Prescription Stimulants & Mental Health

1. Prescription Stimulants and College
2. Prescription Stimulants and the Brain
3. Prescription Drugs for ADHD
4. Psychiatric Comorbidities
5. Treatment

What are Prescription Stimulants?

Prescription stimulants are administered to treat disorders in which attention, activity levels, and/or moods are affected, most commonly attention deficit hyperactivity disorder (ADHD).

Illicit use of these medications often stems from the desire for cognitive enhancement and has been prevalent in academic and business professionals, students, athletes, and performers.

• 
  In the past decade, prescription drug abuse has been on the rise: in 2009, 7 million Americans reported non-medical usage of prescription drugs- which is more than heroin, cocaine, inhalants, and hallucinogens combined. The potential for stimulant drug abuse is high due to the exponential increase in availability, as well as the perceived attitude that they are safe.

Prescription Stimulants and College

Studies have found 4.1% to 10.8% of college students reported non-medical use of prescription stimulants over the past year. Students report the most common way to obtain these drugs is from a friend that has a prescription. This is known as diversion which is the act of sharing, selling or trading prescription medications; 61.7% of students with ADHD report diverting prescriptions.

Interestingly, despite the reported academic reasons for use, illicit prescription stimulant use is associated with lower GPA, skipping class and attention difficulties.

If you're struggling with an addiction, treatment centers are available to help you, and the path to recovery may be just a phone call away. Call 1-888-993-3112Who Answers? to learn about inpatient rehab options.

Prescription Stimulants and the Brain

Prescription stimulants are intended to correct disorders in which ‘deficiencies’ of dopamine in the central nervous system are thought to play a role.

• Stimulants increase the amount of dopamine in the synaptic cleft by excessive presynaptic release or by blocking dopamine reuptake or breakdown.
  
• Higher levels of dopamine are associated with elated mood and increased motor function.
  
• The actions of dopamine are associated with attentional processes, some emotion-related behaviors, as well as motivation and reward.
  
• An excess of dopamine may lead to increasingly atypical and uninhibited behavior over time. It may also lead to changes in the brain that affect the subjective need (or ‘craving’) for stimulant drugs.
  
• This may lead to the risk of over-using prescription stimulants, or augmenting these with other legal or illegal amphetamine-type drugs.
  

Researchers have not determined the exact neurochemical process of stimulant addiction, but some evidence has been found that chronic stimulant use changes the function and structure of neuronal networks in the brain. 

• In addition, chronic exposure to increased dopamine may be associated with oxidative stress in the brain.
  
• This involves the release of irritant or inflammatory chemicals that can damage or kill cells in their vicinity.
  
• There is some evidence that oxidative stress may also contribute to some psychiatric and neurological disorders.
  

Prescription Drugs for ADHD

• 
  ADHD is often managed with treatment by prescription stimulants. These drugs are regarded as effective in the improvement of attentional and cognitive functioning in patients with these deficits (including children). In comparison with illicit amphetamines, they have a reduced potential for abuse and dependence. However, abuse still develops in many cases.

  A study of 545 people in an ADHD treatment center (89% of whom were patients with the disorder) found that 14% of the study cohort abused prescription stimulants and 39% abused illegal stimulants (mainly cocaine, amphetamines or both).

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  The pharmaceutical industry has responded to prescription stimulant abuse issues by developing versions of these drugs that have a slower pattern of release into the body. Making the effects less acute but longer lasting is thought to discourage abuse of these drugs. There is some evidence that this might be effective: the patients in the study above reported that a faster release time was a contributing factor in their initial abuse and in the diversion to illegal drugs.
• 
  Some people with ADHD and substance abuse problems may need to switch to non-drug treatment for this condition. This may involve psychotherapy such as cognitive-behavioral therapy (CBT). Other options include alternative, non-stimulant drugs that may also manage ADHD.

Psychiatric Comorbidities

People with prescription stimulant use disorder and other additional conditions such as ADHD may also be at risk of other, additional mental health problems. These may include:

• Bipolar disorder.
  
• Anxiety disorders.
• Depression.
• Antisocial tendencies and/or behavior.
  
• Eating disorders.
  
• Academic problems (such as poor school attendance or dropping out).
  
• Illegal drug use.
  

Having a mental health condition like ADHD puts one at greater risk for a co-occurring substance use disorder, known as dual-diagnosis. Anxiety disorders, for example, co-occur with substance use disorders at a 12-month prevalence rate of 33-45%, with lifetime prevalence of drug abuse and dependence at 25% to 30%.

Treatment

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Treatment for prescription stimulant abuse (with or without a co-occurring mental health disorder) can take several different forms:

• Psychotherapy and behavioral modification is often considered the first line of treatment, given individuals' existing predisposition for prescription medication abuse. Psychotherapeutic or behavioral approaches may include:
  • Cognitive-Behavioral Therapy (CBT).
  • Motivational Interviewing.
  • 12-Step or other support groups.
  • Contingency management.
  • Alternative approaches such as:
    • Biofeedback or neurofeedback.
    • Meditation, yoga, or other mindfulness-based therapies.
    • Art or expressive therapies.
• Sometimes, alternative medications to stimulants may be used, such as SSRI's or other antidepressants.
• Inpatient or outpatient substance abuse programs can be helpful if you have an addiction and need structured support.

In the case of ADHD, instead of using stimulants to enhance attention and concentration, methods like meditation and neurofeedback are holistic alternatives to prescription or illicit drugs. They teach individuals to self-regulate their attention on their own - instead of relying on external agents (i.e., medication) with side effects - which can create long-term changes in neural networks in the brain.

Finding Treatment

If you are considering treatment, here are a few options:

• Use the Substance Abuse and Mental Health Services Administration (SAMHSA) treatment finder to locate inpatient and outpatient treatment centers in your area.
• Call 1-888-993-3112Who Answers? to learn about inpatient rehab centers in your area.
• Contact your insurance company.

Sources

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Bright G. M. (2008). Abuse of medications employed for the treatment of ADHD: results from a large-scale community survey. Medscape Journal of Medicine, 10(5), 111.

Kollins S. H. (2008). ADHD, substance use disorders, and psychostimulant treatment: current literature and treatment guidelines. Journal of Attention Disorders, 12(2), 115-125.

James A. S, Pennington Z. T, Tran P., & Jentsch J. D. (2015). Compromised NMDA/glutamate receptor expression in dopaminergic neurons impairs instrumental learning, but not pavlovian goal tracking or sign tracking. eNeuro, 2(3).

Slattery, J., Kumar, N., Delhey, L., Berk, M., Dean, O., Spielholz, C., & Frye, R. (2015). Clinical trials of N-acetylcysteine in psychiatry and neurology: a systematic review. Neuroscience & Biobehavioral Reviews, 55, 294-321.

Kollins, S. H. (2008). A qualitative review of issues arising in the use of psychostimulant medications in patients with ADHD and co‑morbid substance use disorders. Current Medical Research and Opinion, 24(5), 1345-1357.

Schubiner, H. (2005). Substance abuse in patients with attention-deficit hyperactivity disorder. CNS drugs, 19(8), 643-655.

Center on Young Adult Health and Development. Nonmedical use of Prescription Stimulants. University of Maryland Public Health. www.medicineabuseproject.org>NPSFactSheet. Accessed 11/20/15

Teter, C. J., McCabe, S. E., LaGrange, K., Cranford, J. A., & Boyd, C. J. (2006). Illicit use of specific prescription stimulants among college students: prevalence, motives, and routes of administration. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 26(10), 1501-1510.

National Institutes of Health (2015). Prescription Drugs. Retrived from: www.drugabuse.gov/drugs-abuse/prescription-drugs.

National Institutes of Health (2010). Prescription Drug Abuse. Retrieved from: https://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2010/09/prescription-drug-abuse.

Epocarates ADHD drug class monograph. Accessed 11/21/15

Center for Substance Abuse Treatment. Treatment for Stimulant use disorders. Rockville (MD); Substance Abuse and Mental Health Services Administration; 1999 (Treatment Improvement Protocol (TIP) Series, No. 330 Chapter 1- Introduction

Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 617-627.

Jane-Llopis, E., Jané-Llopis, E., Matytsina, I., Jané-Llopis, E., & Matytsina, I. (2006). Mental health and alcohol, drugs and tobacco: a review of the comorbidity between mental disorders and the use of alcohol, tobacco and illicit drugs. Drug and Alcohol Review, 25(6), 515-536.

Simon, N. M. (2009). Generalized anxiety disorder and psychiatric comorbidities such as depression, bipolar disorder, and substance abuse. The Journal of Clinical Psychiatry, 70(suppl 2), 1-478.

Scott, E. L., & Hulvershorn, L. (2011). Anxiety disorders with comorbid substance abuse. Psychiatric Times, 28(9).

Nery, F., & Soares, J. (2011). Comorbid bipolar disorder and substance abuse: Evidence-based options: Medication selection may vary based on which substance patients abuse. Current Psychiatry, 10(4), 57-66.

Nejtek, V. A., Avila, M., Chen, L. A., Zielinski, T., Djokovic, M., Podawiltz, A., ... & Rush, A. J. (2008). Do atypical antipsychotics effectively treat co-occurring bipolar disorder and stimulant dependence? A randomized, double-blind trial. Journal of Clinical Psychiatry, 69(8), 1257-1266.