In 2000, I was a freshman at Brown University. One night, still in our first term, I’d come to complain to a friend about the situation in which I found myself: an essay due the following afternoon on a book I had yet to read. All around us, her clothes were strewn messily on her dorm room floor. “Do you want an Adderall?” she asked. “I can’t stand them. They make me want to stay up all night doing cartwheels in the hall.” Could there be a more enticing description? From a ball of tinfoil, she pulled out a single pill, the deep bright blue of a cartoon sky. My hand shot out to receive it. I had come there merely to vent, but I left with my first Adderall — a medication prescribed for attention deficit hyperactivity disorder, or ADHD, a condition I knew nothing about, except for some vague awareness of classmates in high school who had needed extra time when taking their exams. At the time my friend unfurled her tinfoil ball, Adderall had been on the market roughly four years, but it was brand new to me.
An hour later, I was in the basement of the Rock, our nickname for the library, hunkered down in the Absolute Quiet Room, in a state of ecstasy. The world fell away; it was only me, locked in the passionate embrace of the book in front of me, and the thoughts I was having about it, which tumbled out of nowhere and built into what seemed a pile of riches. When dawn came to Providence, I was hunched over in the grubby lounge of my dormitory, typing my last fevered perceptions, barely aware that outside the window, the sky was turning pink. I was alone in my secret new world, and that aloneness was part of the great intoxication. I needed for nothing and no one.
I didn’t know it then, but it was actually in Providence, nearly 70 years before, that Benzedrine, an amphetamine-based precursor to Adderall, had been given one of its first test runs. In 1937, at the Emma Pendleton Bradley Home for disturbed and difficult children, Dr. Charles Bradley performed the first of two experiments to test the effects of Benzedrine on children. The pills were created as decongestants but were also known to boost moods in adults. Dr. Bradley was surprised by the results: The kids calmed down, became less rowdy and raucous, and seemed to gobble up their school lessons with relish. They became, in other words, rapturously, singularly, focused.
Like those difficult children before me, I would experience this same sensation again and again over the next four years, whenever I could get my hands on Adderall, which was frequently but not, I felt, frequently enough. There were ways of getting more, each of them shrouded in a thick ethical dinginess. For instance: The campus black market, where the ADHD kids sold off their prescriptions at exorbitant markups. The heiress whose pills I swiped while attending her numerous parties. Later, the barter system, wherein I helped with other people’s essays in exchange for their meds.
Once I tried Adderall, I couldn’t forget what it promised me: a quality of attention that I now idolized and craved.
Quickly, my Adderall hours became the most precious hours of my life, far too precious for the Absolute Quiet Room. I now needed to locate the most remote desk in the darkest, most neglected corner of the upper-level stacks, tucked farthest away from the humming campus life outside. That life no longer interested me. Instead, what mattered, what compelled, were the hours I spent in isolation, poring over, for instance, Immanuel Kant’s thoughts on “the sublime.” I read and reread the lines. The text was difficult, but my attention was now unflagging, bionic. The single greatest impediment to comprehension had been removed. The Kantian enigma clicked into place.
It was fitting: This was sublime, these afternoons I spent in untrammeled focus, absorbing the complicated ideas in the books in front of me, mastering them, penetrating every inch of their surface with my razor-like comprehension, making them a part of myself. Or rather, of what I now thought of as myself, which is to say, the steely, undistractible person whom I vastly preferred to the lazier, glitchier person I secretly knew my actual self to be, the one who was subject to fits of lassitude and a tendency to eat too many Swedish Fish.
I don’t think that in the years before I took that first blue pill, I had consciously doubted my own ability to focus. But once I tried Adderall, I couldn’t forget what it promised me: a quality of attention that I now idolized and craved. It was attention weaponized, slashing through procrastination and self-doubt, returning me to a place that felt almost like childhood, with its unclouded pleasures of rapt hours, lost in books and imagination. Childhood, but with a jittery amphetamine edge.
Another thing: Adderall wiped away the question of willpower. I could study all night, then run ten miles, then breeze that week’s New Yorker, all without pausing to consider whether I might prefer to lie around, or go to the movies. It was fantastic. I lost weight. That was nice too. Deeper into the Adderall years, I started to snap at friends, abruptly accessing huge depths of fury I wouldn’t have thought I possessed. When a roommate went home one weekend and forgot to turn off her alarm clock so that it beeped behind her locked door for 48 hours, I entirely lost control, calling her in New York to berate her. My anger, unhinged as it was, felt out of proportion to the crime. God knows how long it had been since I had slept more than five hours. Why bother?
As much as I loved Adderall, which I did, from the earliest moments I also knew that, ultimately, nothing good could come of our entanglement. By senior year of college, my schoolwork had grown more, not less, unmanageable. I’d been accepted to a program called the Capstone, which I’d aspired to since I’d first arrived on campus. Instead of writing the usual thesis required for an honors degree, I would write a novella-length fiction manuscript, working with a faculty advisor in weekly editorial sessions. I was assigned to a new member of the creative writing faculty, one who had arrived on campus in a cloud of intrigue, having parted ways with the Mormon Church due to the heretical content of his novels. Or so I’d heard. He and I never really advanced beyond an awkward politeness. Our arrangement, such as it was, usually involved my telling him I was too behind to profit from our slotted editorial meetings. And so, week after week, we would cancel.
As the first semester neared an end, I was behind on the manuscript, and behind on all my other schoolwork as well. My droll, aristocratic Russian history professor granted me an extension on the final term paper. One Friday evening, well into December, when the idyllic New England campus had already begun to empty out for the winter holiday, I was alone at the Sciences Library — the one that stayed open the latest — squinting down at my notes on the Russian intelligentsia. Outside, it was blizzarding. Inside, the fluorescent lights beat down on the empty basement- level room. I felt dizzy and strange. It had been a particularly chemical week; several days had passed since I’d slept more than a handful of hours, taking more and more pills to compensate. When I looked up from the page, the bright room seemed to dilate around me, as if I weren’t really there, but rather stuck in some strange mirage. I seized with panic — what was happening? I tried to breathe, to snap myself back into reality. Shakily, I stood and made my way toward the phone. I dialed my friend Dave in his dorm room. “I’m having some kind of problem at the SciLi,” I told him. My own voice sounded like it belonged to someone else.
Soon, I was in an ambulance, being taken through the snow-storm to the nearest hospital. The volunteer EMT was a Brown student whom I’d met once or twice. He held my hand the whole way. “Am I going to die?” I kept asking him. Dave and I sat for hours in the emergency room, until I was ushered behind a curtain and a skeptical- looking doctor came in to see me. I wasn’t used to being looked at the way he was looking at me, which is to say, like I was insane, an unstable force he needed to contain. By then I was feeling better, no longer so sure I was dying, and as I lay down on the examination table, I joked to him: “I will recline, like the Romans!” His expression remained unamused. His diagnosis: “Anxiety, amphetamine induced.” I had had my first panic attack, an uncommon but by no means unknown reaction to taking too much Adderall. When I left the hospital, I left behind the canister of blue pills that I had painstakingly scrounged together. I still remember the sight of it sitting next to the bed.
I had had my first panic attack, an uncommon but by no means unknown reaction to taking too much Adderall.
I’d had a drug overdose, which seemed like the kind of thing one told one’s parents about. That particular week, my mother, a magazine journalist, was in Europe, deep into the reporting of her latest piece. I didn’t want to call her to say that I had OD’ed on Adderall and gone to the hospital, because she might feel she had to come home and, after all, I was fine. So instead I called my father, whose own parenting style was much less traditional. My parents were long divorced and it was possible, with my father, especially, to keep secrets. On the phone, I told him what had happened. I told him that in the emergency room, it had shocked me to be looked at as if I were nuts. He interrupted me, his voice uncharacteristically stern. “Well, in point of fact, you were nuts. You were nuts to take that number of pills.” He also mentioned, while we were on the subject, that he had felt, for the last two years, more and more, that I had become “unavailable” and “removed.” I promised him I would stop the Adderall. And in that moment, I meant it. A few days later, I drew incompletes in all my classes and came home to New York, where I spent the long winter break at the Forty-Second Street public library, lethargically soldiering through the essays I hadn’t been able to cope with while taking amphetamines.
The warm embrace of Adderall on college campuses and beyond soon produced a success story within the scientific community. In 2008, the journal Nature published a commentary, which quickly made headlines, written by a group of prestigious neuroscientists, neurologists, and neuro-ethicists. Their statement was a kind of declaration: No longer did it make sense to regard cognitive enhancement medication as philosophically questionable. Instead, this commentary suggested, the pills were a fact of modern life and should be understood in the same terms as eating kale, taking vitamins, and getting on the treadmill, just another weapon in the armament of bourgeois ambition. Referring to Ritalin and Adderall, they wrote:
The drugs just reviewed, along with newer technologies such as brain stimulation and prosthetic brain chips, should be viewed in the same general category as education, good health habits, and information technology — ways that our uniquely innovative species tries to improve itself . . . Cognitive enhancement has much to offer individuals and society, and a proper societal response will involve making enhancements available while managing their risks.
The commentary made clear that the authors’ equanimity, if not downright enthusiasm, toward drugs like Adderall — or, at least, the idea of drugs like Adderall — was firm, despite a swarm of unanswered questions, questions that the authors themselves delineated. These included, but were not limited to: “What are the risks of dependence when used for cognitive enhancement? What special risks arise with the enhancement of children’s cognition? How big are the effects of currently available enhancers? Do they change ‘cognitive style’ as well as increasing how quickly and accurately we think? And given that most research so far has focused on simple laboratory tasks, how do they affect cognition in the real world?”
These were not minor questions. Rather, they concerned the very nature of how Adderall affects the brain and the mind. A decade later, they are still largely unresolved.
Yet, in 2016, when I spoke to Martha Farah, a cognitive neuroscientist at the University of Pennsylvania and one of the authors of the 2008 commentary in Nature, she struck a different note. What was now clear to Farah, in large part because of her own lab’s research, was that Adderall, billed as a cognitive enhancing medication and embraced by the neuro-intelligentsia as such, might not actually work. At least, not as it is commonly understood to work.
Since 2008, Farah and others have been looking more carefully at whether people’s performances in cognitively challenging situations actually do improve on Adderall. Farah has tested Adderall’s effect on a host of standardized tasks, from the “go/no-go task,” which examines how well participants are able to restrain themselves from pushing a button in response to the wrong targets, to tasks that look at working memory, such as the “digital span forward and backward,” in which subjects are asked to remember sequences of digits rapidly presented to them. Farah also tried to explore how Adderall might affect what we think of as creativity, using tasks such as the “remote associations text,” in which participants come up with one word that links together three different words, and, as well, the “group embedded figures task,” which asks subjects to identify a small pattern within a larger, more intricate geometric design. These are the kinds of tasks with which attention — a notoriously baggy, catch-all term — is operationalized in labs.
On balance, Farah and others have found, again and again, very small to no improvement when their research subjects confront these tests of impulse control, memory, learning, and creativity while on Adderall. Ultimately, she suggests, it is possible that “lower-performing people actually do improve on the drug, and higher-performing people show no effect or actually get worse.”
What Adderall clearly does extremely well is make people think they are doing better — and to feel good while they’re doing it. “Adderall might not be a cognitive enhancement drug, but a ‘drive’ drug,” says Anjan Chatterjee, a professor of neurology at the University of Pennsylvania’s medical school. Farah explains, “[Stimulants] make boring work seem more interesting, so they increase your motivation to work, energy for work, and that’s not nothing — that’s really helpful . . . Unfortunately, it also gets into the realm of feel-good drugs, and that means the risk of dependence is quite high.” Yet when I ask Farah exactly how addictive Adderall and other stimulant medications are, she tells me that there is currently no good answer. “Nobody has really looked at these drugs used as work enhancers and what the dependence risk there is,” she said.
Adderall, billed as a cognitive enhancing medication and embraced by the neuro-intelligentsia as such, might not actually work. At least, not as it is commonly understood to work.
In retrospect, Farah says, the commentary published in Nature might have represented “the last hurrah in a flurry of optimism about the ability of drugs like Adderall to promote human flourishing.” Yet she is careful to note that she and her colleagues were more intent on praising the idea of a drug like Adderall than they were trying to single out Adderall itself as a long-sought panacea for our modern woes. “Cognitive enhancement is not a bad thing, in and of itself,” she said.
For Chatterjee, the use of Adderall off-label is comparable to plastic surgery: no less, and no more, existentially troubling. Carl Hart, a professor of psychology and psychiatry at Columbia University, tells me that, to his way of thinking, it makes more sense for a person “who knows what they’re doing” to take a small dose of Adderall than to rely on caffeine. Fewer headaches. Fewer calories.
Any basic neuroscience textbook will explain how Adderall works in the brain — and why it’s so hard to break the habit. For years, the predominant explanation of addiction has revolved around the neurotransmitter dopamine. Amphetamines unleash dopamine along with norepinephrine; they rush through the brain’s synapses and increase levels of arousal, attention, vigilance, and motivation. Dopamine, in fact, tends to feature in every experience that feels especially great, be it having sex or eating chocolate cake. It’s for this reason that dopamine is so heavily implicated in current models of addiction. As a person begins to overuse a substance, the brain — which craves homeostasis and fights for it — tries to compensate for all the extra dopamine by stripping out its own dopamine receptors. With the reduction of dopamine receptors, the person needs more and more of her favored substance to produce the euphoria it once offered her. The vanishing dopamine receptors also help explain the agony of withdrawal: Without that favored substance, a person is left with a brain whose capacity to experience reward is well below its natural levels. It is an open question whether every brain returns to its original settings once off the drug.
“Adderall is not meaningfully different from methamphetamine,” says Hart, in between bites of a baked sweet potato. I have come to see him in the spring of 2016, now intent on telling the story of my years on Adderall, and my search for attention in its aftermath. Hart studies psychoactive drug effects in humans; he is also a forceful advocate in the struggle to revise how we think about drug addiction. Hart doesn’t look like your typical academic, with his Hollywood-caliber handsomeness and charisma, his long dreadlocks tied back in a ponytail. We sit together in his office at Columbia, on Manhattan’s Upper West Side. When I arrive, he is guzzling green juice from a glass jar, wearing a T- shirt that depicts, in bright blue outline, an amphetamine compound. He points to his shirt to demonstrate how easy it would be to convert amphetamine to methamphetamine. “You just add one methyl group,” he tells me. “The drugs produce the same effects. They are essentially the same drug.”
In Hart’s view, the “dopamine hypothesis” of drug addiction is overly simplistic. The problem with how most of us think about drug abuse, he says, is in our failure to look past the substance itself to the larger human context around it. In fact, given our context, “Adderall is a smart choice. In our driven society, it’s a logical choice.” Adderall seems, on the surface of things, to fit so well with how life is, speed for the sped-up Internet age. Indeed, as I look back on it, it does not escape me that just as Adderall was surging onto the market in the 1990s, so was the World Wide Web, that the two have ascended in American life in perfect lockstep, like a disease and a cure, made for each other.
Back on campus after the winter holiday, I was soon also back on the old chemical regimen. I was locked again into the familiar pattern, the blissful intensity and isolation, followed by days of slow-motion comedown, when I would laze around for hours, gobbling ice cream straight from the carton, desperate for the sugar rush, barely able to muster the energy to take a shower.
My main concern now was my Capstone manuscript. I was by then so in thrall to Adderall that I was convinced I couldn’t sustain the creative impulse without it, that my attention would wander to trivial pursuits if I didn’t supercharge it with prescription speed. That was what so many writers had done before me, wasn’t it? Kerouac and the rest of the Beats, Graham Greene, Susan Sontag, W. H. Auden. I was simply following in the grand tradition of so many transatlantic geniuses. This was what I told myself.
My writing process consisted of jagged, sleepless nights, humorless stretches of time in which I would lock myself away from my noisy roommates to conjure the amphetamine intensity that I mistook for real work. By the spring, I was so far behind on the manuscript that, in desperation, I spent the spring vacation— my last one in college— not with my friends or family, but alone in a cheap hotel room in Miami. I stayed up for days on too much Adderall, typing frantically in the red glow that came in from the garish lights of South Beach. When I felt stuck, I would walk up and down the beach in a furious state, castigating myself, at a remove from every human being around me. An irony: the manuscript I was writing was about a young man struggling with addiction, but I never thought to connect it to my own, or even to acknowledge that I had one. In the end, I finished it, but I felt a sense of deep shame attached to the manuscript, as if the pages themselves were contaminated. I turned it over to my ex-Mormon authority figure. Though his comments were generous, I did not look at it again for more than a decade. ●
From ATTENTION: A LOVE STORY by Casey Schwartz, published by Pantheon Books, an imprint of Knopf Doubleday Publishing Group, a division of Penguin Random House, LLC. Copyright © 2020 by Casey Schwartz.
Casey Schwartz is the author of Attention: A Love Story and In the Mind Fields: Exploring the New Science of Neuropsychoanalysis. She contributes regularly to The New York Times and lives in New York City.