Science Vs - Adderall: What's It Doing to Your Brain?

Episode Date: December 9, 2022

There’s an Adderall shortage across the U.S., and it’s causing huge problems for people with ADHD. But on the flip side, we hear people saying that we shouldn’t be giving this drug out anyway. So we wanted to know: What is Adderall, exactly? What is it doing in people’s brains? And is there any truth to this idea that Adderall is like meth — could it be dangerous? We talk to psychiatrist Prof. Rachel Fargason, neuroscientist Prof. Habibeh Khoshbouei, and actor Kai Liu. If you or someone you love is struggling with addiction, in the US you can call the Substance Abuse and Mental Health Services Administration’s National Helpline: 1-800-662-HELP or visit their website. Find our transcript here: https://bit.ly/sciencevsadderall This episode was produced by Rose Rimler, with help from Meryl Horn, Michelle Dang, and Disha Bhagat. We’re edited by Blythe Terrell. Editing help from Caitlin Kenney. Wendy Zukerman is our Executive Producer. Fact checking by Diane Kelly. Mix and sound design by Bumi Hidaka. Music written by Bumi Hidaka, Emma Munger, Bobby Lord, SoWylie, and Peter Leonard. And a big thanks to the researchers we spoke to including Dr. Kenny Handelman, Prof. Gail Tripp, Prof. Lily Hechtman, Dr. Nora Volkow, Dr. Joshua Gordon, Prof. Stephen Faraone, Dr. Zheng Chang, and Prof. Carl Hart. A big thanks to Annette Heist, Anya Schultz, and Thom Dunn. And this is our last episode of the season! So an extra special thanks to everyone who helped us out this season, including Jack Weinstein, and Hunter, Chris Suter and Elise, and Presha Bhagat. We’ll see you next year! Learn more about your ad choices. Visit podcastchoices.com/adchoices

Hi, I'm Rose Rimler filling in for Wendy Zuckerman this week because she's busy competing in a 24-hour dance marathon. She'll be back next season. This is Science Versus from Gimlet, the show that pits facts against focus. Today on the show, Adderall. That's a drug that is often used to treat attention deficit hyperactivity disorder, or ADHD. You may have heard that this drug is in short supply right now in the U.S. The Food and Drug Administration is now confirming a nationwide shortage of Adderall. More than six in ten pharmacies are reporting difficulties obtaining Adderall medication.

I just had to call ten different pharmacies to find one that had my ADHD meds in stock. There are several different companies that make versions of Adderall. One company has said the shortage is basically caused by a combination of not enough workers and too much demand. It became easier to get prescriptions during the pandemic because you could do it online from some telehealth companies. But even before the pandemic, demand was going way up. So more and more people are on this stuff.

And this has been freaking some people out because of claims about what Adderall is. A derivative of meth, a highly addictive drug. The scary part, it's made of amphetamine. They give you Adderall, which is f***ing speed. Yeah, Adderall is amphetamine, a stimulant. Lots of illegal drugs are stimulants too, like cocaine and methamphetamine. In fact, Adderall is in the same family as meth. And in some countries, Adderall is illegal, like Japan and Sweden.

So today on the show, we're asking, 1. What can Adderall do for someone who has ADHD? 2. What if you don't have ADHD? Can Adderall boost your brain? And 3. Is it dangerous to put people on this drug that's in the same category as meth? Because when it comes to Adderall, there's no shortage of opinions, but then there's science. Science versus Adderall is coming up right after the break. What does the AI revolution mean for jobs, for getting things done? Who are the people creating this technology and what do they think?

I'm Rana El-Khelyoubi, an AI scientist, entrepreneur, investor, and now host of the new podcast, Pioneers of AI. Think of it as your guide for all things AI, with the most human issues at the center. Join me every Wednesday for Pioneers of AI. And don't forget to subscribe wherever you tune in. It's season three of The Joy of Why, and I still have a lot of questions. Like, what is this thing we call time? Why does altruism exist?

And where is Jan 11? I'm here, astrophysicist and co-host, ready for anything. That's right, I'm bringing in the A-team. So brace yourselves. Get ready to learn. I'm Jan 11. I'm Steve Strogatz. And this is Quantum Magazine's podcast, The Joy of Why. New episodes drop every other Thursday, starting February 1st. Welcome back. Today, we're focusing on Adderall. It's typically prescribed to people who have ADHD. This is where people have so much trouble paying attention or sitting still or both that it really is a big problem in their life. Scientists used to think ADHD was a childhood thing, but more and more people are

getting diagnosed as adults. It's estimated that about 3% of adults around the world have ADHD. And a lot of them say that being on Adderall is a game changer. So what does that look like? To dive in, let's talk to Kai Liu. She's an actor, writer, artist, and pug mom. I have three rescue dogs currently. That's a lot of dogs. You know, you get one dog, and then the other dog needs a friend, and then that dog needs a friend, and pretty soon you're just drowning in pugs.

Kai told us what it was like before she got treated for her ADHD. I would space out a lot. I would dissociate, which presented itself to others as just kind of daydreamy, not really super smart. I just thought I was a very space cadet kind of person. But Kai didn't know that this was ADHD until her late 20s. It came to a head during a rough patch she was going through. She was getting work as an actor, shooting commercials, but it wasn't going well. I would just be so distracted that I wouldn't be able to hear the other performers feeding me lines. I wouldn't be able to take direction very well from the director, which is not a good thing as an actor. Sitting down to learn her lines was giving her panic attacks.

She couldn't memorize scripts, which meant she was botching auditions. Then one night, she had an epiphany. She was at a bar with some friends. Everything was distracting her. The chatter inside the bar, the dogs on the sidewalk, the people coming and going. Suddenly, her friend leaned over and said, Hi. Are you okay? You seem really frazzled. And my first instinct was to just recoil and take offense to that. Because why would you point that out? That's so mean. I'm not frazzled. You're frazzled. But then I realized I didn't know other people could see that I was frazzled all the time. I thought this was an internal thing and that I was masking

it really well. And that's when I realized I might have a problem. Soon after that, Kai got diagnosed with ADHD by her doctor, and they decided she should try Adderall. Kai filled the prescription and took the bottle home. I read the label and I saw that it was an amphetamine and I was like, oh, what a fun day this is going to be. It can either be real good or real crazy. Luckily, it was real good. Within an hour of taking her first pill, Kai could feel a change come over her. She had no trouble focusing on what she wanted or needed to do. Do you remember like the moment you felt it start to kick in? Yeah, it was, it was like clouds parting in my head so that I could see sunlight. Wow. And I couldn't believe that this is how people without ADHD functioned on a daily basis. I was just so surprised. And I even went to my husband and I was like, is this how you live every day?

You can get so many things done. He basically looked at me and went, yeah, it is. To which I was like, why don't you do more things around the house then? But you know, those are daily marriage struggles. Uh-huh. So what happened here? What is going on in the brains of people like Kai who have ADHD? And how does Adderall show some people the light? To find out, we called up Rachel Fargason.

She's a professor and psychiatrist at the University of Alabama at Birmingham. You happen to hit upon probably my favorite subject in the world. Rachel has been treating people with ADHD for years. Here's how she explains what ADHD is like. You know how when you have a list of 10 things to do and you check each one off and you run all your errands and that feels so good? Yeah. Well, so simple things tend to make most people happy, but people with ADHD need a little more stimulation to make them happy. So if it just feels so boring, it's so hard for them to do.

It's like pulling teeth. They're not getting that pat on the back from the brain that this thing they're doing is worth it. Scientists can actually see this when they scan the brains of people with ADHD. For example, in this one study, scientists brought 29 people into the lab. About half had untreated ADHD and half did not have ADHD. Then they scanned their brains while they showed them pictures of money and told them that they'd get some real money for every picture of money they saw. Then the scientists tried a different thing. They tried showing people a symbol, a gray diamond,

before the picture of the money. For people without ADHD, a part of their brain in the reward system started lighting up when they saw that gray diamond. They knew that a reward was probably coming. But in the brains of people with ADHD, the picture of the diamond wasn't enough to light up their brains. It's like their reward systems weren't catching on that something good was about to happen. So that's one big thing that could be different about your brain if you have ADHD. Something else scientists are looking at has to do with this thing called executive functioning. It's like the part of your brain that is the air traffic controller and, you know, tells you what to be focused on and what to ignore. But people with ADHD have a real

hard time screening out other extraneous thoughts. They tell me, you know, my brain is on 14 different channels. And that's hard. Imagine trying to get things done with your brain on 14 channels all the time. If your brain's running on 14 channels and your reward system is powered down, it can actually be dangerous. Like people with ADHD are at higher risk for lots of things They're more likely to get into car accidents, to go to prison, to be suicidal They're even more likely to die earlier than someone who doesn't have ADHD

But drugs like Adderall can help change this It can help their brain pick a channel and stay there If you give somebody a stimulant, so if you have a slightly sluggish reward network and you give somebody a stimulant and normal things like finishing your homework or finishing your assignment give you a sense of reward, then it becomes easier to do. And so what my patients have said to me over the years is, like, it's like you gave me my brain back. Like, it's my brain, but it, like, actually works like how it's supposed to. Overall, studies find that Adderall

can make a big difference for people with ADHD. Like, one trial of about 400 adults with ADHD found that 65% of them got better on Adderall. That's compared to 20% on placebo. Tons of other trials also find it can really help people. For people who don't respond well to Adderall, they might do better on other meds like Ritalin. So this all sounds great, but what if it's a little too good to be true? A lot of people are worried that maybe we've gone too far here. After all, in the U.S., stimulant prescriptions doubled between 2006 and 2016. We couldn't find an exact number, but it's estimated that millions of people are prescribed Adderall. And remember, this is a drug that's similar to meth.

After the break, what are the downsides here? Is there a dark side to this drug? Welcome back. Today, we're looking at Adderall. We know that it can help with ADHD, but some people are kind of freaked out about the fact that we're giving amphetamine to millions of people, including kids. Plus, lots of people who don't have ADHD take Adderall to party or to help them study. So should we be worried? For this, I called up Professor Habibeh Khoshboui, a neuroscientist at the University of Florida. I asked her, how close is Adderall to meth?

So the similarity between Adderall and methamphetamine is that their basic structural backbone is amphetamine. So they have the same, like, skeleton. Yes, it's the same chemical structure. Yeah, they're super similar. They're both amphetamine and they work in a similar way by fiddling with the dopamine in our brains. It's one of the brain juices that makes us happy. And this happy chemical is really important for our survival. When we eat something really good, we have higher dopamine level. We feel good. So that's why we don't starve to death just hanging around, because we need the levels to go back down so they can pop back up the next time something nice happens. And your brain has a little cleanup crew to help with this. It steps in to suck dopamine back up into the neuron. This vacuum cleaner vacuum it. It cleans it up. So dopamine is like the dirt? Yes, it clears it up. It's vacuumed in the back,

put it in the neuron, and it is stored and is ready for another release cycle. Adderall and meth are like special dirt. The vacuum cleaner sucks it up instead of dopamine, and that changes the amount of freewheeling dopamine in your brain. These drugs also tweak other brain chemicals like norepinephrine. So Adderall and meth are similar. But what really matters here is how the drug gets into your system. With ADHD, if you're following a doctor's orders, you're probably swallowing a pill. It has to get broken down, travel through your digestive tract, circulate through your bloodstream, before it finally starts to get absorbed into your brain.

All this means it can take more than an hour for it to start hitting your brain. Compare that to smoking, injecting, or snorting a drug like meth. It gets to the brain much faster. Senior producer Meryl Horn asked Habibé about this. When something is injected, the majority of the drug gets to the brain within a few minutes. That's why you get, this is the feel of rush. And why, what is the rush? Like, why does that rush matter? Oh, the rush. So that rush is huge.

It's something that, actually, I never exposed to it, but that's just what I read. It's the type of feeling that they never felt before. If it feels really good, you might start seeking it out above everything else in your life. Which means that if you inject yourself with amphetamine or crush it up and snort it, it can put you at a bigger risk for addiction than if you take it in a pill. But that doesn't mean there's no risk for people who take this stuff in a pill. So can people with ADHD get addicted to their meds? Well, we couldn't find many studies on this, but the experts we spoke to said the risk for this is really low. They said sometimes people get confused about the difference between needing the drug to function every day versus being addicted to it.

Think about a person with diabetes. They need to take insulin, but no one says they're addicted to their insulin. Being addicted to something means that it's screwing up your life. And for many people with ADHD, taking these meds improves their lives. I am very, very passionate about this because, you know, I understand the stigma of it. But people who need it is really, really helpful to them. Scientists we talked to heard that parents were sometimes worried their kids who take Adderall would eventually seek out stronger drugs. But that doesn't seem to be happening. One study followed kids prescribed stimulants,

including Adderall, into their teenage years and found they weren't more likely to have tried illegal drugs than kids with ADHD who were not medicated. And other studies agree. All this makes some researchers recoil when they hear stuff like, Adderall is f***ing speed. Some of the people out there are saying that, you know, all these people on Adderall, they're really just on speed. No, no, no. Who said that? Yeah, no, no. That's absolutely wrong. So the thing is that this is an incorrect way of describing a certain population who needs medication. They're not on speed. They are taking their medication. So it seems like a lot of the hand-wringing about Adderall is just your standard drug paranoia.

Still, this doesn't mean Adderall is all rainbows and butterflies. We actually don't have long-term studies on adults taking Adderall. And we do know it can have side effects in the short term. Most commonly, lower appetite, higher anxiety, and insomnia. And actually, the insomnia thing, that rings true for Kai. She's the pug mom and actor we talked to earlier. Adderall worked great for her at first, but after about six months, she realized it was keeping her up at night. So I would have trouble falling asleep, but then have a lot of trouble staying asleep. So if I woke up in the

middle of the night, I wouldn't be able to go back to sleep for, you know, several hours, if at all, to a point where I unfortunately became kind of a zombie. One study found that about 10% of ADHD patients on stimulants say they have trouble sleeping. Kai actually ended up switching to Ritalin, a different kind of stimulant, and that's been working better for her. And there's a couple other side effects we should mention. In kids, we know that taking stimulants can slightly stunt their growth

if they take them a long time, by a centimeter or two on average. And in general, it's pretty typical for someone's heart rate and pulse to increase a little bit while on stimulants, so doctors often won't give them to people with certain heart conditions. Bottom line, not everyone can take these meds. But for those who can, experts pretty much agree the positives outweigh the negatives here. The American Academy of Pediatrics, the Canadian Pediatric Society, and Britain's National Health Service all recommend that stimulants be tried in patients with ADHD over age six. But let's talk about the people who are taking Adderall who don't have ADHD.

We know you're out there, and we know a lot of college students are taking this stuff to study. Oh my gosh, yes. That's Rachel Fargeson again, who we heard from earlier in the show. Funny story is I might have a patient who ran out of his Adderall and he's like, oh yeah, I just called my daughter who's in college and she just asked a few of her friends and it's floating all around. One review found that almost one in five college students admit to taking Adderall that wasn't prescribed to them. Taking it to study was the main reason why.

And Rachel wondered what it was doing for them. Were they really getting a brain boost from these meds? So she set up an experiment to try to find out. She and her team posted flyers all around her campus asking for volunteers. And you can imagine these were very enthusiastic students. They couldn't wait to be in the study. Rachel's team ended up with 32 participants.

These are people who did not have ADHD. They came into the lab several times. Each time they took a pill. Sometimes the pill was Adderall. And sometimes it was a placebo. We tricked them. One of the times we told them they were getting Adderall, they did not get Adderall. They got placebo.

And one of the times we told them they were getting placebo, they got Adderall. The students knew going in that they'd be tricked, that they wouldn't know for sure when they were given Adderall and when they weren't. After taking the mystery pill, the students took some tests, about two hours of cognitive testing, memory and attention tests, stuff like... I might give you a whole bunch of things to remember and ask you in one minute what you remember and ask you in three minutes and five minutes and 15 minutes what you remember. The goal was to see how the students performed on tests when they were actually on Adderall versus when they thought they were on Adderall. And the first thing Rachel

found was that they could not tell the difference between the real stuff and the fake stuff. We asked them, what do you think you actually got? And they only guessed right 50 percent of the time, which is equivalent to chance. So, no, they could not tell if they were on Adderall or not. They thought they knew. They were very confident. Oh, I've got it today or oh, I've got. But they could not tell if they were on it or not.

Secondly, Rachel looked at how well they did on the tests. She'd give them about 30 little tests each time. When they were on Adderall, she saw a small improvement. They did a bit better on two of them. So did it have some mild improvement? Yeah, a little teeny bit, but it would not improve somebody's grade. Yeah, nothing to write home about. In fact, similar studies have found that you'd get the same result from a strong cup of coffee. Okay, so this last thing Rachel found is really surprising. When students believed they

got Adderall, regardless of whether they got the drug or not, they did a lot better. And that had a far more robust result than actually the drug itself. It's pretty interesting, isn't it? Yeah. The expectation that Adderall would give them a boost did give them a boost. Students who thought they were on Adderall did better on six tests. So for people who don't have ADHD, it seems like the placebo effect of Adderall might matter more than the actual Adderall. And this isn't the only study that found Adderall doesn't boost test scores for people without ADHD. One study tried it on people taking practice questions from the SATs, and they found no big difference. And when a group of researchers followed non-ADHD students in the real world who take Adderall to help them study, it turned out their GPAs didn't improve over time.

Okay, so if you don't have ADHD, Adderall probably isn't going to help you much. And remember, when you take this drug, you're weighing the upsides versus the downsides, like the side effects we talked about and the possibility of addiction. Plus, if you're buying it on the street, you may not know exactly what you're getting. And there have been cases of fake Adderall pills having stuff like fentanyl in them, which can be really dangerous.

All right, big picture, where does this all leave us? One, Adderall does work for lots of people with ADHD, and it can actually be a really big deal, saving them from car crashes, for example. So for them, this is medicine, and the shortage sucks. We don't know exactly when it's going to be over. Some pharma companies say it should ease up in the next couple of months. Two, it is similar to meth, but people who have ADHD and take it how they're supposed to seem to be at a pretty low risk of getting addicted to it. And three, if you don't have ADHD, it's not much of a brain booster, no matter what your chem lab partner says. That's Science Versus.

Okay, Disha, Meryl, Blythe, and Michelle. Hello. Hi. That's Science Versus. One, two, three. 122. And if people want to check out these citations for themselves, where should they go? The link to the transcript. In the show notes. Happy 13th season, everybody. We got good. And to celebrate, we're going to play some of our favorite tape from the season. Someone's in the bathroom. Someone's in the bathroom.

Someone's in the bathroom. And then we're going to go to Balls Ford Road. Pardon? You know, Balls Ford Road. I think that's where Thomas Jefferson Forded his balls. They looked at the testes and there was no sperm. And they're like, holy cow. That's nonsense. That's totally, that's, you know's it's trying to sell you something it's trying to sell you something that you don't need so i put it in my citations and i'm like they're

gonna understand me they're gonna put this link in and they're gonna know what i'm saying and a reviewer said she put a youtube link as a citation. I thought you guys were going to love it. We were all in a room together working on things and we kind of all gather around one person's computer screen to look at images as they came up and, and then, Oh, look at that one. Oh, look at that one. Um, why does its head look like a butt? Like a butt. So in some pictures, you get that impression, right? Don't you? It's like two cheeks. Yeah.

I'm a little overwhelmed. I just can't believe it that this was a human a month ago. It's just incredible. You can't stop running your fingers through it. I can't stop running your fingers through it. I can't stop running my fingers through it. I know. By the way, I first heard Kai's story on a really cool podcast called ADHD Aha. It's all about stories of people recognizing and dealing with their ADHD. You should check it out. You should also check out the podcast, The Journal. Our colleagues over there are rolling out a miniseries on the reckoning at one of those Adderall dispensing online companies.

And that's coming out soon. Finally, we talk about addiction in this episode. If you or someone you know is struggling with addiction, in the U.S., you can call the Substance Abuse and Mental Health Services Administration's National Helpline. It's 1-800-662-HELP. Or visit their website. This episode was produced by me, Rose Rimler, with help from Meryl Horn, Michelle Dang, and Disha Bagut. We're edited by Blythe Terrell. Editing help from Caitlin Kenney. Wendy Zuckerman is our executive producer. Fact-checking by Diane Kelly. Mix and

sound design by Bumi Hidaka. Music written by Bumi Hidaka, Emma Munger, Bobby Lord, So Wiley, and Peter Leonard. And a big thanks to all the researchers we spoke to, including Dr. Kenny Handelman, Professor Gail Tripp, Professor Lily Heckman, Dr. Nora Volkov, Professor Stephen Farone, Dr. Zhang Cheng, and Professor Carl Hart. A big thanks to Annette Heist, Anya Schultz, and Tom Dunn. And this is our last episode of the season. So, an extra special thanks to everyone who helped us out this season, including Jack Weinstein at Hunter, Chris Suter and Elise, and Prisha Bhagat. We'll see you next year.