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An Examination of Adderall Abuse & Treatment Options
Who Abuses Adderall?
What Is Adderall?
Adderall is a combination of amphetamine and dextroamphetamine. Amphetamines are psychoactive central nervous stimulants that increase dopamine and norepinephrine neurotransmitter activity in the brain.1
Adderall is typically prescribed to manage symptoms of attention-deficit hyperactivity disorder (ADHD); however, some people abuse Adderall for its stimulant and/or dose-dependent euphoric properties. Because it promotes wakefulness and increases focus and attention, Adderall is frequently abused by people seeking to boost their performance at work or school.2 It can also cause a pleasurable “high” and sense of euphoria, especially when taken in high doses or when crushed into powder form to be snorted or mixed with water and injected.2
Since 1971, the United States has classified amphetamines as Schedule II substances. This means that even though they can be legally prescribed for accepted medical uses, they present a high potential for abuse and addiction.1
Several “look-alike” drugs are available on the black market that are designed to mimic the effects of stimulants like Adderall. These drugs contain ingredients such as the FDA-banned stimulant ephedrine, as well as legally available, over-the-counter substances such as caffeine and phenylpropanolamine. These counterfeit pills may then be sold on the street as “uppers” or “speed.”1
What Are the Effects?
For individuals diagnosed with ADHD, Adderall can have numerous therapeutic benefits, including:2
- Increased focus and wakefulness.
- Greater sense of calm.
- Improved academic performance.
- Enhanced cognitive abilities.
- Improved social and familial interactions.
These benefits are typically the same ones sought by non-medical users of the drug. Evidence suggests that Adderall is also sometimes used for appetite suppression to enhance weight loss efforts.
Adderall can cause a range of undesired side effects, some of which are potentially life-threatening depending on the user’s medical history and the amount of drug taken. Side effects may include:3
- Stomach ache.
- Decreased appetite.
- Blurred vision.
- Increased heart rate or blood pressure.
- Heart attack.
- Circulation problems and numbness in the extremities.
- Agitation, aggressive behavior, or hostility.
- Aggravated symptoms of existing mental health conditions.
What Is ADHD?
ADHD is a chronic mental health condition that affects approximately 11% of children between the ages of 4 and 17.2 The number of children diagnosed with and prescribed medication for ADHD is rising each year. The percentage of kids ages 4-17 taking Adderall or other ADHD medications increased from 4.8% in 2007 to 6.1% in 2011.2
Children with ADHD may exhibit a variety of symptoms of hyperactivity and/or inattentiveness.
Common symptoms of hyperactivity include:4
- Inability to sit still (constant fidgeting, tapping, moving around).
- Being unable to maintain a quiet voice.
- Feeling consistently supercharged and “on the go.”
- Blurting out and speaking in inappropriate situations.
- Difficulty with impulse control (e.g., not waiting their turn or interrupting).
Symptoms of inattentiveness include:4
- Inability to pay attention to detail.
- Difficulty finishing tasks.
- Difficulty listening when others are speaking.
- Inability to stay organized or keep track of many things.
- Pronounced forgetfulness.
- Being easily distracted by external stimulation.
ADHD can range in severity from mild to severe. While symptoms often improve during adolescence, difficulties can persist into adulthood for some people. Although less common, ADHD can be diagnosed in adult patients who meet certain criteria after other medical, psychiatric, or addictive disorders have been ruled out.4
When used appropriately, Adderall can help those with ADHD focus and stay calm.3 The medication comes as an extended-release tablet that is typically taken in the morning and early afternoon. Prescriptions typically begin in lower doses and are gradually increased until the desired level of symptom management is attained.5
What Are Study Drugs?
The term “study drugs” refers to the non-medical use of stimulant medications such as Adderall or Ritalin (methylphenidate) for the purpose of improving performance in school. Adderall may be used to stay awake and alert for a night of studying before a big exam, or more regularly to improve focus during class lectures and while completing assignments.
The Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that each year, 137,000 full-time college students start using study drugs.6 Ritalin use has declined in recent years, but approximately 10% of U.S. college students take Adderall for non-medical purposes.7
College students who use Adderall as a study drug actually have lower grade point averages than those who do not use it at all.
On Ivy League campuses, study drugs are so common that nearly 1 in 5 students report using them for increased academic performance, and 33% said they do not view this as cheating.8 Across the U.S., nearly 2/3 of college students report having been offered study drugs.9
Although students may believe that taking Adderall to help them concentrate will give them an academic advantage, research has shown that this is not the case. In fact, college students who use Adderall as a study drug actually have lower grade point averages (GPAs) than those who do not use it at all.10 In addition to lower GPAs, students who use study drugs are more likely to have other academic problems in college, such as skipping classes.10
What Are the Risks?
Even when taken as prescribed for the purpose of managing ADHD symptoms, long-term Adderall use can have potentially serious effects. Non-medical use, particularly in heavy doses, raises the likelihood of developing a problem.
Some of the health risks include:11
- Development of psychological symptoms: Some patients may experience hallucinations, mania, or delusional thinking, even with no prior history of mental health disorder. In some instances, this may even occur within an otherwise normally therapeutic dosing range. Adderall is not recommended for people with certain mental health disorders, especially bipolar disorder, as the drug could exacerbate symptoms of mania.
- Cardiovascular conditions: Adderall can cause an increase in heart rate and blood pressure, which could worsen pre-existing cardiovascular issues such as chronic hypertension and heart rhythm abnormalities. Adderall use may be associated with heart attack and sudden death.
- Suppressed growth in children: Children who take Adderall for ADHD symptoms may not grow or gain weight as expected and may need to discontinue the medication.
- Seizures: Stimulant medications like Adderall may trigger seizures in patients, whether or not they have a history of seizures prior to taking the drug.
Even when taken as prescribed, long-term Adderall use can have potentially serious effects.
Can You Overdose?
It is possible to overdose on Adderall, and some overdose cases have even been reported after low doses such as those prescribed for the management of ADHD.11 People who take Adderall in large doses or by injecting or snorting the drug are at greater risk of overdose than prescription patients.
People who take Adderall in large doses or by injecting or snorting the drug are at greater risk of overdose.Signs of an Adderall overdose include:11
- Tremors or convulsions.
- Excessive restlessness, or oversensitivity to normal stimulation.
- Rapid breathing.
- Elevated body temperature.
- Irregular heartbeat.
- Nausea and vomiting.
- Abdominal cramps.
Using Adderall alongside alcohol or other drugs greatly increases the risk of overdose or adverse reaction between drugs. If you suspect that you or someone near you is overdosing on Adderall, call 911 immediately.
What Is Substance Abuse?
Substance abuse can describe a variety of behaviors—from illicit drug use to the non-medical use of prescription medications. Consistent or chronic substance abuse increases the likelihood of developing an addiction, also known as substance use disorder. Though not necessarily present in all cases, the phenomena of tolerance and dependence underlie the compulsive behaviors associated with addiction.
People who take Adderall without a prescription, or in higher doses than prescribed, risk developing significant amphetamine tolerance. This means they have to take higher or more frequent doses in order to feel the desired effects. Physical dependence may also develop, which means that their body has adapted to the substance’s presence and they may experience withdrawal symptoms if they try to stop using Adderall.
Adderall withdrawal symptoms can range from mild to debilitating depending on the frequency and average daily dose of the drug being used. The severity of effects also depends on other individual factors such as medical history, comorbid psychiatric diagnoses, and the use of other drugs or alcohol.
Physical withdrawal symptoms may include:12
- Malnutrition and/or dehydration.
- Intensified hunger.
- Extreme fatigue or lack of energy.
- Psychomotor agitation and retardation.
- Fever and chills.
- Dulled senses.
- Aches and pains.
- Initial insomnia, followed by hypersomnia.
Common psychological withdrawal symptoms may include:12
- Intense cravings.
- Impaired memory.
- Depressed mood and/or suicidal thoughts.
- Extreme agitation or irritability.
- Inability to find pleasure in activities that are normally enjoyable.
- Vivid, unpleasant dreams.
- Impaired social functioning.
Withdrawal symptoms from prescription amphetamines like Adderall are typically strongest between the initial 24–72 hours after discontinuing the drug, though they can persist for several weeks.3
Uncomfortable withdrawal symptoms and intense cravings can make it difficult for users to quit using Adderall and can potentially lead to a substance use disorder, characterized by compulsive drug use and drug-seeking behaviors despite negative consequences such as health problems.
The following signs, symptoms, and behaviors could indicate that a person has a problem with Adderall use and would benefit from treatment for their drug abuse:4
- Continued cravings for Adderall.
- Failed attempts to quit using the drug.
- Continuing to use Adderall despite consequences such as difficulty keeping up at work or school, strained personal relationships, or health concerns.
- Development of tolerance.
- Experiencing withdrawal symptoms when drug use is discontinued.
- Spending excessive amounts of time using and obtaining Adderall.
How Is It Treated?
Entering rehab can be intimidating. In 2016, an estimated 21 million people needed substance use treatment; however, only 3.8 million actually received it.13 People seeking to stop using Adderall and regain control of their lives should know that help is available in a variety of settings, including:
- Inpatient rehab centers.
- Outpatient programs of varying intensity.
- Individual providers (primary care physician or registered therapist).
- Support groups such as Narcotics Anonymous or SMART Recovery.
Substance abuse treatment typically begins with a detox period to allow the body to eliminate the drug from its system. Professional detox programs provide a safe, comfortable environment for the length of the withdrawal period. There are no medications approved specifically for treatment of stimulant dependence; however, during this time, supportive care, including the use of some medications, may be administered to alleviate some of the more uncomfortable symptoms of withdrawal.
The psychological portion of rehabilitation can take many different forms depending on both the provider and the patient’s individual needs. Some treatment methods commonly used to overcome stimulant abuse and addiction include:
- Cognitive behavioral therapy (CBT). This therapeutic model identifies maladaptive thoughts and behaviors and seeks to reframe them into more positive and realistic responses.
- Motivational enhancement therapy (MET). This method utilizes motivational interviewing skills in order to facilitate positive and motivated change.14
- Contingency management. This approach engages the patient in positive reinforcement and incentive-based interventions to promote sobriety and lasting change.15
- The Matrix Model. This stimulant-specific treatment strategy provides coaching and teaching focused on structured treatment manuals and guidelines designed to promote self-esteem and self-worth.16
If you or a loved one is struggling with stimulants, such as Adderall, please know that you are definitely not alone.
No matter where you are or how much you are struggling, it’s not too late to turn everything around. As long as you commit to getting the help that you need, it’s possible to make a full recovery and maintain a sober lifestyle.
- University of Maryland Center for Substance Abuse Research. (2013). Amphetamines.
- National Institute on Drug Abuse. (2014). Stimulant ADHD Medications: Methylphenidate and Amphetamines.
- U.S. Food and Drug Administration. (2015). Medication Guide: Adderall.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- U.S National Library of Medicine. (2017). Dextroamphetamine and Amphetamine.
- Substance Abuse and Mental Health Services Administration. (2015). First-of-a-kind study shows college students often start using substances during summer.
- Schulenberg, J., Johnston, L., O’Malley, P., et. al. (2016). Monitoring the Future national survey results on drug use 1975–2016: Volume 2, College students and adults ages 19–55. Ann Arbor: Institute for Social Research, The University of Michigan.
- American Academy of Pediatrics. (2014). Many Ivy League students don’t view ADHD medication misuse as cheating.
- Garnier-Dykstra, L., Caldeira, K., Vincent, K., et. al. (2012). Nonmedical use of prescription stimulants during college: four-year trends in exposure opportunity, use, motives and sources. Journal of American College Health, 60(3), 226–34.
- Arria, A., O’Grady, K., Caldeira, K., et. al. (2008). Nonmedical use of prescription stimulants and analgesics: Associations with social and academic behaviors among college students. Journal of Drug Issues, 38(4), 1045–1060.
- U.S. Food and Drug Administration. (2007). Adderall (CII).
- Center for Substance Abuse Treatment. (2001). Quick guide for clinicians based on TIP 33: Treatment for stimulant use disorders. Substance Abuse and Mental Health Services Administration, Rockville, MD.
- Center for Behavioral Health Statistics and Quality. (2017). Results from the 2016 National Survey on Drug Use and Health: Key Substance Use and Mental Health Indicators in the United States. Substance Abuse and Mental Health Services Administration, Rockville, MD.
- National Institute on Drug Abuse. (2012). Motivational enhancement therapy (alcohol, marijuana, nicotine). Principles of Drug Addiction Treatment: A Research-Based Guide (3rd ed.).
- National Institute on Drug Abuse. (2012). Contingency management interventions/motivational incentives (alcohol, stimulants, opioids, marijuana, nicotine). Principles of Drug Addiction Treatment: A Research-Based Guide (3rd ed.).
- National Institute on Drug Abuse. (2012). The matrix model (stimulants). Principles of Drug Addiction Treatment: A Research-Based Guide (3rd ed.).