We get a lot of phone calls from people asking about Adderall and the negative impact they’ve seen on their children or loved ones. In particular, we see issues arise when Adderall is used in combination with other drugs.
It is well known that stimulant medications are therapeutically beneficial for children and adults diagnosed with Attention Deficit Hyperactivity Disorder, as well as people who suffer from narcolepsy. Adderall is a prescription medication that is used to treat these conditions. It contains a combination of amphetamine and dextroamphetamine, which are central nervous system stimulants. Adderall was approved for treating ADHD in 1996, though stimulants have been used since the 1930s to treat the symptoms of ADHD.
Anyone who loves a cup of coffee or tea in the morning understands how stimulants can help get the day going–that jolt of caffeine is just what we need. Narcolepsy is a sleep disorder characterized by excessive daytime sleepiness. It is caused by a dysfunction of the brain mechanism that controls sleep and wakefulness. People with narcolepsy often have sudden, uncontrollable bouts of sleep during the day. These bouts can be both dangerous and debilitating, making Adderall’s use in managing the symptoms of narcolepsy easy to understand, even with the risks inherent in the drug..
Attention Deficit Hyperactivity Disorder (ADHD) is a neurological condition that affects concentration, impulse control, and overall executive functioning. ADHD is characterized by low levels of neurotransmitters, which are chemicals that carry signals between brain cells.
Adderall is a Schedule II drug, meaning it has a high potential for abuse and dependency, but also has acceptable medical uses. Even when taken as prescribed, for legitimate medical reasons, patients are at risk for dependency at best, and addiction at worst. However, the potential for abuse and dependency is much higher when Adderall is used without medical direction and for non-medical reasons.
When a person diagnosed with ADHD takes Adderall, it works to balance the neurotransmitters by increasing dopamine and norepinephrine. This leaves them feeling calmer, more focused, less impulsive, and better able to manage their day, time, and activities. Executive functioning improves, which in turn improves performance at work or school and in relationships..
A person without ADHD has an appropriate amount of neurotransmitters. When they take Adderall, their brain is overloaded with dopamine and norepinephrine. Excess dopamine can disturb normal brain functions and cause euphoria instead of having the calming effect it would typically have on someone with ADHD. Chasing that feeling of euphoria too often triggers addiction.
Adderall on College Campuses
Adderall abuse is a big problem on college campuses across the United States. Students often take Adderall to help them study or stay up all night to finish assignments. Some students believe that Adderall will help them get better grades. However, Adderall is a powerful medication, and it can be very dangerous when it is misused.
“A 2016 study in the Journal of Clinical Psychiatry found that Adderall use among young adults who didn’t have ADHD jumped 67 percent in recent years and that emergency room visits related to these medications rose 156 percent.”
It’s hard to accurately gauge the prevalence of Adderall abuse on campus, but it appears that around 20% of students have misused or currently misuse stimulants.
“While exact numbers are hard to pin down, a 2018 article in the Journal of Undergraduate Neuroscience Education reports that an estimated 20% of college students abuse prescription stimulants—most often by using drugs for which they do not have a prescription.”
College students’ drive to use Adderall to stay up all night studying or get better grades may well backfire. It is true that Adderall can increase alertness and energy levels, but a small pilot-study in 2018 by researchers at the University of Rhode Island and Brown University showed that “the stimulant medication may actually impair working memory performance in college students without ADHD.”
In spite of that, many college students claim that in some ways, Adderall seems to meet their needs. “College is often a high-pressure environment, both socially and academically, and Adderall provides students with a way to meet these demands,” psychologist and owner of Anchor Counseling & Wellness Rebecca Cowan, PhD, LPC, NCC, tells WebMD Connect to Care. “They can stay up all night socializing with friends and use Adderall to help stay alert and focused the next day when writing a paper or studying for an exam.”
While the question of how well Adderall actually meets their needs remains, the perception of doing more, accomplishing more, without the benefit of sleep is a very strong pull. (Sleep deprivation is a whole other topic.)
Adderall, Alcohol, and Other Drugs
In another study, out of the University of Georgia, research shows that College students who use ‘study drugs’ also tend to binge drink and use marijuana. The study’s author, Ash Warnock, said that stimulant use may actually be an attempt to catch up with their studies.
Students who spend their weekends partying with drugs and alcohol will then turn to stimulants to make up for lost study time. He also said that because users feel stimulated, they erroneously interpret that as more focused, when in fact, research shows that people who use stimulants this way are likely doing worse than they would without them.
How Bad is It?
Students may initially consider Adderall for the hoped-for effects of greater focus and concentration (and the ability to stay awake round the clock), but many of those who abuse it are also looking for the high.
Adderall often means they party harder and longer and with multiple substances. The effects of Adderall on metabolism mean that alcohol and drugs enter the system faster, but the effects of those drugs are often masked by the effects of Adderall. This can lead to dangerous conditions where overdosing on alcohol or other drugs can happen simply because the user does not “feel” as drunk or high as they would without Adderall, putting themselves at great risk.
Using Adderall this way is extraordinarily dangerous but is not at all uncommon. According to the Substance Abuse and Mental Health Services Administration’s Dawn Report, in 2010 there were 31,244 ER visits involving ADHD stimulant medications. Of these:
- 25% involved one additional drug,
- 38% involved two or more additional drugs.
- 45% involved other pharmaceuticals
- 21% involved illicit drugs (marijuana, stimulants, cocaine and heroin).
- 19% involved alcohol.
(Don’t be alarmed that the numbers don’t seem to add up – remember that many of these ER visits involved 2, 3 or more drugs.)
Adderall & Addiction
We know that addiction is a complex condition involving psychological or physical dependence (or both.) With Adderall, what may start as an attempt to get ahead with school and grades can quickly devolve into compulsive substance use despite harmful consequences.
Why is Adderall Addictive?
We’ve seen why college students are increasingly turning to Adderall–to help them concentrate during study and exams, and to make up for time lost partying, but it is the rush, the feeling of euphoria, that gets them.
“‘Adderall is addictive largely because of its stimulant qualities,’ Jenna Liphart Rhoads, PhD and nurse educator, tells WebMD Connect to Care. ‘People often take Adderall for help with focus and academic performance. It is also used to elevate mood and decrease appetite.
‘The medication works by increasing dopamine—a ‘feel-good’ hormone—and norepinephrine levels in the central nervous system—the brain,’ Rhoads says. People can get used to these high levels of dopamine and norepinephrine over time and feel dependent on the drug.’”
It’s Not All Euphoric
People who abuse Adderall over a long period start to see negative side effects. They may experience sleep difficulties, depression, irritability, mood swings, paranoia, and panic attacks. No wonder parents and loved ones are concerned!
Other side effects of long-term Adderall abuse are:
The Importance of Qualified Medical Supervision and Full Disclosure
Recently, The Wall Street Journal published an article titled Harlan Band’s Descent Started With an Easy Online Adderall Prescription which highlights another problem in the space of Adderall abuse.
During the Covid-19 Pandemic, telehealth became normalized. This has some definite benefits. Unfortunately, we saw some telemedicine companies, especially those whose focus is on ADHD, make it far too easy to get stimulants, despite their risky side effects. Former clinicians from several of these companies have complained that they were under pressure from the top officials of the company to prescribe drugs like Adderall freely.
Harland Band’s psychiatrist knew about his history of substance abuse, so when Band came to him for ADHD treatment, he prescribed him non-stimulant and ‘low-risk’ (according to the article) stimulant medications. Band returned and reported that the medication wasn’t working. Band wanted Adderall. The doctor refused to give him Adderall, because of the high risk of relapse.
Band arranged a consultation with an online telemedicine company specializing in services for ADHD in October 2020. He neglected to inform the clinician that he was a recovering drug addict and received a prescription for 30mg of Adderall.
Not surprisingly, Adderall triggered his addictive cravings and he relapsed. After several weeks of drug use, Band returned to rehab, but signed himself out after just a few days.
Harlan Band died of a drug overdose a week later. The toxicology report showed that he had amphetamine, methamphetamine, cocaine, morphine, codeine, and various tranquilizers in his system. The official cause of death was acute opiate and cocaine intoxication.
Informed, Aware, and Vigilant
While Adderall’s benefits for those who have legitimate medical need for it cannot and should not be ignored, neither should the inherent risks. It is important to be informed, aware, and vigilant about the possible risks of prescription stimulants and dangers of stimulant abuse.
- If you take Adderall for narcolepsy or ADHD, minimize your risks. Work closely with your doctor, take it only as prescribed, monitor what’s happening with you, and ask a trusted friend or family member to keep an eye out as well.
- If you have a high schooler or a young adult in college, talk to them about the dangers of taking Adderall without medical need or supervision.
- If you have a high schooler or a young adult who takes Adderall for medical reasons, talk to them about the importance of following their doctor’s instructions, the dangers of sharing their medication and the importance of maintaining “custody” of their prescriptions.
If you are worried about a loved one and suspect they may be abusing Adderall or other drugs (prescription or illicit), reach out today. There’s always hope. We can help.