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Stress, Stimulants and Saving Lives

by Ripal Sheth

Right before finals week, the signs started popping up around campus: on the doors to the library, in the bathroom stalls, and in the dorm hallways. These signs advised students on how to be safe when using Adderall and Ritalin to study. College students have always had a high rate of illicit psychostimulant usage. This has often been attributed to the level of stress that students are put under to perform at their highest level. However, in NBC’s new medical drama, “New Amsterdam,” a relatively recently recognized phenomena has been brought to light: the illicit use of psychostimulants among medical students, residents, and physicians. The show follows the storyline of a practicing physician struggling with the misuse of Adderall in response to her high stress environment. Initial hypotheses cite this high stress environment among medical professionals as the cause for increased usage, but the questions now remain: what exactly is causing this and how can we stop it?

Over the 15 past years, many research studies have been aimed at understanding the prevalence of usage of stimulants without medical necessity. These studies show these rates to sit somewhere around 20 percent, with varying rates among medical schools. This is well above the NIH-reported average among college students, which puts the rate of stimulant abuse at around 7 percent. On the other hand, studies report practicing physician use of stimulants as high as 8 percent, but there are some issues with these reported averages. Some studies include the use of caffeine supplements, which inflates these statistics. In addition to this, much of this data is self-reported, making it difficult to obtain a clear picture on the prevalence of nonmedical usage of stimulants among medical professionals.

Still, the medical community’s use of stimulants has long-lasting and damaging effects. Adderall and Ritalin usage among physicians can be especially problematic. The job requires constant attentiveness and focus to understand, assess, and diagnose. There are currently not many studies attempting to uncover the specific stressors that cause physicians to engage in psychostimulant usage. However, the leading assumptions are that stimulant usage stems from stressful patient care, long and demanding shifts, and pressure to succeed. Misuse of these stimulants can render physicians impaired. They often can experience exhaustion, impulsive behavior, aggressiveness and much more. Imagine a cardiothoracic surgeon impulsively recommending a patient for surgery that is not needed due to Adderall usage. The patient could be left with unnecessary life-long effects because of the doctor’s unaddressed drug dependence.

Medical students, on the other hand, have slightly different motivations for taking stimulants, though their stressors are still a result of the demands of the medical field. Medical students are often faced with the challenges ranging from massive debt to the massive amounts of material that they must master in a short amount of time. Many studies found that these stressors are behind the use of psychostimulants among students. In a 2013 study that attempted to understand the use of psychostimulants among medical students, the top three answers for use were: “to help me study,” “to help me concentrate” and “to stay awake.” Similar studies found this to be true, but there are some studies that claim that usage of stimulants has no correlation with levels of stress. For example, Nonmedical Usage of Stimulants Among Medical Students found that “stress showed no association with use.” (648) However, they later hypothesized that medical students might just have overall high levels of stress compared to other student groups, so the baseline stress was higher than other student groups. Although these drugs might end up helping students get ahead in the short-term, many of root issues go unaddressed and  end up impacting student beyond their time in medical school.

The problem with many of the current treatments for drug dependence is that they require medical students and physicians to seek out help themselves. There often is little motivation to do so because of the risk of leaving medical school or losing their license. So what can we do to help alleviate this problem? The best possible solution is to make the environment of medical school and of practicing physicians less stressful. The stresses of patient care will always exist as a part of the profession. However, stresses from excessive competitiveness do not have to exist. The selectiveness of the medical school admissions process and residency admission generates a cut-throat culture among medical professionals. This means that students and professionals are rarely put in an environment that is genuinely supportive. Reducing the stress of competition could mean drastically reducing stimulant usage among medical professionals. The American Medical Association has taken some steps in the right direction. As of June 2018, physicians are now required to disclose any mental health or physical impairment that hinders them from proper practice of medicine. They also created the Steps Forward program which provides modules to help professionals cope with everyday challenges in medical practice. Although these modules are proven to be useful, it cannot end there. As a community, professionals and students need to strive to cultivate a culture of self-care and of collaboration in order to reduce stress-induced drug dependence on stimulants.

Among the entire medical community, the use of non-prescribed Adderall and Ritalin has become an increasingly imminent issue. Many of the reasons why these rates are so high point to the ultra-competitive nature of medical school, residency, and practice. All three levels are being placed in a toxic mental health environment where substances are used to cope or to get ahead. However, this can be reduced through some simple first steps. Cultivating an environment among all levels that allows people to freely talk about mental health is crucial. This comes down to increasing collaboration among every level so that people do not feel judged or are not perceived as weak if they choose to prioritize mental health. This issue must become a priority to be addressed by the medical community in order to curb the long-lasting effects of substance abuse.