Adderall has become infamous for its recreational and off-label use as a study drug. Restrictions on the medication, initially designed to help people with narcolepsy and attention deficit hyperactivity disorder (ADHD), have led some to wonder about obtaining over-the-counter replacements, but questions remain as to whether the alternatives work and if they are worth the risk.

Inside Adderall

There are two drugs inside every dose of Adderall: amphetamine and dextroamphetamine. As amphetamines, the two excite the central nervous system by inducing the brain to produce dopamine, a neurotransmitter that is normally released as the result of a person performing an activity that is pleasurable or self-affirming.

Medical Daily explains that another neurotransmitter released during Adderall consumption is epinephrine, which uses the fight-or-flight response of the sympathetic nervous system to trigger alertness, focus, and concentration in users. This is what helps college students plow through all-nighters or employees in high-stress jobs stave off fatigue. A final neurotransmitter, norepinephrine, keeps these chemical responses going on for much longer than they would under normal circumstances.

When amphetamine and dextroamphetamine are bundled together in this way, the resultant product is known by the brand name of Adderall. For treatment of narcolepsy or attention deficit hyperactivity disorder, Adderall has to be prescribed in exactly the right amounts. However, people who use Adderall for off-label purposes likely will take excessive amounts of the drug, which can cause psychological dependence and long-lasting changes to brain operation. Repeated exposure to Adderall also causes the effects to plateau, which compels users to take higher doses, thereby deepening their reliance on the drug and gradually losing the ability to function without it.

Adderall Abuse and Harm

Due to the high potential of abuse, the U.S. Drug Enforcement Administration has placed Adderall on its Schedule II list of controlled substances. While there are legitimate medical applications for Adderall, the risk of abuse and dependence is high enough to incur some of the strongest regulations on its prescription and distribution.

The high potential of abuse is well-documented. NPR reported than 20 percent of college students have abused prescription drugs, including Adderall; of that 20 percent, 44 percent of them believed Adderall would increase their academic performance, and 31 percent used Adderall to stay awake. Researchers feared the “normalization” of using powerful prescription medication, with myriad side effects, to subvert the body’s natural need for rest, especially among youths and young adults.

So popular and common is the use of Adderall that many people are of the mindset that “Adderall is definitely not a drug,” according to findings published in the Substance Use and Misuse journal. As many as 74 percent of the students who abuse Adderall get the drugs from friends and family members with their own prescriptions, writes the Journal of American College Health. Those people believe that since the medication came from a trusted source, there cannot be anything harmful about it.

However, there is harm, and a lot of it. The Johns Hopkins Bloomberg School of Public Health notes that the number of young adults requiring emergency hospitalization for “Adderall-related reasons” went up by 156 percent between 2006 and 2011. Symptoms of Adderall misuse can include anything from sleep disorders and sexual dysfunction to anxiety disorders and unpredictable mood swings. When users attempt to discontinue their Adderall intake, they are usually thrown into withdrawal, experiencing hallucinations, depression, and extreme physical distress.

The Rise of Nootropics

The controversy surrounding the abuse of Adderall has led some to wonder if over-the-counter replacements can still give users a mental edge for work and study without the side effects or obstacles of the prescription drug. This has led to the emergence of so-called “nootropics,” also known as smart drugs, brain boosters, or simply memory-enhancing drugs. The term “nootropics” comes from the Greek word noos (mind) and the French word trope (change).

Nootropics work by protecting neurons in the brain from toxins and aging, so the neurons can increase blood and oxygen flow to the brain. There are many substances that do this or that claim to do this, so researchers have created two categories for nootropics: substances that occur in nature (such as creatine, phenibut and Ginkgo biloba) and manufactured substances (prescription medication like Adderall and over-the-counter products like Noopept).

Caffeine is not a nootropic, but it is often mentioned in conversations about nootropics, and it is occasionally used as an ingredient in nootropic supplements. Adderall and caffeine are the only substances that have the scientific backing of improving cognitive ability with relative safety. Caffeine boosts attention spans, helping people remember information. Adderall, as explained above, stimulates communications between neurons, leading to longer periods of concentration.

Do Nootropics Work?

But when it comes to nootropic supplements that can be purchased in supplement stores, there is no evidence that those substances will have the desired effects. An associate clinical professor at Stony Brook University told Men’s Health that nothing bought over the counter at a health food store would really improve a person’s thinking skills; a regular cup of coffee in the morning and afternoon will achieve the same effect.

This is not just hyperbole; the Journal of Cognitive Enhancement found that a combination of nootropic supplements fared even worse than a simple coffee at improving people’s cognitive functioning. The nootropic combination contained 100 mg (milligrams) of caffeine, 200 mg of l-theanine, 40 mg of vinpocetine, 300 mg of l-tyrosine, 1 mg of vitamin B12, and 20 mg of vitamin B6, and it did not provide any significant benefit to the 20 adults who participated in the study compared with the 100 mg of caffeine that was also tested. The only area in which the nootropic mix beat caffeine was in subjective alertness; however, caffeine proved more effective in helping the test subjects with their working memory, increased reaction times, and verbal memory recall.

The lead researcher on the study suggested that people should be critical of the effectiveness of nootropics when trying to use them to improve their performance. While individual substances may have some benefit to thinking and memory, there is no evidence that different nootropics can stack to provide any additional benefit. The study theorized that one nootropic might change the effect that another nootropic has on cognitive functioning.

Ultimately, the researchers concluded that “caffeine by itself is sufficient to benefit some aspects of cognitive performance,” and that loading up on nootropics might even overstimulate users to the point where their optimal performance suffers.

The Original Nootropic

Herbal Supplements in CapsulesIn examining the effectiveness of nootropics, it is important to look at racetams, a class of synthetic nootropics. One of them, piracetam, is commonly found in most over-the-counter nootropics, and it has long been one of the substances mentioned in the conversation about nootropics. Even the term “nootropic” was first used to describe the effects of piracetam as early as 1964.

Despite this, however, piracetam’s mechanism of action remains largely unknown. Most of the anecdotal information available suggests that it increases the fluidity of the brain’s membrane, which would, in turn, enhance neuron functioning and communication, but there are no established studies that might confirm this.

Additionally, most of the research conducted on piracetam has been to help patients who could benefit from the increase in cognitive functioning, and not for people who are looking to improve their focus and concentration to give them an edge at work or school. The British Journal of Pharmacology, for example, noted that regular doses of piracetam could help brain function in elderly patients.

Similarly, Psychopharmacology reported that piracetam was useful in cognitive recall in adult test subjects, and a study in the Journal of Clinical Psychopharmacology suggested that it can help dyslexic students improve their reading ability and reading comprehension. The crux is that there is still no consensus on how piracetam does this, and no one is seriously looking at mass producing piracetam for use in high-stakes academic or professional settings.

A Billion-Dollar Industry

One of the reasons that research on nootropics has stagnated is because their effectiveness is heavily dependent on every consumer’s individual physical and psychological makeup, down to the very neurochemistry of their own brain. This can include genetics, weight, age, sleep patterns, environment, and lifestyle. The result of one nootropic on one person can be hugely different to that of another person taking the same supplement.

This lack of standardization means that under current U.S. regulations, the manufacturers of nootropics can advertise that they are cognitive enhancers without having to obtain the otherwise necessary evidence from human trials to prove it. Because of this, manufacturers don’t need to spend time and money testing their products, which might explain why the nootropic industry was worth $1.3 billion in 2015 and could reach $6 billion in 2024, according to Credence Research.

The Secret to Cognitive Enhancement

This has alarmed some doctors, like Pieter Cohen, an associate professor at Harvard Medical School, who told the New York Post that his own research has uncovered “unlabeled, untested and potentially active dangerous active ingredients” in “several” nootropics. Nonetheless, Cohen said that there might still be some benefit to the supplements, but only in theory.

Nonetheless, medical support for nootropics does exist, albeit not necessarily as an over-the-counter replacement for Adderall. The New York Post profiled Dr. James Lee, an anesthesiologist trained at Stanford University, who turned to nootropics after suffering from cognitive issues as the result of chemotherapy to treat a brain tumor. Despite his doctors telling him that his condition was irreversible, the nootropics proved so successful that Lee launched his own brand of supplements. They contain “dozens of active ingredients,” which he says have helped him feel better than he did before the tumor. Other doctors say the possible benefits of nootropics are worth the risks.

In general, the jury is still out. Business magazine Inc. reported that despite interest in Silicon Valley regarding an over-the-counter drug that can give developers an edge, the answer to the question of whether an Adderall replacement really works is partly “sometimes,” partly “maybe,” and partly “not by much.” Any improvements are marginal at best, and even the communities dedicated to advocating for the greater use of nootropics note that the best way to improve cognitive performance is to cultivate good lifestyle habits: consistent sleep, self-motivation, and a healthy diet.

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