- Adderall Tolerance: Can You Decrease It?
- How Does An Adderall Tolerance Build Up?
- How Long Does Adderall Last?
- What Are The Risks Of Abusing Adderall?
- How To Stop Adderall Abuse?
- Why Are Amphetamines So Addictive?
- Addictive Properties of Amphetamines
- Dependence and Cravings
- Methods of Use and the Effects of Amphetamine
- Effects: Short- and Long-Term
- How Long Does Withdrawal From Adderall Last?
- The Dopamine Dilemma—Part II: Could Stimulants Cause Tolerance, Dependence, and Paradoxical Decompensation?
Adderall Tolerance: Can You Decrease It?
Adderall is a stimulant medication that is prescribed to treat attention deficit hyperactivity disorder (ADHD) and sometimes used to treat daytime sleepiness associated with narcolepsy. The drug combines dextroamphetamine and amphetamine, which helps those with ADHD stay focused on tasks and control their movements or attention.
While Adderall has been a prescription medicine since 1960, the drug became popular in the 1990s alongside Ritalin as the medical understanding of ADHD improved and more children and adolescents received timely diagnoses.
The wider prescription of ADHD medications Adderall led to wider diversion of these drugs, usually when children with ADHD gave their medication to their friends. This led to the rise of “study drugs,” or stimulants that were abused to cram for tests or stay up all night writing papers.
Many people who abused Adderall for these reasons as adolescents have not stopped abusing the drugs; they continue abusing stimulants to work longer hours and complete tough projects in a competitive workplace.
Whether one takes Adderall as prescribed or abuses the drug for nonmedical reasons, it is possible to develop an Adderall tolerance. Treating tolerance to a prescription medication will differ, depending on whether the drug is medically necessary or being abused for illicit reasons.
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How Does An Adderall Tolerance Build Up?
The National Institute on Drug Abuse (NIDA) defines tolerance to a drug as a biological process in which one’s body gets used to the presence of a drug and does not respond to it the same way. Over time, any drug’s effects will diminish with frequent, consistent dosing, whether this is through a prescription or because of addiction.
As the original effects fade, the person may be tempted to take more of the substance to achieve the prior sensations. This is especially risky among those who misuse or abuse potent drugs, including Adderall or other prescription stimulants, because they do not have medical oversight.
They may overdose, or they may experience addiction to the substance as they take more and more of it.
People who take Adderall because it has been prescribed should seek advice from their physician, which could involve slowly increasing the dose or moving to a different medicine.
A prescribing physician will always get their patient the minimum effective dose of Adderall, since it is a strong drug; however, this dose is not dependent on age, body weight, or gender, and it can change over time, including as the person develops an Adderall tolerance.
People who are not tolerant to Adderall, but are taking too much, as well as those who abuse Adderall for nonmedical reasons, may experience these side effects:
- Stomach upset, nausea, or vomiting
- Weight loss from decreased appetite
- Dry mouth
- Trouble sleeping
Regardless of the physician’s approach, Adderall tolerance is a normal part of taking this drug for several years to manage a lifelong condition ADHD.
It is not a sign of addiction in those who have a legitimate use for the substance, and doctors understand this.
Warnings from the Food and Drug Administration (FDA) on the drug’s labels clearly state that doctors should re-evaluate their patients’ dose of Adderall over time to ensure they receive the best, therapeutic benefit.
However, people who abuse Adderall to get high or to enhance their performance, and who do not have ADHD or narcolepsy, put themselves at risk, not just for becoming tolerant to or dependent on Adderall, but also for experiencing an overdose, addiction, or chronic health problems from abusing it for a long time.
How Long Does Adderall Last?
Each dose of Adderall Immediate Release (IR) lasts between four and six hours, and many people may move to taking the drug twice per day, or they may increase their dose after several years because the original dose does not manage the symptoms of ADHD. They may switch to Adderall XR (Extended Release) because that drug lasts 12 hours. The largest recommended daily dose of Adderall, according to the Physicians Desk Reference 2011, is 40 mg for ADHD and 60 mg for narcolepsy.
If one has developed an Adderall tolerance at a high dose, their doctor may recommend detoxing and switching to a different stimulant medication. This is because the individual’s body may not respond to any combination of amphetamine, and they may need different stimulants those that make up Ritalin or Concerta.
What Are The Risks Of Abusing Adderall?
People who abuse Adderall and develop a tolerance to it will often rapidly increase how much they take. This puts them at risk of an overdose. If someone overdoses on Adderall or another stimulant, call 911 immediately.
Signs of an Adderall overdose include:
- Extreme restlessness
- Aggression or mood swings
- Confusion or trouble thinking
- Panic attacks
- Anxiety and paranoia
- Rapid, shallow breathing
- Heart palpitations or rapid pulse
- Physical shaking or tremors
- Extreme, paradoxical fatigue
- Passing out or falling into a coma
Additionally, people who develop a tolerance to Adderall because they abuse the drug may seek out other substances to enhance Adderall’s stimulation. Mixing Adderall with illicit drugs, other prescription drugs, or alcohol is extremely dangerous, as it increases the risk of overdose and death.
How To Stop Adderall Abuse?
Physicians are not ly to reduce the dose of Adderall for a person with ADHD because their body has already developed a tolerance to the stimulant, and the person needs consistent medical treatment to manage their condition. Always follow the prescribing physician’s instructions regarding any prescription drug, including Adderall, and let them know if the substance is no longer effective at its current dose.
People who struggle with Adderall abuse need help from addiction specialists. Safely detoxing from the drug may involve tapering the dose down over time because the individual does not have ADHD or narcolepsy as an underlying condition that requires stimulant treatment.
While they may experience withdrawal symptoms, their mental and behavioral health will improve with detox and evidence-based rehabilitation. Entering a rehab program is the second step to ending Adderall addiction, and it will help change behaviors related to stimulant drugs.
Why Are Amphetamines So Addictive?
Amphetamines are a class of synthetic drugs that similarly stimulate the central nervous system (CNS). They are prescribed for legitimate use in the management of attention deficit hyperactivity disorder (ADHD), narcolepsy and, rarely, in cases of extreme obesity.
Commonly Prescribed Amphetamines
Despite their status as legal, yet controlled prescription substances, they are also illicitly abused for their potent stimulant effects that are similar to those of cocaine.
Through their stimulant effects on various processes in the body, and the rewarding high that they elicit, amphetamines have the potential to be physiologically and psychologically addictive.
Through direct molecular interaction and resultant stimulation throughout the nervous system, the amphetamines have the potential to increase activity in both the body and the brain.
While this increased activity can boost alertness, attention, and energy, it can also generate a range of unintended effects—some of which are dangerous, or even life-threatening.
Users of these amphetamine drugs need to be aware that dependence and addiction are potential risks, even if taking them therapeutically. These risks increase when the drug is abused, as the typical medical oversight that occurs among those taking it for medical need is absent.
According to the 2012 Treatment Episode Data Set (TEDS), prescription stimulants amphetamine were involved in 7% of admissions to treatment facilities. In addition, those admitted for amphetamine/methamphetamine treatment were more than ly than all other substance admissions combined to have been referred to treatment by the legal system.
Addictive Properties of Amphetamines
Amphetamine users may find themselves taking increasingly larger doses in order to experience the drug's expected “high” effect.
The brain is made up of neurons (nerve cells) that communicate with each other through the release of chemicals called neurotransmitters.
Amphetamines exert their influence on a family of key brain neurotransmitters (norepinephrine and dopamine) that are related to attention, alertness, blood flow, reward, motor control, and motivation. Amphetamines boost the effects of these chemicals in the brain and body.
The associated increase in activity of these neurotransmitters can induce a feeling of euphoria, as well as a rewarding feeling that motivates continued use.
People who use amphetamines regularly can develop a tolerance to them, which means they need to regularly boost their dosage to achieve the same effect.
Amphetamine users may find themselves taking increasingly larger doses in order to experience the drug's expected “high” effect. This process will continue for as long as a person keeps taking the drug.
The resulting cycle of amplified tolerance and increasingly compulsive drug use fosters addiction and accounts for amphetamines’ high addictive potential.
Dependence and Cravings
A person trying to quit amphetamine use may experience very pronounced physical and psychological cravings for the drug.
As addicts use amphetamines, their bodies chemically adjust to the persistent presence of the drug, and may feel or perform subjectively worse or sub-optimally when the drug is removed.
This state of physiological dependence can result in powerful cravings for the drug when the individual is not using – a major contributor to relapse. Cravings can last for several weeks, while accompanying effects of withdrawal such as depression can last for months and even years after discontinuing use.
When users experience cravings, they often are convinced that they cannot function without the drug because the boost of energy that amphetamines supply is intense and difficult to mimic in normal life.
They also may use amphetamines to cope with personal issues or psychological pain.
Therefore, they become psychologically dependent on the powerful effects that the drug provides to keep them feeling motivated or to “numb” emotional pain and distress.
Cravings (both physical and psychological) are particularly acute at the beginning of detox. The longer the user remains amphetamine-free, the fewer cravings he will experience. In the absence of amphetamines, the brain is able to reestablish its chemical balance. Cravings can be the last of the withdrawal symptoms to dissipate.
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Methods of Use and the Effects of Amphetamine
Amphetamines may be taken orally, snorted, smoked, or injected. Even small doses may exert a profound effect. Depending on the method of administration, the user may experience an intense 'rush' or a prolonged 'high'. Both effects are believed to be due to the release of high levels of dopamine into the pleasure-regulating areas of the brain.
Oral administration of amphetamines is the only route used in the therapeutic setting, but is also a common method of recreational use.
When snorted or inhaled, amphetamines are absorbed rapidly through the mucous membrane. According to the 2012 TEDS, 8% of prescription stimulant abusers inhale the drug as the primary method of use.
Injection of amphetamines is the most complicated and dangerous method of administering amphetamines—not only due to the drug's intense effects, but also to the dangers surrounding needle use. Many variables can cause dose ineffectiveness, serious side effects and even death.
Additionally, the inherent risks of this method (disease transmission, infection, abscesses and other damage due to inadequate technique) make injecting amphetamines a particularly risky habit.
A troubling 25% of prescription stimulant abusers report injection as their method of use, according to the Substance Abuse and Mental Health Services Administration (SAMHSA).
Effects: Short- and Long-Term
Short-term effects of amphetamines may include:
- Euphoria or brief, elated mood.
- Reduced appetite.
- Dry mouth.
- Mild delusions.
- Hypertension (raised blood pressure).
- Rapid heart rate.
Over the long term, abuse of amphetamines can lead to:
- Extreme mood changes.
- More frequent signs of psychosis (e.g., paranoia, tactile and auditory hallucination, etc.).
- Difficulty breathing.
- Loss of motor coordination.
- Markedly disrupted sleep patterns.
- Seizures or stroke.
Combining alcohol with amphetamines is extremely risky, because the stimulant effects of cocaine counter the user’s awareness of alcohol intoxication, which can lead to excessive alcohol consumption and alcohol poisoning. This combination also increases heart rate and blood pressure – in fact, there have been multiple medical reports of heart attacks occurring when alcohol and amphetamines are used together.
According to the Diagnostic and Statistical Manual of Mental Disorders, some of the diagnostic criteria of a stimulant use disorder include (but are not limited to) the following:
To think of it simply, when the user stops taking amphetamines, he may experience withdrawal symptoms because his body and mind have yet to get used to functioning without the substance. Some of the withdrawal symptoms that may be experienced include:
The acute initial symptoms of amphetamine withdrawal can last 1-2 days, followed by a period of days to weeks of mood changes, sleep disturbances, low energy levels, and cravings.
Cravings – which are one of the hallmark signs of withdrawal– can, in some cases, lead to drug relapse even when there is no conscious desire to use the drugs.
The brain becomes conditioned to associate past use behaviors and the pleasurable effects of the drug with emotions, events, and thoughts that can trigger cravings and encourage the individual to return to use to obtain those feelings once again.
Quitting amphetamines can be a difficult and uncomfortable process. Seeking treatment in a professional facility that offers supervised detox can increase the level of comfort during the process and help to minimize the risk of relapse.
Additionally, should any medical issues arise during the process, treatment can be initiated immediately.
This is especially important because someone going through detox on his own may not be able to distinguish between benign withdrawal symptoms and those that would benefit from medical intervention—such as severely depressed mood.
There are several treatment modalities available to those addicted to amphetamines. Initially, the user will have to go through a period of amphetamine detox. During this phase, medications may be used to help manage troublesome and unpleasant withdrawal symptoms.
While no medication has been found to be fully effective in treating amphetamine withdrawal, there are a number of medications that may be used to manage individual symptoms.
Antidepressants may be used to address significant cases of depression and benzodiazepines/antipsychotics may be used to help with irritability and agitation.
After detox, formal treatment, including therapy and counseling, begins. Below are the treatment modalities available:
A number of other means of treatment can also be offered such as herbal remedies, supplements, exercise, and holistic practices (e.g., acupuncture, yoga or massage). Alternative methods have helped many in easing the discomfort associated with amphetamine withdrawal.
A relapse prevention plan will help the user tremendously, not only with preventing amphetamine relapse but also with avoiding a problem with other drugs and/or alcohol (polysubstance abuse or cross addiction).
When the user leaves an addiction treatment facility, it is imperative that they do so with a plan of action at hand. The treatment team in most treatment facilities creates a plan to be followed before discharging the recovering addict from treatment.
The plan should be customized to meet the individual’s needs and address any unique challenges.
While the appropriate recovery approach will vary from individual to individual, the following sobriety-promoting tools are available and helpful for many as they navigate through the journey of recovery.
The more tools the recovering addict has in his toolbox, the more ly he will be to possess and utilize the right one when temptation arises. Early recovery can be challenging and tends to be full of surprises.
Preparation can make the journey a lot easier. The recovering amphetamine addict needs to learn to spot the various relapse triggers and have readily available relapse prevention tools to be used at the right moment.
How Long Does Withdrawal From Adderall Last?
Adderall dependence is more common than you might think. It can happen to anyone who has been using it for an extended period of time, even people who take it exactly as directed. When you become physically dependent on a drug Adderall, it means that when you try to quit you will experience withdrawal symptoms.
If you’ve been using Adderall to study, get high, or to feel more awake, you can also become addicted to it. Addiction is a complex disease that adds another layer of difficulty to the withdrawal experience.
According to research published in 2016, Adderall misuse is most common among people ages 18 to 25. A sizable portion of these users take Adderall because they believe it makes them smarter or more capable of studying.
Adderall use can be daily or intermittent. Some people take Adderall under a doctor’s supervision to treat ADHD, while others acquire it illicitly or intentionally abuse it.
When it comes to withdrawal, the context actually doesn’t matter too much. Anyone who has been using amphetamines for an extended period of time can experience withdrawal symptoms.
If you take large, nontherapeutic doses of Adderall or go on Adderall binges (consecutive days of large doses), then you have probably experienced an Adderall crash before.
The Adderall crash is an intense mini-withdrawal. It typically begins within several hours of your last dose and can continue for one or two days. Most people experience physical and mental exhaustion along with a markedly depressed mood.
After an Adderall binge, you are ly to be sleep deprived and starving. You may eat and sleep a lot while you recuperate.
When you quit Adderall for good, your symptoms will resemble those of an Adderall crash in the beginning, but they will become less intense over time.
If you are not coming off an Adderall binge or you take your Adderall on a regular, daily schedule, then withdrawal symptoms can appear more slowly. You may not notice any symptoms until a couple of days go by.
Adderall withdrawal typically lasts from three days to several weeks, but you may have lingering psychological symptoms and cravings.
Un other withdrawal syndromes, Adderall withdrawal is not associated with any dangerous medical problems. The primary risk that your depressed mood will escalate to suicidal thoughts or behaviors.
Adderall withdrawal is different for everyone. Your withdrawal experience will depend on a number of factors, including the nature of your Adderall use. If you have a stimulant use disorder (Adderall addiction), then there will be additional issues to contend with in the weeks following your last dose.
The initial withdrawal syndrome can be severe. Withdrawal may affect your ability to function normally and fulfill your responsibilities at home, school, and work.
Adderall increases the activity of two neurotransmitters (chemical messengers) in your brain: norepinephrine and dopamine. Dopamine is responsible for activating your brain’s reward system. Norepinephrine is responsible for boosting your alertness, focus, and cognitive functions. Both play a role in mood regulation.
During long-term Adderall use, your brain gets used to the increased activity of these neurotransmitters. Withdrawal symptoms occur because your brain is experiencing what it believes to be low levels of dopamine and norepinephrine.
It’s no wonder that the hallmark of Adderall withdrawal is depression. Depression from Adderall withdrawal is temporary, typically continuing for about one week after your last dose. In some people, however, depression can linger for weeks or months.
Severe depression is a lot different than just feeling sad. You may experience any of the following:
- Feelings of emptiness or hopelessness
- Loss of interest in activities that normally bring you pleasure, such as sex or exercise
- Extreme irritability or frustration
- A complete lack of energy or excessive tiredness
- Sleeping too much or too little
- Feelings of anxiety
- Feeling you’re moving, thinking, or talking slower than usual
- Intense self-criticism or a sense of worthlessness
- Feelings of guilt and regret
- Eating too much or too little
- Problems thinking, focusing, or making plans
- Unusual aches and pains
- Thoughts of death or suicide or suicide attempts
Because your brain is reacting to low levels of dopamine and norepinephrine, the withdrawal symptoms are not limited to depression.
One recent study found that changes in brain chemistry during amphetamine withdrawal might make people more sensitive to stress. This may explain why things that normally wouldn’t bother you feel extremely annoying or frustrating during withdrawal.
Another study, in rats, found that amphetamines alter brain chemistry in such a way that encourages reward-seeking behavior.
The researchers found that these changes lasted for months after the rats’ last dose.
This provides a good explanation for why drug cravings are so persistent and why people withdrawing from Adderall seek out other ways to trigger their reward system, such as overeating.
According to the American Psychiatric Association, other symptoms of stimulant withdrawal include:
- Vivid or unpleasant dreams
- Increased appetite
- Problems thinking or concentration
- Slowed movements or reflexes
- An unusually slow heartrate
- Adderall cravings
Most people’s symptoms will resolve within a few weeks. After the withdrawal period, however, you may face some unexpected psychological, social, or emotional problems.
A depressive episode can have long-lasting effects, such as bringing up painful or traumatic thoughts, feelings, and memories. You may also have to contend with the consequences of failing to meet your responsibilities during withdrawal. This may include problems at work, school, or home.
Unfortunately, there are no medications currently recommended for the treatment of amphetamine withdrawal, but there are some things you can do to reduce your discomfort. With the help of your doctor, you may want to consider the following medications:
- Anti-anxiety medications: Although these drugs are usually not recommended, especially not in the long-term, they may provide some relief for the first few days of withdrawal. If you are experiencing intense irritation, aggravation, or aggression, talk to your doctor about getting a week’s worth of a long-acting benzodiazepine clonazepam (Klonopin).
- OTC pain relievers: If you are experiencing bad headaches or body aches, consider an over-the-counter painkiller aspirin, acetaminophen (Tylenol), ibuprofen (Advil), or Excedrin.
- Sleep aids: If you are having trouble falling or staying asleep, you may want to talk to your doctor about a prescription sleep aid Ambien. You can also use an OTC antihistamine Benadryl (not the non-drowsy kind).
- Antidepressants: If you start taking them in advance, antidepressants might help prevent lingering, post-withdrawal depression, but they have not been shown to reduce acute symptoms of withdrawal.
Other things you can do to ensure a smooth and safe withdrawal experience include:
- Asking someone you trust ( a sibling, parent, or friend) to check in on you from time to time to make sure you’re alright.
- Planning to take some time off of your daily responsibilities and obligations. Give yourself some time to rest and recuperate by taking a few days off from work, school, and studying.
- Preparing for cravings by cutting off your supply. Avoid a relapse by dumping your stash or telling your supplier to cut you off.
- Drinking plenty of fluids and eating healthy meals. You need to replenish your body with vitamins and electrolytes.
- Preparing for a depressed mood by surrounding yourself with things that bring you joy or peace, even if those things are just ice cream and a good Netflix binge.
- Exercising to encourage the release of natural feel-good neurotransmitters.
Adderall is generally considered to be safe for home withdrawal. Un other drugs with complicated withdrawal syndromes, such as alcohol and benzodiazepines, withdrawing from amphetamines is unly to trigger any serious medical problems.
The problem with Adderall withdrawal is that it can be a bit unpredictable. It’s hard to know in advance whether you will experience intense depression or extreme irritation.
It could be helpful to talk to a doctor about your plans to quit. Your doctor may be able to give you both short- and long-term support.
The primary risk of going through Adderall withdrawal on your own is that you will experience suicidal thoughts or behaviors. Even if you have no history of suicidal thoughts or depression, it is still a risk. Adderall has serious effects on your brain chemistry and it is difficult to predict how your moods will shift.
Long-term treatment for amphetamine withdrawal will depend in part on the nature of your amphetamine use. If you were taking Adderall for ADHD exactly as your doctor prescribed, then you probably won’t need any long-term treatment at all.
If you’ve been misusing or abusing Adderall for some time, you would definitely benefit from a comprehensive, long-term addiction treatment plan.
All drugs of addiction affect dopamine in some indirect way. Stimulants have a direct effect on your dopamine receptors, which basically gives them VIP status in your brain’s reward system. This means that your brain is going to have a lot of trouble resisting cravings.
Think of it this: you will be starting off with a real physical disadvantage. During withdrawal and in the weeks and months to follow, your brain is going to be weak and vulnerable. To resist drug cravings, you are going to need a lot of support. This may include both medication and psychotherapy.
The leading treatment for amphetamine addiction is behavioral therapy. Two types have proven effective, cognitive-behavioral therapy (CBT) and contingency management (CM).
During CBT, you work with a therapist or counselor to identify and manage your drug triggers. You learn to modify the negative thought patterns that have led you to abuse Adderall in the past, such as believing you can’t ace a test or write a paper without Adderall.
CM is a type of therapy that capitalizes on your brain’s desire to stimulate its reward system. Basically, you work with a counselor to improve your behavior and your counselor rewards you for your successes. For example, when you study for a test without Adderall, your counselor might reward you with a gift card for coffee and donuts.
It is also important to understand that because your brain is craving stimulation of its reward system, you are at risk of developing other substance abuse problems or behavioral addictions. People use all sorts of things as a substitute to amphetamines, including other drugs, nicotine, gambling, shopping, and sex.
Working with a therapist or addiction counselor will help you maintain long-term abstinence from Adderall and a healthy balance in other areas of your life.
There are many in-person and online resources you can seek out if you or a loved one are dealing with addiction or withdrawal.
Most colleges have excellent counseling and behavioral health services. Check out your school’s website for more information about the services they offer and how to make an appointment to speak with a counselor.
Quitting Adderall isn’t easy. If you’re in school and using Adderall to study, quitting can be particularly hard. There will inevitably be a midterm that you need to cram for or a research paper that has to get done.
Working with a therapist or a counselor at your school can help you deal with these triggers and develop new study habits. In fact, you may find that you’re more clear-headed and stable once you cut the Adderall your life.
The Dopamine Dilemma—Part II: Could Stimulants Cause Tolerance, Dependence, and Paradoxical Decompensation?
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