Don’t resort to illegal drugs to stay alert at the poke table.



This column first appeared in Ante Up Magazine in February 2009.

With AK in early position, I raised four times the big blind and got only one caller. The J-7-2 flop didn’t worry me so I cut a pot-sized continuation bet out of my stack. It was at that moment it happened.

You didn’t have to be Joe Navarro to notice the tell. The player two seats to my left had assembled all of his remaining chips into one medium-sized tower and clearly was planning to slide it across the betting line as soon as the action got to him.
I missed it, though. Before I could stop, my continuation bet fell out of my fingers and across the line. He, of course, pushed and I realized my hand was way behind. I folded. He showed AJ and collected the pot.

I noticed his tell but wasn’t quick enough to avoid wasting some chips. I had been playing for some hours so maybe I was a little fatigued or bored or inattentive. This hand made me wonder if there was something I could do to improve my concentration at the table, something a little more effective than stale coffee or an energy drink. What about the pros? How do they stay focused for such long periods? Do they take something? It turns out some certainly do.

At first glance, speed and cocaine seem to be obvious candidates for performance enhancers. They make you feel more awake and alert, but at great risk to your health. These drugs increase blood pressure and heart rate at the same time as they shrink the blood vessels that supply oxygen to the heart. Heart attacks with permanent damage are amazingly common in young otherwise healthy people who use these drugs. Plus they’re highly addictive, expensive and illegal. So unless you fancy having constant chest pain and being locked in a cage with a tattooed giant named Sugarlips, it’s best to seek performance enhancement by other means.

What about drugs such as Ritalin and Adderall? Attention Deficit Disorder and its hyperactive cousin, Attention Deficit Hyperactivity Disorder, are real diseases most common in school-age children. Ritalin and Adderall allow children to filter out multiple competing and confusing stimuli and concentrate on one task. They become more calm and focused. Once they hit adolescence, the calming effect becomes somewhat diminished and jittery side effects become more common. The improved focus effect seems to remain for all age groups.

Sounds great, right? Improved focus but a little jittery … sounds like it might work just fine at the tables. Let me be absolutely clear about these drugs. They are speed; nothing more or less than pharmaceutical-grade amphetamines. All the side effects of speed, the increased blood pressure, the rapid heart rate, the heart-attack risk, the addiction potential, are the same for crystal meth brewed by skinny guys with bad teeth.

For those adults who truly have debilitating ADD or ADHD, these drugs are indeed effective and may be worth the risks. But that decision is complicated and serious and should be made in conjunction with a physician or psychiatrist.

In his blog, poker pro Paul Phillips credits Adderall with taming his ADHD and allowing him to win $2.3 million one year. Here’s an entry from his blog:

“With Adderall in my system, I am like an information sponge, able to process data from several players at once while considering my next action. It also improved my patience. I can’t count how many chips I used to squander playing hands out of boredom. Now, I have no problem folding as many (or as few) as the game conditions require.”

So what can the average player do? What if you don’t have ADHD? What if you don’t want to risk a heart attack, and jumpsuits don’t flatter your figure? Is there something else? The unqualified answer is “Maybe.” Next month I will give you the detailed scoop about the drug that has been called “steroids for the brain.”

— An avid poker player, Frank Toscano, M.D. is a board-certified emergency physician with more than 28 years of front-line experience. He’s medical director for Red Bamboo Medi Spa in Clearwater. Email your poker-health questions to

Ante Up Magazine

Ante Up Magazine