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