Students crowd into College Library on the University of Wisconsin-Madison campus during the weeks preceding final exams. Under intense academic pressure, some students have been known to seek out and sell Adderall, a prescription stimulant, as a study aid. Allie Tempus/WCIJ

Adderall easy to find, but users face health risks

By Adam Riback, Bob Marshall and Alex Morrell
Wisconsin Center for Investigative Journalism

MADISON — Last school year, two University of Wisconsin-Madison journalism students walked into a campus library with a mission: See how quickly they could score some Adderall, a popular prescription “smart drug” that users say improves their ability to study.

They were good to go in 56 seconds.

All it took was a tap on the shoulder of one woman, a stranger at a table of students studying in silence. Asked if she knew where someone could buy some Adderall, the woman offered to call her friend downstairs who was selling it.

Experts say such easy access and casual acceptance is increasingly common on campuses, including UW-Madison, where students coping with high academic demands are turning to illicit use of Adderall and other stimulants. Adderall is prescribed to treat Attention Deficit Hyperactivity Disorder (ADHD).

The drug, also known to aid weight loss, is readily available for $5 a pill, which some consider a small price for the energy rush it can provide.

“When I first started taking Adderall, I was like Superwoman,” says Alyssa, a recent UW-Madison graduate now studying at a law school in New York. She asked that her real name not be used out of fear it might harm her career.

“You get a little jolt, and you’re just so much more motivated.”

But Alyssa also experienced the downside of the stimulant. A few years ago, she began overusing Adderall and landed in the hospital with an overdose.

An investigation by UW-Madison journalism students, in collaboration with the Wisconsin Center for Investigative Journalism, found university officials and local law enforcement across the state have not made it a priority to track or crack down on the apparent growing abuse of Adderall, despite health and addiction risks.

Interviews with health-care experts, university officials, police and students found:

• Overall use of Adderall is growing on campuses, and the drug is regularly abused by those with or without a prescription. It helps users stay alert as they cram for tests while coping with hangovers or lack of sleep.
• Adderall is readily available on the black market, usually sold or given away by those with prescriptions.
• Studies indicate long-term users can face side effects including sleep disruption, headaches, dependency and tics.
• Adderall also can cause mood changes, erectile dysfunction and create or exacerbate mental health problems.
• Doctors can be convinced to prescribe the drug by students who claim to have ADHD symptoms.

Despite doctors’ warnings, UW-Madison officials and police appear to have little concern over the abuse of Adderall on campus — findings that echo a 2008 report from The Capital Times. And officials at other Wisconsin campuses are seeing growing use of the prescription stimulant.

While no firm data exist, a survey conducted at an unnamed Midwestern campus and published in 2005 found 44 percent of students knew someone who used illegally obtained stimulants like Adderall — and experts suggest that trend continues. The study found four in 10 students with a stimulant prescription abused the drug at some point.

Despite Adderall’s prevalence and accessibility, UW-Madison does little to address the issue, even among incoming freshmen who participate in Student Orientation, Advising and Registration (SOAR). The program offers information ranging from housing options to tips on how to stay healthy and manage personal finances.

Dave Laur, coordinator for the campus’ Center for the First-Year Experience, says alcohol and marijuana are usually covered in-depth, while the rest of the discussion is steered by questions from students and their parents. Adderall usually doesn’t come up, he says.

“We certainly recognize that we have limited time with the students, and have many many topics of importance to cover,” Laur says. “Also we have found that students have a very short attention span for this.”

Students could face months or years behind bars if they convert prescription pills for unauthorized use, especially if the recipient overdoses. In February, a 13-year-old town of Milton boy died after a 14-year-old girl gave him some of her grandmother’s oxycodone. She is now serving a three-year term in juvenile prison, to be followed by two years of supervision.

Federal law also bars college students from getting or keeping federal financial aid if convicted of some drug crimes. Adderall-related arrests on campus are rare but not unheard of, says UW-Madison Police Sgt. Aaron Chapin.

“I know that we have had cases in the past where we’ve arrested people for selling Adderall,” Chapin says. “It’s not as prevalent as abuse of other drugs, alcohol and marijuana.”

Prescription drugs less dangerous?

The effects of Adderall are seen by students as more benign than alcohol or marijuana, says William Frankenberger, the UW-Eau Claire professor who led the 2005 study. Frankenberger, who studies ADHD, describes the prevailing attitude as, “They’re giving it to kids. It must be safe.”

He adds, “I don’t think students realize the side effects associated with stimulant use, so they have no second thoughts about taking a drug that seems to help them concentrate and gives them lots of energy.”

Dr. Eric Heiligenstein, a psychiatrist at UW-Madison’s University Health Services, says some doctors also don’t recognize the dangers of Adderall abuse.

“Physicians haven’t caught up to realize how serious the problem is,” Heiligenstein says. “Emergency room admissions, overdoses, legal problems — everything has skyrocketed.”

About 100 to 150 students come into UHS each semester saying they have ADHD. At most, he says, 1 percent of them actually do.

In reality, “They have learning disabilities, depression, anxiety, substance abuse disorders,” Heiligenstein says. “ADHD is a well-publicized and simplistic way of understanding lots of different problems, and it’s much more culturally acceptable now than some of the other difficulties are.”

He says UHS tries to properly diagnose students using such criteria as clinical histories, standardized rating scales, parental assessments and careful examination of outside information, such as school records. Still, the use and abuse of Adderall grows, Heiligenstein says, calling it one of the most diverted prescription medicines around.

“There are a lot of physicians who are not well-trained in assessing (ADHD), and they’re getting a lot of pressure from their patients to prescribe it (Adderall).”

Adderall helped Alyssa to focus in high school. Several years later, on a trip to Europe, she overdosed. Alex Morrell/WCIJ

At first, drug aided her studies

When used correctly, Adderall helps treat children and adults with ADHD, a serious disorder that causes problems with concentration or hyperactivity and interferes with learning and social functioning.

By 16, Alyssa had struggled her whole life to concentrate, but she had never been diagnosed with ADHD. Her mother, a pharmacist, grew weary of watching her daughter toil over a single subject’s homework for five hours a night.

She recalls her mother telling her pediatrician that her daughter “works way too hard for the grades that she’s getting, and it’s not fair to her.” Her doctor agreed and prescribed 20 milligrams of Adderall.
For Alyssa, the impact was immediate: She bumped her grade point average from a 3.4 on a 4.0 scale to 4.3 with the help of Adderall and advanced placement classes.

“It just made it so much easier to focus,” she recalls. “I hate saying that it’s a miracle drug, but I definitely don’t think I would be where I am today without it.”

The law student says that as an undergraduate, she was repeatedly asked by friends to sell them her pills.

“Wisconsin was insane,” she says. “My roommates, my friends in college, all the time, none of them were prescribed, and they would take it to write a paper, they would take it to go out.

“I was totally tempted. It’s such an easy way to make money.”

But her mother kept close tabs on her medication, doling out pills as Alyssa needed them.

A UW-Madison senior who agreed to talk on the condition of anonymity acknowledged she has sold pills from her Adderall prescription. She didn’t want her name used because she had sold the drugs illegally.

“I don’t think I’ve talked to anyone who doesn’t take it. It’s like taking Advil,” she says.

She also says it was “pretty easy” to get Adderall legally. “I didn’t get a full examination for my prescription. We just knew I had something …. it was minimal testing.”

Rising abuse of prescription drugs

Dr. Alex Faris, staff psychologist and substance abuse specialist at the University Counseling and Consultation Services at UW-Madison, has noticed a rise in the non-medical use of prescription drugs.

“More students are coming in because they are abusing prescription medicines like Adderall, Xanax or Valium than when I first got here five years ago,” Faris says.

Faris estimates about 5 percent of the 4,000 students treated each year at the university clinic have problems with prescription drugs. Out of those 200 students, Faris estimated about 120 have problems specific to Adderall.

However, he cautions the actual number of students suffering from prescription drug abuse is greater than the number seeking help.

“It’s very tricky to report on those numbers because I’m not sure that the number of people seeking treatment for abuse is a good indication of the seriousness or the prevalence of the problem,” Faris says.

In response to concerns about over-prescription of Adderall, UHS protocols have become increasingly stringent.

“We’ve really raised the threshold for students who want to obtain medication for (ADHD) at UHS,” Faris says. “There’s a rigorous assessment that requires two to four sessions, and we get information from the students and other sources.

“We really go above and beyond because we know that students are sometimes drug seeking.”

Problem not on the ‘radar’ for some

Despite the anecdotal evidence of increasing Adderall use, no one is quite sure how many prescriptions are written at UW-Madison. The consensus from more than a dozen university officials contacted for this story is that no one tracks the number of prescriptions of controlled substances such as Adderall.

Likewise, university officials and police have little data on Adderall abuse, and police say it is not a high priority.

Tonya Schmidt, assistant dean of students at UW-Madison, says in six years, she can recall two instances in which students were charged with misconduct due to illegal use of Adderall.

“We don’t see a ton of Adderall abuse,” Schmidt says. ” We know it’s happening, but we can’t prove it.”

UW-Madison Police have no records of any case during the 2009-10 academic year involving prescription drugs. There were six cases involving prescription drugs during the 2008-09 school year, three involving Adderall.

At UW-Eau Claire, officials say they had no evidence of Adderall abuse and don’t see it as a problem affecting their campus.

“The use of Adderall is not even on our radar here in terms of abusive practices … It’s just not something our students have been engaged in or come up in a situation where we have disciplinary action,” UW-Eau Claire spokesman Mike Rindo says. UW-Eau Claire Police Sgt. Chris Kirchman says he can’t think of any cases involving Adderall.

UW-Milwaukee Police had a handful of arrests for Adderall in the first half of 2010 that resulted in charges. Sgt. Art Koch says Adderall isn’t a special area of focus, but it’s a concern any time students are abusing drugs. Kelly Johnson, associate director of housing at UW-Milwaukee, says her department plans to do more education of students in residence halls about the dangers of prescription drug abuse, including Adderall.

At Marquette University, Dean of Students Stephanie Quade calls Adderall abuse a “silent problem” and acknowledges it’s likely a growing problem on her campus. The drug usually turns up in room searches related to other violations.

“We certainly know it’s an issue on other campuses, so we cannot be naive to think that it wouldn’t be an issue here,” Quade says. “But I have no evidence to bear that out.”

At UW-La Crosse, the story is similar.

Sgt. Scott McCullough doesn’t recall any Adderall cases, and Paula Knudson, assistant chancellor and dean of students, says she knows some students misuse the drug, but it hasn’t “become a focus at this point.”

Matt Vogel, UW-La Crosse community health specialist, teaches a class on the history of drugs and gives about 50 presentations a year on drugs and alcohol. He knows stimulant abuse is present on campus.

“We need to empower young people with accurate and honest information,” Vogel says. “If they’re empowered, I personally feel and I think there’s a lot of evidence to show that they’re much more likely to make a wise decision around substances.”

Risks serious, but many unaware

When students use Adderall without medical supervision or adequate education, they may be oblivious to its risks and side effects. Students may hear that stimulants like Adderall can make sex more enjoyable, but few users realize Adderall can have the opposite effect, says Heiligenstein, the psychiatrist.

“It’s a well-kept secret,” he says. “Erectile dysfunction in males occurs in at least 10 percent of people who take it, if not more.”

Dr. William Frankenberger. Courtesy of UW-Eau Claire

In addition, Faris, the staff psychologist at UW-Madison’s counseling service, says students may not realize Adderall can amplify existing mental health problems or create new ones. They also can grow psychologically dependent on the drug, Heiligenstein says.

“They … think that they can’t pass the tests unless they’re taking the drugs,” he says. “It becomes a very destructive cycle that requires them to abuse the medications to succeed. It’s not a good situation.”

Frankenberger, the professor and ADHD expert from UW-Eau Claire, says students without prescriptions risk taking high doses, which can have long-term consequences.

“The longer you take the drug and the higher the dose — and this is what we found in our research — the more side effects and the more troubling the outcomes for the people involved, ” Frankenberger says.

In a 2001 study of middle and high schoolers, Frankenberger found most children using stimulant medications for two or more years developed sleeping difficulties and headaches. In 40 percent of his sample, students developed tics, or involuntary muscle twitches, that they didn’t have before.

From success to addiction

Alyssa experienced striking improvements at school thanks to Adderall. But she discovered the drug’s dark side. When she was an undergraduate, her mother was discovered to have late-stage colon cancer.

“I was going through a real hard time when my mom was diagnosed,” she says. As the pressures of school and her mother’s illness mounted, Alyssa began to change her Adderall habits.

“I’m a little bit of a control freak,” Alyssa says. “Adderall helps you focus and control, so I thought the more I took the more I’d be able to control some sort of situation.”

On a trip to Europe, she overdosed.

“I was drinking and had snorted about 10 milligrams (of Adderall). I had to get my stomach pumped, and I was throwing up,” Alyssa says. “I woke up in the hospital with no recollection of the night.”

She stayed free of alcohol and Adderall for five months after the incident. After talking with a psychiatrist, Alyssa was back on medication.

Instead of Adderall, Alyssa now takes Vyvanse, a different ADHD treatment that she says makes her less anxious. She attributes much of her negative experience to the demands she felt at UW-Madison to balance academics and a frenetic social life.

“When I was at Madison, and going out three or four days a week, most of the days after I was hung over. So I was really crunched for time when I did my work. Here (in New York), since I’m not going out, I have so many more A’s and so much more time to finish my work,” Alyssa says.

“Wisconsin’s such a big party school,” she adds. “The mentality is sort of ‘work hard, play hard.’ I think a lot of people go to the extreme.”

Editor’s note: Wisconsin Center for Investigative Journalism intern Allie Tempus and UW-Madison journalism student Lavilla Capener contributed to this report, which began in a reporting class taught by Professor Deborah Blum. Adam Riback and Bob Marshall were students in the class, while Alex Morrell was an intern for the Center.

The nonprofit Wisconsin Center for Investigative Journalism (www.WisconsinWatch.org) collaborates with its partners — Wisconsin Public Television, Wisconsin Public Radio and the UW-Madison School of Journalism & Mass Communication — and other news media.

By Nick Penzenstadler

Officials at the University of Wisconsin-Madison say they defused threats from 125 troubled students, employees and area residents under a little-known program launched two years ago in response to deadly tragedies on college campuses in Virginia and Illinois.

But the program didn’t identify at least three individuals before they caused problems at Wisconsin’s flagship campus, including threats against a campus leader, a bomb threat and a murder near campus.

The program, called the Threat Assessment Team, has helped keep the campus safe overall, officials say.

However, officials decline to release details of the 125 cases they’ve handled, or much information about the three incidents, contending that most of their records aren’t public.

“As of now we’re doing a good job,” said Kevin Helmkamp, associate dean of students and co-chairman of the Threat Assessment Team, which strives to avert violent incidents. Helmkamp also co-chairs a related panel, the Intervention Team, which for many years has attempted to prevent troubled students from harming themselves.

“We would love to say we’re 100 percent but we’re not; it’s all part of the university experiment,” Helmkamp said.

The threat-assessment program was launched in the wake of mass shootings at Virginia Tech in 2007 and at Northern Illinois University in 2008.

The UW-Madison Threat Assessment Team identifies people who pose a threat — and also crafts plans for helping many obtain treatment.

“Most of the times we think of it as putting a tree in front of a person to slow down the snowball effect,” Helmkamp said.

And sometimes, they just can’t get the tree in place; threats aren’t detected in time.

‘People will show the warning signs’

Capt. Karen Soley, who represents the University Police on the team, said in cases where individuals are off campus it’s especially difficult to detect early signs of danger.

“People will show the warning signs, they do always show the warning signs, it’s seeing the warning signs and talking to somebody who can actually do something with the warning signs,” Soley said.

Records obtained through Wisconsin’s Open Records Law provide a glimpse into several such cases involving individuals who posed threats to the UW-Madison community:

• Leonard Taylor Jr., a former Wisconsin football player, pleaded guilty in March to charges of stalking and making phone threats toward Athletic Director Barry Alvarez. The former defensive back had been seeing a therapist, but never showed up in any of the Threat Assessment Team’s reviews before he was charged.
• Adam Peterson, a former UW-Madison student who had stopped attending classes in October 2007, was arrested in June 2008 for the January 2008 murder of Joel Marino, a Madison resident. Police launched a manhunt for the killer of Marino, and eventually arrested Peterson, who had dropped out of UW-Madison, in Minnesota. An internal Madison Police Department list identified Peterson in early spring 2008 as a person with potential mental health problems. Later that list would lead to detectives solving the case. While a student, Peterson never caught the attention of the Threat Assessment Team.
• Jesse A. Miller, a former Madison resident, was charged in September 2007 with threatening the campus by phoning in a bomb threat from California. Officials locked down the campus during the search for the bomb. Later that week Miller was arrested at a U.S. Navy base in San Diego. He claimed to have mental health issues. The Threat Assessment Team, which hadn’t had prior contact with Miller, met in October 2007 to review the response and add him to its watch list.

Peterson and Miller committed suicide while incarcerated.

Soley said that in both the Taylor and Miller cases, the university and police successfully responded to the first threatening contact from the individuals. Since Taylor and Miller were both living off campus, city police officials took the lead on following up with the two individuals and reported back to UW-Madison.

With the Peterson case, Soley said Peterson had already dropped out of class, and even while in class, his behavior never rose to a level to catch the team’s attention.

“As for Peterson the failure isn’t with the team, the failure is the same as in any shooting or incident,” Soley said. “The only way we know is ifpeople come to us with information.”

Knowing when to intervene is a difficult judgment call, as situations at other universities this year have shown.

In early October, a UCLA student allegedly slashed the throat of a classmate during a chemistry lab. Reports have surfaced that the man had been identified as having mental health issues 10 months prior to the attack. At Yale University in September, a laboratory technician was charged in the strangulation murder of a graduate student. The employee had been described as bossy and controlling but not diagnosed as having mental health problems.

Although earlier identification of the problem is ideal, a mental health expert said some diseases and disorders don’t appear until the college years.

“All teachers should be aware of the warning signs of depression and anxiety; those are the two most frequent ones that show up during the college years,” said Bonnie Loughran, executive director of the National Alliance on Mental Illness in Dane County.

Loughran said everyone who touches the lives of students should be aware of early warning signs of mental illness so they can intervene before any type of violence can occur.

Identifying problems at UW

Both the threat assessment and intervention teams include representatives from UW housing, campus police, the dean’s office, counseling services and legal staff.

“This is 42,000 students on a campus with 16,000 faculty (and staff) and untold amount of visitors every day,” Helmkamp said. “It’s very labor intensive, and very difficult to measure” the effectiveness.

John Lucas, a university spokesman who attends Threat Assessment Team sessions, said that “we’ve built a better radar system, people are getting together around the table and talking about cases, in a way that they haven’t always happened in the past.”

A person is added to the threat assessment program’s list of cases when one of the members receives a report of a person who seems threatening, an act or behavior is detected, or when violence is directed at an individual.

The Threat Assessment Team looks for people exhibiting any of seven “indicators of violence,” including poor impulse control, obsessing about injustice, other obsessiveness, substance abuse, fascination with weapons, police or the military, preoccupation with violence and paranoia or delusions.

Soley said police look for signs, such as substance abuse, acting out, attempting to harm themselves or others, or strange messages or e-mails. She emphasized that police focus upon the behavior — not the mental health — of individuals.

“We certainly encounter a lot of people with mental health issues or personality disorders, but to assume everyone on campus battling mental health issues poses a threat does a disservice to the vast majority of those people who pose no threat to anybody else,” Soley said.

After a person comes under the scrutiny of the committees, his or her behavior is analyzed and a response plan is developed, Helmkamp said.  That may lead to a range of actions, including hospitalization, counseling, a “behavioral contract” or written apology. In some cases, Helmkamp meets face to face with students who may pose a threat to the campus community.

“I’m pretty serious and straightforward. I say, ‘Are you going to kill someone?’ ” Helmkamp said. “I’m very hesitant to diagnose problems because we look at behaviors, and you can’t diagnose off of that. I see threat assessment as an initial screen, and paranoia is one of those first indicators.”

The dean’s office can’t force a student to undergo a mental health assessment, but officials can work with University Police to enforce an “emergency detention.” Helmkamp said that has occurred in fewer than five cases in the past two years.

Helmkamp said, there is “reasonable evidence” that the program prevented harm to roommates, neighbors and others. He declined to be more specific.

Although the Threat Assessment Team’s duties have been handled by existing employees, Helmkamp says help is needed. This fall, he requested funding for a full-time employee and graduate student hourly position. The $132,500 request is awaiting review.

Records are secret

The teams meet every two weeks, behind closed doors. The meetings are closed to the public. Officials cite the federal Family Educational Rights and Privacy Act, which protects the confidentiality of student records, as a reason for denying the public access to many records, such as the specific response, identities of individuals on the list, and results from actions. Campus police treat the records as ongoing investigations, and contend they are exempt from public records laws.

Records are kept private to protect the individuals being investigated, but also to efficiently perform security responsibilities at the university, according to Soley.

Helmkamp said the groups have never conducted an audit to track their progress, but plan to begin the process this fall.

In addition to the closed meetings, University Police host training sessions for anyone on campus on how to detect early warning signs of a person in crisis. The next session is at 1 p.m. on Nov. 12 in room 5045 at 21 N. Park St. For more information about UW’s safety initiatives visit www.uwpd.wisc.edu/PMCSCS.html

Editor’s note: This story was produced by UW-Madison journalism student Nick Penzenstadler for a reporting class taught by Professor Deborah Blum. The class collaborated with the Wisconsin Center for Investigative Journalism (www.WisconsinWatch.org) in All Together Now, a community-wide journalism project examining health-care issues. For coverage by other news organizations, see www.ATNMadison.org.