What appears a virtual epidemic of attention deficit disorder among NFL players, based on the number of positive tests for ADD medication in the last year, isn't so easily diagnosed.
Start with the case of safety Tyler Sash, the second of three Giants who failed a league doping test because -- all three players said -- they had taken the prescription drug Adderall, a stimulant banned by sports bodies because it increases alertness, aggressiveness, reaction time, speed, strength, power and endurance.
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"No, I don't have ADD,'' Sash said Friday. He took Adderall, he said, because offseason public appearances before large crowds caused his "head to start spinning" and he needed to stay focused on his talks.
Before Sash, teammate Andre Brown avoided a four-game ban when he successfully appealed his positive test for Adderall by receiving the league's therapeutic- use exemption. Since Sash's return from suspension, the third Giant, safety Will Hill, said his failed doping test also was the result of taking Adderall, which commonly is prescribed for ADD or narcolepsy, a sleep disorder.
In the last year, Cleveland's Joe Haden, Houston's Bret Hartmann, Green Bay's Mike Neal, Pittsburgh's Weslye Saunders, St. Louis' Austin Pettis, Tennessee's Ahmard Hall, New Orleans' Garrett Hartley and Arizona's Ben Patrick all said taking Adderall -- or its pharmaceutical cousin, Ritalin -- had led to doping positives.
Some of those players said they had received doctor-prescribed Adderall as an aid to stay focused during late-night driving situations. (A similar stimulant, modafinil, was cited by a handful of U.S. Olympic athletes who said they had narcolepsy after their positive tests.)
This football plague follows what Major League Baseball experienced in recent years, when MLB began granting an average of more than 100 therapeutic exemptions for anti-ADD drugs per year -- a fact that startled Dr. Gary Wadler, the anti-doping expert who now is a professor at Hofstra North Shore LIJ School of Medicine.
"ADD is not common in adults," Wadler said. "In all my years of practicing medicine, I can count on one hand how many cases I've seen of ADD in adults."
In fact, according to a 2006 study by the National Institute of Health, only 4.4 percent of U.S. adults between 18 and 44 experienced ADD symptoms, and Wadler said that ADD is the only "real" reason to prescribe Adderall.
Sash said he takes full responsibility for his positive test, though he said he was unaware of the therapeutic exemption option -- mandated by the players' collective-bargaining agreement -- and therefore did not apply for it. He also acknowledged that, because the NFL does not confirm the specific drug in announcing a positive test, the public might assume that players merely say they have been found with Adderall when, in fact, they took steroids.
Sash said that when he met with Roger Goodell, the NFL commissioner offered to send out a follow-up press release that was more specific about the drug but Sash preferred to let it drop. "I said, 'I don't even want another press release about this. I don't want my name associated again with drugs, because people hear that Tyler Sash had a drug test, they don't know the difference between a prescription drug and a street drug.' And Adderall is not a steroid."
But Wadler pointed out that amphetamines -- the generic term for drugs such as Adderall -- in fact are "the quintessential performance-enhancing drug, going back to the early days of doping, and it was demonstrated in a Harvard study, years ago, that they really work" in enhancing performance.
In his 1989 book, "Drugs and the Athlete" -- before he spent years identifying banned substances for the World Anti-Doping Agency -- Wadler documented that the first doping-related deaths in sports, 1960s cyclists Tommy Simpson and Knut Jensen, were caused by amphetamines.
Long term, Wadler said, amphetamines can cause increased blood pressure, increased heart rate, even stroke and heart attack, convulsions and dependency. Still, they remain legal in the NFL with a therapeutic exemption. And plenty of players say they need them.