There can be a great deal of stigma and confusion surrounding the use of prescription medications to treat ADHD. And many parents worry about the long-term effects of ADHD medications. Although ADHD medications can be extremely effective when used appropriately, many families fear exploring such options because they fear that the medications could harm their child, change his personality, or otherwise lead to some form of ADHD medication abuse.
Our guest contributor offers some insight on those issues.
ADHD is a neurodevelopmental disorder based in the Right Frontal Lobe (RFL)of the brain. That part of the brain controls inhibition, impulse control, manners, consideration of long-term consequences, and self-restraint. Children who have ADHD generally will not grow out of it. They can, however, reduce the obviousness of their symptoms. Ideally, the ADHD child will grow into an ADHD adult who has better learned to regulate their impulses and behavior. But, it’s expected that the ADHD child will have a persistent lifelong difference in the function of the RFL.
Medication for ADHD
A typical treatment plan for ADHD involves medications, primarily Central Nervous System (CNS) stimulants. While it may seem counter-intuitive to give a child or adult with ADHD a stimulant. CNS stimulants will increase activity in the RFL. Specifically, it will cause neurons in the RFL to fire faster and release neurotransmitters responsible for the inhibitory functions.
Some of the more common medications for ADHD are:
- Ritalin (Methylphenidate) is an oral CNS stimulant.
- Adderall (Amphetamine & Dextroamphetamine) is a combination of two oral CNS stimulants.
- Vyvanse (Lisdexamfetamine) is another oral CNS stimulant.
- Daytrana (Methylphenidate) is a transdermal patch of CNS stimulant medication (Drugs.com., 2021). Unlike some of the short-acting stimulants like Ritalin that must be administered two to four times a day, the Daytrana patch only needs to be applied once; then, it will provide a steady release of medicine throughout the day.
- Strattera (Atomoxetine) is an oral medication that works by a different mechanism than the other CNS stimulants. It targets the neurotransmitter norepinephrine rather than globally increasing RFL activity. (Drugs.com., 2020).
ADHD Medication Abuse
Many parents have concerns about potential ADHD medication abuse. Many parents are reluctant to seek medication-based treatment for their ADHD children because of fear about potential substance abuse – now or later in life.
Prescription stimulations such as Ritalin and Adderall are considered Schedule II federal controlled substances which have higher levels of restriction than regular prescription medications. They have been classified as controlled substances because of the high potential for misuse and abuse.
Many parents may have concerns that allowing their kids to take such controlled substances will lead to some form of substance abuse now or in the future.
There are three components to consider with these concerns:
1. Can Properly Prescribed ADHD Medications Create an Addiction?
All CNS stimulants, from caffeine, nicotine, cocaine, and amphetamine-based medications for ADHD, can potentially produce dependence. When properly prescribed and supervised, the risk of developing dependence on the drug is minimal.
For addiction to occur, the Dopamine Reward Loop (DRL) must be activated. This refers to the excessive release of dopamine, a brain chemical associated with feelings of pleasure. Dopamine is also responsible for memory and reward.
The DRL is:
- That was good.
- Don’t forget how good it was.
- Doing it over again.
Properly prescribed ADHD meds that are taken as directed do not activate the DRL. The amount of drug substance is relatively low compared to the amount required to generate euphoria in non-ADHD people, and it is dispersed over time.
Typically, any actual ADHD medication abuse occurs when someone who does not have ADHD takes large amounts in a short period of time (e.g., crushing and snorting multiple pills).
ADHD medications have been prescribed for decades. The consensus is that their use does not predispose children to addiction. If the DRL is not activated, there are no pleasurable memories of use which will trigger the desire for other drugs.
2. Can ADHD Medications Increase Risk for Substance Abuse?
This component may be the most significant concern. A prominent feature of the ADHD child or adult is a compulsion for adventure, excitement, thrill-seeking, and sensation seeking. People with ADHD often crave intense experiences and tend to be very curious. When this is combined with other factors such as:
- genetic predisposition to chemical dependency
- a drug-tolerant community/society
- living in a home where one or more members are actively using substances
- and/or associating with drug-using peers,
The risk of seeking out mind-altering substances is increased. But that is not a function of taking ADHD medication. It is a function of other ADHD symptomology combined with other environmental or social factors.
3. Will Kids Taking ADHD Medications Have Increased Risk for Substance Abuse as Adults?
A related issue is that some adults with ADHD will gravitate toward substances like cocaine or methamphetamine to gain relief from the effects of their ADHD. They will self-medicate to escape from scattered or muddled thinking or to numb other negative emotions.
These unlawful substances are also CNS stimulants. They produce an RFL enhancement that may allow a person with untreated ADHD to settle down and focus instead of becoming agitated as a neurotypical person would. Unlike someone without ADHD, such stimulants paradoxically create remarkable restraint and improved focus and attention. But the nature of such substances, consumed outside of a medically controlled and supervised environment, creates a risk for dependence, both short-term and later in life.
Alternatives to Medication
Therapy & Behavioral plans
There are alternatives to medications that can be discussed with a prescriber. Non-pharmacological methods include behavioral plans where the parents and other family members and teachers all work together to set limits on the ADHD child’s behavior. They will assist them in learning impulse control and delayed gratification. These behavioral plans require the collaboration of a clinician who’s experienced in the treatment of ADHD.
The concept of neuroplasticity is essential to understanding how behavioral plans work. The brain constantly prunes and proliferates connection. The axons, which are the transmitting connections between nerves, and the dendrites, which are the receiving connections between nerves, will wither and die off or increase and grow in quantity and complexity. Other elements of neuroplasticity include:
- increased neurotransmitter release
- increased receptor site sensitivity to the available neurotransmitter
- and less re-uptake of neurotransmitters.
All these processes will work together to produce positive change at the neurological level, which will be reflected in behavior. Behavioral plans train the brain to work with greater efficiency.
The Cost of Untreated ADHD
Many parents have concerns about the long-term effects of ADHD medication. But any potential long-term effects must be weighed against the impact of not properly treating a current and existing ADHD condition.
ADHD children and adults tend to have significant social problems. They tend to frustrate their peers, be scapegoated, mocked, ridiculed, bullied, or otherwise rejected by their peers. As adults, they may develop a reputation in the workplace as a high maintenance employee, who requires micromanagement. This can impact career opportunities, self-image, self-worth, and self-respect. These realities can lead to depression and risk of dependence on substances in a vain effort to cope, or other more destructive behaviors.
The risk of using any medication must be balanced against both the potential rewards to be gained from taking it, as well as the potential harms that arise from doing nothing.
Pharmacological interventions may be necessary and effective, but they are not the only option. A global approach from correct diagnosis to exploring viable alternatives to medication should be considered.
Baik, J.H. (2020). Stress and the dopaminergic reward system. Experimental Molecular Medicine. 52, 1879–1890. Available: https://doi.org/10.1038/s12276-020-00532-4
Center for Disease Control. (2021). ADHD. Retrieved April 6, 2021, from https://www.cdc.gov/ncbddd/adhd/facts.html
Vaidya, C.J. (2012). Neurodevelopmental Abnormalities in ADHD. Current Topics in Behavioral Neuroscience. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3329889/
The content of this article is for educational purposes only and does not constitute medical or clinical advice. Always seek feedback from your health care provider if you have any questions or concerns about your medical or psychological well-being.
David A. Porter, MA, LADC is a licensed alcohol and substance abuse counselor with 20 years of clinical experience in a variety of clinical settings, including private practice, community mental health clinics, a MAT (Medication Assisted Treatment) Program, and a program for the severely/chronically mentally ill. He also has 22 concurrent years of college teaching experience in behavioral sciences (Psychology, Criminology, and Substance abuse).