Adderall: A Drug to Watch as Schools Reopen

College student tries to study.

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With many students returning to college campuses this fall, young people will have an opportunity to reconnect with their friends in person again. Considering the mental health impact of social distancing and isolation from their peers, this switch from virtual to in-person schooling is a welcome change for many. But it can also mean a number of risks for vulnerable students.

Substance use among college students will be an important trend to watch as in-person classes resume. According to a 2021 study, college students reported less frequent alcohol use during the pandemic, especially those who moved back home to live with their parents. This raises the question of whether young people, as they return to campus, will be more likely to turn to drinking as a means of fitting in with peers, “self-medicating” social anxieties, or managing other stressors.

And this risk goes beyond drinking, of course. Adderall (and other stimulant medications prescribed for ADHD) has been increasingly misused by college students. Researchers from John Hopkins University noted that people aged 18-25 made up 60 percent of unprescribed Adderall users pre-COVID.

A year and a half after the start of the pandemic, the 2021-2022 academic year could bring even more significant rises in Adderall misuse and addiction rates among young people.

What Is Adderall?

Adderall is a prescription medication meant to treat attention deficit hyperactivity disorder (ADHD). It contains a combination of amphetamine and dextroamphetamine, which are central nervous system (CNS) stimulants that affect the chemicals in the brain that contribute to hyperactivity and inattention. The stimulant class of medications (which also includes prescription drugs such as Vyvanse®, Ritalin®, Concerta®) work on the dopamine transporter system in the brain, affecting both norepinephrine and dopamine receptors and activating the CNS.

Clients with ADHD have what is traditionally called a “paradoxical” response to stimulants, meaning they generally become calmer and more focused when taking these medications at proper doses. They do not become “wired” or “stimulated” by these drugs. Stimulants like Adderall can have a very positive impact on the professional and educational performance and experience of those with ADHD by increasing one’s ability to focus. They often have the added benefit of improvements in self-esteem and mood in clients who suffer from ADHD.

Of course, there are side effects to stimulants, including decreased appetite and sleep disturbance (especially if taken later in the evening). Some patients experience irritability or anxiety when they’re on the medication, and some patients simply do not like the “zoned-in” feeling they get. Others may experience mood changes and irritability when the medication wears off.

Abuse, Misuse, and Diversion

When Adderall is misused, the potential negative outcomes are maximized. Adderall abuse can include consuming larger doses or taking the medication more frequently than prescribed, “snorting” the medication rather than taking it orally, or using the stimulant medication to counteract the effects of more sedating drugs (like benzodiazepines, alcohol, or opiates).

When stimulants like Adderall are taken improperly or in excessive amounts, people may experience the classical “crash” of withdrawal. People who take excess Adderall in order to stay up late, or to get high, may experience next-day feelings that are similar to depression.

Prolonged misuse of high doses of amphetamines can cause a depletion of neurotransmitters — including dopamine, norepinephrine, and serotonin — and may require treatment for these sustained depressive symptoms. Seizures and amphetamine-induced psychosis are possible as well. Using excessive amounts of amphetamines can also cause elevated heart rates and cardiac arrhythmias, which can be fatal.

Diversion of stimulant medications is also a significant problem on college campuses. For many students with ADHD, this may be the first time they are “in control” of their supply of their medications. Even clients who know they need their stimulants to focus and succeed in school may be tempted or pressured to give their medication to a roommate or a fraternity brother or a girlfriend/boyfriend for unprescribed use. Providing college students with a lockbox to safely store their medications is a worthwhile back-to-school expenditure.

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Alternatives to Adderall for Those Struggling With ADHD and Addiction

It is crucial that the ADHD diagnosis is properly established before prescribing medications like Adderall. This is usually through neurocognitive or educational testing done by a psychologist specifically trained in psychometric testing.

But students with ADHD do deserve to be treated. People with untreated ADHD are at higher risk for developing depression, anxiety, and substance use disorders (SUDs). Clients with untreated ADHD are also at a higher risk of being involved in motor vehicle accidents and are more likely to struggle to find social and academic success.

Although stimulants may be the treatment of choice for ADHD, there are non-stimulant medications (such as Strattera® and Intuniv®) as well as off-label use of medications that improve concentration and motivation. These might be considered as first-line treatment for clients in recovery, who have a history of addiction to other substances. Adderall’s effect on the brain may trigger cravings and increase the risk for returning to other substances — and, therefore, may be contraindicated in this population. Similarly, clients with a history of “abusing” their stimulants (including diverting their prescribed medications to their peers) might be switched to one of the non-stimulant options.

Additional Resources for Students With ADHD

And medications (whether stimulants or non-stimulants) are not the only answer for students with ADHD. Clients with ADHD should be encouraged to connect with the school’s Students-with-Disabilities department. Students with ADHD may qualify for special accommodations, including extra time for testing, testing in a distraction-free environment, or one-on-one tutoring for those students who have difficulty paying attention in large lecture halls. Additionally, students with ADHD should supplement medications and accommodations with proper sleep and regular exercise to support holistic wellness. All individuals with ADHD should be encouraged to maintain a close connection with their prescribing doctor and other caring professionals who can help them develop strategies to manage their ADHD symptoms and help them avoid some of the risks and pitfalls.