Unless you’ve been living under a rock, you’re likely well aware that stimulants such as Adderall or Ritalin have been increasingly used in recent years by students who are eager to get better grades. In this post, I’ll cover the science behind stimulants and whether or not they help students in school.
Cognitive Enhancer Overview
Let’s get a couple important items out of the way. First, for those of you who are wondering, I have never taken any drugs or substances to help me study or be productive, other than the occasional coffee once every few months. Second, I am not your doctor and I am not providing medical advice in any capacity. Third, this video and the content here are primarily geared towards individuals who are using or considering using these substances as cognitive enhancers, without a diagnosis of ADHD, narcolepsy, or another condition that warrants their prescription. Please speak to your physician prior to starting, stopping, or changing any medications that you’re currently on.
What are Stimulants (Adderall and Ritalin)?
Methylphenidate (Ritalin) and amphetamine (Adderall) are the two prescription stimulants most commonly used by students seeking to improve their attention, concentration, and ultimately their grades. These are Schedule II substances in the US, meaning they have high potential for addiction but have certain accepted medical uses. This places them in the same category as oxycodone, cocaine, and PCP. That’s some serious stuff. While these stimulants are effective with professional supervision for treating ADHD, their utility as a study or concentration aid has not been strongly validated. And while prescribed use and supervision by your physician is relatively safe, misuse or abuse of any stimulant can have adverse effects. A sizable portion of college students use these stimulants as cognitive enhancers, under the belief that these drugs will improve their grades. To answer the question of whether or not they do, let’s first start with how the substances work.
Stimulant Mechanism of Action
The cognitive enhancing effects of stimulants are due to the preferential effect of catecholamines in the prefrontal cortex (PFC) and activation of the norepinephrine α2 and dopamine D1 receptors. Catecholamines are a group of neurotransmitters including norepinephrine (NE), epinephrine (EPI), and dopamine (DA). At low doses that a doctor may prescribe, the PFC-dependent function is enhanced, which contributes to the stimulants’ use in ADHD. At larger doses, the PFC-dependent attention processes are improved at the expense of other processes, like working memory or response inhibition. Methylphenidate (Ritalin) and amphetamine (Adderall) both increase extracellular levels of NE and DA throughout the brain, largely by blocking NE and DA reuptake. Amphetamine additionally stimulates the release of DA through the DA transporter. And while amphetamines at higher doses block serotonin reuptake, methylphenidate only blocks NE and DA reuptake.
Cognitive Effects of Amphetamine & Methylphenidate
The cognitive enhancement properties of stimulants can be broadly categorized into the following 1| Inhibitory control, which is linked to focus and avoiding distraction 2| Working memory3| Short-term episodic memory, referring to memory and recall within 30 minutes of learning 4| Delayed episodic memory, referring to memory over longer intervals, such as 1 hour to 1 week between learning and testing In a systematic review of the literature, Ilieva et al. demonstrated that stimulants cause a small but significant degree of enhancement of inhibitory control and short-term episodic memory. The effects on working memory are inconclusive, as one statistical analysis demonstrated small but significant improvement, and the other demonstrated no statistically significant difference. Delayed episodic memory was the cognitive factor that demonstrated the largest effect. Because stimulants had stronger effects on delayed episodic memory over short-term episodic memory, the data suggest that stimulants may more potently affect memory consolidation in comparison with encoding or retrieval. Interestingly, there is evidence that stimulants can actually impair performance in normal individuals who are especially high performing. In short, individual variations account for a significant degree of the benefit or detriment in different people.
Student Performance & Considerations
In 2017, Arria et al. published a prospective cohort study examining close to 900 college students without ADHD using stimulants. Their conclusion? Use of non-prescribed stimulants did not demonstrate a statistically significant effect on student GPA’s. Interestingly, there are multiple other factors that have been linked with stronger cognitive enhancement and improvements in grades. Mindfulness meditation, for example, has demonstrated stronger effects on inhibitory control, which ultimately helps you focus on the task at hand. The cognitive enhancement from stimulants is smaller, comparable with the cognitive benefits seen with physical exercise. Ultimately, the most important things you care about are your academic performance and test scores. The bottom line is that stimulants have not been shown to improve student GPA’s. However, when speaking about broader cognitive benefits, it is important to note the limitations of these studies. Notably, sustained attention and processing speed were not adequately studied. The current literature also does not examine performance under fatigue, sleep deprivation, or distraction. And while the cognitive benefits are often emphasized, it is important that we do not overlook the adverse effects of using these medications. Short term side-effects may include GI problems, blurred vision, irritability, insomnia, increased body temperature/blood pressure/heart rate, and many others. Long term adverse effects include hallucinations, psychosis, cardiac arrest, and death. Don’t forget the risk of addiction, headache, panic attacks, aggressive behavior, and link to suicidal and homicidal tendencies, all of which have been described.
Dr. Jubbal’s Opinion on Stimulants
I have covered the science and current literature on stimulants used by students for cognitive enhancement. I was as objective as possible, withholding my opinion until now. But at this point, there are a few points I’d like to raise. Again, keep in mind these messages are for those who do not have a medically valid prescription for stimulants. If you are on these medications for a medically diagnosed condition, this does not apply to you.
Moral & Ethical Implications
First, if you believe that taking stimulants is in fact benefiting you, even though the literature is inconclusive in that regard, is it fair to those students you are competing with who are not taking these medications? This opens up a debate similar but distinct from performance enhancing drugs in sports. Just some food for thought.
Second, think about the long-term consequences you may incur. The potential upside is limited, and yet there are significant health risks, from cardiovascular complications to addiction and other detrimental effects on your health and well-being. The legal implications of using these substances without a prescription are also substantial. From a cost/benefit analysis perspective, using stimulants does not appear wise.
Effect on Study Habits & Strategies
Lastly, understand that by using stimulants to help you study, you’re using a shortcut. That shortcut may ultimately make you a weaker student. Relying on stimulants to help you concentrate or focus may diminish your ability to rely on your own habits, willpower, and systems to produce the results you want. You may think “So what?” But let’s take a moment to think of how that may pan out long term. If you’re in college right now and rely on stimulants, you’ll find it harder and harder to perform without them. You simply won’t be building the habits and strategies that will make you an effective student in the long run. When you start medical school, your study habits and strategies will be weaker so that you’ll again be dependent on stimulants, unable to be an effective student without them. If the idea of being dependent on a prescription medication with significant medical adverse effects and legal repercussions doesn’t bother you, know that you may be drug tested in the medical profession. And that could have consequences as severe as the end of your medical career. By taking this shortcut, you’re depriving yourself of the growth and development necessary to become an effective and competent future physician.
I’m not here to say what is morally right or wrong. However, in my opinion, it simply doesn’t make sense for students to use non-prescription stimulants as cognitive enhancers. You don’t need them. I never touched them, and I yet I still crushed undergrad, aced the MCAT, excelled in medical school, and matched into plastic surgery– all without any stimulants. I recommend that you hone your habits, adjust your study strategies, and continue to practice. The broad range of Med School Insiders content is a great place to start. If you want to take your productivity, study strategies, and overall effectiveness to the next level, check out MedSchoolInsiders.com. We have countless resources and individuals willing and ready to help.
Dr. Kevin Jubbal graduated from the University of California, Los Angeles magna cum laude with a B.S. in Neuroscience and went on to earn his M.D. from the University of California, San Diego. He matched into Plastic & Reconstructive Surgery residency at Loma Linda University Medical Center. He has authored more than 60 publications, abstracts, and presentations in the field of plastic surgery. Dr. Jubbal is now a physician entrepreneur, and his passion for medical education and patient care led him to found the Blue LINC Healthcare Incubator and Med School Insiders. Through these and other projects, he seeks to empower future generations of physicians, redefine medical education, and improve patient care through interdisciplinary collaboration.