Adult, legal Adderall use - long-term consequences?

In My Humble Opinion
1

I’m an early-thirties lawyer with a good-but-not-great career. One of the things holding me back has traditionally been that, well, my work tends towards the dull side, and I’m not great at concentrating on tasks I find dull. After a few years in my last job, I wasn’t keeping pace with my peers. A friend in a similar situation had good results with Adderall, so I decided to give it a go last February. I found a local psychiatrist, described my symptoms honestly, and received a prescription.

It helped! I had no history of ADD, nor any other psych diagnosis, but I found that I could concentrate more readily, and even took joy in my work. Nor was I kidding myself - the improvement in my work was dramatic, and bosses noticed it. I’d previously had a reputation as a solidly middling guy; on Adderall, I gained a reputation for thoroughness and integrity. Senior colleagues sang my praises when I left for a new (better) job.

I’m not trying to brag, at least not for bragging’s sake - my point is only that Adderall seems to have made a real, observable difference in my life. And this difference persists; bosses in my current job are impressed with my work on Adderall, but comment on errors when I skip my medication.

At present, I’m on 20mg/day during the week. And, again, this is perfectly legal - I go to a licensed psychiatrist, I never malinger or exagerrate symptoms, and my insurance covers both shrink visits and my scrip. I’m not asking the Dope to advise me on illegal activity. Nor am I asking the Dope to play physician.

This being said, I’d like some general information on the long-term consequences of my Adderall use. Should I fear addiction? At present, I don’t take Adderall when I’m not working, and I feel fine without it - will that change over time? What about other health consequences?

Or, on the other hand, is there a reasonable chance this will just be a non-issue for the forseeable future?

I’d be particularly interested in hearing from other Dopers who have started on (legal!) Adderall as adults, or physicians who have prescribed it. I would also be interested in references to web sites with pertinent and reliable information - googling “adult Adderall use” generates a lot of hits, but many of them clearly have an ax to grind.

I’m well aware that I can (and should!) talk to my shrink about all this. I already have, and I may discuss with him more. But, frankly, he takes a liberal approach to Adderall prescription - he’s known for that. So, I’d like a bit more of a sense of the universe of issues surrounding adult Adderall use.

Finally - feel free to tell me that psych meds are bad, psychiatry is bad, or that Adderall is bad because it’s dextroamphetamine salts, if you like; it’s a free Board. But I’m not particularly keen on the naturalistic fallacy, and my view is that “the dose makes the poison” with amphetamine-class drugs, as in all others - chemical similarities to meth, in themselves, aren’t that frightening to me. So, posts along these lines may be interesting to other people, but aren’t that helpful to me personally.

2

I don’t have much to add, but here’s a great article from 1999 in The New Yorker:

3

This is a really good question.

There’s a perception, it seems, that legal prescriptions for Class 2 drugs commonly lead to addiction. This is especially true for narcotics - the stereotype is that you start today with a perfectly legal prescription for Oxycontin for post-operative pain today (some silly knee surgery thing), three months later you are unconsciously exaggerating lingering pain to your doctor to convince him to give you more, three months after that you are consciously exaggerating symptoms but not technically lying per se, six months after that you are lying through your teeth to get more, six months after that you are forging prescriptions, stealing drugs, and trying other narcotics (grandma’s morphine, that stupid neighbor’s codeine, etc.). You lose your job due to your rapidly declining health and end up living on the street and giving handjobs for smack. You get arrested and sent to jail for a while and end up in rehab and wonder what the hell happened to you.

4

I took Ritalin for a couple of years with good results, the kind you mentioned, and no bad ones. The only thing I noticed was that I couldn’t really consume my typical amount of caffeine, which was a lot. After a couple of cups I started to shake.

Then the doctor who prescribed it for me died, and the doctor I switched to refused to prescribe it–because, I think, a lot of doctors won’t prescribe anything you come in and ask for, just on general principles, thinking you’re a drug seeker. (Which I kind of was.)

However, the time I was on this drug helped me change my thinking somewhat and develop certain strategies to deal with the problems. If I went into the problems I would sound like an insane person–I was kind of fluttering around thinking “Should I answer this email? Oh, before I do that I need to make this phone call. Only first I need to clear off my desk a little. Oh, wait–did I forget to put the PTA meeting into my datebook?Wait, what do I need to do?” If it sounds nuts think of actually living it–it was awful.

When I got the prescription the doc mentioned that it could be an appetite suppressant and could cause insomnia. Since I already don’t have much of an appetite and have always had insomnia I wasn’t too worried. In fact, it seemed to help my insomnia, because one factor in my insomnia was that I would lie in bed thinking about all the things I should have accomplished that day but hadn’t, and while on this drug, I did accomplish them.

I think the addiction is psychological, and it’s an addiction to getting things done efficiently rather than flapping around and being inattentive. The drug (it was Ritalin, a pretty low dosage at that) turned what had been a spiky jumble of things into a smooth flow, and yeah, it seemed like a magic pill.

5

I was prescribed Nuvigil for daytime sleepiness caused by sleep apnea, but my insurance wouldn’t pay for it and instead requested the prescription be changed to Adderall. I took 20mg twice a day for two years.

My performance rating at work went from average to above average, and I spent post-work time studying and learning iOS programming. On the down side, I had several road rage incidents (nothing that involved law enforcement) and my husband asked that I stop taking the drug because he said it was making me irritable.

That was two years ago, and I’ve had no withdrawl symptoms or other difficulties quitting. My performance rating is back to average, and I’m taking a considerably longer time working on my current iOS app. My daytime sleepiness due to sleep apnea is much improved, largely due to a better-fitting CPAP mask.

I miss the better productivity and the euphoric rush of the Adderall, but am happy to trade these things for a more-stable me.

6

I go back and forth between Ritalin, Nuvigil, Provigil, and nothing at all. I’ve done this for fifteen years. For the past 10 months, I’ve taken none of these on a regular basis, but a Provigil or Ritalin as needed. Just because something CAN be addictive, doesn’t mean you WILL be addicted.

I have narcolepsy and these drugs definitely saved my ability to hold down a job and support myself. Currently, I’m taking Xyrem which is basically GHB. It makes people who aren’t informed convinced that I’m a hard core addict, but I’m absolutely thrilled with the results. Sleeping through the night and staying awake during the day is an amazing thing if you’ve gone most of your life without it.

7

It’s important to know that the doses of amphetamine, meth, or similar stimulants taken by those who abuse it for kicks is typically much higher than a typical therapeutic dose.

That said, it can nevertheless be habit-forming, which is why consumers are usually cautioned against suddenly stopping or sharply lowering the dose of the drug.

8

One thing to consider is the possibility of an “I’m better/more effective with this drug” psuedo-addiction. If for some reason it becomes unavailabl you could have a hard time adjusting to your previous performance level, especially if you’ve been promoted or given more responsibilities due to your improved ability level.

If you’re not experiencing excessive side effects or withdrawal symptoms, relax and trust your doctor and pharmacist. As tightly as these medications are controlled, any doc overprescribing them would lose his license pretty quick, if your insurance didn’t stop covering him first.

9

Provigil is what that dr. who wouldn’t prescribe Ritalin gave me instead. It was way way WAY more expensive and as far as I could tell did nothing. I think she must have gotten some kickback.

Although it’s a funny thing. While usually I’m very sensitive to drugs, there are some that just do nothing. If I have a headache, aspirin or Advil will knock it right out. Tylenol does nothing. So…

10

I can only offer you my personal experience. I was given amphetamine to counter lethargy caused by chronic use of morphine to control pain. The amphetamine was wonderful, it woke me up and I had my life back. A side benignity was that I list a ton of weight. However, I bulky a tolerance up very quickly and the drug became useless after about six months. So, I’m skeptical that you’ll see long term benefits after daily use.

11

Long term, we’re mostly focused on any effects the therapy is going to have on your cardiovascular health, if we’re triggering/worsening issues with insomnia and/or anxiety, if we’re actually making you more irritable/angry, and yeah, we’re definitely considering the possibility of an addiction.

Should you fear addiction? IMO, No. If you’re being absolutely honest with your prescriber and pharmacist, and they are doing their due diligence with regards to monitoring, addiction isn’t actually a huge concern. There is, in fact, limited evidence that successful treatment of individuals with AD(H)D actually reduces the chance of later developing a substance use disorder (ie an addiction), though the bulk of that evidence currently applies more towards children/adolescents than adults.

Not taking the Adderall and feeling fine without it? Not unusual, IME. At one point, medication holidays were actually recommended. Currently, we don’t necessarily recommend medication holidays, but we don’t really oppose them unless they seem to contribute to worsening of ability to perform non-work/school activities. Some individuals develop a withdrawal phenomenon if they take their stimulants regularly and stop suddenly, which can include symptoms of lethargy, depression, and rebound difficulty focusing. IF you were to experience this, please understand that this is NOT necessarily a sign of addiction. Addiction and Dependence are two different phenomena that are often, but not always, related.

Psych meds are NOT bad, psychiatry is NOT bad, and Adderall is NOT bad. :stuck_out_tongue:

12

I’ve been taking 20 mg of Adderall twice a day for 4 years. My doctor takes me off it for a couple weeks about once a year to keep my tolarance stable. I don’t notice not taking it, but those around me do.

I don’t feel a need for it on my 2 weeks off.

13

Medical advice is best suited to IMHO.

General Questions Moderator

14

It sounds like, if managed, physical withdrawal is minimal, but as suggested, the psychological withdrawal might be the bigger issue. Do you plan to be on Adderall your entire life?

15

My shrink started me on Adderall 4-5 years ago, and like you, it made a huge difference for me. I had been winding down around early afternoons, and I started off on 40 mg a day. My shrink told me to take an extra 20 mg in the afternoon if I felt like I needed it, which I’ve done a few times.

There were a few times I forgot to take them, or the pharmacy ran out because demand exceeded supply. When that happened, I felt like my eyes were about to drop out my head. It wasn’t like I was addicted and going through withdrawal. It was more like I was reverting back to my old sluggard self.

Nowadays I’m taking 20 mg. I cut back because I felt too wired to sleep at night. It’s also because it’s a bitch to get refills, because Adderall is a controlled substance, and I have to turn paper scrips in to my pharmacy (can’t have the doctor call it in). Now I’ve got a reserve of scrips, hee hee.