Why do people abuse prescription medications?
Every person with an abuse issue will have an individual answer, but often, that answer involves perceived safety. Since prescription medications are made in laboratories, not backyard labs, and since they’re sold by pharmacists, not drug dealers, they’re often considered a safe alternative to illicit drugs.
Consider Adderall. This is a stimulant medication, similar in chemical structure to notorious stimulants like methamphetamine, but some people consider it a safe drug to abuse. Even so, Adderall has been connected to very serious side effects, including psychosis.
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Adderall Use and Abuse
When people with Attention-deficit/ Hyperactivity Disorder (ADHD) use Adderall, they experience an enhanced ability to focus. Things they were once unable to do well, including routine work tasks or studying in a classroom, become possible for them.
Some people, in the hopes of gaining their own type of focus, abuse Adderall. In fact, this type of abuse is relatively common on college campuses.
In an informal study for the college newspaper The Heights, the author asked his fellow students to report if they had a prescription for Adderall and if they had used Adderall to boost performance at school. While only 20 percent of these students had a prescription, more than 50 percent had taken the drug for performance at school.
In addition to students looking for a lift, people seeking euphoria may also turn to Adderall. The drug boosts the production and uptake of the brain chemical dopamine, which can leave people feeling relaxed, silly, and very happy.
Since Adderall can boost both a sense of focus and a sense of happiness, it’s become a popular drug to abuse. According to an article in Psychology Today, this isn’t the first time stimulants have been popular drugs of abuse. In the 1960s, stimulants were given to people who needed energy for work as well as people who wanted to lose weight. It was only when the dangers of stimulants became clear did popularity dip.
Experts are hoping that news about Adderall psychosis will have the same dampening effect on abuse.
According to the National Alliance on Mental Illness, as many as 3 in 100 people will have a psychotic episode at one point.
Someone experiencing psychosis is dealing with an alternate form of reality. It’s a problem of the mind, but psychosis often comes with external symptoms that others can see. According to the National Institute of Mental Health, those symptoms include:
- Incoherent speech
- Inappropriate behavior
- Descriptions of sights or sounds that others can't perceive
- False beliefs
Someone in the midst of a psychotic episode is hard to reason with. While outsiders may know that something is wrong and that the person’s descriptions of a scene don’t match up with objective reality, the person in the midst of an episode cannot be convinced of that fact. To them, this new reality is the only reality. A person like this may grow angry or agitated at the very suggestion that what is happening isn’t real.
Psychosis is common. According to the National Alliance on Mental Illness, as many as 3 in 100 people will have a psychotic episode at one point. Psychosis is a key symptom of the mental illness schizophrenia, but it can also be triggered by stimulant abuse.
Stimulants Causing Psychosis
Psychosis caused by drugs tends to be a short-term issue that is triggered by the drug, and that stops when the drug has been processed. There is a clear cause and effect between the drugs and the psychosis.
Schizophrenia is different. Someone who has schizophrenia may have persistent psychosis for days or even weeks unless treatment is provided. If the person stops following the treatment plan, the psychosis may return.
There is some evidence that suggests that drug psychosis is also mild when compared to schizophrenia psychosis. In a study published in the journal Cochrane, researchers found that most stimulant users have subclinical psychosis symptoms that do not require intensive care. The same may not be true with schizophrenia.
Researchers think that there is a link between medication psychosis and the development of schizophrenia. Researchers writing in the journal Current Addiction Reports suggest that people who have a psychotic episode triggered by stimulants tend to develop persistent psychotic conditions in time. Researchers are trying to understand this relationship, and it’s possible that underlying damage caused by drugs makes the brain more vulnerable to schizophrenia, but the results are not yet clear.
Researchers do think, however, that children of parents with schizophrenia are more likely to develop psychosis after taking stimulants. In a study in the journal Pediatrics, researchers studied children of parents with major mood and psychotic episodes and found that 62.5 percent of children who had taken stimulants had psychotic symptoms compared to only 27.4 percent of those who hadn’t taken stimulants. The researchers believe that this underlying tendency is somehow triggered when stimulants are part of the child’s routine.
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Other Mental Health Issues
Stimulants work by changing chemical levels inside the brain, and that chemical alteration can be persistent. In time, the cells responsible for making chemicals associated with pleasure can burn out. Similarly, the cells responsible for picking up and processing signals of pleasure can become less sensitive.
These two changes, when combined, can lead to a chemically induced form of depression. People with this form of depression are incapable of feeling happiness in response to common triggers. They may always feel a little sad and low.
That feeling of sadness can be enhanced when people attempt to stop taking stimulants. According to the National Institute on Drug Abuse (NIDA), withdrawal symptoms associated with stimulants include depression as well as an inability to sleep. People who can’t sleep may feel yet more depressed.
Dealing With Psychosis and Addiction
There are many medications that are designed to help people overcome a psychotic episode. Research published in Cochrane suggests that traditional antipsychotic medications, including Haldol, can help to block psychosis symptoms. People who get these medications experience a slowdown in activity within the brain, and that can help the reality distortions to fade away.
Medications like this are not protective against future episodes of psychosis. They do not treat the underlying brain cell damage that has caused the psychosis to take hold. The only way to prevent another episode is to ensure that the person no longer takes stimulant medications. That means the person must enter a treatment program if the person is unable to stop the abuse without help.
NIDA reports that there are no medications designed to help people recover from a stimulant addiction. Instead, doctors use behavioral therapies to help their patients recover.
Behavioral therapies aim to help people take control of unhealthy thought and behavior patterns. Therapists also help people learn to avoid the situations that spark the urge to relapse, and they offer techniques people can use when they feel the need to dive back into drug use. Therapy might be provided on an individual basis, but if the person needs to repair relationships with family or friends, others might be invited to sessions for group work.
Treatment like this can take months to complete, and the work isn’t done when the program comes to a close. People with an addiction may need to continue to get treatment support periodically, especially if they deal with new challenges that boost their risk of relapse. Recurrent treatment is an effective way to ensure that people have all the tools they need to avoid relapse even as their lives and circumstances change.
When Is Abuse an Issue?
Since some Adderall addiction issues begin with a prescription, it can be hard for families to know when they should intervene. The National Council on Alcoholism and Drug Dependence reports that signs of an addiction issue include:
- Changes in behavior, personality, or appearance
- Financial distress, including repeated requests for money
- Poor performance at work or school, including frequent absences
- Moodiness, irritability, defensiveness, or aggression
- Poor physical health
An episode of psychosis in someone who has never shown these signs before could be another red flag. If that person enters the hospital due to those symptoms, families can ask for a drug screening to confirm the presence of drugs. That could help make the next step a little easier.
People with an addiction may not be willing to admit to that fact. Students using Adderall for performance may truly believe they’re not doing anything wrong or out of the ordinary. Someone using Adderall for a mood boost may feel like the drug is required for survival.
Denial like this can be hard to see, but therapists are adept at working through it. The important thing is to connect the person in need with a therapist that can help. Any method the family uses to make that connection, including referrals or bargaining, could be well worth the effort.
(April 2017) Analyzing Adderall on Campus. The Heights. from http://bcheights.com/2017/04/24/analyzing-adderall-on-campus/
(May 2018) Will Adderall Be the New Opioid Crisis? Psychology Today. from https://www.psychologytoday.com/us/blog/where-science-meets-the-steps/201805/will-adderall-be-the-new-opioid-crisis
What Is Psychosis? National Institute of Mental Health. from https://www.nimh.nih.gov/health/topics/schizophrenia/raise/what-is-psychosis.shtml
Early Psychosis and Psychosis. National Alliance on Mental Illness. from https://www.nami.org/earlypsychosis
(January 2009) Treatment for Amphetamine Psychosis. Cochrane. from https://www.cochrane.org/CD003026/ADDICTN_treatment-for-amphetamine-psychosis
(December 2015) Understanding the Relationship Between Amphetamines and Psychosis. Current Addiction Reports. from https://link.springer.com/article/10.1007/s40429-015-0077-4
(January 2016) Stimulant Medication and Psychotic Symptoms in Offspring of Parents With Mental Illness. Pediatrics. from http://pediatrics.aappublications.org/content/137/1/e20152486
(January 2018) Misuse of Prescription Drugs. National Institute on Drug Abuse. from https://www.drugabuse.gov/publications/research-reports/misuse-prescription-drugs/which-classes-prescription-drugs-are-commonly-misused
(January 2009) Treatment for Amphetamine Psychosis. Cochrane. from http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD003026.pub3/abstract
(January 2018) Misuse of Prescription Drugs. National Institute on Drug Abuse. from https://www.drugabuse.gov/publications/research-reports/misuse-prescription-drugs/how-can-prescription-drug-addiction-be-treated
Fact Sheet: Prescription Drug Abuse. National Council on Alcoholism and Drug Dependence. from https://www.ncadd.org/images/stories/PDF/factsheet_ncadd_%20prescriptiondrugs.pdf