What Kind of Drug Is It?
Adderall and Adderall XR are amphetamines (pronounced am-FETT-uh-meens), which are drugs that increase mental alertness. Adderall is manufactured by Shire Pharmaceuticals Group, a drug company headquartered in the United Kingdom with offices throughout the UK, the United States, Canada, and parts of Europe. Amphetamines are stimulants, or substances that increase the activity of a living organism or one of its parts.
In the 2003 edition of their book Drugs 101: An Overview for Teens, Margaret O. Hyde and John F. Setaro defined stimulants as "drugs used to increase alertness, relieve fatigue, [and make users] feel stronger and more decisive."
Adderall tablets are blue or orange, depending on the dosage, and are imprinted with the letters "AD." Adderall extended–release capsules are also blue or orange, depending on the dosage, and are imprinted with the name "Adderall XR." One side of each capsule is transparent. Both the tablets and the capsules are marked with a number (for instance, 5, 10, or 20) to identify the strength of the medication in milligrams.
The active ingredients in Adderall are used to treat symptoms of attention-deficit/hyperactivity disorder (adhd), narcolepsy, and sometimes obesity. In the 1960s, the drug was marketed under the name Obetrol. The U.S. Food and Drug Administration (FDA) approved a new formulation of the drug, known as Adderall, for the treatment of ADHD in early 1996.
Official Drug Name: Adderall (ADD–urall), Adderall XR; a mixed amphetamine sulfate (am–FETT–uh–meen SUL–fate)
Also Known As: Speed, uppers
Drug Classifications: Schedule II, stimulant
ADHD is a disorder that begins during childhood. However, in many cases, it is not diagnosed until adulthood. It is very difficult for people with ADHD to focus their attention and control their behavior. Children with ADHD are easily distracted and have difficulty concentrating, especially on schoolwork. They may also talk excessively, interrupt conversations, and have trouble waiting their turn. In many cases, people with ADHD display impulsive behavior, which frequently continues into adulthood.
More About ADHD
The terms hyper and hyperactive are often used negatively when referring to people with ADHD. Such terms are stereotypes—labels, often negative, used to describe all people within a certain group regardless of whether they are true about everyone or not. It is important to note, however, that not everyone who talks a lot has ADHD. Not everyone who fidgets or gets antsy has ADHD. Not everyone who taps a pencil when taking a test has ADHD.
The truth is that ADHD affects people in completely different ways. Some of the symptoms are described in a booklet on the disorder published by the National Institute of Mental Health (NIMH). The authors note that some children with ADHD may "appear to be daydreaming, 'spacey,' easily confused, [or] slow moving" rather than overly active. Either way, the authors explain, it is important to realize that "many normal children may have these symptoms, but at a low level, or the symptoms may be caused by another disorder." The NIMH stressed the need for children with symptoms of "hyperactivityimpulsivity" or "inattention" to "receive a thorough examination and appropriate diagnosis by a well–qualified professional."
Adderall helps manage the symptoms of ADHD by increasing the release of dopamine. Dopamineisa neurotransmitter. Itactsonthe part of the brain responsible for filtering incoming information, making choices, judging behavior, and deciding when and how to act.
What Is It Made Of?
Amphetamines like Adderall do not occur naturally; they cannot be grown in a garden or dug up from the ground. Rather, amphetamines are synthetic, or manufactured, substances that consist of the elements carbon, hydrogen, and nitrogen.
Amphetamines are drugs that give people more energy. This allows users to do more and stay awake longer without getting tired. This effect of "speeding up" people's actions explains how amphetamines came to be known by the street names "speed" and "uppers."
The composition of amphetamine pills or capsules is actually a combination of various types of crystalline compounds called amphetamine salts. Adderall is a chemical compound that contains equal parts of four different amphetamine and dextroamphetamine salts. For this reason, it is referred to as a mixed amphetamine. (The only difference between amphetamine and dextroamphetamine is a few molecules of dextrose, which is a type of sugar.) (Entries on amphetamines and dextroamphetamine are also available in this encyclopedia.)
How Is It Taken?
Adderall comes in both tablet and capsule form and is taken by mouth. Adderall tablets can be prescribed for patients as young as three years old. Adderall XR is the name given to the "extended release" form of the drug. It is recommended for use only in patients age six and older.
People who take Adderall tablets by prescription need to take two or three pills each day, one at a time, approximately four to six hours apart. Adderall XR is a once-a-day treatment for ADHD. The key to this extended relief formula lies in the two different types of tiny ball-shaped granules packaged in each capsule. These granules are known as amphetamine beads. Half of the beads in Adderall XR begin working immediately after their release from the capsule. The other half takes several hours to dissolve. This bead mixture "extends" the effect of the drug throughout the day, relieving the symptoms of ADHD for a full twelve hours. It is very important that the full contents of thecapsulearetakenatthesametimeto ensure the proper timing of the drug's release.
The starting dose of Adderall for new patients is 5 to 10 milligrams daily. The maximum dose is 30 milligrams per day. It takes about 30 to 60 minutes for a prescription-strength dose of Adderall to begin working on the symptoms of ADHD.
Are There Any Medical Reasons for Taking This Substance?
The FDA has approved the use of mixed amphetamine salts to treat ADHD and the sleep disorder narcolepsy. As of 2005, the main medical use for Adderall was as a treatment for ADHD. In Internal Medicine Alert, William T. Elliott and James Chan stated that mixed amphetamine salts like Adderall are as effective as Ritalin and other methylphenidates in the treatment of ADHD in children, adolescents, and adults. (An entry on Ritalin and other methylphenidates is also available in this encyclopedia.)
Amphetamines are successful in the treatment of ADHD because they help improve the user's ability to concentrate. Drugs like Adderall and Adderall XR have been shown to increase performance accuracy, improve short-term memory, speed up reaction time, aid in solving mathematical problems, and even increase problem-solving abilities in games. In November of 2004, the Washington Neuropsychological Institute released the results of a series of tests involving simulated driving experiences in nineteen- to twenty-five-year-old ADHD patients. Asia Africa Intelligence Wire reported that Adderall XR was shown to improve driver safety for up to twelve hours in the young adults who took it before participating in the driving experiment.
What's the Difference between ADD and ADHD?
According to the Attention Deficit Disorder Association's Fact Sheet on ADHD, "the difference is mainly one of terminology, which can be confusing at times.… Many people use the term ADD as a generic term for all types of ADHD.… Whether we call it ADD or ADHD, however, we are all basically referring to the same thing."
In 2003, Jessi Castro, a high school student in Miami, wrote a letter to Time magazine about her experience with ADHD and Adderall. She credited her straight-A success in school to Adderall. "I may be naturally smart," she wrote, "but I never could have applied myself as much without it [Adderall]."
Adderall and Narcolepsy
Adderall has also relieved the symptoms of narcolepsy, an unusual condition that causes people to fall asleep quickly and unexpectedly. A narcoleptic's sleep is often brief but quite deep and usually unplanned. The possibility of falling into an uncontrollable sleep at any time makes everyday life very difficult. Thus, ordinary activities such as driving can be very dangerous for people with narcolepsy.
Like all amphetamines, Adderall speeds up bodily functions. In fact, one of the most common side effects reported among Adderall users is an inability to sleep. Although this side effect can be troublesome for patients taking Adderall to treat the symptoms of ADHD, it produces a much-desired feeling of alertness in people with narcolepsy. By decreasing the frequency and severity of narcoleptic sleeping episodes, Adderall allows people with this condition more freedom to engage in the activities of normal daily life.
Adderall and Weight Loss
Adderall was originally manufactured and prescribed as a weight loss drug called Obetrol. Amphetamines tend to decrease feelings of hunger in people who take them, making them an often-abused drug among dieters. Amphetamine use for weight loss can be very dangerous. Most doctors agree that the best way to regulate weight is through moderate exercise and a healthy diet. Drugs like Adderall are only available with a doctor's prescription and are rarely used legally for weight control.
ADHD: Not Just Kids' Stuff
According to a 2004 Pharma Business Week article, "Up to 65 percent of children with ADHD may still exhibit symptoms into adulthood and an estimated 4.4 percent of the U.S. adult population is affected by ADHD." Based on U.S. Census Bureau information released on January 7, 2005, 4.4 percent of the adult population adds up to more than 8.8 million people over the age of eighteen.
In September of 2004, Adderall XR was approved for use by adults with ADHD. Results of a U.S. survey cited by Pharma Business Week revealed that "adults with ADHD are twice as likely to be divorced or separated and have had almost twice as many jobs… compared to adults without ADHD. Importantly, 43 percent of adults with ADHD report that they lost or left one or more jobs due in some part to their ADHD symptoms." In addition, survey takers found that adults with ADHD run a greater risk of depression, antisocial behavior, and low educational achievement.
The use of Adderall among overstressed high school and college students became a problem in the early 2000s. "In the past, pick-me-ups like coffee, Diet Coke, or over-the-counter caffeine pills have been popular choices among students to get an extra buzz for studying," wrote Jillian Foley in America's Intelligence Wire in December 2004. "But in recent years, some… students have started turning to Adderall… to help them study, take tests, and write papers." But why would so many students without ADHD want to take a medicine for a disorder they do not have? Nicholas Zamiska offered an explanation in the November 8, 2004 issue of the Wall Street Journal. He explained that "studies conducted by the National Institutes of Health in the late 1970s found that low-dose stimulants increase concentration and alertness in everyone, not just people with attention disorders."
"What's It Like to Have ADD?"
Author and physician Edward M. Hallowell has ADD himself. In the article "What's It Like to Have ADD?," available on the Attention Deficit Disorder Association Web site, he describes his experiences:
It's like driving in the rain with bad windshield wipers. Everything is smudged and blurred and you're speeding along, and it's really frustrating not being able to see very well. Or, it's like listening to a radio station with a lot of static and you have to strain to hear what's going on. Or, it's like trying to build a house of cards in a dust storm. You have to build a structure to protect yourself from the wind before you can even start on the cards.
Inotherwaysit'slikebeingsuper-chargedall thetime.Yougetoneideaandyouhavetoact on it, and then, what do you know, but you've got another idea before you've finished up with the first one, and so you go for that one, but of course a third idea intercepts the second, and you just have to follow that one, and pretty soon people are calling you disorganized and impulsive and all sorts of impolite words that miss the point completely. Because you're trying really hard….
Plus which, you're spilling over all the time. You're drumming your fingers, tapping your feet, humming a song, whistling, looking here, looking there, scratching, stretching, doodling, and people think you're not paying attention or that you're not interested, but all you're doing is spilling over so that you can pay attention. I can pay a lot better attention when I'm taking a walk or listening to music or even when I'm in a crowded, noisy room than when I'm still and surrounded by silence….
The adult syndrome of ADD, so long unrecognized, is now at last bursting upon the scene. Thankfully, millions of adults who have had to think of themselves as defective or unable to get their acts together, will instead be able to make the most of their considerable abilities. It is a hopeful time indeed.
"The effects that make [Adderall] appealing to many students include decreased drowsiness and increased attentiveness for hours," wrote Omid Fatemi in America's Intelligence Wire in 2004. "[B]ut Adderall is a prescription drug for a reason." Many of the students
who use the drug know very little about the way it works, how it interacts with other drugs, and how easy it is to overdose. Side effects, Fatemi stated, range "from stomach pain to insomnia to an irregular heartbeat, and it can even cause brain damage." More and more media reports describe how Adderall is being used for academic success in increasingly competitive school environments. Many members of the educational community predict that the issue will need to be addressed head on in the coming years.
Effects on the Body
Technically, Adderall is a psychostimulant. As Dr. Robert Hart explained in an article for Drug Topics by pharmacist Katie Rodgers, "Psychostimulants, in a sense, put your foot on the brake and help with the stopping." This is what makes them so effective in the treatment of ADHD. Patients who take Adderall are better able to ignore distractions and focus solely on the task at hand, whatever that task may be.
The most frequently observed side effect of Adderall is difficulty sleeping. Adderall can also cause nervousness, dizziness, restlessness, rapid heart rate, headache, stomachache, nausea, decreased appetite, weight loss, dry mouth, and skin rashes. A study cited in the Journal of the American Academy of Child and Adolescent Psychiatry (2001) showed that younger patients are more likely to experience a loss of appetite when taking Adderall than older ones. In addition, as noted in Psychopharmacology Update in 2005, Adderall and other psychostimulants used in the treatment of ADHD may cause users to develop jitters, motor tics (repeated blinking or tapping of feet or fingers, for example), and/or vocal tics (such as frequent throat clearing).
A two-year study showed reductions in both the average height and the average weight of preteens taking Adderall for their ADHD, according to Sherry Boschert in Pediatric News. Results of the study indicate that higher dosages of Adderall affected the growth rate more than lower doses did. Overall, however, the children's growth was slowed by about one-half inch per year. Adderall tends to decrease the appetite, so some scientists believe that the children who take it are not eating as well as they should. This could play a role in their slower gains in height and weight. "No one knows whether these children might catch up in growth during adolescence or if stopping the medication would lead to catch-up growth," noted Boschert. "And no one knows if the growth lag could be modified by good nutrition."
"Taking Adderall for ADHD when you do not have ADHD can have serious consequences," noted Jillian Foley in America's Intelligence Wire. The human body needs sleep in order to function properly. Sleep deprivation is just one of the many dangers associated with amphetamine use. Frequent use can result in a psychological addiction, which can develop quickly, especially in people who already show signs of depression. Overdose of amphetamines can result in fever, convulsions, hallucinations, and even death.
A Psychopharmacology Update article published in January 2005 warned that Adderall can increase the severity of "behavior disturbances and thought disorder in psychotic patients." Psychotic patients suffer from one or more forms of psychosis, which disrupts the way the mind functions. As a result, people suffering from a psychotic episode can become completely withdrawn from reality.
Is It Cheating?
By the early 2000s, Adderall abuse among high school and college students had become a significant problem. "Overall, prescriptions for stimulants have risen to 2.6 million a month in 2004, from 1.6 million in 2000," according to a Wall Street Journal article. About 850,000 of those prescriptions are for Adderall. Students without ADHD reportedly find it fairly easy to get the drug from fellow students who have a prescription for it.
High school students of the early twenty-first century seemed to face increasing pressure to perform well on standardized tests. Many students feel like their "entire future may be riding on the results," explained Frances Mejia in an article for CNNfyi.com. The results of these tests weigh heavily in the college admissions process. Higher scores on standardized tests like the SAT and the ACT improve students' chances of being able to attend the schools of their choice. "[P]art of a [high school guidance] counselor's role these days is not only to prepare a student for the test academically, but also emotionally."
Some high school students admit taking Adderall in the hopes of improving their performance. They reported a jump of up to 200 points in their overall SAT scores. One twelfth grader interviewed in the Wall Street Journal claimed that Adderall helped her get her highest-ever SAT score in March of 2004. "It's a crazy kind of feeling of confidence, looking at a problem and saying I can do this in five seconds," she recalled.
Reports like this raise questions about drug use, academic fairness, and the law. Are students who deliberately use drugs like Adderall to improve their school performance guilty of cheating? Can they get into legal trouble for their actions? What about the students who do not take any performance-enhancing drugs? Will the Adderall-taking students gain an academic edge over their drug-free peers? High schools usually suspend students caught using other drugs on school grounds. However, a guidance counselor from Bethesda, Maryland's Chevy Chase High School sees a different trend with Adderall use to boost standardized test scores. He told the Wall Street Journal that as of 2004, the school had "never suspended or otherwise punished a student for using a prescription drug to help on an SAT."
Reactions with Other Drugs or Substances
Children taking a doctor-prescribed dosage of Adderall or Adderall XR for ADHD should be given their dose early in the day and should avoid high-fat breakfasts. In the early 2000s, medical researchers were investigating the possibility that high-fat foods might delay how quickly the drug is absorbed throughout the body. It has also been noted in several medical journals, includingPsychopharmacology Update, that some fruit juices may interfere with the release of Adderall into the system.
Adderall should not be used by people with depression or suicidal tendencies or by people taking medicine to control their high blood pressure. In late 2004 the FDA called for changes in how boxes of Adderall XR were labeled. New labels warn that "misuse of amphetamine may cause sudden death and serious cardiovascular adverse events." This means that people who take Adderall XR without a doctor's prescription run the risk of suffering serious heart damage and could even die.
Treatment for Habitual Users
In the question-and-answer section of a fact sheet titled "Evidence–based Medication Management for Children and Adolescents with ADHD," researchers reported significant findings. The authors note: "Multiple studies that have followed children with ADHD for 10 years or more support the conclusion that the clinical use of stimulant medications does not increase the risk of later substance abuse." In fact, when children with ADHD receive the appropriate drug treatment, their risk of later drug or alcohol problems is the same as that of any other non-ADHD individual. The researchers further stated that "although there is potential for abuse when misused, psychostimulant medications do not cause addictions to develop in those being treated appropriately."
Regular users who stop taking Adderall should be taken off the drug slowly and are advised to do so under the care of a physician. Long periods of sleep, increased irritability, and severe depression can result if users discontinue Adderall suddenly rather than gradually.
Abuse of Adderall can lead to tolerance and psychological dependence. This means that, over time, the frequent user will begin to feel that he or she needs more and more of the drug to function effectively. "For now," wrote Sheena Smith in America'sIntelligence Wire in late December of 2004, "there is little regulation concerning the illegal use of Adderall."
Adderall is a controlled substance. Its use is regulated by certain federal laws. The Controlled Substances Act (CSA) of 1970 called for the assignment of all controlled drug substances into one of five categories called schedules. These schedules are based on a substance's medicinal value, harmfulness, and potential for abuse and addiction. Schedule I is reserved for the most dangerous drugs that have no recognized medical use.
Amphetamines like Adderall fall under Schedule II, dangerous drugs with genuine medical uses that also have a high potential for abuse and addiction.
Possessing amphetamines without a medical doctor's prescription is against the law and can result in imprisonment and stiff fines. People convicted of distributing amphetamines—selling or giving away prescribed drugs—face lengthy prison terms and fines of up to $2 million.
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