12/06/2012 12:44 pm ET Updated Feb 05, 2013

The NFL's ADHD, Adderall Mess


Apparently the Adderall craze that has hit America's college students is also making an impression on the professional football players in the National Football League (NFL), at least according to a news report in the sports section of the Sunday New York Times. NFL drug suspensions will hit a record this year, and at least some are felt to be related to amphetamine use, which is the main ingredient of Adderall, a drug that is also prescribed to children and adults with attention-deficit/hyperactivity disorder (ADHD).

Some of the players claim they didn't realize that this mood-enhancing, performance-improving, potentially-addicting drug was on the banned list of substances for the league. That seems unlikely in that amphetamine has had an 80-year track record of legal and illegal use in our country. Like steroids, amphetamine is now banned in professional sports. Their use debases achievement founded upon hard work and practice. It also puts pressure on all the other non-using athletes to employ the drugs as well in order to stay competitive.

The news story illuminates a growing problem for the NFL but also perpetuates two urban legends about Adderall and ADHD. Repeatedly, Adderall is described as a "powerful stimulant" for normal people but "calms" those with ADHD. In fact, amphetamine and its variants (like Ritalin and Concerta) act exactly the same in everyone, whether you "have" ADHD or not. Low doses of amphetamine will get anyone to stick with tasks they find boring or difficult. It also will make you more deliberate and methodical.

Adderall's supposed "calming" effect on hyperactive children is simply these kids staying with things longer and acting less impulsively. As you increase the dose of amphetamine, children and adults with ADHD will become more verbal, overactive and eventually "tweaked," just like a "meth" (methamphetamine) addict. The only difference between children and adults is that children regularly complain about higher dosages and many adults will report they "feel powerful and grand" on above therapeutic dosages of Adderall.

The news report also suggests that as long as a doctor diagnoses ADHD in an athlete, then Adderall use becomes legitimate. The problem is that there are no biological or psychometric tests for ADHD. The disorder is a list of symptoms that anyone can learn to report to a doctor. Even if the doctor properly seeks independent confirmation from a spouse, school or employer, anyone striving in a position for which they are not well-suited by talent or temperament could potentially qualify for the diagnosis.

Doctors used to say that if a child or adult responded to Adderall, then they must have ADHD. If that were the case then everyone could potentially have the disorder. Obviously, there are severe cases in children and adults that benefit from the drug. But attentional problems run a spectrum, from mild to severe, and in my opinion the vast majority of those receiving the ADHD diagnosis are of the mild variety (if they "have" it at all).

The NFL problem with Adderall only highlights a much broader societal quandary over the use of performance-enhancing drugs. But the history of amphetamine use, prescribed or not, strongly suggests that a core group of adults using this drug will start to abuse and then become addicted to it. There have been waves of doctor-prescribed amphetamine abuse epidemics, which led to the Federal Drug Administration making amphetamine a controlled substance in 1972.

Getting ahead is wired into the American psyche. America represents 4 percent of the world's population but produces 88 percent of the world's legal amphetamine (and a great deal of illegal methamphetamine and cocaine as well). Will Hill, a safety for the New York Giants who served a suspension this season for Adderall use, may have said it best: "How do we decipher the fakers from not? When you try to get an advantage over the next person, that's why we get into these situations we're in."

Mr. Hill is right on, but he's not just speaking about the NFL; he's talking about the United States of Adderall.

For more by Lawrence Diller, M.D., click here.

For more on ADHD, click here.