Part I Gen Adderall; What Is Adderall?

Photo by E. Wagele

This blog is taken from Casey Schwartz’ article in the NY Times of 10-12-16. I have edited and shortened it:

Adderall is the brand name for a mixture of amphetamine salts prescribed to treat Attention Deficit Hyperactivity Disorder, a neurobehavioral condition marked by inattention, hyperactivity and impulsivity, predominantly seen in children. That condition (also Attention Deficit Disorder) has been increasingly diagnosed over recent decades: In 1990, 600,000 children were on stimulants, usually Ritalin, an older medication usually taken multiple times a day. By 2013, 3.5 million children were on stimulants; Adderall was the new, upgraded choice for A.D.H.D.—more effective, longer lasting.

By the mid-2000s, adults were the fastest-growing group receiving the drug. In 2012, roughly 16 million Adderall prescriptions were written for adults between ages 20 and 39. Adderall has now become ubiquitous on college campuses, taken by students with and without a prescription. Black markets have sprung up at many, if not most, schools. According to a review published in 2012 in Brain and Behavior, the off-label use of prescription stimulants had come to represent the second-most-common form of illicit drug use in colleges by 2004. Only marijuana was more popular.

Adderall was an accident. In the late 1920s, chemist Gordon Alles, searching for a treatment for asthma, synthesized a substance related to adrenaline, which was known to aid bronchial relaxation. Alles had created beta-phenyl-isopropylamine, the chemical now known as amphetamine. Injecting himself to test the results, he noted a feeling of well being, followed by a rather sleepless night. By the 1930s, the drug Benzedrine, a brand-name amphetamine, was being taken to elevate mood, boost energy and increase vigilance. The military dispensed Benzedrine tablets, also known as “go pills,” to soldiers during World War II. After the war, with slight modification, an amphetamine called Dexedrine was prescribed to treat depression. Women, especially, loved amphetamines for their appetite-suppressing side effects and took them to stay thin, often in the form of the diet drug Obetrol. But in the early 1970s, with around 10 million adults using amphetamines, the Food and Drug Administration stepped in with strict regulations, and the drug fell out of such common use. More than 20 years later, pharmaceutical executive Roger Griggs revisited the now largely forgotten Obetrol. Tweaking the formula, he named it Adderall and brought it to market aimed at the millions of children and teenagers who doctors said had A.D.H.D.

Martha Farah, a cognitive neuroscientist at the University of Pennsylvania, has studied the effect of Adderall on subjects taking standardized tests that measure restraint, memory and creativity. On balance, Farah and others have found very little to no improvement when their research subjects confront these tests on Adderall. Ultimately, she says, it is possible that “lower-performing people actually do improve on the drug, and higher-performing people show no improvement or actually get worse.”

For years, the predominant explanation of addiction, promulgated by researchers has revolved around the neurotransmitter dopamine. Amphetamines unleash dopamine along with norepinephrine, which rush through the brain’s synapses and increase levels of arousal, attention, vigilance and motivation. Dopamine, in fact, tends to feature in every experience that feels especially great, be it having sex or eating chocolate cake. This is why dopamine is so heavily implicated in current models of addiction. As a person begins to overuse a substance, the brain—which craves homeostasis and fights for it—tries to compensate for all the extra dopamine by stripping out its own dopamine receptors. With the reduction of dopamine receptors, the person needs more and more of her favored substance to produce the euphoria it once offered her. The vanishing dopamine receptors also help explain the agony of withdrawal: Without that favored substance, a person is suddenly left with a brain whose capacity to experience reward is well below its natural levels. It is an open question whether every brain returns to its original settings once off the drug.

Jeanette Friedman, a social worker with a specialty in addiction, said, “There’s such a casual use of something like Adderall nowadays—because it’s seen as benign, or a help to becoming more productive. There’s a tremendous pressure not just to do well but to excel.” When she is face to face with an addicted patient, what is at stake is that patient’s very ability “to become a full person without the shadow of always needing something. It’s very hard to think about going off it, because you don’t know if you’re going to be able to produce,” she says.

Harris Stratyner, a psychologist and addiction specialist, said each year he’s in practice he sees more people desperate to get off Adderall. Many are using it to mask a sense of disappointment in themselves because it narrows their focus down to simply getting through each day, instead of the larger context of what they’re trying to build with their lives. “It becomes extremely psychologically and physiologically addictive,” he says. “It’s really a tough drug to get off of.” The side effects of Adderall withdrawal that his patients report include nausea, chills, diarrhea, body aches and pains, even seizures. Occasionally, it is necessary for him to hospitalize his patients as they come down off Adderall.

See Part II of Gen Adderall in my next WordPress blog, January 31—a personal story of the author of this article, who was addicted to it.

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