Stimulant Use and Abuse
It is thought that 5% of the general population, and 2% to 8% of college students, have Attention Deficit Hyperactivity Disorder (ADHD) or sometimes abbreviated to Attention Deficit Disorder (ADD). With ADHD, patients have difficulty concentrating on tasks and find themselves easily distracted. Patients are also often impulsive, either speaking without thinking or taking action before considering what they are about to do. Sometimes though, patients describe having hyperfocus, that is, the inability to break away from a given task, despite trying. This is often seen when patients watch screens (television, video games, movies, social media, smartphones), which are very mentally stimulating activities. Interestingly, the symptom of being impulsive and of being easily distracted can actually improve creativity. The symptom of having hyperfocus can improve productivity. However, when these symptoms persist and negatively impact day to day functions, the diagnosis of ADHD should be considered and treated.
Stimulant medications are pharmacological first-line treatment for ADHD. Stimulants improve focus, improve concentration, reduce distraction, and reduce hyperfocus. With any medication for any condition, the use of stimulants needs to be considered in the specific context of the patient. Effects and side effects are evaluated and addressed accordingly.
Unfortunately, some people use stimulant medications not as prescribed. In youth aged 18 to 25, 7.4% of people misuse prescription stimulants, but in college students, that figure increases up to 42%. They are misused to help with studying, to have more energy, to have an “even better” focus and concentration, or to compensate for having not slept well the previous night. Curiously, despite the prevalence of stimulant misuse, studies do not demonstrate that its use improves overall grades or overall school performance.
The use of stimulants can also be associated with a feeling of euphoria. Despite the subjective feeling that stimulant use improves these symptoms, studies demonstrate that the subjective improvements are counterbalanced with very real consequences. The use of non-medical use of stimulant medication (amphetamine-based or methylphenidate-based) can be associated with irritability, disrupted mood, sleep impairment, appetite suppression, psychosis, aggressivity and depression. It can also be associated with heart arrythmias.
Even worse, these medications can be self-reinforcing and can induce tolerance. That is, once a person starts to use a stimulant not as prescribed, the subjective effects, including the euphoric effects, wear off faster and in order to compensate, the dose is increased. To increase the dose, the stimulant is taken in larger quantities or in ways not intended, such as inhalation or injection. By increasing the dose, the risks of side effects also increase significantly.
Stimulants are also misused to counter the sedative effects of alcohol, allowing the individual to drink more alcohol than would have been otherwise possible, which is actually extremely dangerous. In the absence of stimulants, alcohol has a sedative effect, which ultimately limits the amount of alcohol that can be consumed. However, if the individual has overcome that sedative effect with stimulants, the individual can drink significantly more, thus increasing the risk of alcohol poisoning, death, cardiac arrhythmias, or engaging in risky or illegal behaviours such as sexual assault or operation of a motor vehicle.
As with most addictions, one of the main steps of treatment involves the individual to stop using the substance they are addicted to. When stimulants are discontinued, withdrawal is common. This can manifest with symptoms of difficulty concentrating on a certain task, being easily distracted, being impulsive and having hyperfocus. Fatigue, poor sleep, irritability and a rebound in appetite are also common. Fortunately, many of these symptoms are temporary in nature and resolve on their own over a period of weeks or months. Unfortunately, while not directly life-threatening, they can be very incapacitating. Many of the withdrawal symptoms mimic those same symptoms of ADHD, and can give the false impression that the individual actually has ADHD, when in fact the individual does not.
To prevent stimulant abuse and to reduce overall risks of stimulant addiction, it is not recommended to use stimulants non-medically. Good life hygiene is recommended – that is, healthy eating, healthy sleeping, healthy physical activity, and healthy study habits. If one develops a stimulant abuse, treatment is possible, available, and successful.
Dr. David Luckow, MDCM, CFPC(AM), FASAM, MRO
Andy’s House
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