Seems like I read a post everyday where someone claims therapeutic levels of stimulants causing drug dependency or tolerance build up to the point of the drug becoming ineffective. I have not seen any clinical evidence to support either claim for the general adhd population.

Links please.

Not all the evidence is so direct, many conclusions have to be reached much like you put together the pieces of the puzzle. If you have 90% of the pieces and the result and or tendency seems clear, you will always find a devil's advocate. Also consider possible confounding factors in studies showing continued amphetamine efficacy over time such as learning new behavior, and whatever else might be going on.

I will see if I have the time to dig up some links later. I suggest somebody else with the inclination take care of it however if expediency is a concern.

Tolerance or dependency would be a major issue with stimulant medication. You would think if this was a universal issue, that some advocacy group would have collected the pieces of the puzzle to make their point. Beyond Baughman, Breggin et al, and Scientology, I just haven't come across it and the Antipsych's attempts are laughable. When we do talk about tolerance I would like you to show me that tolerance would be such an issue, that most would have to stop taking the medication because it had become ineffective. Legally insane has done this. Do you support his contention about theraputic levels of stimulants?

http://www.addforums.com/forums/showthread.php?p=181076#post181076

"Every person is different though and building up tolerance may come within weeks or it may come within months. It's just like a tolerance to alcohol. It depends how much and how often you use it".

I am really hoping that we can get something conclusive out of this thread. It's *so hard* to find good info on a lot of this stuff, because the internet is so full of rubbish of so many varieties.

Really, nothing about tolerance is clear; It's not clear if it develops at therapuetic doses, or how frequently if so; it's not clear how long it takes to develop and get rid of; it's not clear what effects/side-effects one becomes tolerant of, etc etc etc.

There is a consensus that tolerance/dependence *is* possible if taken in an abusive pattern. But this is also unclearly defined; what if your doctor overprescribes you quite a bit? Is the cutoff 50 mg? 100 mg? 500 mg? 1 g? Nobody is too sure. Most of the people who choose to abuse really go nuts, scarfing down 10x or more of the recommended dose, and do so typically through snorting it rather than taking a lot of pills. Is snorting alone the cause of the dependence? Or perhaps it's the goal of such abusive use - that one becomes "tolerant" of the high, but other factors can remain in play?

The only thing even close to touching the topic of long term use that I have found I posted in the Adderall forum, Shire's Adderall cheerleading (http://www.adderall.com/pdf/athomeatwork.pdf"), which has a page (6) where they show those being continuously dosed still show increasing improvement vs. symptoms over a period of, if you're to believe it, years. Whether or not this is a result of Shire running a study (poorly) and then lying with it, I don't know.

well in my opinion...tolereance is generally equated to substance abuse rather than use....most all drugs have a tolerance...even including aspirin, i read one post from the origin of this one that stated amphetamines create more dopamine...which isnt true.....they only release more dopamine as well as norepeniphrine, there are some suppliments than can certainly hlep...l tyrosne would be one to consider (it helps replinish dopamine)....and 500 mg of vitamin c before bed wouldnt hurt either.....

Tolerance and dependency ARE two terms most often equated with substance abuse and that is why I started this thread. The antipsychs and Scientologists have injected these terms into the adhd med vernacular and polluted the landscape. There language is often darkened with fear. It was time to shed some light on the issue.

This is because even as scientific materials treated substance dependence like addiction.

Further support for my original contention.

http://www.bnl.gov/bnlweb/pubaf/pr/1998/bnlpr092998.html

"We saw a dramatic difference between Ritalin taken orally by ADHD children and Ritalin injected by teenagers and adults to get high, as well as the difference from cocaine," she continued. "And when the pathway to the brain is less direct, as with a pill, the effects aren't sudden enough to cause a high and to develop a reinforcing effect that leads to addiction. But they are enough to focus the attention of the child and calm the hyperactivity."

and more support...


Dr. Diller as quoted from the PBS series on ADHD
http://www.pbs.org/wgbh/pages/frontline/shows/medicating/drugs/diller.html

"Experiencing euphoria is, of course, one of the features of a drug that makes it a candidate for abuse. The most serious drugs of abuse are those that readily cause users to develop tolerance (the need for a higher and higher dose to obtain the same effect) or addiction (a physical and emotional craving for the drug). In the typical dose range of 5 mg to 20 mg, up to perhaps 60 mg total per day, Ritalin does not produce either tolerance or addiction. Ritalin does not accumulate in the bloodstream or elsewhere in the body, and no withdrawal symptoms occur when someone abruptly stops taking the drug, even after years of use. However, with teenagers and adults who abuse Ritalin--by taking high doses, sometimes via snorting or shooting the drug--the phenomena of tolerance, addiction, and withdrawal can occur".

and.... Dr. Russell Barkley, in his book Taking Charge of ADHD, pg 273

Myth 3: Stimulants make children "high" as other drugs do, and are addictive

You may have heard that adults who take stimulants often have a sense of elevated mood, euphoria, or excessive well-being. While this does happen, it is not common, and in children it is rare. Some children do describe feeling "funny", "different", or dizzy. Others actually become a little bland in their mood, and a few even report feelings of sadness. These mood changes occur a few hours after medicine is taken and occur more often amoung children treated with higher doses. In most children, these changes are minor.

Parents are often also quite concerned about the risk of addiction to stimulants and about an increased risk of abusing other drugs when the children become teenagers. There are no reported cases of addiction or serious drug dependence to date with these medications, and the several studies that have examined whether children on these drugs are more likely than those not takng them to abuse other substances as teenagers suggest that they are not. Indeed, several recent studies conducted by Dr. Timothy E. Wilens and colleagues at Massachusetts General Hospital ( Harvard Medical School ) and by Drs. Howard Chilcoat and Naomi Breslau at Henry Ford Hospital in Detroit, found that taking stimulants during childhood did not predipose children with ADHD to an increased risk of substance use or abuse as teenagers. In fact, Dr. Wilens's study found that adolescents with ADHD who had remianed on their medication during the teen years had a significantly lower likelihood of substance use or abuse than did children with ADHD who were not taking medications during adolescence. Thus the scientific literature to date should reassure parents that they are not predisposing their children to potential for later substance use or abuse by giving stimulants to their children for the management of ADHD. Parents should know that the most important factors in determining a child's risk for adolescent substance use or abuse are 1) early onset of conduct disorder or antisocial behaviour in the child, 2) poor monitoring by parents of the child's or teen's whereabouts in the community, 3) the affiliation of the child or teen with other teens who are using or abusing illegal substances, and 4) the degree to which the parents may also be using alcohol or tobacco products or illegal substances".

With the possible exception of a few drugs that you will likely never encounter outside of scientific journals (Salvinorin A is the only one that comes to mind), all drugs have the potential to create a tolerance effect, whether it is Adderall, Aspirin, or Alcohol. Whether it is through neuroreceptor downregulation or increased metabolic efficiency, tolerance can develop to just about any drug. Actually, what I think is most amazing about Adderall is the fact that if one takes a steady dosage level as indicated, tolerance doesn't often become an issue for most people.

As to dependency, it's complete bunk. Given that AD/HD people are often neurologically incapable of getting "high" off of amphetamines...or more to the point, that the effects that amphetamines on AD/HD people isn't really recreational since it may as well be Martha Stewart in a pill for us...I have difficulty understanding how dependency could occur. Yes, any dopaminergic drug has the neurological potential for addiction, and yes, stopping daily amphetamine use does make even someone with AD/HD feel a bit ****ty, but this is a far cry from the addiction potential of prescription painkillers such as hydrocodone, and doesn't even come within the same league as the dangers posed by benzodiazepine withdrawal.

And of course, given how freely so many people ingest caffeine, should we really be worrying about Adderall what with the level of regulation and supervision involved in its medicinal useage?

Thank you very much! That was well stated (meaning it kicked ***):)


mctavish23 (Robert)

I have posted what amounts to a definite answer to the question posed by this thread.

Keep in mind that this isn't "my answer" but is simply a listing of the research that puts the question to rest.

I suppose it's another....."Here's your proof" kind of thing.

It's in the Adderall thread, however, the studies mentioned also involved methylphenidate as well as dexedrine.

Hope you all have a Happy 4th

mctavish23 (Robert)

Here is McT's post on the Adderall thread.



The title of research study #1 is as follows:

"Does the Treatment of ADHD With Stimulants Contribute to Drug Use/Abuse?
A 13-Year Prospective Study
-Barkley et al, Pediatrics,2003

Objective
To examine the impact of stimulant treatment during childhood and high school on the risk for substance use, dependence, and abuse by young adulthood.

Methods:
A total of 147clinic-referred hyperactive children were followed approximately 13 years into adulthood ( mean:21 years old;range 19-25). At adolescent (age 15) and adult follow-up,probands were interviewed about their use of various substances and duration of stimulant treatment.

Results:
1) Duration of stimulant treatment was not significantly associated with frequency of any form of drug use by young adulthood.

2) Stimulant-treated children had no greater risk of ever trying drugs by adolescence or any significantly greater frequency of drug use by young adulthood

3) Stimulant treatment in either adulthood or high school was not associated with any greater risk for any formal drug dependence or abuse disorders by adulthood.

Conclusions:
Thirteen-year followup study concurs with 11 previous studies in finding no compelling evidence that stimulant treatment of children with ADHD leads to an increased risk for substance experimentation, use,dependence or abuse by adulthood.

Reference: Barkley RA ,Fischer M ,Smallish L ,Fletcher K. Does the treatment of attention-deficit/hyperactivity disorder with stimulants contribute to drug use/abuse? A 13 year prospective study.Pediatrics.2003;lll:97-109.


Here are some additional data derived from 2 different studies looking at the same question over a shorter duration (4 year follow up). You'll notice that the principal researcher in Reference #3 is Harvard psychiatrist Joe Biederman. I have commented on him several times in the past as being among the best ADHD researchers in the world.


Study #2 : Does Stimulant Therapy of ADHD Beget Later Substance Abuse? A Meta-analytic Review of the Literature
- Wilens et al, Pediatrics, 2003

Objective:
Concerns exist that stimulant therapy of youths with ADHD may result in an increased risk for subsequent substance use disorder (SUD).The authors investigated all long-term studies ini which pharmacologically treated* and untreated youths with ADHD were examined for later SUD outcmes.

Methods:
A search of all available prospective and retrospective studies of children, adolescents,and adults that had information relating to stimulant therapy and later SUD oucome in adolescence or adulthood was conducted through PubMed supplemented with data from scientific presentations. Meta-analysis was used to evaluate the relationship between stimulant therapy and subsequent SUD in youths with ADHD in general while addressing specifically differential effects on alcohol use disorders or drug use disorders and the potential effects of covariates.

Results:
1) Data from 6 studies comprising 674 medicated subjects and 360 unmedicated subjects produced a pooled estimate of the odds ratio indicating a 1.96 fold reduction of risk for SUD in the youths who were treated with stimulants compared with the unmedicated group.

2) Authors also found similar reductions in risk for later alcohol and drug use disorders

Conclusions :
The results suggest that stimulant therapy for ADHD in childhood is associated with a reduction in the risk for subsequent drug and alcohol disorders.

Reference: Wilens TE, Faraone SV, Biederman J, Gunawardene S.DOes stimulant therapy of attention-deficit/hyperactivity disorder beget later substance abuse? A meta-analytic review of the literature.Pediatrics.2003 lll : 179-185.


Study # 3 :

Pharmacotherapy of ADHD Reduces Risk for Substance Use Disorder
-Biederman et al,Pediatrics,2003

Objective:
To assess the risk for SUD associated with previous exposure to stimulant medication in a longitudinal study of boys with attention- defict disorder.

Methods:
A study of males greater than or equal to 15 years.
The cumulative incidenceof SUD in 56 medicated subjects, 19 unmedicated subjects, and 137 non-ADHD control subjects.

Results:
1) Unmedicated subjects with ADHD were at a significantly increased risk for any SUD at follow-up compared with non-ADHD subjects (adjusted odds ratio [OR 6.3 )
2) Subjects with ADHD medicated at baseline were at significantly reduced risk for an SUD at follow-up relative to untreated subnjects with ADHD (adjusted OR0.15)
3) For each SUD subtype, the direction of the effects of exposure to stimulant therapy was similar to that for any SUD category.

Conclusions:
1)Consistent with findings in untreated ADHD in adults,untreated ADHD was a significant risk factor for SUD in adolescence
2) In contrats, stimulant therapy was associated with an 85% reduction in risk for SUD

Reference: Biederman J,Wilens T, Mick E, Spencer T,Faraone SV. Pharmacotherapy of attention-defict/hyperativity disorder resduces risk of substance use disorder. Pediatrics [serial online].August 1999;104(2)e20.



You will find more posts by McT on that thread.

http://www.addforums.com/forums/showthread.php?p=195026#post195026

Hi All,
I don't no about dependancy but I can tell you that I have a blood pressure problems, prior to being rediagnosed with adhd, and for me my cardiologist and phyciatrist have been monitoring my intake because the working dose for me now is 30m 2x and 20mg early evening, and thats because the side effects from the blood pressure medicine made me drowsy and un focussed while taking a smaller dose of the Aderall, Its been a juggiling act now for 3 months getting a working dose of Aderall and a safe blood pressure range while on that dose. While I'm on 30mg of aderall my blood presure is around 130-145... over.... 87-89 pulse rate 88-90, so in my case its been a trying time for me thinking my (HEART) will blow up, which just adds more stress to the situation.
And beleive me we have tried all the non stimulant drugs first that they did absolutly nothing for my sever adhd condition, But now I'm dialed in and life is ok.

Best.......chris m.

You build a tolerance to anything, regardless of whether it's used "therapeutically" or not. Ever hear of alcohol tolerance? Same concept. Ever wonder why you need "booster shots" every 10 years for vaccinations? Your body "forgets" the tolerance.

There's a difference between needing to increase the dosage periodically to help the meds work better and creating an addictive need for more.

ALL of those studies say that isn't true. If you have a reference that says otherwise, please post it because I looked back as far as 18 years and couldn't find one.

People become addicted to vaccinations? :eek:

With myself,I have had this problem and Im sure some of you have read my threads.I do not abuse,I take as directed and heres what I have found.This last time I had it upped it did start to diminish but not as quickly as last time and I did not go back to square one like before.I am still much better off than before.I can function great!Im taking a total of 40ml. a day,I keep things clean but I am noticing as the weeks go by that Im starting to drift a little again.I can always see it with my own eyes.The clutter will get higher and higher and then Me and my kids will be swimmin' in it!!Like I said Im still much better off than before and if this is the max result I will accept it with a smile...

OH YEA!I forgot,the addiction thing is not what some think.I am addicted! Im addicted to feeling happy and normal now.Who the heck(Isay that loosly)would want to go back to the old way they felt?Thats the whole reason that we got help in the first place.