George, 34, works as a marketing consultant and tech entrepreneur in Silicon Valley. He was never really one for fitness — “I was sort of a fat ass,” he says — until he met Adderall, which helped him deal with the stress, and drown out the distractions, of launching a Bitcoin debit-card service. He believes he legitimately has ADHD, at least probably, but what he loves most about Adderall isn’t how it helps him think. It’s how it makes him look. A few years later, George is no longer a fat ass. (He sold the Bitcoin business for a profit, too.)
On Adderall, George says, he found that being in motion felt amazing. “I’d go to the gym,” he says, “and I just wanted to keep running and running.” He bought himself a stand-up paddleboard, began to compete in amateur races, and found himself winning them. He now takes ten milligrams twice a day, typically “just before hitting the gym.”
Thanks to the high-intensity boutique-fitness boom sweeping the nation, urban Americans are taking a weaponized approach to working out. And for many, Adderall and other psychostimulants — many of which contain essentially the same compounds that decades earlier were sold as weight-loss aids — have become as indispensible as a good pair of compression socks. Los Angeles personal trainer Lalo Fuentes says a pre-workout Adderall boost is happening “more often than not,” especially among busy professionals looking for a fast track to fitness. “They want to find a shortcut,” he says.
“Lots of patients do the juicing, they exercise, but it’s all for looking good with their shirt off at the beach,” says Beverly Hills internist Ehsan Ali, Ph.D., who runs a concierge practice with services that include primary medical care and vaccines as well as vitamin shots, IV drip therapy, Botox, and Juvéderm. “They don’t mind doing some ‘less holistic’ things to make themselves look better, and, yes, ADHD medications come up as part of that. They want to be their best, if not the best, in all aspects of life.”
It’s well established that the use of prescription psychostimulants — including Adderall, Ritalin, and Vyvanse — has exploded over the last decade among college students who find these medications can help them write a term paper when they otherwise might be sleeping. Some studies estimate as many as 30 percent of undergrads use stimulants nonmedically. Among college students, the prevalence of “cognitive doping” puts nonusers at enough of a disadvantage that some schools, including Duke, have begun to implement policies that regard “unauthorized use of prescription medicine to enhance academic performance” as cheating.
Perhaps it’s no surprise that such pharmaceuticals have migrated from study hall to gym. According to a recent report on the use of stimulants among college students and athletes, “A therapeutic dose of MPH [which is sold under the brand name Ritalin] will benefit concentration, and may improve motor coordination.” Following the release of the Mitchell Report, which looked at the illegal use of performance enhancers in Major League Baseball and led to the MLB’s ban on stimulants except in cases of a legitimate diagnosis, the number of pro baseball players diagnosed with ADHD jumped nearly 8 percent in a year, suggesting that many players were simply seeking to evade the ban.
Stimulants are “the quiet performance enhancer no one really talks about,” says Gregg D’Andrea, a personal and corporate trainer and owner of a boutique spin studio in Boston. D’Andrea has noticed a significant increase in the use of ADHD meds among his largely upper-middle-class suburban clientele. As workouts have become more social (and, as a result, more appealing), they’ve also become more competitive, even among relative dilettantes. “Like in the old days, I’d drink a coupla-three espressos to have a kick-ass workout, and be better than the guy lifting next to me,” D’Andrea recalls. “But this would have been at a hard-core gym. Today, the way fitness has evolved, there are programs that bring that ‘faster, harder, longer’ mentality to more people. Part of the point becomes comparing yourself to others.”
This is your WOD on drugs — getting high to get shredded.
“I get asked all the time, ‘Will Adderall help me be better?’” reports Scott Weiss, DPT, a physical therapist and strength coach in Manhattan who works with recreational athletes as well as pros from the NHL, NFL, and WNBA. “Does it really work? Do they pick it up in drug tests? Pros, but also regular guys. Guys who’ve seen what it’s done for them in school or at work; they figure, Maybe I can do this for my sport. They want an edge. They want to look like the magazines, or the guy next to them in class. One pathway is through drugs.”
And it works, sort of. Taken before exercise, amphetamine- and methylphenidate-based medications of the kind typically prescribed to treat ADHD can provide anyone, but especially those without actual ADHD, a burst of energy and focus that can help them work out longer and harder (at the same time, because they are amphetamines, reducing appetite and revving metabolism as well). “It doesn’t have any direct correlation on strength — that is, the medication itself does not promote muscle growth — but you will have more energy and therefore be more inclined to go harder and maybe try things you wouldn’t have tried otherwise,” says Dr. Weiss. “Your energy is up, and so is your heart rate, and blood flow. You may be able to lift slightly heavier, too,” or at least you’ll think that you can.
“Adderall helps me when I need that extra push,” says Adam, who’s 40 and works in private equity in Los Angeles. “Sometimes I do coffee, but Adderall’s a little bit stronger and quicker and really sets the pace of the day.” (Five milligrams is his “sweet spot,” he says. “More than that and I get real jittery.”) When Adam first started taking the pills, presumably for “better focus at work,” he found he could work out 25 percent longer. He lost 50 pounds that first year, with no change in his diet. Although he’s been made aware of the side effects, which include sudden death, he expects to continue with the pills for “as long as I care about what I look like,” which in L.A. might be some time.
That said, the off-label use of stimulants is not without some risk. Dr. Ali, of Beverly Hills, says many of the requests for ADHD medications come from guys who otherwise follow a mantra of clean living and CrossFit and who don’t display symptoms of ADHD. While he will on occasion prescribe these healthy patients stimulants for off-label use, he does so under strict guidelines that include regular blood-pressure checks, limiting the intake of other stimulants (including caffeine), and at least a tacit promise to try to engage in vigorous exercise before taking the pill, or hours later. “If taken properly and under the supervision of a doctor, and in low dosages and for a short duration, these stimulants are relatively safe,” he says. In higher doses or without proper medical supervision, however, the side effects can be significant: high blood pressure, dehydration, palpitations, and muscle fatigue, as well as hallucinations, psychosis, seizures, stroke, and even death.
“Amphetamines are known to improve physical endurance and mental aptitude because they allow an increase in catecholamines [hormones produced by the adrenal glands] as part of their mechanism of action,” says Dr. Maria Pino, a toxicologist and pharmacology professor at Touro College of Osteopathic Medicine. “But they are also known to cause vasoconstriction, or increased blood pressure, and increased heart rate. So they can be dangerous.”
There’s also the risk of overtraining and, of course, overstimulation. As D’Andrea says, “Great, you can crush your workout. But when that same human being tries to go to bed, he’ll have trouble.” And without adequate sleep, the body won’t be able to produce the growth hormones that help muscles recover. “So as far as building muscle, you won’t get anywhere anyway,” he says.
And eventually many find they need, or simply want, to take more, a slippery slope toward addiction or psychological dependence. George never, ever misses a pill, and he says he’s been known to double (and triple) his dosage on “special occasions,” like before a recent stand-up paddleboard race. He’d barely had any sleep the night before (too much Adderall, perhaps), and he’d skipped breakfast. He was late. “I had to literally run with my board and paddle from my parking spot several blocks away and jump in the river,” he says. “I got to the starting line a minute before the gun, exhausted and heaving.” He went on to take first place in his division.
He double dosed again a few weeks later before mountain biking with a considerably more experienced friend. “I’d never gone more than 15 miles in any given setting, never mind uphill,” he says. “She was the one who had to keep up with me. And I don’t even have the right kind of bike! I was at the top of the mountain and looked around and was like, ‘How the hell did I even get here?’”