By Britt Gottlich, Psy.D.
At Fifth Avenue Psychiatry, we often get new clients seeking stimulant medications for ADHD. These individuals are usually surprised with how cautious we tend to be with these medications, as our NYC psychiatrists require new or recent neuropsychological testing to confirm this diagnosis rather than just handing out medications based on reported symptoms. The reason we are more conservative with stimulant medications is because of the high rate of stimulant addiction that we see as a result of these controlled substances being prescribed too readily.
What are Prescription Stimulants?
The National Institute on Drug Abuse defines stimulants as “medications generally used to treat attention-deficit hyperactivity disorder (ADHD) and narcolepsy- uncontrollable episodes of deep sleep. They increase alertness, attention, and energy” (NIDA, 2018). Stimulants affect the dopamine and norepinephrine chemicals in our brains, which is why people often report feeling a “rush” when they take these medications. The reason this type of medication can be helpful for clients with ADHD diagnoses is that it can help them focus for longer periods of time and curb impulsivity and hyperactivity. Some common names of these medications include:
If diagnosed with ADHD and prescribed appropriate doses of stimulants, the medications can be helpful and often do not necessarily lead to a substance use disorder. In fact, people who have ADHD and are prescribed these medications have lower rates of overall substance abuse because of the way these medications help curb their impulsivity.
The problem we are facing is the over-prescription of stimulant medications. This is usually a result of incorrect ADHD diagnoses which can be due to poor or no assessments. Some ways to avoid an incorrect ADHD diagnosis is using standard diagnostic assessments, and to receive comprehensive histories including:
- Childhood symptoms
- Parent/teacher reports
- Past assessments
Prescription Stimulant Abuse
The Addiction Center reported that “prescription Stimulants are classified as Schedule II drugs under the Controlled Substance Act because they have high potential for abuse and addiction. Approximately 900,000 Americans abuse prescription Stimulants every month” (https://www.addictioncenter.com/stimulants/).
Our psychiatrists in NYC see a lot of stimulant medication misuse in high school and college-aged individuals. These individuals either buy pills off friends with diagnoses or from dealers in order to help them through finals season, to buy them a few more hours of focus to write a paper, or to take recreationally at parties to get “high.”
When it comes to abusing stimulants, our Adderall addiction psychiatrists in NYC tend to see that more in the workplace. In my own practice, the majority of clients I have seen who struggle with stimulant abuse are in law and finance careers and take these medications not to get high, but to enhance their performance in comparison to their peers, or simply to keep up with the volume of work they have and expectation of others. Another reason these individuals become addicted to these prescriptions is their physical dependence. Their brains become reliant on the dopamine from the drug to the point that if they do not take it, they will experience withdrawal. Therefore, individuals become physically dependent just to feel normal.
Health Effects of Prescription Stimulants
Yale Medicine reported that “stimulants increase the amount of neurotransmitters in the brain, including dopamine, which leads to heightened alertness and feeling of euphoria. At the same time, stimulants elevate a user’s blood pressure, heart rate, and breathing. Heavy use can cause irregular heartbeat, heart failure and seizures, and, in some cases, death” (https://www.yalemedicine.org/conditions/stimulant-abuse). Stimulant abuse can be very dangerous for the heart and, oftentimes, individuals who seek treatment can feel the effects or have been told by their doctors they are developing problems associated with the drug.
Treatment of Prescription Stimulant Abuse
There are a few things to consider when an individual is seeking treatment for prescription stimulant abuse. First and most important is the effect the prescription stimulant is having on their bodies, but we must also consider ADHD diagnoses and whether it is realistic for an individual to be completely off these medications or not. Once we can establish whether a person has a valid ADHD diagnosis (through assessments we can conduct ourselves, or past testing confirmation), we can discuss a plan as to whether the individual should be completely abstinent from stimulants or whether we may need to come up with a plan where they stay on a lower and more controlled dose.
Coming off stimulants can be uncomfortable due to the withdrawal. Since our clientele tends to use this as a performance enhancer in the workplace, we are very aware of the effect of withdrawal on work performance. Therefore, we work with the client to taper them off the medication at a pace that feels comfortable and manageable for them. In regard to the therapeutic aspect of this treatment, we work with clients using a behavioral model to identify patterns of their use both in regard to their emotions and cognitions. Our NYC stimulant addiction psychiatrists then work with them to reframe their thinking regarding their need for the substance. We teach healthy coping skills, emotional regulation, and relapse prevention.
When working with individuals with ADHD who plan on staying on a lower dose of the medication, the treatment can become a little more complicated. In regard to medication management, the medication is given in a much more controlled fashion to ensure there is no abuse. Regarding the therapeutic approach, there is a lot more emphasis on impulse control and redefining the way the client views the medication and the intention behind taking it.
There is not one plan that suits all, so treatment can be flexible and modified to a person’s needs, specific situation, and concerns. The road to recovery can be overwhelming but making an appointment and discussing the issue openly can be the first positive step in this journey.
Seeking stimulant addiction treatment in New York City? Fifth Avenue Psychiatry provides private addiction treatment for executives and professionals in the Manhattan, NYC area.