The combination of amphetamine and dextroamphetamine is marketed under the brand names of Adderall and Adderall XR (extended release) and prescribed to treat symptoms of attention deficit hyperactivity disorder, or ADHD. A relatively commonly diagnosed disorder, primarily associated with childhood, about one out of every three children in a classroom of 30 will suffer from ADHD on average, the journal ADDitude reports. The Centers for Disease Control and Prevention (CDC) calls ADHD one of the most common neurodevelopmental disorders that afflict American children and states that a prescription medication like Adderall, along with therapeutic techniques, is often the recommended treatment protocol.
ADHD is a disorder that affects focus, the ability to concentrate, energy levels, and willpower. When used to treat ADHD, prescription stimulants such as Adderall can actually help to calm some of the overactive brain functions related to the symptoms of the disorder, helping individuals to focus, calm down, improve self-esteem, and better control their impulses.
Adderall, and other prescription stimulant drugs, are not always used as directed, however. The National Survey on Drug Use and Health (NSDUH) publishes that around 1 million American adults (aged 12 and older) misused a stimulant drug (excluding methamphetamine) in the month prior to the 2014 survey. When used for nonmedical purposes, Adderall increases energy levels, decreases the need to eat and sleep, and enhances focus, attention, concentration, and pleasure. It may be commonly abused as a “study drug” or “smart drug” by students or young professionals trying to get or stay ahead in school or in their fields. Individuals taking Adderall may be able to stay awake longer, focus more intensely, and be more productive in a shorter amount of time.
Studies published by CNN indicate that as many as 30 percent of fulltime college students may be abusing a prescription stimulant like Adderall. The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that fulltime college students (who were between the ages of 18 and 22) were at least twice as likely as their peers to abuse Adderall, according to a national survey. In addition, around 60 percent of those who abuse Adderall are between the ages of 18 and 25, a Johns Hopkins University publication reports. High school aged teenagers may also abuse Adderall at high rates, as the National Institute on Drug Abuse (NIDA) publishes results from the Monitoring the Future (MTF) study that indicate that 7.5 percent of 12th graders in 2015 report past-year Adderall abuse.
Risk vs. Reward
Adderall may be abused for a variety of reasons: as a method of increasing production, for studying, as a diet drug, or to produce a “high.” Adderall, as a central nervous system stimulant, increases body temperature, heart rate, and blood pressure while also acting on some of the neurotransmitters in the brain that help to regulate emotions, willpower, and pleasure.
Since it is a prescription drug, individuals may feel that it is “safer” than other illicit drugs. Adderall is considered a Schedule II controlled substance, however, meaning that the Drug Enforcement Administration (DEA) recognizes that it has a high potential to be diverted and abused, and that Adderall is potentially addictive. Individuals abusing Adderall may take more of the drug than intended at each dose, use the drug without a prescription, or chew, crush, or alter the drug for snorting, smoking, or injecting. When Adderall XR is chewed or crushed and then taken, the intended extended-release format is circumvented, and the whole amount of the drug is released into the bloodstream at once. This can cause blood pressure, body temperature, and heart rate to increase to dangerously high levels, resulting in stroke, heart attack, or even death from an overdose.
Someone under the influence of Adderall is likely talkative, energetic, focused, and highly productive, and may not need to eat or sleep for long periods of time. They may be overly happy and have fewer inhibitions than normal. When Adderall wears off, in around 4-6 hours for regular Adderall and 10-12 hours for Adderall XR, a “crash” may ensue. Individuals may be lethargic, sleep for long periods, eat more, and suffer from depression and difficulties concentrating after “coming down” from Adderall, as brain chemistry struggles to restore balance without the drug.
Adderall may be abused in conjunction with alcohol or other central nervous system depressant drugs in an effort to counteract the effects of each drug. Polydrug abuse may lead to more negative reactions, side effects, and an increased risk for overdose.
Adderall may also be linked to psychotic symptoms, including hallucinations, increased aggression, suicidal thoughts, depression, anxiety, and significant mood swings, ABC News reports. Additionally, Adderall is considered to be habit-forming and can lead to drug dependence and addiction when used regularly.
Who Abuses Adderall?
When a person takes Adderall for nonmedical reasons, they may desire stimulation, increased attention, sustained wakefulness, increased physical energy, a euphoric high, or weight loss. There are many reasons that people abuse Adderall, and while it may feel like the drug works for these reasons in the short-term, its use can actually be very dangerous and quickly lead to addiction.
One of the largest and most discussed demographic groups abusing Adderall are students, especially high school and college students. Adderall, and related drugs like Concerta, Vyvanse, and Ritalin, are considered “study drugs” because they help people with ADHD focus on a task and reduce restlessness. For people without ADHD, however, this focus may or may not occur; the person will experience increased physical and mental energy, but that does not mean they will use that energy to focus on studying or writing a paper, and the drug does not improve memory at all.
According to research examined by the National Institute on Drug Abuse (NIDA), students who abuse study drugs like Adderall have poorer scholastic performance than their peers and typically have lower grade point averages. Students with ADHD are found to be pressured by their peers to divert their prescriptions; between 16 percent and 29 percent of people with ADHD have reportedly diverted their medications at some point in their lives.
However, abusing Adderall appears to make students think that they did well, which could be a mild delusion – a side effect of abusing Adderall. A 2015 meta-analysis found that one in six college students took Adderall for nonmedical, performance-enhancing reasons. Other researchers believe that as much as 30 percent of high school and college students have abused Adderall for nonmedical reasons.
As the first generation of students addicted to Adderall enters the workforce, it is apparent that they are not able to abandon abuse of this potent stimulant. Instead, competition over available jobs, high-stress careers, and difficulty balancing work demands and home life have led many people who began abusing Adderall in high school or college to continue the problem once they enter the workforce.
Abusing drugs is a negative coping mechanism for stress for many people, especially those who struggled with substance abuse in adolescence, have a predisposition to the condition, or who have mental illnesses like depression, anxiety, bipolar disorder, and more. The New York Times wrote, in 2015, that workers between the ages of 25 and 45 were one of the more rapidly increasing demographics abusing Adderall and similar prescription stimulants in order to meet work deadlines or manage work stress. The youngest members of the workforce, between ages 18 and 25, are more likely to steal Adderall from friends and family than to receive a prescription for the drug or purchase it illicitly.
In 2012, 10 players with the Seahawks professional football team were found to be abusing Adderall. Allegedly, the drug helped them feel “in the zone” for practices and matches because it masked pain from impacts, reduced fatigue, and increased physical stimulation.
The drug has been officially banned by major professional sports organizations, including the National Football League (NFL) and the National Collegiate Athletic Association (NCAA). However, players may receive legitimate prescriptions for the drug if they need it as a treatment for ADHD, which is a therapeutic use exemption. Unfortunately, it is possible that, like college students, athletes who truly need Adderall divert the drug to their teammates or that some players doctor shop for prescriptions.
Many stimulant drugs, including Adderall, are abused by those who have a poor self-image and want to lose weight. Stimulant drugs suppress hunger and increase physical energy, so people who abuse them eat much less while having the ability to exercise more. This is extremely dangerous, not only because of the side effects of Adderall abuse, but because malnutrition, anorexia, and exercise bulimia can be extremely harmful to the body.
Spotting Adderall Addiction
Adderall makes changes in the chemistry of the brain, increasing levels of some of the neurotransmitters like dopamine that help to regulate emotions and make a person feel happy. The brain may become used to Adderall’s influence on production and absorption of these chemical messengers and stop functioning normally without it.
Chronic Adderall use or abuse can create a tolerance to the drug, and higher doses may be required to keep feeling the drug’s effects each time. This can cause drug dependence, and the brain may now need Adderall to remain balanced.
When Adderall leaves the body or is removed after a dependence has formed, withdrawal symptoms are common. Adderall withdrawal symptoms may include: difficulties sleeping, fatigue, irregular heart rate, abdominal pain, nausea, anxiety, sweating, restlessness, drug cravings, and depression. According to the prescribing information for Adderall XR published by the drug’s manufacturer Shire, someone who abuses the drug regularly may suffer from psychotic symptoms similar to schizophrenic side effects, insomnia, personality changes, hyperactivity, irritability, and skin issues. Regular Adderall abuse may also be recognizable by significant weight loss, aggressive behavior, suicidal ideations, extreme emotional highs and lows, strange sleep patterns, and a lack of attention to personal hygiene.
Coupled with all of the physical manifestations, Adderall addiction has many behavioral indicators. Some common signs of drug addiction are:
- More risk taking and out-of-character actions
- Withdrawal from friends and family
- Secretive behaviors
- Lack of interest in things that were previously very important
- Inability to consistently take care of work, school, or family obligations
- Increased absences at school or work
- Legal and/or financial troubles
- Erratic behaviors, including increased hostility
- Many attempts to stop taking Adderall without success
- Taking more Adderall at a time or for longer than intended
- Perpetuated use of Adderall even in full awareness of negative consequences
Even though Adderall is often used to get ahead at school, individuals who abuse the drug generally have lower college grade point averages (GPAs) than students who don’t abuse it, NIDA reports. Prolonged abuse of Adderall can lead to cardiovascular complications, increased risk for the transmission of an infectious disease, malnutrition, psychiatric issues like paranoia, troubles with interpersonal relationships, and other negative social, emotional, physical, and behavioral manifestations.
People who abuse drugs like Adderall are more likely to have a buildup of the drug in their bodies, which can lead to an increased risk of uncomfortable or harmful side effects. Some of these include:
- Dizziness from blood pressure changes
- Paradoxical restlessness and inattention
- Reduced appetite
- Dry mouth
- Trouble sleeping
- Changes in heart rate
- Raised body temperature
- Hallucinations and delusions
People who take a lot of Adderall, especially for a long time, are at greater risk of developing an addiction, suffering chronic health issues, or overdosing on the drug.
Some people who abuse Adderall believe that prescription drugs are safer than “street” drugs, but this is only true of prescriptions that are taken as directed by a doctor for conditions that need treatment. Taking prescription drugs for nonmedical reasons is just has risky as taking illicit substances like cocaine. And, as with cocaine or crystal meth, it is very possible to overdose on Adderall. Overdose symptoms include:
- Rapid, irregular heartbeat
- Irregular, shallow breathing
- Hyperthermia, or dangerously high body temperature
- High blood pressure
- Stroke or heart attack
- Extreme paranoia
- Violence toward oneself or others
If a person appears to be overdosing on any drug, including Adderall, call 911 immediately. They need emergency medical attention to survive. After an overdose, the person may still suffer chronic problems with their heart, kidneys, liver, and brain.
Adderall and Other Drugs: Polydrug Abuse
When a person mixes two or more drugs for nonmedical reasons, that is polydrug abuse. Although Adderall is abused among thousands of people for performance-enhancing reasons, it is also abused for purely recreational reasons; in these instances, it may be mixed with other drugs, most commonly alcohol.
Mixing stimulant drugs with depressants, including alcohol or opioids, is very dangerous. These two substances compete in the body, increasing the risk of overdose and alcohol poisoning. Mixing drugs like Adderall and opiates, alcohol, benzodiazepines, or other substances may also increase the risk of temporary psychosis, which can lead to self-harm or harm to others. Severe sleep deprivation can harm the mind, and behavioral changes can cause a person to break bones, experience a concussion, have a serious accident, or contract a sexually transmitted infection.
A recent study conducted by researchers at Johns Hopkins University found that, between 2006 and 2011, nonmedical abuse of Adderall among adolescents and young adults, ages 18-25, went up over 67 percent; emergency room treatment and admissions for Adderall overdose rose over 155 percent; and half of those ER admissions involved Adderall and alcohol.
Treating Adderall Abuse and Addiction
Adderall abuse may start out simply enough, with someone merely seeking to get an “edge” professionally or academically. It may even begin with a legitimate prescription for the drug and devolve into nonmedical use. Individuals may “doctor shop,” or seek out multiple doctors for an Adderall prescription. Others may invent ADHD symptoms in order to get a prescription. Individuals may suffer from ADHD and not be diagnosed with the disorder, causing them to potentially seek out the drug for purposes of self-medication.
The NSDUH of 2013 published that over half of the prescription drugs that were abused that year were obtained from a friend or relative for free. Fulltime college students with legitimate Adderall prescriptions divert their medications for abuse about 30 percent of the time, the National Association of Boards of Pharmacy (NABT) reports. The journal Pharmacotherapy published a study indicating that individuals who begin using a prescription stimulant in college are close to four times as likely as their peers to develop issues with substance abuse.
After detox, an individual may enter into either an outpatient or residential substance abuse treatment program that will likely employ behavioral therapy, counseling, and often holistic treatment methods as well. Motivational Interviewing (MI) is a type of behavioral therapy that uses a nonconfrontational approach. Individuals develop a relationship with a trained mental health professional who provides nonjudgmental support and encouragement while helping the individual to see the need for change and improvement. Individuals attend group and individual sessions in which they are able to find the motivation within themselves to make positive changes.
Other behavioral therapy models and techniques, like Cognitive Behavioral Therapy (CBT), may also be beneficial during Adderall addiction treatment. CBT can offer new and healthier tools for coping with stress and improving communication skills.
Adderall abuse may occur alongside other mental health concerns or disorders, in cases of co-occurring disorders. SAMHSA reports that almost 8 million people over the age of 17 in the United States suffered from co-occurring disorders in 2014. When this is the case, both the substance use disorder and the mental health disorder are typically treated in an integrated fashion with the aid of both pharmaceutical and therapeutic techniques.
Addiction treatment isn’t a “cure” for addiction. Long-term recovery for Adderall abuse and addiction must be sustained, as addiction is a disease that must be actively managed. Ongoing attendance at support groups and participation in aftercare programs can help to sustain recovery in this way.