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How Does Adderall Addiction Start?

In 2018, more than 4.6 million people were estimated to have misused prescription amphetamines—a group of drugs that includes Adderall.1 Adderall is a psychostimulant medication intended for use to treat attention deficit hyperactivity disorder and narcolepsy. Adderall is a Schedule II controlled substance, meaning that despite its approved medical uses, the drug has a high potential for abuse and significant physiological dependence.2 Adderall does come with serious risks; misuse or nonmedical use can dangerously increase the likelihood of adverse effects, including addiction development.

Adderall and other amphetamines increase the activity of several monoamine neurotransmitters—in particular, dopamine and norepinephrine—by both increasing their release and subsequently blocking their reuptake by the brain cells that released these chemical messengers in the first place.3,4 Though the mechanism of therapeutic effect (e.g., increased focus) isn’t fully understood, increased norepinephrine activity is associated with several characteristic physiological effects (e.g., increased heart rate, breathing, blood pressure) and increased dopamine activity is thought to underlie the reinforcing properties of several drugs of abuse.4,6

Adderall and its generic equivalents are commonly taken as oral tablets or capsules.5 In some instances, individuals may attempt to inject, snort, or smoke the contents of the capsules or crushed tablets in an attempt to achieve a more rapid onset, intense high.4,5Such methods of intentional misuse could increase the reinforcing effects of the drug, and increase the likelihood of addiction development over time.

Effects on the Body

Adderall misuse is associated with several characteristic physiological effects, ranging from mild to severe. Some of the more short-term or acute effects include:6,7,8

  • Euphoria.
  • Hyperactivity.
  • Gregariousness.
  • Grandiosity.
  • Anxiety.
  • Insomnia.
  • Hallucinations.
  • Psychomotor agitation and movement irregularities.
  • Seizures.
  • Muscular weakness.
  • Chest pain.
  • Arrhythmia.
  • Confusion.
  • Sweating.
  • Dilated pupils.
  • Dry mouth.
  • Loss of appetite.
  • Nausea or vomiting.
  • Changes in heart rate—often tachycardia, or rapid heart rate.
  • Blood pressure changes—often elevated.
  • Increased body temperature.

Some of Adderall’s long-term side effects may arise in connection with certain short-term effects such as reduced appetite and cardiovascular stress. Potential long-term problems may include malnutrition/unhealthy weight loss, cardiomyopathy, necrotizing vasculitis, and adverse mental health changes such as chronically erratic behavior and psychosis.6,8

For those who attempt to inject Adderall, there may be a greater risk of contracting blood-borne illnesses, such as HIV/AIDS or hepatitis, if non-sterile needles and supplies are used.5 Additionally, blood vessel inflammation or blockage may also be a risk with injectable routes of Adderall misuse.8

Adderall overdose is also possible, and can be fatal. Signs that someone may be overdosing on Adderall include: 4,7,10

  • Marked agitation.
  • Vivid hallucinations.
  • Panic.
  • Confusion.
  • Hyperpyrexia (dangerously elevated body temperature).
  • Tremors.
  • Seizures and convulsions.
  • Toxic dysrhythmia (aberrant heart rhythms).
  • Heart attack.
  • Loss of consciousness.
  • Coma.
  • Death.

If overdose is suspected, emergency services should be contacted immediately.

How Does Addiction Take Hold?

Adderall is a federally controlled substance with known potential for abuse as well as physical or psychological dependence. The United States Drug Enforcement Agency indicates that Schedule II drugs like Adderall are considered dangerous, despite its medical use.2

How does Adderall addiction develop? Amphetamine addiction—which is diagnosed as a stimulant use disorder—is thought to develop as a result of a complex interplay of several factors, including both biological/genetic and environmental components. Like cocaine, Adderall influences dopaminergic neurotransmission throughout the “reward circuitry” of the brain.4 And, though it is no doubt an oversimplified approximation of a precise neurochemical basis for addiction, such altered neurotransmission is thought to underlie the reinforcing, euphoric qualities of drugs like Adderall, which helps to drive their compulsive use for many individuals.

The reinforcing reward of Adderall use and subsequent addiction risks may be increased in several situations, such as:8

  • Taking a higher dose of Adderall than prescribed.
  • Taking Adderall more often than prescribed.
  • Crushing tablets and then snorting or injecting Adderall.
  • Taking Adderall nonmedically merely for a euphoric high.
  • Mixing Adderall with other reinforcing substances, such as alcohol or opioids.

Prescription stimulants like Adderall are widely abused by college students, in part because of a misconception of their efficacy as study drugs or performance enhancers—for example, to help someone stay awake for late-night studying sessions.4 Despite this popular belief, the National Institute on Drug Abuse states that there is no evidence for any academic performance benefit in people without ADHD; intentional misuse of the drug in this manner continues to expose people to health risks such as cardiovascular disease and addiction.8,9

A substance use disorder involving prescription stimulant misuse is likely to have developed as use of the drug becomes compulsive, and such use is associated with significant issues such as health problems or difficulties meeting work, school, or family responsibilities.4

Other diagnostic features of a stimulant use disorder involving Adderall include:7

  • Adderall is frequently used in larger doses and/or for longer periods of time than intended.
  • Inability to quit or cut back on using Adderall, despite persistent efforts to.
  • Devoting a large amount of time to obtaining, using, and recovering from Adderall
  • A failure to manage responsibilities at home, work, and school as a result of Adderall use.
  • A strain on interpersonal relationships related to Adderall use.
  • Declining interest in participating in or fulfilling recreational, social, or occupational activities or duties.
  • Use of the drug in potentially hazardous situations.
  • Tolerance to the effects of the drug.
  • The development of withdrawal symptoms when Adderall use slows or stops altogether.

Some individuals may use other substances, such as alcohol or benzodiazepines, to counter some of the unpleasant side effects of Adderall. Such concurrent substance use can introduce additional health hazards and may increase the likelihood of a polysubstance addiction.5

Getting Help

Some people who develop significant Adderall dependence will experience uncomfortable withdrawal effects when attempts are made to stop using the drug. Such withdrawal symptoms may include:4,7,11

  • Dysphoric mood.
  • Depression and the potential for suicidal thoughts.
  • Fatigue.
  • Changes in sleep patterns (e.g., insomnia or increased sleep).
  • Anxiety.
  • Agitation.
  • Irritability.
  • Cravings for Adderall.
  • Anhedonia (inability to feel pleasure or excitement without being under the influence of Adderall).

Though the physical effects associated with stimulant withdrawal are seldom inherently dangerous, they can be distressing, and present a significantly troublesome start to early recovery. Some withdrawal-associated risks, such as that of suicidal ideation are not to be ignored, and professional medical attention may be required.7,11

Though there are no treatment medications specifically approved to manage stimulant withdrawal, close patient monitoring and treatment for associated depression, should it be necessary, may be facilitated in a medical detoxification setting.11 A patient may otherwise be kept as safe and comfortable as possible with professional detox interventions.

While medical detox is not a standalone treatment option, it is a good way to start the recovery process—which often includes a tapered schedule of the prescription stimulant to ease withdrawal and set the course for ongoing recovery—in a safe and supportive environment. Such continued treatment efforts commonly include various behavioral treatment interventions, such as cognitive-behavioral therapy and contingency management.4,12

CBT pairs a client with a therapist to work on identifying and changing learned, drug-related behaviors. Individuals will learn how to recognize situations that put them at risk for using Adderall. They will also learn how to avoid those situations, when appropriate, and how to cope with cravings. Contingency management provides rewards for positive behavior changes, such as negative drug tests resulting from ongoing abstinence.4

As part of a comprehensive addiction treatment program, clinicians will devise the most appropriate plan for the individual in need. With proper care, individuals can stop abusing Adderall for good and sustain long-term recovery.

References

  1. Substance Abuse and Mental Health Services Administration. (2018). Reports and Detailed Tables From the 2018 National Survey on Drug Use and Health (NSDUH).
  2. United States Drug Enforcement Administration. (n.d.). Drug Scheduling.
  3. U.S. Food and Drug Administration. (2017). Medication Guide—Adderall CII.
  4. National Institute on Drug Abuse. (2018). Prescription Stimulants.
  5. National Institute on Drug Abuse. (2019). Commonly Abused Drug Charts.
  6. Lakhan, S. E., & Kirchgessner, A. (2012). Prescription stimulants in individuals with and without attention deficit hyperactivity disorder: misuse, cognitive impact, and adverse effectsBrain and behavior2(5), 661–677.
  7. Diagnostic and statistical manual of mental disorders: DSM-5.(5th ed.). (2013). Washington, D.C.: American Psychiatric Association.
  8. National Institute on Drug Abuse for Teens. (2019). What are Prescription Stimulants (Amphetamines)?
  9. National Institute on Drug Abuse. (2018). What Classes of Prescription Drugs Are Commonly Misused—Stimulants.
  10. United States Drug Enforcement Administration. (2017.) Amphetamines—Fact Sheet.
  11. Substance Abuse and Mental Health Services Administration. (2015). TIP 45: Detoxification and Substance Abuse Treatment.
  12. National Institute on Drug Abuse. (2018). Misuse of Prescription Drugs—Treating Addiction to Prescription Stimulants.
About The Contributor
Scot Thomas, M.D.
Senior Medical Editor, American Addiction Centers
Dr. Thomas received his medical degree from the University of California, San Diego School of Medicine. During his medical studies, Dr. Thomas saw firsthand the multitude of lives impacted by struggles with substance abuse and addiction, motivating... Read More