Is it true that people are taking Adderall to get high?
Yes, and it has been true for as long as the drug has existed. When we picture Adderall misuse, we tend to imagine a college student up at three in the morning with a textbook and a pill bought from a roommate who has a prescription. That student exists. So does the one who took the same pill at a party, with no exam anywhere in sight, simply to get high.
Adderall is an amphetamine, or more precisely a mixture of amphetamine salts, and its label from the Food and Drug Administration, or FDA, approves it for two conditions: attention deficit hyperactivity disorder, or ADHD, and narcolepsy. It is not approved for weight loss. For a person with ADHD or narcolepsy it is a legitimate treatment, and it works.
The same drug that steadies a person with ADHD can keep anyone awake, talkative, and confident for hours. That is the whole problem. So, what is a stimulant actually doing in the brain, and why is it so hard to put down once the effect wears off?
What does a stimulant do in the brain?
Dopamine is a chemical messenger in the brain’s reward system, the system that marks an experience as worth repeating. Amphetamine and methylphenidate, the two drugs behind the common prescription stimulants, are thought to push dopamine and norepinephrine levels up, according to their own labels, and the brain reads the surge as something important having just happened.
While this is not a perfect analogy, a stimulant works a bit like a credit card for energy and attention. The card lets you spend focus and wakefulness you have not earned today, and the purchase feels free at the moment you make it. The bill arrives when the drug wears off, as fatigue, hunger, and a low mood, and the easiest way to make the bill go away is to swipe the card again.
Yet, that second swipe is where misuse starts turning into something else. A person who takes a stimulant for a diagnosed condition pays the bill on a schedule, under a doctor’s eye, and usually at a dose that keeps it small. A person taking it to get high pays no attention to the bill at all, until the day the card is declined.
Which drugs are we talking about?
Adderall is the famous one, but it has a large family. Ritalin and Concerta both contain methylphenidate, Ritalin as the short-acting tablet and Concerta as the extended-release form, and the Daytrana patch delivers the same drug through the skin. Some doctors feel more comfortable with methylphenidate because it is not technically an amphetamine. Yet, its label carries the same warnings.
While Vyvanse, or lisdexamfetamine, is sold as a smoother, longer-acting alternative, in the body it is converted into dextroamphetamine. That is the same drug sold as Dexedrine, one of the oldest members of the family, and the one the military handed to pilots as a “go pill.” The Vyvanse label approves it for ADHD and for binge eating disorder in adults, and the same label states that it is not indicated or recommended for weight loss.
Then there are the names most people never hear: Evekeo, Dyanavel, Quillivant, QuilliChew, and a long list of generics. On the street the whole family is known as “speed,” and the FDA treats it as one family too. In 2023 the agency required every prescription stimulant to carry the same boxed warning. In the label’s words, the drug has “a high potential for abuse and misuse, which can lead to the development of a substance use disorder, including addiction,” and misuse “can result in overdose and death.”
Phentermine, sold as Adipex-P, is the cousin that is written for weight loss, as a short-term adjunct to a diet. A few of the older amphetamine products, Evekeo and Desoxyn among them, still carry a short-term obesity indication on their labels. Adderall does not.
Phentermine is related to amphetamine and raises heart rate and blood pressure the same way, and the federal government schedules it as a lower-risk controlled substance than amphetamine itself. It is still a stimulant, and it is still a controlled substance.
Should Adderall be illegal, like methamphetamine?
You may wonder why Adderall is legal at all, when it is a dangerous and habit-forming stimulant. Why not treat it like methamphetamine and cocaine? This is a good question, and the answer surprises people. In fact, methamphetamine and cocaine are legal drugs too.
Methamphetamine is sold by prescription as Desoxyn, with an FDA label of its own that approves it for ADHD. Cocaine hydrochloride is an FDA-approved topical anesthetic, used to numb the inside of the nose before certain procedures.
What makes methamphetamine the more feared drug is not its legal status. It is that the molecule is thought to cross into the brain more easily than amphetamine and hit harder, and that what is sold on the street comes out of an illegal lab, not a pharmacy. The reason a box of Sudafed now lives behind the pharmacy counter is a federal law, the Combat Methamphetamine Epidemic Act of 2005, written because pseudoephedrine can be cooked into meth in a kitchen.
So, legality is not the test. Dose, purpose, and supervision are the test. Taken as prescribed for ADHD or narcolepsy, Adderall is a legitimate medical treatment, and taken from a friend’s bottle to get through finals week, it is the same drug with none of the safeguards. There is a separate page on this site about cocaine and another about methamphetamine.
Of course, a doctor who has a choice should reach for the lower-risk option first. The FDA has approved several non-stimulant medications for ADHD, and if you have a history of stimulant trouble, it is not a bad idea to ask your prescriber whether one of those would do the job.
Stimulants strain the heart at prescribed doses, and misuse multiplies the risk.
The Adderall label puts it plainly: sudden death, stroke, and heart attack have been reported in adults taking stimulant drugs at recommended doses. The label also warns of rises in blood pressure and heart rate, and it tells doctors to avoid the drug in people with structural heart problems, cardiomyopathy, serious rhythm disturbances, or coronary artery disease. Those are the risks at prescribed doses.
Imagine a young man in an emergency room at four in the morning with chest pain and a racing heart, after a night of Adderall and very little else. He may be having a panic attack. Or, he may be having a heart attack, and no one can tell which from across the room. The ER doctor has to work it up as the real thing.
Unfortunately, the heart is not the only organ at stake. The same label describes new psychotic or manic symptoms, at usual doses, in people with no history of either, a circulation problem in the fingers and toes known as Raynaud’s phenomenon, and a lowered threshold for seizures. In overdose, the body overheats. A stroke can leave permanent brain damage, and it happens to young people too.
Does taking Adderall mean a lifelong addiction?
No. Does one semester of borrowed Adderall mean a lifetime of addiction? Does ten years on a prescription? Does feeling terrible on the day you miss a dose? An earlier version of this page said that a student who buys Adderall from a friend may be setting themselves up for a lifelong addiction, and that was an overstatement. Many people who misuse a stimulant for a season never develop a lasting disorder, some do, and no one can tell in advance which group a person is in.
It helps to separate three things that get lumped together. Physical dependence is what any brain does after months on a stimulant: tolerance builds, the dose feels weaker, and stopping brings a crash. Misuse is taking the drug without a prescription, or at a dose or for a reason the prescriber never intended. Addiction is a pattern of behavior: the obsession with the effect, the dose climbing far past anything a doctor would write, the day planned around getting more.
If you have taken prescribed Adderall for ten years and feel terrible when a dose is missed, you are physically dependent. You are not addicted, and you do not need an addiction program. Just because someone misuses Adderall does not mean they are addicted to it either. Each of the three calls for a different response, and the biggest mistake we make in medicine is to answer all three with the same one.
What happens when you stop taking Adderall?
Stopping a stimulant is not dangerous in the way that stopping alcohol or a sedative is dangerous. There is no withdrawal seizure. What there is, the Adderall label spells out: after the drug is stopped suddenly or the dose is cut, depression, fatigue, vivid and unpleasant dreams, too much or too little sleep, and increased appetite. Older versions of the label put it in one sentence, as extreme fatigue and mental depression after prolonged high doses.
Patients often describe the first days as sleeping for most of a day and a night, eating everything in the house, and feeling depressed and worthless. Going back to the credit card, this is the bill, and it arrives all at once.
The hunger and the sleep pass within days. The low mood can last longer, and in someone who was already struggling it can go deep enough to be dangerous. Older methylphenidate labels asked doctors to supervise withdrawal after misuse carefully for exactly that reason, because severe depression may occur.
Yet, there is a second group of people who stop stimulants, and they get much less attention. Maybe you were started on a prescription years ago, were never told how long it was meant to last, and would like to find out what you are like without it. For you, older versions of the same label noted that withdrawal after long therapeutic use may unmask the original condition. That is not a reason to stay on the drug forever. It is a reason to come off of it gradually, with a prescriber who is paying attention, and to decide together what to do about whatever surfaces.
Fortunately, this is the kind of problem a slow taper handles well. The dose comes down in steps, as tolerated, and you set the pace. If a step is too much, the doctor must help you by slowing down. Going back to the credit card one last time, a taper is a way to pay the bill in small installments instead of all at once.
There is no schedule worth printing here, because the right one depends on your dose, your years on the drug, and you, and it is worked out with your own prescriber.
There is no medication that treats stimulant addiction.
The FDA has approved none, and anyone who tells you otherwise is selling something. Doctors do not like saying that out loud. Yet, the absence of a pill does not mean the absence of help.
What helps is a person, and work. The work is on the life around the drug: the hours of the day the drug used to fill, the people it was taken with, the reasons it got reached for, and the family that is either pushing the person away or holding on.
Motivational interviewing, which starts from your own reasons for changing rather than a doctor’s lecture, and cognitive behavioral therapy, which works on the thoughts that come right before the next dose, are the main tools. Inside programs that can run it, a reward-based approach known as contingency management is another. None of them is fast.
One part of the work surprises people. Stimulants have a long history as a sexual drug, and for some people the two become so tightly linked that one reliably cues the other. Untangling that is slow and private work, and it is one reason a person who seems to have quit keeps finding their way back.
Family matters more than any technique. If it is your son or your sister, “tough love,” kicking them out, cutting off the phone, withholding the basics of survival, puts them directly in danger and does not get them one day closer to quitting. The family member who learns harm reduction, keeps the door open, and refuses to pretend that nothing is wrong is doing the most useful thing anyone can do.
Of course, readiness moves, and a person who is not ready today may be ready in a month. The family that stayed in contact will be the first to hear it.
What can Dr. Leeds do for a person who is addicted to stimulants?
That question is answered in a consultation, and nowhere else, because it depends on the person. There is no medication to prescribe, so there is no program to sell.
What Dr. Leeds can offer a motivated person is a doctor who will work with them, one on one, on resources, on the family situation, and on their own life. The counseling that goes with that is part of medical care, not a separate service. When the work calls for more than a doctor’s visits can hold, a referral to a therapist is part of the plan, and the patient will be told so honestly.
In fact, a patient who wants off of a prescribed stimulant after years of use is asking a more familiar question. Dr. Leeds’ practice is built around helping patients taper off of medications they no longer want to take, at the patient’s own pace, and a stimulant that has been part of someone’s daily routine for years is a reasonable thing to bring to that conversation.
Dr. Leeds provides concierge telemedicine care for patients located in Florida, with an office in Fort Lauderdale. New patients start with the contact form.
When is a stimulant problem an emergency?
Call 911 for chest pain, trouble breathing, a seizure, a very high body temperature, severe agitation or confusion, or any sign of stroke, such as a drooping face, a weak arm, or slurred speech, in anyone who has taken a stimulant. If the crash after stopping brings thoughts of suicide, call or text 988, the 988 Suicide and Crisis Lifeline, at any hour. Emergency care is never the wrong call.
This article is educational. It is not medical advice, and reading it does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician.