Jack and Nancy Krogstad were scared that night in July 2011 when they found their daughter's ominous, hastily scrawled note, spelling out her preference for cremation rather than burial.
Then they were devastated the next morning when Kristy Krogstad Sigvartsen's body was found in a rural culvert, three miles from their southwest Iowa home. She was dead of a self-inflicted gunshot wound.
As the Krogstads grieved, they also tried to figure out why their 36-year-old daughter had taken her own life.
They were puzzled by the panicked and erratic behavior she had displayed in her final weeks, and by the discovery that Adderall, a stimulant, was in her system when she died.
The Krogstads soon learned that Adderall — properly prescribed for those with attention deficit-hyperactivity disorder — is increasingly misused by students who take the drug to help them focus. It turned out that Kristy, a graduate student, did have a prescription for Adderall, although her parents had never seen signs of ADHD.
Then they read a New York Times article last year about Adderall misuse, including a possible link to suicide. For the Krogstads, it was as if a light went on.
There's no proof that Adderall had anything to do with their daughter's suicide. Nor does the couple know for certain whether it was responsible for her paranoia just prior to her death.
But to the Krogstads, the circumstantial evidence seems overwhelming.
“She had all the classic signs,” her mother said, “and we missed them.”
An amphetamine, Adderall produces feelings of exhilaration, increased energy and mental alertness. It has been called “the study drug,” “the library drug” and “the competition drug.” In some cases, students can obtain the drug from other students on a campus black market.
“I think it is a significant problem on college campuses,” said Allison Dering-Anderson of the College of Pharmacy at the University of Nebraska Medical Center in Omaha. “I think it gets misused more than we can possibly estimate.”
Health officials at Creighton University, where the Krogstads' daughter had been a pharmacy student, and at the University of Nebraska at Omaha said they warn students about the dangers of abusing various drugs, including stimulants such as Adderall.
In 2006, the American Journal of Psychiatry reported on a study indicating that even proper, doctor-supervised use of stimulants can trigger psychotic behavior or suicidal thoughts in one in 400 such patients.
The New York Times article about Adderall misuse last year told the story of “an athletic, personable college class president and aspiring medical student” from Virginia who had become addicted and hanged himself.
Last June, U.S. Sen. Chuck Schumer, D-N.Y., called on colleges and universities to crack down on the abuse of ADHD pills.
Besides possible medical problems, taking Adderall without a prescription as a study aid raises a question of academic integrity.
Business students at Creighton recently included Adderall misuse in a survey they conducted on academic ethics. The results are still being processed, but lead investigator Alexis Taylor, a Creighton senior from the Kansas City, Mo., area, said Adderall misuse is like an athlete taking a performance-enhancing drug.
“If you get it unprescribed and under the counter,” she said, “using it is just an unfair advantage.”
Meanwhile, more and more of the pills are out there. Nearly 14 million monthly prescriptions were written in 2011 for Americans ages 20 to 39 for Adderall or other ADHD drugs, such as Ritalin. Four years earlier, there were 5.6 million.
A warning that comes with Adderall containers says medical professionals should pay particular attention “to the possibility of subjects obtaining amphetamines for non-therapeutic use or distribution to others.”
Dr. Ronald Kirchner of Omaha, medical director of the Nebraska Regional Poison Center and an assistant professor at UNMC, said physicians also need to be vigilant because some people try to mimic ADHD symptoms to get a doctor to write a prescription.
“Our society is kind of over-medicated,” he said. “A lot of patients want a drug, and a lot of physicians find it easier to give the patients what they want. They may not spend a lot of time evaluating.”
Jack Krogstad, a Creighton accounting professor, and Nancy, a former high school guidance counselor, knew little about Adderall before their daughter's death. Nor did they know she had been taking the drug for the previous two years.
The Krogstads, who live in rural Glenwood, Iowa, say their daughter never had been a drug abuser — Adderall was the only drug in her system when she died — and she had no psychiatric history.
The Krogstads had adopted Kristy in infancy. She graduated from Glenwood High School in 1993, studied for a year in England during college and lived for a summer in Spain. She graduated from Andrews University in Michigan with a degree in mathematics.
After college, she lived overseas, nurturing her love of languages, especially Spanish, Hebrew, Arabic and Norwegian. She married Jan Sigvartsen of Norway, and they lived for two years in Jerusalem, where both studied at Hebrew University. They spent a summer near Amman, Jordan, on an archaeological dig.
After several years of marriage, they moved to the United States but eventually divorced.
Kristy worked as a computer software consultant in Indiana before returning to Omaha. She enrolled in Creighton's College of Pharmacy, a decade or so older than most of her classmates.
Without a science background, her parents said, she may have felt pressure to keep up with the classes.
The couple has spoken with the physician who prescribed the Adderall and said they bear no ill will. They declined to name the physician.
Based on knowing Kristy's personality — not from anything the doctor told them — the Krogstads surmise that the pressure to keep up is why she went to a doctor and received the Adderall prescription.
Before her suicide, Kristy had been planning to switch to another field, bioinformatics, which uses computer science, math and engineering to process biological data.
She enjoyed a wide range of personal interests, such as scuba diving, ice skating, motorcycling, snowboarding, yoga, knitting, gardening, ballet and ballroom dancing. Her parents said she had a good relationship with her boyfriend, construction contractor Mike Poloncic.
Despite some sad experiences, including the accidental death of Kristy's birth mother a decade earlier and her divorce about five years before her death, the Krogstads said she hadn't seemed despondent.
“In reading through her many, many journals,” Nancy said, “there is never any hint that suicide ever entered her mind. It appears that she was filled with future plans and looking forward to life ahead.”
Poloncic, who had dated her for nearly three years, said Kristy's last phone message to him on her final weekend was an upbeat “See you later, sweetie.”
But he, like her parents, said her demeanor generally had changed in the weeks before her death. She became convinced that a man living in their midtown Omaha apartment building was trying to hack into her computer's Web camera.
“She thought people were following us,” Poloncic said. “I told her, 'You need to see a doctor.' ”
Kristy left their apartment and stayed at her parents' rural home. She was afraid the supposed hacker would harm her or her parents.
“One day she was really scared, so afraid he would find her,” her mother said. “We now realize she was just imagining that.”
Besides the paranoia, she also complained that her stomach hurt and that her mouth was constantly dry. She was losing weight and sleep. All of those symptoms are associated with Adderall use.
The Krogstads left town overnight for a wedding in Kansas. Kristy found a handgun in their home and apparently bought bullets.
Then she wrote her last will and testament and left it on a table, with a note about cremation.
That final note was scribbled, Nancy said, as if she was terrified.
In the aftermath of Kristy's suicide, Jack Krogstad said, he appreciated the support he received from the Creighton community and others.
“When this happens to you,” he said, “you are absolutely paralyzed. The pain is incredible. We couldn't function. Thankfully, other people stepped up and did things.”
The Krogstads say they have heard from two other families with children who took the drug and were on the verge of attempting suicide.
Kristy's death is still painful to talk about, her parents say. But in speaking publicly, they want to warn others of possible dangers.
Said Nancy: “This is our final gift to Kristy.”