Stimulant drugs are the most commonly used treatment for the symptoms of short attention span, impulsive behavior, and hyperactivity associated with the diagnosis of ADD/ADHD. These drugs improve ADHD symptoms in about 70% of adults and 80% of children shortly after starting treatment. They may be used alone or in combination with behavior therapy. Stimulants work by increasing dopamine levels in the brain; dopamine is a neurotransmitter associated with pleasure, movement, and attention. The most commonly prescribed stimulants are Concerta, Adderall, Vyvanse, Dexadrine, Metadate CD, Ritalin LA, and Focalin. In severe cases methamphetamine hydrochloride (Desoxyn) may be prescribed. Stratterra is the only non-stimulant medication approved by the FDA for the treatment of ADD/ADHD in both children and adults.
There are some inherent difficulties in treating adults ADD/ADHD with stimulants. Stimulants are controlled substances (Schedule II) and it is not uncommon for adults with ADHD to have substance abuse problems. Any prescribed stimulant has a high potential for drug dependency and abuse. These medications are closely related to illegal street drugs.
Stimulants have also been abused for both performance enhancement and recreational purposes. Stimulants allow an individual to lose weight, increase wakefulness, and increase focus and attention. The euphoric effects of stimulants usually occur when they are crushed and then snorted or injected.
There are serious side effects when an individual is taking a stimulant: increased blood pressure, heart rate, body temperature, and decreased sleep and appetite. Additionally, repeated use of stimulants can lead to feelings of hostility and paranoia. At high doses, stimulants can lead to serious cardiovascular complications, including stroke.
Problems with the Proposed Lowering of the ADD/ADHD Diagnostic Bar
The reasons for changing the criteria for any mental health disorder is the concern that individuals were under-diagnosed due to overly cautious mental health clinicians and/or the stigma of having a psychiatric diagnosis. However, when you decrease the criteria for a diagnosis, you also decrease its specificity. Lowering the ADD criteria has the strong potential for misidentifying adults with fairly mild attention problems as having ADD. Giving stimulants to individuals who do not need them will result in an increased risk of substance abuse as well as harmful, even fatal, side effects. Additionally, lowering the criteria will make it easier for adults to access stimulants simply for performance enhancement (athletes and college students) and/or recreational purposes. Finally, a rush to a diagnosis of ADD will result in misdiagnosing a more accurate mental illness. The symptoms of ADD are quite nonspecific. These symptoms are also found in many other mental health disorders: substance abuse, bipolar disorder, depression, anxiety disorders, OCD, autistic disorders, psychotic disorders, and personality disorders.
ADD/ADHD and Problems for Law Enforcement
Studies have shown that an adult with ADD/ADHD has more difficulties with law enforcement than the average citizen. These individuals are more likely to suffer from substance abuse; alcohol and marijuana are the most commonly abused substances. On a smaller scale, they are more likely to have multiple speeding tickets and minor traffic collisions. The impulsivity that accompanies these disorders makes individuals more likely to have impaired judgment when dealing with difficult situations, such as being confronted by officers. Impulsivity and anger management issues, including domestic violence, are also more prevalent than in the general population.
There has become a large secondary market for prescription stimulants. It has been reported that 30% of college students use stimulants. If a prescribed patient does not use the stimulant, they can be sold for a hefty profit. This leads to the societal concern that there will inevitably be greater abuse of stimulants and to their illegal sales. This will impact law enforcement agencies and officers.