Addicts and Adderall
Many people in recovery struggle with ADD. But is the treatment more dangerous than the problem?
Henry is 40 years old and has spent much of his adult life addicted to heroin and alcohol. In 2001, after his last of several court-mandated stints in rehab, he stayed sober for two years and then started drinking again—first in moderation and then spiraling downwards into alcoholism. Two years ago, he quit drinking and started seeing a psychiatrist, who prescribed Adderall XR—which Henry describes as “a revelation.”
Karim and Sharp both agree that several factors need to be in place before an addict can safely be prescribed the drug.
“The first time I first took it, it stopped the noise in my head long enough and effectively enough that I could cope with life,” he says enthusiastically. “I didn’t feel high, I didn’t feel any kind of euphoria—I didn’t even feel like it gave me extra energy. I felt like it took away the roadblocks and I could get on with my life.”
Henry had been diagnosed with ADHD many times in his life but because most of the psychiatrists who treated him had been part of his rehabilitation program, he’d never been prescribed the drug before because of the potential for abuse.
Psychiatrist Dr. John Sharp, a faculty member at Harvard Medical School and UCLA’s David Geffen School of Medicine who’s also a consulting psychiatrist on the current season of Celebrity Rehab, says there’s a good reason doctors are wary about prescribing Adderall to addicts—recovering or otherwise. “I think it’s good to start with no,” he says. “It’s unsafe for an addict to be given prescription amphetamines.”
Sharp suggests beginning any addict’s ADHD treatment by trying out Atomoxetine [Strattera]—a selective norepinephrine reuptake inhibitor—first. The doctor explains that atomoxetine “boosts dopamine in the frontal cortex, which is what you want to do, without taking a traditional stimulant—which would also run the risk of giving the patient cravings that could lead to relapse. It’s a smoother, safer approach to the problem.”
Exercising extreme caution is especially critical during the early stages of recovery and Sharp points out that the beginning can be a difficult time to analyze someone’s psychiatric issues anyway. “Coming off a substance makes anyone distracted and irritable and challenged in terms of their sustained attention,” he explains. “So you have to see how that person behaves going forward, and also get a good history from them.”
Patty Powers, a New York City-based sober coach, agrees. “It’s interesting today how almost every addict in early recovery believes they need to get Xanax or Adderall prescriptions—even if their personal history involved illegally purchasing and abusing these drugs,” she says. “They’re so desperate to feel ‘normal,’ but in most cases these feelings pass once they’ve been clean for a while.”
Dr. Reef Karim, an assistant clinical professor at UCLA and the founder and director of a treatment facility called The Control Center in Beverly Hills, says that “there are many ways to treat ADHD—there’s cognitive behavioral therapy and individual psychotherapy if it’s related to acute stressors. But when looking at pharmacotherapy, there’s definitely an association between certain prescribed stimulants and illicit drugs. What meth or coke does to the area of the brain is not that dissimilar to short-acting Ritalin or regular Adderall or Dexedrine.”
Karim has had success prescribing a drug called Concerta. “I had a hardcore meth patient who was asking for all sorts of drugs,” he recalls. “I put him on a moderate dose of Concerta and his ADHD went away and his craving for meth went away.”
Like Sharp, Karim has also cautiously prescribed Adderall XR to recovering patients. Karim and Sharp both agree that several factors need to be in place before an addict can safely be prescribed the drug. First and foremost, it must be the long-acting formula. “There’s less potential for abuse,” explains Karim. Sharp adds, “Using longer-acting extended release formulas is a much better idea because it’s smoother, doesn’t wear off as quickly, and the patient can’t crush up the pills and snort them.”
They also both stress that the patient has to be actively working towards their recovery. Karim says whether or not he prescribes Adderall would “depend on the patient’s support system, other types of treatment, whether they are in the program [AA], and their history of addiction, among other factors.”
The person also has to be far enough along in recovery that relapse is less of a concern. Sharp says that “until someone’s proven they’re able to live that recovery, and actually see what kind of problem they have, it wouldn’t make sense.” He or she also needs to be monitored carefully. “If you prescribe Adderall to someone who was previously out of control, and see them every week, that can mitigate any potential risks,” notes Sharp.
Despite the glowing reviews he gave Adderall XR, Henry hasn’t used the drug in several months—after growing dissatisfied with the therapy aspect of his treatment. “As a psychiatrist, he was fine,” Henry says of his last doctor. “But he was a really bad shrink.” When asked why he didn’t just find a new doctor, Henry gives vague answers and admits that the anxiety and depression that his ADHD had caused him were creeping back. Even though he claims that “being on Adderall keeps me from picking up a line of coke or a bag of dope or a drink,” he’s still oddly reluctant to return to his old psychiatrist or find a new one.
Which puts Henry in a scary place. “Imagine a graphic of a scale,” says Karim. “It’s a risk-benefit scale. On one end are ADHD symptoms and on the other end are abuse-liable medications. You’re always counter-balancing, asking what is the best for this specific patient. Is it treating the ADHD but not treating it with a medication that negatively stimulates them because it gets them aroused to think about their drug of choice? Or is it treating them and watching them carefully? It’s a balancing act.”
And if, like Henry, you do nothing? “You’re much more likely,” Karim says, “to relapse with unchecked ADHD.”
Judy McGuire is a Brooklyn, NY-based freelance writer and a columnist at the Seattle Weekly who also wrote about moderate drinking studies for The Fix. You can find her at dategirl.net.