Adderall is a combination of amphetamine and dextroamphetamine that is designed to be used in the treatment of attention deficit hyperactivity disorder (ADHD) and narcolepsy.
Adderall comes in several different forms, including Adderall IR (immediate release) and Adderall XR (extended release).
Adderall is classified as a central nervous system stimulant, and any form of Adderall is considered to be a Schedule II controlled substance by the Drug Enforcement Administration. Drugs in this classification status are considered to have medicinal purposes but also to have a high potential for abuse and physical dependence. Adderall can only be legally obtained with a prescription from a physician.
- Abuse of Adderall
Stimulant medication abuse is always been a concern in the United States. Typically, individuals who are prescribed stimulant medications by physicians, and use them for medicinal purposes within the confines of the prescription, are not as likely to abuse them as people who obtain them illegally or use them to achieve the euphoric effects that they can produce in large amounts. Adderall and other stimulant drugs used in the treatment of ADHD have recently been noted to be popular drugs of abuse by students in high school and college.
Whenever someone uses a prescription medication outside the intent of the medication, such as grinding pills into a powder and snorting it, this is a definitive sign of abuse. When these drugs are taken in this manner, their effects are felt immediately, and they are enhanced. The abuse of these medications on college campuses has been based on the notion that they provide individuals with energy, at low to moderate doses increase the ability to concentrate (although at higher doses, they interfere significantly with concentration), and people under the influence of these drugs can remain awake for extended periods. This has made them popular with students who attempt to study for lengthy periods, and to party and engage in other activities without needing as much sleep as they might need without the drug.
Students who abuse Adderall are more likely than their non-college peers to abuse other drugs. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), a national survey of college students investigating their use of stimulant medications and other medications within the previous year of taking the survey indicated that:
- Fulltime students in college between 18 and 22 years of age were more than twice as likely as individuals in the same age group who were not in college to have abused Adderall.
- College students who abused Adderall were nearly three times more likely to have used marijuana, eight times more likely to use cocaine (another stimulant), five times more likely to have abused prescription pain medications, and eight times more likely to have abused prescription tranquilizers, such as benzodiazepines.
- Almost 9 out of 10 fulltime college students who abused Adderall were also binge drinkers within the last month, and more than half of college students abusing Adderall were heavy users of alcohol.
The above findings and similar studies indicate a severe issue with substance use disorders in college students who abuse prescription stimulant medications, such as Adderall. Mixing central nervous system depressants, such as tranquilizers, pain medications, and alcohol, with stimulants can be a potentially fatal practice due to the increased potential to develop a stroke, cardiac arrest, or even respiratory failure. In addition, the book Young Money: Inside the Hidden World of Wall Street Post Crash Recruits, released in 2014, claims that Adderall was the go-to drug for the majority of young college graduates seeking careers in the business world. This indicates that Adderall abuse may be a growing concern in the United States.
- Signs of Abuse and Withdrawal
The abuse of stimulant drugs leads to a rapid development of tolerance (the need to use more of the drug to get the same effect one got initially). Chronic abuse of stimulant medications can also produce withdrawal symptoms that have some physical aspects to them but are considered to be primarily psychological in nature. These symptoms are generally described as consisting of:
- Physical symptoms, such as an increase in appetite, a decrease in energy, an increased need for sleep, weight gain, chills, sweating excessively, irregular heartbeat, tremors (rare), and flulike symptoms
- Psychological symptoms that include cravings, anxiety that can be mild or severe (in some cases, panic attacks are reported), social withdrawal from others, uncertainty or a lack of confidence in one’s ability to perform tasks that were typically performed under the influence of the drug, and depression (commonly referred to as “the crash”)
- Severe symptoms, such as suspiciousness, paranoia, and hallucinations
In addition, long-term physical issues, such as cardiovascular issues, are associated with chronic stimulant abuse.
Negotiating the ‘Crash’ from Adderall Abuse
The withdrawal process from Adderall and other stimulants is considered to occur in the following manner:
- An initial crash occurs relatively quickly following the discontinuation of Adderall and can last up to several days. The average time individuals experience this crash is 24-48 hours after last use, although there is quite a bit of variation, and the crash can last for several days. This stage is often the most severe and includes many symptoms, such as a loss of energy, need for sleep, hunger, increased cravings, shakiness or tremors, anxiety, depression, and even issues with concentration and memory.
- An extended withdrawal phase that can last up to 10 weeks following the initial crash occurs in many people. This phase is characterized by alternating periods of fatigue and irritability, issues with attention and concentration, and intermittent cravings to use the drug.
- An extended period of withdrawal is believed by some clinicians to occur in some individuals and may continue for months to even years. This phase is characterized by depression, apathy, and cravings that are most often triggered by stress or by situations that were associated with using the drug. Some researchers termed this “the extinction phase.”
In order to reduce the effects of the initial crash, one can approach the process “cold turkey,” use central nervous system depressants such as alcohol (this is not recommended), start using Adderall again (which will simply delay the inevitable crash that will occur when one stops using the drug), or become involved in a medically assisted detox program.
There are some medications that can assist one in the early phases of withdrawal from Adderall; however, these should only be administered under the supervision of a physician. This can be done either in an inpatient or outpatient setting. The choice of the setting for the medically assisted detox process will depend on the specific case. Individuals should discuss their options for detox from Adderall with a licensed, addiction treatment professional.
Most of the medications used in treating withdrawal symptoms from cocaine and other stimulant medications are useful in the early phases of withdrawal from Adderall.
- Some anticonvulsant medications, such as Neurontin and Topamax, have been found to be useful in the initial stages of withdrawal from stimulant medications. They can reduce cravings and assist with avoiding the crash.
- Baclofen is a muscle relaxant that has also been demonstrated to be useful in negotiating cravings and issues with the crash during withdrawal from stimulants.
- Provigil is a mild stimulant that is sometimes used to reduce the extreme sleepiness and lethargy that are associated with the early crash.
- Antidepressants or anti-anxiety medications (anti-anxiety medications need to be used with discretion) can also be useful for some people.
- Other medications can be used for specific symptoms, such as antipsychotics for individuals who may become seriously paranoid, analgesics if individuals experience headaches, medications for nausea, etc.
Individuals going through the initial stages of withdrawal from Adderall can also adopt some personal strategies to ease the crash.
- Drinking plenty of water and remaining hydrated will reduce some of the symptoms of withdrawal and also help to rid the system of toxins.
- Eating healthy by avoiding excessive fatty foods or carbohydrates may help to deal with some of the lethargy associated with withdrawal. Some sources suggest taking vitamins. Certainly, taking healthy amounts of vitamins is not detrimental; however, taking megadoses of vitamins is probably not going to make a significant difference. The research regarding the use of megadoses of vitamins to assist with withdrawal from drugs remains mixed. Individuals who wish to use high doses of vitamins should discuss this with their physician before engaging in this practice.
- Mild exercise, such as walking, and just remaining active with friends and family can reduce the psychological effects of the crash and also keep the mind busy and focused.
- Getting involved in an active treatment program will also help the person to focus on the recovery process, deal with the early withdrawal symptoms associated with discontinuing Adderall, and provide the person with useful information from other individuals who have experienced similar issues. Treatment can assist with the development of coping strategies and other methods of negotiating withdrawal that can be useful.
It is important to remember that the initial crash one experiences with discontinuing Adderall is only a temporary situation. After 3-4 days, a person should be able to regain focus and concentrate on moving forward. However, cravings will continue to return for some time and will often be sparked by stress and other environmental triggers. Sometimes, they may appear to come out of nowhere. Without engaging in a focused treatment program that identifies personal triggers, develops coping strategies, and prepares for long-term recovery, a person remains at a high risk for relapse.