Ritalin and Adderall Abuse

What Causes Ritalin/Adderall Abuse?

Addiction to stimulants like Adderall and Ritalin occurs when repeated exposure to the drug changes the brain’s response to neurotransmitters. With frequent drug use over time, communication between nerve cells is hindered when the drug isn’t present, causing the user to feel unwell whenever they stop taking the drug. The situation causes the user to seek out more of the drug to keep the good feelings and head off withdrawal symptoms.

Some of the people who become addicted to stimulants are those who have misused their prescription drugs. Many people, however, develop a dependence on the drugs when they use them entirely recreationally. A variety of risk factors make specific individuals more likely than others to develop a substance abuse problem. These risk factors include:

• Family history. People who have close relatives who have suffered from drug addiction are more likely to develop an addiction themselves.
• Abuse of other substances. Stimulant abuse often occurs in conjunction with the abuse of other drugs or alcohol.
• Use in childhood or adolescence. The earlier in life that stimulants are first abused, the more likely the user will develop an addiction.
• Mental illness. Drugs are often used as a coping tool by people with depression, anxiety, post-traumatic stress disorder (PTSD), and other mental illnesses. This can be especially problematic in prescription stimulants because their abuse can worsen some mental illness symptoms, such as bipolar disorder.

Is Ritalin/Adderall Abuse Hereditary?

Researchers determined that there is an inherited risk for abuse of and addiction to stimulants such as Ritalin and Adderall, as well as other drugs. People who have a family history of substance abuse are more likely to develop a dependence on substances themselves. The reason for the increased risk is not apparent, but studies have concluded that the tendency is at least partly genetic.

It may be that specific genes change an individual’s ability to create or respond to neurotransmitters. The increased risk may come from a complex interaction between several genes and external factors. Research into the exact mechanism of the risk is ongoing.

How is Ritalin/Adderall Abuse Detected?

The sooner that stimulant abuse is identified, the more effective the treatment. Abusive behavior is often covert, though, so sometimes the only way to spot it is to look for external signs of drug use.

Warning signs that someone might be abusing or addicted to Adderall or Ritalin include:

• Excitability, irritability, or agitation
• Aggression
• Difficulty communicating thoughts
• Disorientation or confusion
• Risky or impulsive behavior
• Memory problems
• Loss of interest in social activities, relationships, or hygiene
• Weight loss
• Fatigue or changes in sleeping behavior
• Work or school difficulties
• Financial or legal problems

How is Ritalin/Adderall Abuse Diagnosed?

The key to clinically diagnosing a dependency on Ritalin or Adderall lies in distinguishing the drug’s casual misuse from truly abusive behavior or addiction. If the drug’s use has a significant negative impact on the user’s life, a diagnosis may be possible.

The manual used by mental health professionals, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), lays out diagnostic criteria for a condition called stimulant use disorder. The disorder may be diagnosed if the patient exhibits at least two of the following symptoms over a 12-month period:

• Stimulant use is greater than the user intends, either in dosage or frequency.
• The user has a desire to quit or has unsuccessfully tried to stop using the drug.
• The user spends significant time acquiring, using, or recovering from the effects of the drug.
• The user has an intense craving for the drug.
• Drug use is interfering with the user’s obligations or responsibilities.
• Drug use continues despite the harm it does to the user, physically or otherwise.
• Drug use interferes with the user’s everyday activities and routines.
• The drug is used in dangerous situations.
• Tolerance for the drug develops, creating the need for higher doses or more frequent use to achieve the same effect.
• Abstinence from the drug causes withdrawal symptoms.

How is Ritalin/Adderall Abuse Treated?

The appropriate treatment for Ritalin or Adderall abuse depends on the severity of the problem and the individual’s needs. Some people respond better than others to specific treatment approaches, and the best treatment programs are tailored to the individual’s circumstances.

Some commonly used approaches include:

• Inpatient rehabilitation. Residential treatment programs attempt to provide an environment where the patient can recover without being tempted to use the drug.
• Cognitive-behavioral therapy (CBT). This type of talk therapy helps drug users to recognize the triggers that prompt their drug use. CBT also focuses on developing strategies and techniques for dealing with those triggers when they occur.
• Group counseling and 12-Step programs. These programs give the patient the encouragement and support of people experiencing similar struggles with substance abuse.

How Does Ritalin/Adderall Abuse Progress?

Long-term abuse of Adderall, Ritalin, or other stimulants can lead to severe–sometimes even fatal–health effects. Long-term substance abuse can also lead to debilitating social, professional, legal, and financial consequences. Long-term effects of stimulant abuse can lead to:

• Memory loss or concentration problems
• Anxiety or depression
• Lethargy, fatigue, or chronic sleep disruptions
• Irritability and moodiness
• Paranoia
• Suicidal thoughts
• Headaches
• Hallucinations
• Heart disease
• Uncontrollable weight loss
• Chronic constipation
• Tremors or muscle weakness

How Is Ritalin/Adderall Abuse Prevented?

When taken according to the doctor’s instructions, Ritalin and Adderall are relatively safe drugs. When abused, however, they can lead the user to dependency and addictions, conditions from which it’s challenging to recover. To decrease the risk of becoming dependent on or addicted to these drugs, follow these guidelines:

• Use Ritalin and Adderall only as directed. Don’t take more of the drug–or take it more often–than your doctor advises. Don’t adjust the dosage on your own without consulting your doctor. And don’t take the drug expecting an effect other than as a treatment for a medical condition.
• Never take any else’s prescription drugs. Ritalin and Adderall can be dangerous when taken in combination with other substances. Don’t take either of these medications unless your doctor has prescribed them after you’ve let him or her know what other medications you’re taking.
• Don’t get prescription drugs from any unreliable or illegal sources. Illegal sources often sell drugs that have been mixed with other substances or that don’t contain what they claim. Taking these substances can be extremely dangerous.

Ritalin/Adderall Abuse Caregiver Tips

• Don’t be unrealistically afraid of addiction. Attention-deficit/hyperactivity disorder is common among children, and Ritalin and Adderall are commonly prescribed to treat the condition. When used correctly, the drugs are an effective treatment for the disorder, and they are very unlikely to be addictive. However, some parents are also concerned that their child’s use of these drugs could lead to substance abuse problems later in their lives; studies have shown that this is not the case.
• Be aware of how the drugs are used. A common misconception is that Adderall abuse is most prevalent among children and adolescents, the population to whom the drug is most often prescribed. However, abuse of the drug is most common among college-age and older adults. Misunderstanding the problem can lead parents, friends, or loved ones to overlook the possibility of Adderall abuse in young adults.

Stimulant abuse often exists alongside other mental health and brain-related conditions, a situation called co-morbidity. Here are a few of the disorders commonly associated with stimulant use problems:

• Depression and stimulant abuse are often comorbid.
• People with stimulant use disorders also often suffer from anxiety disorders.
• Stimulant abuse is often associated with affective disorders such as bipolar disorder.
• Tobacco addiction, alcoholism, and other substance use disorders are more common in people with stimulant use disorders.

Ritalin/Adderall Abuse Brain Science

In patients with ADHD, Adderall has proven to be effective at increasing memory, mental focus, and impulse control. Those effects have led many young people to believe that the drug can improve school performance and at tasks that require mental agility. Abuse of Adderall often begins when someone without ADHD tries to use the drug to boost their cognitive skills or focus.

Studies have shown, however, that the cognitive effects of Adderall on people without ADHD are minimal. Several studies have suggested that Adderall does not increase academic performance, and some studies have even indicated that stimulant use may impede cognitive ability. The drug may produce over-confidence in users. A user may think they are performing better when they are, in fact, not performing as well as they would otherwise.

Ritalin/Adderall Abuse Research

Title: Relapse Prevention in Stimulant Use Disorder

Stage: Not Yet Recruiting 

Principal Investigator: Edythe D London, PhD     

University of California, Los Angeles

Los Angeles, CA

The purpose of this study is to assess the relationship between bupropion, stimulant use and relapse, ADHD (Attention Deficit Hyperactivity Disorder), and measures of mood, drug craving, and inhibitory control in individuals enrolled in inpatient treatment for stimulant-use disorder with and without ADHD.

The experimenters hypothesize that Bupropion and Contrave (Bupropion/Naltrexone) will increase inhibitory control and decrease drug craving and depressive symptoms in recently abstinent stimulant users in inpatient treatment with effects greater than those seen in recently abstinent stimulant users completing inpatient treatment as usual. An additional hypothesis is that relapse rates after leaving inpatient treatment in the group receiving bupropion will be lower than those of the group completing inpatient treatment as usual.

The study design consists of four assessments of drug craving, inhibitory control, impulsive choice, and mood (depression and anxiety). The time points for these assessments include:

1. baseline after entering treatment 
2. 2 weeks after starting drug 
3. 8 weeks after starting drug 
4. 1 month after leaving treatment. 

Following eligibility screening, 60 stimulant users will be enrolled in one of 3 groups. 

Group 1 Bupropion Active Group: 20 subjects will receive bupropion for 8 weeks during inpatient treatment. 

Group 2 Contrave Active Group: 20 subjects will receive Contrave for 8 weeks during inpatient treatment. 

Group 3 Control Group: 20 subjects enrolled in inpatient treatment will complete treatment as usual, and the four assessments (A-D) described above will not receive the drug (convenience control). 

Half of the subjects in each group will be diagnosed with ADHD, and half will not, for a total of 10 subjects per group with ADHD.

Title: Brain Indices of Stimulant Treatment in Drug-Naive Youth at Risk for Substance Use Disorder

Stage: Recruiting 

Principal Investigator: Jeffrey Newcorn, MD     

Icahn School of Medicine at Mount Sinai

New York, NY

Childhood ADHD and comorbid oppositional defiant disorder (ODD), and conduct disorder (CD) are considered risk factors for subsequent substance abuse. Youth with both ADHD and ODD/CD are at the greatest risk.

However, the effects of treating ADHD with stimulant medications such as methylphenidate (MPH), mixed amphetamine salts (MAS), and the risk for substance abuse are poorly understood. The study team proposes to use fMRI to study the effects of extended-release mixed amphetamine salts (MAS-XR) in drug-naïve youth 7-12 years at low risk (i.e., ADHD only) and high risk (i.e., ADHD + ODD/CD) for substance abuse on the brain’s reward system.  In doing so, the team hopes to better understand the impact of these medications on brain functions which are thought to underlie vulnerability to substance abuse.