In 2010, when Raphael was a first-semester college freshman struggling to get through finals, he did what it seemed like all his friends were doing: he got an Adderall from a fellow student and holed up in the library. It was the first time he'd tried the stimulant—a mixture of amphetamine salts often prescribed for attention deficit hyperactivity disorder (ADHD)—which is often used off-label as a "study drug" by those not diagnosed with the disorder.
"I was a little surprised by how much I loved it," Raphael, now 25, tells Quartz. "It made me feel like a philosopher king." Soon, he became part of the estimated 20% of college students who abuse prescription stimulants. But he didn't anticipate that, six years later, he'd be using Adderall daily while working as a web developer at an e-commerce shop in Los Angeles.
The story of how he procured his first stimulant prescription proves how prevalent an ADHD diagnosis has become. "I don't really have ADHD. But after freshman year, I found a drug dealer with a PhD," Raphael says, referring to his psychiatrist. "I said that people thought I had ADHD in high school, and the psychiatrist just said, 'Okay,' and took out her little pad. I've had a prescription ever since."
As a millennial, Raphael is part of the first generation of Americans to be routinely prescribed stimulants during childhood and adolescence and who gone on to abuse those stimulants in high school and college. Now, as Alan Schwarz points out in his new book ADHD Nation: Children, Big Pharma, and the Making of an Epidemic, millennials are graduating into the workplace, and many of them are continuing to use prescription stimulants as job-performance enhancers.
If you used Adderall throughout college, quitting when you start working can be difficult. This isn't just because ADHD medications like Adderall are highly addictive Schedule II-controlled substances—putting them in the same category as cocaine—but also because many users come to see them as a driving factor in their success. "It stands to reason that if you feel as if you succeeded in college partly because of these drugs, you're more likely to feel as if you need them to succeed in the workplace," Schwarz says.
"If you feel as if you succeeded in college partly because of these drugs, you're more likely to feel as if you need them to succeed in the workplace." While there is a lot of research about the abuse of stimulants on college campuses, there's still no reliable data quantifying stimulant use among American adults in the workplace. The National Institute on Drug Abuse is looking into this relatively new trend, however: A recent study of 11 million US workers found that workplace drug tests are coming back positive at the highest rates in a decade, and they're continuing to increase. Amphetamines, including Ritalin and Adderall, were the second most common drugs detected after marijuana. (Drug test results sometimes include methamphetamine, or crystal meth, in the amphetamine category, so it's unclear how much of this increase is due to prescription amphetamines.) Meanwhile, the number of adults with prescriptions for ADHD medication is moving past 5 million, and prescriptions among 26- to 34-year-olds are the driving force.
"You'll likely see more [prescription stimulant use] in professions that are dominated by people in their 20s," Schwarz says. As an example, he cites a millennial-run tech company in New York City where an employee "keeps Adderall in an Altoids case in her open purse for anyone to grab as necessary." The company's founder, a woman in her 20s, takes Adderall in order to sleep just three and a half hours a night and says it's "necessary for survival."
Assessing the issue of amphetamine use in the workplace is tricky for many reasons, one being that adults with legitimate ADHD diagnoses can greatly benefit from medication. For those plagued with chronic disorganization and an inability to focus, an Adderall prescription can be a career saver. But as Schwarz points out in his book, "There's no way to know how many of [the 5 million stimulant prescriptions for adults] were legitimate—the reasonable result of greater awareness of adults truly having ADHD—and which materialized from dishonest patients or lazy doctors."
Raphael credits his own tech knowledge to Adderall. In college, he often used his amphetamine-induced laser focus to teach himself to code. He eventually started a successful freelance web-design business, and now makes $75,000 a year as a full-time web developer. Raphael says he feels "totally dependent" on Adderall to succeed: "Without it, I don't really see the art within the coding."
The impulse to chemically enhance one's work performance, of course, isn't limited to particular fields. While doing research for ADHD Nation, Schwarz talked to a glassblower, a yoga teacher, a beer-warehouse stacker, newspaper reporters, bartenders, professors, dentists, doctors, and truck drivers who all acknowledged taking Adderall to power through their work.
"The number of people entering drug rehab specifically for abuse of Adderall and other ADHD medications has risen substantially." As there's no long-term research on Adderall's effects, even the safety of controlled use is still up for debate. Known risks include side effects such as insomnia, increased blood pressure, irregular heart beat, appetite suppression, headaches, dry mouth, and anxiety. In some cases, according to a wealth of research, amphetamines can trigger hallucinations, delusions, and psychosis. "The number of people entering drug rehab specifically for abuse of Adderall and other ADHD medications has risen substantially," Schwarz writes.
News stories about prescription stimulants often concern the estimated one in ten people who become dangerously dependent. In "Generation Adderall," a recent piece for the New York Times Magazine, journalist Casey Schwartz detailed her decade-long Adderall addiction, during which she wound up in the ER after an amphetamine-induced panic attack. "My life was no longer my own…. The Adderall made my life unpredictable, blowing black storm systems over my horizon with no warning at all," Schwartz writes. "Still, I couldn't give it up." In 2011, Richard Fee, once a popular college class president and aspiring medical student, committed suicide after struggling for years with an Adderall addiction enabled by careless doctors. "Recent years have seen several other such stimulant-related suicides," Schwarz writes. These cautionary tales illustrate the dire consequences of rampant misdiagnosis and cavalier overprescription.
Partly because of such alarming news stories, Raphael, for one, is concerned that his older colleagues will judge him negatively for being part of "Generation Adderall." He feels that Baby Boomers wring their hands over prescription-drug use among millennials—despite the fact that Baby Boomers created "Generation Adderall" in the first place.
"I think the blame is a little backwards there," Raphael says. "You can't prescribe a whole generations of kids drugs, tell them to 'be the best you can be,' and then when they go take the drugs, turn around and accuse them of cheating and call them 'Generation Adderall.'" Judgment is often misdirected at young adult users themselves instead of at the doctors and pharmaceutical companies who perpetuate the trend. Fearing repercussions, Raphael hasn't told his colleagues about his usage.
Not that they'd ever likely suspect it, anyway: Raphael looks more like a workaholic than a drug addict. He's the type of Adderall user who doesn't usually make news. "I've never had panic attacks or wound up in the ER," he says. "I get enough sleep." He calls himself a "chronic but high-functioning user" with "just enough self-control to keep [intake] below the level at which it would start to negatively impact my work performance."
It has negatively impacted his relationships, though. "Since it makes you focus on work, it can be a lonely drug," he says. His mother is concerned about his use, and his one significant attempt to quit happened a year ago, at his girlfriend's request. She'd accused him of "being more interested in aligning things on websites than going to dinner and a movie," so he agreed to stop. Aside from a couple of days spent binge-watching Frasier, he had no withdrawal symptoms. Soon, his relationship improved, but his career suffered. "I had obligations to all these clients," he says. "When I stopped taking Adderall, I just stopped emailing them, because I didn't want to build a website—I wanted to hang out with my friends." Three months later, Raphael started taking the drug again.
Employers, so far, haven't done much to address ADHD medication misuse in the workplace. Employers, so far, haven't done much to address ADHD medication misuse in the workplace. One rare attempt to regulate prescription stimulants in a professional setting took place in the millennial-dominated world of esports, also known as competitive video gaming. In 2015, the Electronic Sports League, or ESL Gaming, added Adderall to its list of substances prohibited from ESL tournaments, and started drug-testing players. The ban came after a prominent 26-year-old professional Counter-Strike: Global Offensive player admitted in an interview that his whole team had used Adderall during an ESL tournament.
"Adderall is just part of the esports culture," says Ryan Morrison, who's known as the "Video Game Attorney" at the law firm Morrison/Lee. "Some people joke that 95% of players take it." Top professional esports players make "literally millions of dollars" and usually live in team houses where they'll practice games like League of Legends and Dota 2 for nine hours straight. "One player told me, 'I want to win, and I'm not gonna win if everyone else is taking Adderall and I'm not,'" Morrison recalls. "Another said, 'It's just like drinking a monster energy drink.' It's not—they're taking a Class 2 controlled substance. They don't realize it."
The ESL's amphetamine ban proved hard to enforce, especially as players with "legitimate prescriptions" were still allowed to use it during tournaments. "This just meant the players went and got prescriptions," Morrison says. "Not every esports player needs Adderall, but all of them can get prescriptions if they decide it's necessary."
It's hard to imagine a tech company or a law firm enacting a similar ban. A few years ago, the National Business Group on Health published a short report called "ADHD Diagnosis and Stimulant Medication Misuse: Five Things Employers Can Do." "This sounded encouraging, until it focused almost entirely on reducing employers' insurance costs for the growing number of unnecessary prescriptions," Schwarz says. "Frankly, because the report didn't discuss the 'misuse' mentioned in its title in any meaningful way, it indicated how blind employers are to this trend."
Even if employers were aware of the trend, would they be inclined to try to stop it? Unlike many other drugs—especially "downers" such as marijuana, Valium, and even heroin—stimulants like Adderall often help job performance instead of hurting it. Perhaps because of this, employers haven't been quick to complain. "What could my boss possibly say about it?" Raphael says.
If you're like Raphael and don't experience significant physiological downsides to taking ADHD medication, it's not hard to see why you'd be reluctant to stop taking it, despite the health risks. But aside from the potential for addiction, Schwarz is concerned that, even if one person's stimulant use at work doesn't directly hurt them or their colleagues, widespread use among workers could have insidious societal ramifications, especially for productivity.
"If several of your competitors in the workplace are using Adderall, and if you feel as if your competition is getting an advantage—that they're staying up three extra hours working, or billing more hours, or developing more ad campaigns, or whatever it may be—you might feel compelled to take the drug, too, even if you'd prefer not to," Schwarz says. "These are serious drugs with great addictive possibilities. You start to play with fire."
The career trajectories of "Generation Adderall" are just beginning. It remains to be seen how many millennials will find themselves struggling with stimulant addictions enabled by doctors as teenagers, and how many will continue the Adderall habits they started in college for the rest of their working lives.
Raphael, for one, can't predict what his relationship with Adderall will look like in the future—but as his job isn't getting easier, he's not planning to quit again anytime soon: "We might end up being one the smartest, saddest, loneliest groups of people ever."