"You still have adrenaline flowing in your body, but you don't feel that adrenaline rush so you're not distracted by your own nervousness"

Karen Kaplan and Denise Gellene of Los Angeles Times consider the use and benefits of cognitive enhancers like Adderall and Provigil for those in high stress positions. Of course, golfers call penalties on themselves and Nick Price tried beta blockers during the Reagan administration years and found them to be useless, so why I'm even linking this is a mystery...

Philips, the poker player, started using Adderall after he was diagnosed with ADHD five years ago and later got a prescription for Provigil to further improve his focus. ADHD drugs work by increasing the level of the brain chemical dopamine, which is thought to improve attention. Provigil's mechanism of action is not well understood, but boosting the effect of dopamine is thought to be part of it.

The drugs improved his concentration during high-stakes tournaments, he said, allowing him to better track all the action at his table.

"Poker is the sort of game that a lot of people can play well sporadically, but tournaments are mostly won by people who can play close to their best at all times," he said. "It requires significant mental effort to play in top form for 12 hours a day, five days in a row."

In the world of classical music, beta blockers such as Inderal have become nearly as commonplace as metronomes.

The drugs block adrenaline receptors in the heart and blood vessels, helping to control arrhythmias and high blood pressure. They also block adrenaline receptors in the brain.

"You still have adrenaline flowing in your body, but you don't feel that adrenaline rush so you're not distracted by your own nervousness," said Dr. Bernd F. Remler, a neurologist at the Medical College of Wisconsin in Milwaukee.

That's why Sarah Tuck, a veteran flutist with the San Diego Symphony, takes them to stave off the jitters that musicians refer to as "rubber fingers."

"When your heart is racing and your hands are shaking and you have difficulty breathing, it is difficult to perform," said Tuck, 41, who discovered them when she began performing professionally 15 years ago.

A survey she conducted a decade ago revealed one-quarter of flutists used the pills before some or all of their performances or in high-pressure situations like auditions. She believes use is now more widespread and estimates that three-quarters of musicians she knows use the drugs at least occasionally.

Prescriptions for Inderal and other beta blockers can be readily obtained from physicians. Tuck said some doctors had told her they used the drugs themselves to calm their own nerves before making presentations at medical meetings. Musicians say their drug use is all aboveboard.

"It's not like we're sending our clubhouse attendants to BALCO to get us our Inderal," said double bassist Bruce Ridge, 44, referring to the Bay Area Laboratory Co-Operative that allegedly provided slugger Barry Bonds and other athletes with performance-enhancing drugs.

That's right, because it is made by a publicly traded company, it must be A-okay!