The (un)Prescribed Life: Kenyon Students Medicating Heavily, with Questionable Legitimacy

74 comments

Overheard at Kenyon:

Student 1: Wait, where do you get your Adderall from?

Student 2: Chelsea, but she needs a refill soon. It’s cool, I have another hookup.

Every Kenyon student has heard conversations like this one; under-the-table Adderall (or other study drug) use has been standard practice in academia for a long time. But no one is ever sure if the stories they hear are representative or exceptional. How many Kenyon students are actually turning to Adderall to get through their classes?

I, along with psychology major Joshua Samuels, just completed a study in an attempt to quantify this anecdotal evidence that study drug use, among other forms of self-medication, are increasingly commonplace and socially acceptable as part of our college experience. Our survey was conducted online from Monday, April 22nd through Monday, April 29th and received responses from 374 students, nearly a quarter of Kenyon’s student body. We received levels of responses from various demographic groups (class standing, gender, race, etc.) that were in line with Kenyon’s student composition; given the level and nature of responses, we can be reasonably confident that our results paint a relatively accurate picture of Kenyon students’ behavior.

Attention Deficit Hyperactivity Disorder

In a recent New York Times article, it was reported that eleven percent of American children, including nearly twenty percent of high school boys, are diagnosed with ADHD. Moreover, two thirds of those who receive a diagnosis also receive a prescription for a stimulant, such as Ritalin or Adderall, in an attempt to treat the disorder’s symptoms.

And Kenyon is no exception. In our study, 11.7 percent of Kenyon students reported having a prescription for ADD/ADHD medication.

But some in the psychology community are becoming increasingly skeptical that such high levels of diagnoses are either necessary or beneficial. And given the behaviors of those who do have a prescription, their skepticism may be warranted. Only 30.5 percent of Kenyon students with a prescription for ADHD medication reported taking their medication on time; a majority reported taking their medication only up to half of the times they were supposed to and students were more likely to completely ignore their medication than to take it on schedule:

Clearly, a significant percentage of students who have medication prescribed to them consider themselves perfectly able to function day-to-day without the use of their medication. And when a large number of pills are prescribed and not taken, a surplus is created. This surplus, as you can probably imagine, is used to spur academic performance:

To put these charts in perspective, if you line up ten Kenyon students, one of them will have a prescription for ADD/ADHD medication, which they probably won’t need, and at least two others who don’t have a prescription will have used such medication for the sole purpose of writing a paper or studying for/taking a test.

While an imperfect comparison, these findings are in line with prior literature, mentioned in the Times article, which pegs the percentage of ADD/ADHD medication that goes to non-prescribed friends at about 30 percent.

ADHD has historically been estimated to affect between three and seven percent of children, but, as pediatric neurologist William Graf notes:

Mild symptoms are being diagnosed so readily, which goes well beyond the disorder and beyond the zone of ambiguity to pure enhancement of children who are otherwise healthy.

And while current levels of diagnoses are already at record highs, the number is only expected to increase. As the Times article says:

…even more teenagers are likely to be prescribed medication in the near future because the American Psychiatric Association plans to change the definition of A.D.H.D. to allow more people to receive the diagnosis and treatment.

…The final wording has not been released, but most proposed changes would lead to higher rates of diagnosis: the requirement that symptoms appeared before age 12 rather than 7; illustrations, like repeatedly losing one’s cellphone or losing focus during paperwork, that emphasize that A.D.H.D. is not just a young child’s disorder; and the requirement that symptoms merely “impact” daily activities, rather than cause “impairment.”

There is no official test used to diagnose ADHD; psychiatrists evaluate patients based on extensive conversation with the patient, their parents and teachers. It is also common practice for doctors to allow their patients to “set their own dosage” by prescribing increasingly high levels of medication until the patient finds one that “feels right.”

Given the choice, many psychiatrists would rather wrongly diagnose someone with ADD or ADHD than to turn a patient away when they really do have a disorder. While this thinking is certainly not without merit, it opens the door for pharmaceutical companies, parents and patients to push for diagnoses that are increasingly unwarranted.

Depression

While self-reports of ADD/ADHD prescriptions were high, 23.4 percent of respondents reported having a prescription for an anti-depressant, twice the rate of ADD/ADHD prescriptions.

The Center for Disease Control estimates that depression rates for Americans over the age of twelve is around eight percent.

As seems to be the case with ADD/ADHD, it could be that depression is heavily over-diagnosed. After all, one in four is an awfully high proportion for any psychological disorder, almost high enough to call the use of the word “disorder” into question. Like the third grader who doesn’t want to do their homework and winds up with a prescription for Ritalin, there’s a fine line between having an awkward phase in high school and having a persistent clinical disorder – a line that probably isn’t crossed as often as we think it is.

In conjunction with the findings related to ADD/ADHD medication, these numbers on anti-depressants could speak further to the idea that we are becoming increasingly reliant on pills and less reliant on each other when dealing with emotional stress/anxiety/hardship. While there’s no doubt that in many cases medication is, at least temporarily, necessary and does a lot of good, we may find it all-too-convenient to get a prescription instead of investing time in talking out our issues.

These sentiments aren’t new to the psychiatry community. University of New South Wales, Australia Professor Gordon Parker has spearheaded the growing concern that depression is being used to describe normal feelings of sadness, at the behest of pharmaceutical companies that have a vested interest in using depression as a “catch-all” illness. As the Guardian wrote:

[Professor Parker] said the drugs were being marketed beyond their “true utility” in cases in which people were unhappy rather than clinically depressed.

…the “over-diagnosis” of depression began in the early 80s, when the diagnostic threshold for minor mood disorders was lowered.

His 15-year study of 242 teachers found that more than three-quarters met the current criteria for depression.

Prescription anti-depressants are taken more regularly, and more responsibly, than ADD/ADHD medication. 59.8 percent of respondents with a prescription for anti-depressants take their medication on time; 19.6 percent reported never taking them:

Furthermore, only 6 percent of respondents who did not have a prescription for anti-depressants reported taking them for the purpose of coping with their environment. At Kenyon, using “happy pills” is practically nonexistent compared to the use of study drugs.

Anxiety

While our survey didn’t dive as deep into the use of anti-anxiety drugs as it could have, one interesting finding was that a higher percentage of respondents without a prescription for such drugs reported having taken them (16.0) than the percentage of respondents who reported having a prescription (12.7). Furthermore, students with a prescription for an anti-anxiety drug were even more likely to never take their medication (40 percent) than students with a prescription for ADD/ADHD medication (32.2 percent).

Perceptions

Not only are Kenyon students’ self-medicating behaviors high in volume, they’re freely discussed to the point at which Kenyon students are uncannily accurate in estimating the extent to which their peers are engaging in them. When asked what percentage of the student body they thought had used study drugs, the average estimate was 33.45 percent (actual percentage: 34). When asked to estimate the percentage of Kenyon students who take anti-depressants, the average prediction was 28.66 percent (actual: 23.4).

Perhaps the fact that study drug use is so candidly discussed is the reason that when respondents were asked to rate their favorability towards people who engaged in various activities, study drug use was barely rated unfavorably (3.41 on a scale of 1-7, with 1 being totally unfavorable, 4 being neutral and 7 being totally favorable), and was rated less unfavorably than cigarette smoking (3.25):

We are past the point at which everyone simply knows of someone who abuses study drugs, we are at a point at which everyone has a few friends who do it and find it socially acceptable to talk about it openly.

Perhaps the most shocking result of our study is that the results aren’t all that shocking. The volume, knowledge and acceptance of study drugs and anti-depressants on our campus should lead us to take a long, hard look at ourselves. Can we call ourselves a healthy community when one in three of us are taking academic performance-enhancers and one in four of us are depressed? Do we really need these drugs?

It would seem that the answer to both of these questions is: no.

For a more comprehensive look at the results of this study or to request its data, please email Jon Green at greenj@kenyon.edu, Joshua Samuels at samuelsj@kenyon.edu or the Kenyon Observer at tko@kenyon.edu.

74 comments on “The (un)Prescribed Life: Kenyon Students Medicating Heavily, with Questionable Legitimacy”

  1. I personally think some of the scales you used on your survey were flawed; for example, most anti-anxiety drugs that have a daily schedule are one and the same with anti-depressants. Many anti-anxiety drugs, including the one I have a prescription for and answered about, are taken “as needed” and have short-term, fast-acting effects, like an aspirin for panic attacks, so I had no idea how to respond to your question about how often I take mine. I answered “about half the time,” as there was no N/A option.

  2. I find it highly offensive and very worrying that the author of this article insinuates that taking anti-depressants is an excuse for not “working through problems.”

    In writing “…these numbers on anti-depressants could speak further to the idea that we are becoming increasingly reliant on pills and less reliant on each other when dealing with emotional stress/anxiety/hardship. While there’s no doubt that in many cases medication is, at least temporarily, necessary and does a lot of good, we may find it all-too-convenient to get a prescription instead of investing time in talking out our issues,” the author discounts the fact that medication may be required to live a relatively normal life. Having chemical imbalances in the brain is not something you can fix by talking about issues, just as there might not be ‘issues’ except those derived from the imbalance. ‘Issues,’ as the author eloquently puts it, can lead to depression, but depression can also lead to ‘issues.’

    I am not suggesting that the majority of students taking anti-depressants at Kenyon have a chemical imbalance, nor am I discounting the fact that talking can help and perhaps some people may not completely need the pills they are taking, but mental health–mental illness–is a serious problem for many people, and too many people brush it off and make jokes about it. This article certainly won’t help.

    1. Hear, hear. The illness-shaming and discrediting in this article is disgusting and appalling. Depression, when chronic and diagnosed by a professional, is NOT something that can just be “worked through”. As the commenter above points out, it is characterized by biological failings in the brain that CAN and ARE helped by specific medications. I am very disappointed by the tone in this article. It is misinformed and ignorant to make such broad, sweeping claims about those who take prescribed anti-depressant medication. We can be better than this, in a community that is supposed to be open and accepting of differences.

      1. Wow. I’m sorry, but I really don’t think we disagree on all that much. As I pointed out (and as the above commenter quoted), there are definitely cases where medication is absolutely necessary and I absolutely did not mean to insinuate that depression isn’t a real thing because it is. But if 20 percent of people who have a prescription never take their medication and we have prescription rates at three times the national average, it would seem that some of it is over-prescribed.

        As I also write, “there’s a fine line between having an awkward phase in high school and having a persistent clinical disorder – a line that probably isn’t crossed as often as we think it is.” This doesn’t mean that no one has a chemical imbalance, it means that not EVERYONE with a prescription does. I don’t think I painted a black and white picture here.

        And finally, as I also point out, many doctors feel (and I’d have a hard time disagreeing) that it’s better to err on the side of writing a prescription, especially for depression. But that doesn’t negate the fact that when you do, you’ll wind up prescribing medication that some people don’t need.

      2. In reply to Jon Green (as there isn’t a reply button to press for his comment):

        Having a prescription rate three times the national average doesn’t mean that the people anti-depressants are being prescribed to don’t need them. There have been studies done that certain types of students will go to smaller, private colleges–and one of those types are those with mental health problems. It’s just how it is.

        In terms of not taking your prescription: It’s very hard to come to terms with who you are when you take your medicine versus who you are when you don’t. Which person is really you? Does the medicine normalize how you would be without depression/other mental health problem? Or does it change you? Do you feel more dead and fake when you’re on medicine? Does that outweigh the immense struggle to continue when you’re off the medicine? There are lots of valid reasons why someone might not be taking their prescription–how you live, after all, is your own decision.

        Of course not everyone who has a prescription has a chemical imbalance, but that doesn’t negate the fact that they might need the prescription. At college it’s harder to control medication, etc, because you are away from your psychiatrist. Technically, you have to be in touch with your psychiatrist regularly in order to continue to receive your prescription, but the terms can be loose depending on who you see. Talking over the phone isn’t the same as sitting down, and you don’t get to do it as often. As much as you may want to work through your issues, some things can’t be talked about with friends, with counselors at college–no matter how well they are trained. For most people on medicines–especially those related to depression–there is a major trust obstacle to overcome. It’s hard to open up to people about certain things; you don’t just start talking. For many it is a long process. That is also a large component to the problem.

      1. As unfortunate as some of this article’s wording is, it nonetheless raises timely and pertinent points. It seems eminently reasonable (to me at least) to suggest that childhood ADD/ADHD rates of 11% are almost certainly exaggerated. When you consider that we then are prescribing these children amphetamines — about whose long-term impact, incidentally, there’s little literature — it might be irresponsible to continue dispensing medication at the current rate. Especially considering the rate of abuse. When it comes to depression, there is a rising body of literature suggesting that depression is over-diagnosed in patients. This is not to suggest that depression is not a very real disease, or that it can be very dangerous if untreated. What it does say is that we still know very little about the root causes of depression (the term “chemical imbalances” is both very vague and controversial). When you consider that scientists have minimal clue about why antidepressants work, about their affects on the brain, that antidepressants themselves alter brain chemistry and can create dependencies, and that they have very serious side effects: when you consider all of this, it seems once again somewhat reckless to prescribe them for cases in which the diagnosis is uncertain or for which alternative treatments exist.

  3. Very pertinent piece. Tricky and sensitive topic for a lot of college students. However you feel about it, this discussion needs an injection of relative reality, so props to the author for bringing some.

  4. Wouldn’t another way to read these results be that Kenyon somehow attracts depressed kids? Like, as a person with depression, I chose to come here because I knew it was important to talk to my professors about my condition, and because I don’t have the easiest time making friends and I thought a small school would be more welcoming. Or maybe Kenyon makes people depressed, I dunno. Also it would be interesting to compare these results with similar studies of other schools, or of college students in general. I highly doubt Kenyon has an exceptionally high rate of Adderall use compared to other colleges.

    1. Absolutely, and I think that there’s probably a little of both involved. Also, I wasn’t able to find a ton of comparable studies, but one at a UW-Madison satellite university put the rate of study drug use there at 14%.

      1. If so, why did you jump to such sweeping conclusions about the results of the survey, instead of acknowledging other possible interpretations of the data?

        1. I actually did initially write a paragraph saying pretty much that but I deleted it. I forget why, and perhaps I should have left it in. Either way, I feel like explanation doesn’t explain the sheer volume of responses – it’s a legitimate explanation for some, but not for this many. Basically, do we really believe that Kenyon being inherently depressing explains a full quarter of our student body? I doubt it.

  5. Ever think that a national survey may not be entirely generalizable to the population of students at Kenyon College? We are not a random sample of United States residents, rather we have been selected through a highly-competitive admissions process and have, ourselves, self-selected Kenyon College. The fact that we may not entirely reflect the country’s depression and anxiety rates is not surprising, given the nature of the students that come to Kenyon and the high level of achievement that is expected of us by influential people in our lives. I am not suggesting that it is okay by any means that Kenyon students report such a high level of anxiety and depression, I am simply proposing that it may not be completely accurate to so casually compare national population parameters to the relative frequencies of anxiety and depression in the Kenyon College student population.

  6. Clearly, a significant percentage of students who have medication prescribed to them consider themselves perfectly able to function day-to-day without the use of their medication.

    -not neccesarily—the side effects can often outweigh the benefits when ones mood and energy levels come into play and are often supressed.

    1. “-not neccesarily—the side effects can often outweigh the benefits when ones mood and energy levels come into play and are often supressed.”

      Exactly. I couldn’t agree more. I just mentioned it in a comment above, but side effects can be hard to deal with when you aren’t around your regular psychiatrist. You can’t just work out a new prescription easily. You might need a higher dosage, maybe a lower one–perhaps you need to switch medication (many anti-depressants become ineffective after a certain amount of time).

  7. also kenyon—socioeconomics status of the student body—must play into this somehow. after all, diagnoses and testing is INCREDIBLY EXPENSIVE and often goes unnoted in a large elementary school classroom.

    1. Socioeconomic status does play a large part and medication is massively expensive, but depending on how serious a condition you have, some of the poorest families scrape together something to make things work–even if it means skimping heavily on food. The thing is, if you have depression related to bipolar disorder, for example, you need the mood stabilizers and anti-depressants. Not taking them can be worse than having trouble paying bills. Without them, there’s a large chance you won’t be able to keep your job or have a stable, intimate relationship. I’m not saying that’s how it is for everyone, but there is a large preponderance of incidents like that.

  8. Jon Green, please add a reply button to your posts. The lack of one makes it difficult to have an intelligible debate.

        1. haha this is going beyond my wordpress comprehension. and I can’t see any way to set that up on the admin page. anyone with more wordpress knowledge want to weigh in?

      1. My knowledge of WordPress is a bit outdated, but I think if you go to the admin panel => settings => discussion and check “enable threaded (nesting) comments” it will give you an option of how many levels you want. I think you have it set at two–I think you can change that to more.

    1. Also, you can fool around with the with your themes’ comment.php file. Depending on what theme you have, it’s in html or css. You have to fool around a bit, but it you’re good at coding, it’s not too hard. Oh, and depending on your theme, you might not be able to expand the levels unless you fool around with the original code.

  9. I think a lot of the discussion here is great. This is an issue that needs to be brought out into the open and by allowing Jon’s conclusions to be challenged we move this discussion forward. Simply stated, the more information we have, the better the conversation becomes. For that, I thank Jon and Josh for their hard work. That being said, I’m surprised at how casual some of the responses have been to the reported data.

    One commenter writes: “There have been studies done that certain types of students will go to smaller, private colleges–and one of those types are those with mental health problems. It’s just how it is.”

    Really? That’s just how it is? Jon drew his own conclusions from the data; he believed that the 25% represents misdiagnoses. That’s a conclusion that is free to be challenged as it has been in the comments. Yet even if that figure represents only legitimate diagnoses isn’t that just as, if not more, distressing? One-in-four Kenyon students are depressed? That’s shocking. That’s an epidemic. Shame on us if we accept that as “just the way things are.”

    1. I’m not saying that one-in-four Kenyon students being diagnosed as depressed is “just the way things are.” I was commenting on the fact that certain people are drawn to certain environments.

  10. I think everyone would do well to take a deep breath and stop attacking Jon for a minute. Jon isn’t a clinical researcher or a psychiatrist – he’s not even a Psychology major – and he never claimed to be any of those things. The point of this article was to open up a discussion, which was clearly done, and done tastefully without stepping on too many toes (I thought). That said, it should be considered that above-average intelligence and depression are often co-morbid; it isn’t that Kenyon makes people depressed or draws in the depressed, but it might be that it draws in people who also happen to be depressed. Assuming, in the spirit of modesty, that Kenyon students (or most of them) are slightly more intelligent than the average American, I don’t think it’s so surprising that prescriptions for anti-depressants should be so prevalent on our campus. The most intelligent are often those who worry the most, are the most self-conscious, have the highest expectations, and have the greatest fear of making mistakes. If you say any of those things to a psychiatrist, it’s not unlikely that you’ll get diagnosed with some sort of mood or anxiety disorder.

    Also, in response to the first comments: I find the idea that depression as a chemical imbalance can only be treated with other chemicals and NOT by therapy or counseling to be totally bogus and 100% false. Changing your thinking patterns can be a crucial step in changing how you feel. There is no magic formula for how much of one or another treatment someone needs in order to see improvement: some may not respond well to therapy, some may not respond to drugs, and many, many people benefit from a regimen of both drugs and therapy simultaneously.

    1. I don’t believe I dismissed the need for other forms of therapy in the case of depression due to a chemical imbalance–If I did, I didn’t mean to imply that. What I’m saying is that you can’t just fix chemical imbalances by changing thinking patterns, etc, no matter how hard you try. ‘Chemicals’, as you say, is a necessity. The brain doesn’t have a chemical imbalance due to thinking patterns, and the imbalance can’t be changed via changing the patterns. And actually, in order to be prescribed medicine, you have to have therapy sessions. Depending on the state, it’s either once every month for 50 min or once every 2 weeks–and that’s just what’s federally required. Most responsible psychiatrists refuse to prescribe medicine unless the patient continues to meet with them weekly. So yes, drugs and therapy is certainly the best way.

  11. I find the term “happy pills” highly offensive. You call what you did a study, but clearly have little to no understanding of what today’s antidepressants do. They don’t make you feel happy, it’s not a thing like a painkiller. No one wants to be in those meds, because the only reason you’d take them is a depression diagnosis. They’ll just make you feel groggy if you take them in excess/really don’t need them… There won’t be a benefit.

    This is an important mistake, and it calls into question your ability to interpret the rest of the results as well. After seeing the phrase “happy pills,” I lost all my trust for the authors. They have zero credibility to deal with data of this nature, and make no attempt to fix this.

    1. apologies, I was using the term in reference to recreational use, not as a general “this is what I think of everyone ever who’s depressed.”

  12. as someone who has dealt with severe depression and whose family has suffered through many treatments of mental illness in the past ~50 years from medical procedures as excruciating as multiple courses of electro shock to witnessing people close to me develop deeply methodical non-medical or prescriptive practices (yoga, exercise, whatever) i think it is RIDICULOUS to use this kind of umbrella terminology to talk about mental illness. i don’t even know what to say. as a friend of gabe i feel a certain…attenuation. but this isn’t a new issue. it doesn’t need to be “brought into the light”. it is a substantial part of human life and has been for a very long time and if you are lucky enough not to have depression or suicide penetrate your personal or familiar sphere until this moment or this decade count yourself as very lucky. i do not know whether or not to be disgusted or befuddled.

    -lucy tiven

  13. 1.) Selection Bias and all that stuff needs to be considered.
    2.) Define abuse.
    3.) Forms of coping aren’t mutually exclusive so someone could have glass of wine to de-stress and skype their friend from back home to cope.
    4.) Is the primary reason people take study drugs for studying or is it a two birds with one stone kind of thing. Getting high and it just so happens I can focus more on this assignment too.

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