In the United States alone, millions of children and adults have been diagnosed with Attention-Deficit Hyperactivity Disorder (ADHD)1. 'An effective treatment for this disorder is the use of psychostimulants of the central nervous system such as methylphenidate, dextroamphetamine, and amphetamine2.' The abuse of these pertinently named drugs has been on the rise. The particular use of Adderall has faced much scrutiny since its initial creation by Shire Pharmaceuticals in the early 1930's. In addition, the recent misuse of the drug by professional athletes in the NFL has been highly publicized. Historically, both professional and collegiate sports organizations have been vigilant in their monitoring and elimination of performance enhancing drugs, such as steroids and stimulants, by athletes. The NFL, however, does allow players who have a properly diagnosed disorder and reported medical need may use the drug without being penalized so as long as they have applied for and been granted a therapeutic use exemption. But lately, players around the league are failing drug tests and acquiring suspensions – "according to NFL. figures, 21 suspensions were announced this calendar year because of failed tests for performance-enhancing drugs, including amphetamines like Adderall... a 75% increase over the 12 suspensions announced in 2011.15"
The question of whether Adderall's presence in NFL locker rooms is for performance enhancing or just another medication used to treat a condition is at the crux of many debates. Does Adderall give athletes an unfair advantage over their competitors? What are the long-term effects this drug has on people who really don't need it?
In order to better understand the issue, the pharmacological implications of this stimulant and its effect on the central nervous system and the brain must be acclimatized. Monitored and responsible usage give amphetamines tremendous potential in treatment of ADHD. Abused and used at inappropriately high levels, however, amphetamines produce side effects in an individual that can be severe – with hypertension and psychosis prominent on the list. Other side effects such as loss of appetite, insomnia, abdominal pain, increased blood pressure, increased heart rate, irritability, headaches, and increase in body temperature are also consequences of taking this psycho-stimulant. Severe cardiovascular problems and physical withdrawal, including rebound and dependence has also been reported. Days to weeks of repeated misuse and high dosage may lead to adverse psychiatric effects such as a psychotic state of hostility and paranoia. In severe cases, high doses of stimulants used over a long period of time can even generate a condition that mimics schizophrenia and bipolar disorders due to excess neurotransmitter release3. A comorbidity may also present itself – mood and anxiety symptoms need to be primarily treated and diagnosed as stimulants exacerbate these conditions. The constriction of blood vessels and the increase in blood sugar may also become present – effectively preparing the body for an emergency by eliciting the fight-or-flight response. It is not surprising then, that Adderall belongs to a class of drugs known as Schedule II under the Controlled Substance Act due to its potential for abuse, dependency, and addiction4.
When the risks far outweigh the benefits, why do people who clearly do not need it take these stimulants?
The answer may lie in the desirable biochemical and psychological effects achieved by amphetamines such as Adderall. The performance enhancing effects observed by users are very similar to adrenaline. Since amphetamines are broken down in the liver and enter the bloodstream fairly rapidly, the onset of effects occur quickly and last for 2 to 4 hours4.
It is no surprise that athletes find themselves taking performance enhancing drugs due to pressures such as winning games, performing at a high level, to improve personal body image, and desire to do well. Athletes want to be at their best during a game – their salaries and reputations as players are in direct correlation to their performances on and off the field. The active ingredients in Adderall, dextroamphetamine and levoamphetamine, give players a competitive edge. An increase in alertness and concentration, maintaining of focus, diminishment of fatigue, and intensification in pleasure are potent effects. These drugs also raise levels of dopamine in the brain. Dopamine is the neurotransmitter responsible for movement, emotions, cognition, motivation, and feelings of pleasure. Neurotransmitters facilitate the transmission of signals from one neuron to the next. These neurons contribute to the control of purposeful movement and effectively prepare the body for physical activity. People who abuse these drugs become full of energy and may produce grandiose thoughts – an ideology that they can accomplish anything. They are in constant motion and may exhibit excitable talkativeness. In contrast, people who actually have ADHD notice that they can actually function and complete day-to-day activities without hitch. Another sign of abuse may present itself through pattern. Taking the drug on a schedule versus on an as-needed basis may clarify the lines between abuse and necessity. For example, usually athletes use stimulants only while engaged in a particular activity and in a particular environment, such as during game time. Off the field, when the setting is more relaxed, the use of the drug is abstained. 'Dr. Gary Wadler, a past chairman of the World Anti-Doping Agency's Prohibited List Committee, admits: "There's no question [Adderall is being used as] a performance-enhancing drug.5'"
Another effect that athletes may find advantageous is Adderall's ability to metabolize energy through the rapid dismantling of fat. This may increase the potential of exercise and "make the most of their time" at the gym by increasing capacity for muscle workload. However, Adderall also increases a person's body temperature – which can pose a potentially dangerous situation during exercise.
So what if the player in question has actually been diagnosed with ADHD? Should the NFL be allowed to hinder a person's general well-being and livelihood by prohibiting a medication because it makes the playing field uneven? Even in instances where the proper paperwork is filed on time and correctly, and the player legally obtains a prescription for Adderall, are the odds of performing above and beyond in unfair favor to the athlete?
Any good physician can prescribe a medication – but a great one will exhaust all other efforts before putting a person on a highly addictive drug. Given the high salary of most athletes, I refuse to believe those with ADHD have tried every other pathway before coming to Adderall. In fact, 'a nonstimulant agent approved by the U.S. Food and Drug Administration for the treatment of ADHD is atomoxetine which has shown to be effective in both adolescents and adults. In addition, atomoxetine exhibits little effect on serotonin reuptake and has minimal affinity for other neurotransmitters.6' Yoga, special diets that are high in essential fatty acids and glyconutrients while eliminating sugars and caffeine or allergies to wheat, milk, and eggs, vitamin/mineral/herbal supplements, and neurofeedback training have all shown effectiveness in reducing the debilitating features of ADHD.
Finally, it is important to acknowledge that ADHD is a complex disorder and each person is different. As with any treatment and medication, it is imperative to consult with a doctor to ensure safety, achievement of optimal benefits, and maintenance a high level of personal well-being.
Treatment for Adderall addiction is available. If you suspect a loved one or yourself may be addicted to amphetamines and are interested in getting help call 1-877-653-9087.