It allows children with attention-deficit hyperactivity disorder (ADHD) to settle down and concentrate on their studies in the classroom. It treats narcolepsy, allowing people who suffer from sudden attacks of sleep to lead normal lives. And, increasingly, it’s being abused amongst adults without any disorders in efforts to become more productive and “get ahead.” Have you heard about Adderall?
What Is Adderall?
Adderall is the brand name of a legal prescription medication that’s been around since the 1960s. The drug is a combination of two stimulants, amphetamine and dextroamphetamine, which boost levels of the neurotransmitters that control hyperactivity and impulse control. When taken by people who have ADHD, this stimulation in the brain caused by Adderall has a calming effect, allowing the person to concentrate on the task at hand and calm behavior.
Currently, there are two versions of the drug available: the “original” Adderall and Adderall XR (there are generic versions of both). The XR version, or extended release, is meant to mimic the effect of taking two doses of the drug four hours apart. Currently, children as young as 3 years old can take the original Adderall, while XR is approved for ages 6 and above.
And there are many people eligible for Adderall. The Center for Disease Control and Prevention estimates that as of 2011, approximately 11 percent of children ages 4–17 were diagnosed with ADHD – that’s 6.4 million. (1) Though the disorder is more common in children and young adults than “grown-ups,” about 4 percent of America’s adult population has been diagnosed with the disorder. (2)
There is no strict test for diagnosing someone with ADHD — a doctor can’t draw blood and proclaim that someone does or doesn’t have ADHD. Because of that, doctors instead follow a standard of diagnosis that includes asking whether the hyperactive/impulsive symptoms have been present for at least six months; symptoms are interfering with functioning in social, academic or professional settings; and symptoms aren’t better explained by another cause. Whether or not a person receives a “positive” diagnosis is at the doctor’s discretion, but medication is usually part of the treatment plan.
Side Effects of Adderall
Though I advocate for more natural remedies for ADHD and following an ADHD diet (see below) when feasible, for many people, Adderall may be medically necessary. But like any prescription drug, Adderall comes with a long list of possible side effects.
For starters, Adderall comes labeled with the FDA’s black box warning. This is the strictest warning available for prescription drugs and indicates serious or life-threatening risks. (3)
Adderall’s label states that “amphetamines have a high potential for abuse. Administration of amphetamines for prolonged periods of time may lead to drug dependence and must be avoided … Misuse of amphetamine may case sudden death and serious cardiovascular adverse events.”
Remember, this is a drug that children as young as 3 years old can be prescribed. And if you thought amphetamines sound familiar, you might have heard of them as speed or as part of crystal meth.
Adderall XR’s medication guide also comes with some helpful tips on what can occur from taking the drug:
- For all patients, hazards include mental problems, like new or worse behavior and thought problems, aggressiveness and hostility. It can also cause increased blood pressure and heart rate, sudden death in patients with heart problems or defects (good luck if you aren’t aware of these beforehand) and circulation issues in fingers and toes, or peripheral vasculopathy.
- For children, there are a few extras to watch out for, including new psychotic symptoms like hearing voices or believing things that aren’t true.
These hazards are quite scary. High blood pressure, for instance, can lead to an aneurysm, heart failure, reduced kidney functions and damage to the arteries.
Likewise, peripheral vasculopathy, or PVD, is a progressive circulation disorder, often characterized by a burning pain in the fingers and toes or the feeling of extremities always being cold.
PVD is caused by the narrowing, blockage or spams in a blood vessel. When the blood flow to the arms and legs are reduced, there’s less oxygen and nutrients available for the tissue. Clots end up forming on artery walls, restricting the flow of blood to the limbs even more and even blocking major arteries. If this decrease in blood flow continues over a long-enough amount of time, complications including severe pain, stroke, reduced mobility and even amputation can follow.
Another concern with Adderall is that it’s often masking another disorder, like depression, manic depression or bipolar disease. While Adderall might temporarily lessen the symptoms, the underlying problem isn’t being resolved.
On top of all that, Adderall can cause a whole host of more common side effects, like a loss of appetite, insomnia, headaches, changes in sex drive, dry mouth and gastrointestinal complications, like diarrhea and constipation.
For someone who genuinely needs Adderall, this is a terrifying list. But increasingly, Adderall is also being used off-label by people who are either abusing the drug or don’t medically need it.
Off-Label Use and Addiction
Adderall enables people who have serious difficulties keeping focused. But in people without the disorder, the drug becomes a performance enhancer, enabling them to concentrate on specific tasks, improve attention and do it with very little sleep.
That is, many of Adderall’s side effects, detrimental to people who actually need the medication, are the very reasons that off-label use is so popular. A lack of appetite and insomnia become a way to lose a few pounds while being able to pull an all-nighter and write that paper for class or get extra work done to score that promotion.
What’s frightening is that people often don’t consider Adderall a “real drug.” How can it be a real drug, they wonder, when I know so many people who get these prescriptions?
One study found that, among college students, Adderall was considered physically harmless and morally acceptable. (4) Since their peers are using it, the argument goes, it’s necessary to keep up the competitive advantage. And besides, all things in moderation, right?
It’d be easy to chalk this up to another crazy fad happening on college campuses. But off-label Adderall use is common outside of dorm rooms and libraries. After amphetamines were banned from major league baseball in 2005, “therapeutic use exemptions” shot up from 28 players to 103 in 2013. (5) Busy moms who are keeping up with the Joneses are popping pills. (6) Even scientists are trying to enhance their mental performance with Adderall. (7)
People who use Adderall off-label often start out by getting Adderall pills from a friend or family member. But because Adderall can be obtained legally and a friend’s generosity only goes so far, most eventually get their own prescription.
Since there’s no real test for ADHD, getting this approval is easier than you might think. There are entire web posts with tips on convincing your doctor you need an Adderall script: “Study the following sample questions and you’ll be sure to come out with an FDA certified lifetime meth subscription. All for the price of a $20 per month insurance co-payment. And all it takes is one hour of your attention.” (8)
Another study even assessed three groups of students who were told to convince the doctor they had ADHD (9).
One group was made of students who really did have the disorder and were off their medication; the second group didn’t have ADHD; and the third group didn’t have the disorder but were told to convince the assessor they did.
Based off the two self-report tests, researchers couldn’t distinguish the real ones from the fakers. Even the more complex neuropsychological tests couldn’t make the distinction.
Being loose with the prescription pad has another side effect as well: profit. Since 2002, sales of prescription stimulants have more than quintupled, to over $8 billion annually. From the New York Times:
The rise of A.D.H.D. diagnoses and prescriptions for stimulants over the years coincided with a remarkably successful two-decade campaign by pharmaceutical companies to publicize the syndrome and promote the pills to doctors, educators and parents. With the children’s market booming, the industry is now employing similar marketing techniques as it focuses on adult A.D.H.D., which could become even more profitable. (10)
All this for a drug that might only let people think it’s making them smarter or allowing them to perform better. A University of Pennsylvania study found that after being given Adderall, subjects were more likely to attribute a better job on tasks they’d been given to the pill, even while they didn’t show an improvement over those given a placebo. (11)
As Adderall’s own warning advises, the drug is also highly addictive, though there is one bright side: once a person ceases to use Adderall and the drug has left their body, there is no permanent brain damage. But using the drug over the prescribed dosage over an extended period of time increases risk of Adderall’s scary side effects and may even worsen them.
Unfortunately, the rampant misuse of Adderall also winds up having a detrimental effect on people who really do need the drug and use it as indicated. It was only in the 1960s that ADHD was recognized by scientists as a real disorder, but it still suffers from the stigma that it’s a convenient excuse for not paying attention or being rowdy.
Alternatives to Adderall
I appreciate that for some people, prescription medication might be the missing ingredient to living a healthier life. But I encourage you to try natural alternatives to Adderall as well:
Eliminate foods with artificial coloring. While the FDA says that food dyes are safe, they have been linked to hyperactivity in children. (12) There are quite a few food colorings that are banned in Europe because manufacturers cannot prove they’re non-toxic, but are allowed in the U.S.
Avoid gluten. Is there a correlation between gluten and ADHD? Maybe. One study eliminated gluten from the diets of people ages 7–42 who identified as having Celiac’s and ADHD. (13) After six months of a gluten-free ADHD diet, the subjects reported a significant improvement in their ADHD symptoms, leading researchers to believe that gluten might exacerbate ADHD-like symptoms.
Cut out sugar. And not just that teaspoon of sugar in your morning tea, but addictive sugar in all its sneaky forms: soda, fruit juice, candy, artificial sweeteners, condiments. Riding a sugar high can intensify behaviors similar to ADHD symptoms.
When used properly, Adderall might help treat an ADHD problem. But with its high risk of side effects, abuse and likelihood of addiction, it’s best chosen as a last measure.