4 Questions You Probably Have About Adderall

Last season on Riverdale, it was revealed that Betty, the whip-smart, do-gooder in the group, had been taking Adderall to help her with her school work. This isn't the first time that this stereotype has been used in a TV show targeting teenagers; even Spencer from Pretty Little Liars had a storyline involving her amphetamine addiction. But while Adderall is often depicted as a secret weapon that smart kids use when they're under a lot of pressure, there's a lot more to it than that, which people using it IRL may not know.

In a study published last week, researchers at New York University examined survey results from 24,000 high school seniors, to see whether teens reported "nonmedical" Adderall or amphetamine use (aka without a prescription). Weirdly, more than a quarter of the students who reported using Adderall without a prescription said that they don't use amphetamines. But Adderall is an amphetamine formulation, so clearly many students who use it are confused about what exactly they're taking. Researchers say that these survey discrepancies also mean that the amount of high schoolers misusing Adderall may be as high as 9.8%, or 1 of 10 high school seniors, which is higher than was previously believed.

Given the scope of its use and persistent confusion around Adderall, we asked Frances Levin, MD, a board-certified psychiatrist who specializes in addiction at the Columbia University Department of Psychiatry, to answer some common questions you might have about the drug — including exactly what it d0es.

How does Adderall — or any amphetamine — work?

On a basic level, amphetamines work by releasing dopamine, as well as preventing reuptake of dopamine into the cells, Dr. Levin says. "Dopamine is one of the neurotransmitters that is implicated in what we perceive as being reward, or feelings of euphoria," she says. This means that dopamine is responsible for pleasure and motivation. Studies have shown that ADHD is associated with lower levels of dopamine, and higher levels of dopamine transporters. For people with ADHD, taking Adderall essentially adds more dopamine to their system, which in turn allows them to concentrate or feel calm. Conversely, people with narcolepsy are often prescribed Adderall, too, because it keeps them awake, according to Medline Plus.
Can Adderall really help you study?

Adderall is known to help with executive functioning and concentration, which may be why it's often associated with studying, schoolwork, and academic performance, Dr. Levin says. If you're someone with ADHD, it can certainly help you focus on tasks better, which can help in school, she says. But it's not entirely clear exactly how Adderall would work on someone who doesn't have ADHD.

"I think if you don't [have ADHD], it's just keeping you up so you don't fall asleep," Dr. Levin says. She adds that she's "not convinced" that people are better able t0 take in study materials by being on a stimulant. She strongly cautions against taking someone else's medication because you think it will be helpful to you. She often tells patients to safeguard their prescription pills, and not advertise that they have it. "There's always the chance that patients who should not be on it get it."
Is using Adderall dangerous?

Adderall is an amphetamine drug, so it is possible to be addicted to it, Dr. Levin says. "You have to be careful." While some people abuse Adderall to get high, "the most common reason people will report misusing Adderall or other amphetamine formulations is for performance enhancement," she says. Generally, patients who are at a greater risk of developing problems with it are young adults or teenagers in school.

The reason why Adderall in particular has "high abuse liability" is because it's easier to misuse or abuse it by injecting it or snorting it, she says. Misuse, which is defined as use of a substance for a purpose outside of medical guidelines (for example, using a medication without a prescription), can put you at risk for other side effects, including a fast, pounding, or irregular heartbeat or pulse, and bladder pain, according to the Mayo Clinic. For example, if you have a history of cardiovascular issues, misusing a stimulant like Adderall might lead to side effects as serious as cardiac arrest. That's why it's so important to go to a doctor before taking prescription medications, so they can weigh potential side effects with other health issues you might be dealing with.

But back to the topic of addiction and abuse: People who rely on this kind of medication to help with ADHD or other psychiatric disorders don't necessarily have to worry about that. Dr. Levin says, "There's convincing longitudinal studies demonstrating that, if anything, it's protective" against the risk of developing a drug-abuse problem when prescribed at a young age and maintained consistently.
So should I take it or not?

Ultimately, you shouldn't be taking Adderall without a prescription and diagnosis from a doctor, period — even if you're getting it from a trustworthy, smart friend who says they use it all the time. And if you do have trouble focusing, talk to your doctor before you self-diagnose. "ADHD is a clinical diagnosis and it should be done by somebody who has expertise in making a diagnosis, and can ask questions carefully," Dr. Levin says. Your doctor has a responsibility to make that decision, and balance the risks and benefits.

If you have ADHD, taking Adderall as advised by your doctor can be very therapeutic, Dr. Levin says. But for people without a specific psychiatric need for the drug, it can throw necessary systems out of whack, and in some cases be very dangerous. Just remember: Your health and safety is way more important than any bad grade.