, and often experience a crash into exhaustion as the medication wears off.

Joe reported effects like these, saying he would typically stay up all night after taking Adderall, but later would have to sleep for hours to combat feelings of sickness. And even while he was awake, Joe said, the medication's effects were almost too extreme.

"It made me stay up all night, but I wasn't able to concentrate on what I was trying to concentrate on," Joe said. "I spent more time staring at and investigating the numbers on my telephone than studying."

Other trends in study habits
Prescription drug use is not the only tactic college students are employing to battle through exam week.

The more common cramming practice of pulling all-nighters fueled by coffee and soda may be less extreme then pill popping, but forgoing sleep has its negative consequences as well.

"The first thing to go is sleep, and that's the most basic part of being healthy," said Rob Sepich, a stress management counselor for UHS.

According to Sepich, students who get less than the recommended seven-and-a-half to eight hours of sleep per night are likely to experience some degree of memory lapse when trying to perform the following day.

"There is really good research that shows we recall more information after sleep," Sepich said. "The time I can see an all-nighter being appropriate is with a paper or project when it's just a matter of getting it done."

Other exam-time habits include getting too much sleep — students will sleep 12 hours or more to avoid the stress of exam-time studying — or Internet addiction, McGrath of UHS said.

"Unfortunately," he said, "there is a whole range of creative ways to not address the problem."