The pills are typically long, flat and white. They are easily disguised as candy, or crushed and thrown into pots of coffee in the desperate, final hours before an exam.

Adderall, Ritalin, and their other derivatives are long-wear ADHD medications often referred to as “smart drugs,” providing a tempting alternative to coping with stress in an academic system where a growing number feel it is impossible to succeed without them. With an increased workload and the overwhelming sense of the future, it is no surprise that students on both the high school and university levels who have not been diagnosed with ADHD are becoming tempted by the drugs—and then addicted.

In fact, some researchers estimate that close to 30 percent of college students have abused amphetamines over the course of their academic careers. With statistics that high, it seems that there would be an even larger attempt to regulate what appears to be a broken system. But for the moment, too few are successfully addressing the problem—perhaps out of fear of failure.

At first glance, it appears relatively easy to monitor a child’s prescriptions, but as they mature and seek greater independence, lines of communication and care become increasingly blurred. With the added stress of succeeding in the classroom, it’s no wonder that smart drugs are not only firmly embedded into our academic culture, but they are also often romanticized into appearing less dangerous than they actually are.

Increased awareness and decreased stigma has allowed for those with the condition to be more accurately diagnosed and treated — Dr. Tia Horner

Although students who abuse amphetamines may argue that the drugs’ effects are minor, it’s not widely known how harmful they actually can be when not taken as directed. In fact, the side effects of taking ADHD medications without a prescription can be extreme.

The list of side effects, as reported by Healthline, the company that manufactures Adderall, includes development of hepatitis, hallucinations, aggressive or anxious behavior, and in some cases even death. Some argue that these incidents are few and far between with those who take the drug as prescribed.

However, it’s important to point out that if a user isn’t diagnosed with ADHD but still takes amphetamines, a drug might not work as desired, while still putting the abuser’s life at risk.

The National Institute of Drug Abuse reports that amphetamines “don’t enhance learning or thinking ability when taken by people who do not actually have ADHD, and people who abuse stimulants often have lower GPAs than those who do not.” Despite the overwhelming evidence against abusing amphetamines, our culture makes it too easy to abuse them.

With all of this in mind, we must ask ourselves a straightforward question: Where does this all start, and what can we do about it?

It is easy to point to early diagnosis of ADHD in children as the problem, with many finding the practice of treating inability to concentrate akin to treating childhood itself. 

Although it may be true that such diagnoses, which have skyrocketed in the last several decades, make prescription drugs relatively easy to come by, it is untrue that the condition itself is over-diagnosed.

Dr. Anne Brochin says that in her experience as a child psychiatrist, while ADHD is “difficult to diagnose, it’s not necessarily overdone.” All the same, she believes that in some instances, doctors misjudge patients, resulting in questionable diagnosis.

Dr. Tia Horner, another child psychiatrist, adds that with few qualified clinicians, making accurate diagnoses proves more challenging. Adult psychiatrists, she says, are treating a growing number of children, which may result in inaccurate diagnosis. “Increased awareness and decreased stigma has allowed for those with the condition to be more accurately diagnosed and treated.”

But challenges remain—especially in that clinicians qualified to make accurate diagnoses are not proportional to their demand. But without the right resources, how do we help students who need extra support, while protecting everyone else from the potential risks of abuse?

The answer is difficult to discern and will require creative solutions from unlikely places. It is nearly impossible to prevent abuse with a drug that so many take. At the same time, what can shift is the values we present to our kids, both in and out of school.

When we start talking about stimulant abuse for what it actually is—an epidemic—the conversation shifts to changing our social mindset as opposed to blaming the medical field.

It is no secret that the mental state of the American student is a precarious one. The American Psychological Association reports that in a survey of college counselors, 21 percent of students within the counseling system are recognized as having severe mental problems, with another 40 percent on the more minor end of the scale. Taking amphetamines is not a symptom of clinical depression, but for suffers of any mental disorder it’s certainly more tempting to seek relief. If you’re already stressed out of your mind and there appears to be a relatively safe way out, why not take a drug?

I can speak to this culture of success at any cost.

I was diagnosed with ADHD last April and put on stimulants as a result. I remember some small part of me being almost relieved that I was accurately diagnosed by a child psychiatrist, and that I would never have to resort to abusing stimulants—either during the college application process or once enrolled. For me, taking an amphetamine was not so much about aiding my diagnosis, but about leveling the playing field.

When everyone around you appears to be achieving on such an impossibly high level, it’s no surprise that feelings of inadequacy and anxiety are often thought of as the most obvious character traits of the American student.

I have lived in Boston most of my life, the epicenter of higher education and medicine. As a result, I have attuned myself to the often hysterical attitudes of some adults around me about what it takes to get into a top college, and on a larger scale, what it means to be successful in life.

For much of my adolescence, it has been hammered into me that perfection in all things is necessary to achieve what many say they expect of me. I’m not ashamed of my prescription, but speaking as someone who has always considered herself to be the “smart kids,” taking stimulants should not have been something that made me feel more secure.

I’m definitely a school person, but I don’t think school should be so pressure-inducing that students feel that they won’t be able to succeed on their own, without some type of aid. It’s all very convenient for elite universities, who foster the mania from afar and watch their acceptance rates drop, but one really has to think about what is and isn’t worth the mental health of our youth. 

We all want the best for ourselves, but too much of the academic world is set up to create a toxic culture of exclusivity, and not only is it forcing us to unnecessarily condemn the medical community for over-diagnosis of ADHD, it’s hurting our kids.