Adderall is a combination of amphetamine and dextroamphetamine. The most common medicinal uses for Adderall include the treatment of the symptoms of ADHD and narcolepsy.
ADHD (attention deficit hyperactivity disorder) is a developmental disorder consisting of issues with attention impulsivity and hyperactive behavior. It occurs most often in children and adolescents but can occur in adults. Narcolepsy is a sleep disorder where individuals have severe issues with daytime sleepiness.
The ingredients in Adderall are classified as central nervous system stimulants. Adderall is marketed in immediate-release and extended-release versions (Adderall XR). The extended-release alternative was designed to be used by individuals with ADHD so they could avoid having to take the drug more than once daily.
Despite very well-intended medicinal uses, the drug is a potential drug of abuse. The United States Drug Enforcement Agency classifies all forms of Adderall as Schedule II controlled substances, meaning they can only be legally obtained with a physician’s prescription, and despite their utility in the treatment of certain medical or psychological conditions, they also have the potential to be abused. Chronic use can lead to physical or psychological dependence.
The abuse of stimulants is a major issue because these drugs have the effect of increasing energy levels, instilling a sense of wellbeing and euphoria, decreasing the need for sleep, and bolstering productivity at work or school, but they can also lead to physical and mental impairments.
For the most part, these drugs are prescribed for a number of medical and psychological conditions, and individuals who use stimulant medications within the confines of their prescription and according to their doctor’s orders will typically not develop a substance use disorder, but they may still develop some level of psychological or physical dependence to them. While the development of psychological or physical dependence can be a sign of a substance use disorder (drug abuse or addiction), it is not necessarily an indicator of the abuse of the drug. A substance use disorder is defined as the nonmedicinal use of a drug that leads to issues with control and has negative ramifications on the individual’s life. People who use the drug for medicinal purposes and within the confines of their prescription are not abusing it, even if their use does result in some level of psychological or physical dependence.
The majority of people who abuse Adderall are between the ages of 12 and 30. Stimulant drugs like Adderall have gained popularity with high school and college students who grind up the pills into a powder and snort them to achieve greater energy and awareness for long periods of study. This is obviously drug use outside the instructed methods of the prescription.
Stimulant abuse is often associated with the abuse of sedatives and other central nervous system depressants that include benzodiazepines, narcotic pain medications, and alcohol. These substances often help individuals who abuse stimulant medications to “come down” from the effects of the drugs; however, this can be a fatal combination due to the potential for respiratory suppression, stroke, or even heart attack.
Tolerance to stimulant drugs often develops rapidly. As individuals need to use more and more of the drug to get the same type of effects they got at lower doses, they begin to also develop the potential for physical dependence. Physical dependence consists of both tolerance and withdrawal (negative consequences as a result of either stopping the drug altogether or significantly cutting down the amount one is taking).
The actual presentation that occurs in any single individual will vary depending on a number of general and specific factors, including how long the individual abused Adderall, how much Adderall they typically abused, if they typically abused Adderall with other drugs, and personal differences in metabolism and psychological or emotional disposition. In some cases, individuals will present with only a few symptoms of withdrawal, and in others, they may present with a number of varied symptoms.
Withdrawal from Adderall
Even though there will be quite a bit of variance in the actual experience of withdrawal that an individual goes through, a general timeline for the withdrawal process from Adderall would most likely include three stages:
- Most people will experience the initial “crash” relatively quickly, and the majority of individuals will experience this 24-48 hours following discontinuation. There is quite a bit of variation in the time it takes the individual to experience the crash and in its intensity. In addition, depending on the factors mentioned above, the crash may last for one day, several days, or longer. This initial stage is often very severe and induces strong cravings and the desire to use Adderall. Symptoms can include a loss of energy, extreme hunger, increased need for sleep, anxiety, severe depression, issues with concentration, issues with memory, irritability, and extreme feelings of depression.
- An extended period of alternating issues with irritability, attention, fatigue, mood swings, and cravings to use the drug that are not as strong as in the initial crash but still discomforting usually occurs. This extended period can last for many weeks.
- After 10-12 weeks, some individuals may also experience longer periods of subclinical symptoms, such as issues with motivation, restlessness, fatigue, apathy, and intermittent cravings that are variable in their intensity.
When attempting to discontinue Adderall after a period of abuse, it is prudent to consult with a physician who specializes in addiction medicine. The potential for relapse is quite high during the withdrawal period, and medical detox will increase the chances that the individual will not relapse during withdrawal.
Treatment for Withdrawal from Adderall
Medical detox will often include the administration of other medications to assist with the negotiation of withdrawal symptoms and cravings. Withdrawal management can be performed in an inpatient or outpatient setting, and the choice to use inpatient or outpatient treatment for withdrawal depends on individual circumstances. Someone who is at a high risk for relapse, has attempted to quit using Adderall numerous times unsuccessfully, has significant severe withdrawal symptoms, or has a potentially toxic living situation may be more suited to inpatient detox.
The use of medications to assist with the withdrawal process from Adderall should only be undertaken while one is under the supervision and treatment of a licensed physician.
- The muscle relaxant baclofen is useful in treating the initial symptoms of withdrawal from stimulants, including severe depression and cravings for Adderall.
- Topamax and Neurontin are anticonvulsant medications that have significant empirical evidence indicating that they are useful in avoiding significant cravings and alleviating the symptoms of the “crash” associated with withdrawal from Adderall and other stimulants.
- Withdrawal from Adderall is often associated with extreme lethargy and sleepiness, especially in the early stages. This is because individuals who abuse stimulant medications often do not get sufficient sleep or their sleep cycles are severely disturbed. Provigil has been used to reduce the sleepiness associated with the withdrawal from Adderall.
- Specific medications to address certain types of symptoms can be used depending on the individual case. Individuals may need medications for nausea, headache, and even more serious but rare symptoms, such as hallucinations. These can be used at the discretion of the physician.
- The withdrawal management process may extend the acute phase of withdrawal slightly; however, the person will be able to negotiate the withdrawal syndrome with significantly fewer symptoms and have an increased probability of avoiding relapse.