View Full Version : Preventing Tolerance


driver8
10-09-06, 03:20 PM
"While continuous dosing with amphetamine causes tolerance, intermittent dosing produces "reverse tolerance" or sensitization to its psychological effects. As a result, regular users commonly experience a quick decrease of unwanted side effects, without an equivalent loss of its stimulant properties."

I read this statement on the internet and wondered if "drug holidays" or intermittent dosing can prevent or reduce tolerance effects. If anyone has any links to the subject of tolerance avoidance and dosing strategies, I would really appreciate the links! Thanks!

JustNeedHelp
10-09-06, 03:53 PM
there was another topic about this using magnessium, in the nutrition section of the forums look there, and ketamine was mentioned (although illegal and NOT recommended, hallucenogenic properties in ketamine).

LittleD1981
10-09-06, 11:35 PM
Should this statement read: "While continuous dosing with amphetamine causes tolerance, intermittent dosing produces "reverse tolerance" or sensitization to its psychological effects. As a result, regular users commonly experience a quick decrease of unwanted side effects, WITH an equivalent loss of its stimulant properties." The original statement says "without" where I capitalized "with" and it just doesn't make any sense. Now I'm confused. Sigh. I shall look around, though, as I have the same concern.

driver8
10-10-06, 08:59 AM
I am also confused by the statement and that is why I posted my question. From what I've been reading about tolerance, it appears that drug holidays and intermittent dosing can prevent tolerance. Furthermore, from what I am reading, intermittent dosing can induce "reverse tolerance" whereby the negative effects of the drug are eliminated, but the stimulant properties continue. As I learn more, I'll share. One example that I was given is that some alcoholics reach a point where they can get drunk on one drink because they move from tolerance to reverse tolerance. I still don't quite get it though. I want to know if intermittent dosage offers an benefit to ADHD individuals taking stimulants and what dosage strategy to follow to avoid tolerance.

Rayzor
10-10-06, 11:28 AM
I am also confused by the statement and that is why I posted my question. From what I've been reading about tolerance, it appears that drug holidays and intermittent dosing can prevent tolerance. Furthermore, from what I am reading, intermittent dosing can induce "reverse tolerance" whereby the negative effects of the drug are eliminated, but the stimulant properties continue. As I learn more, I'll share. One example that I was given is that some alcoholics reach a point where they can get drunk on one drink because they move from tolerance to reverse tolerance. I still don't quite get it though. I want to know if intermittent dosage offers an benefit to ADHD individuals taking stimulants and what dosage strategy to follow to avoid tolerance.
To put it simply, taking it without the breaks eventually causes reduced benefits but pronounced stimulant side effects. The intermittant holidays keep the side effects moderate while keeping the benefits of the med.

Stabile
10-10-06, 12:23 PM
To put it simply, taking it without the breaks eventually causes reduced benefits but pronounced stimulant side effects. The intermittant holidays keep the side effects moderate while keeping the benefits of the med.
That might be the closest to an accurate statement about it, but it still grossly overstates the case.

First fact: tolerance is a strongly defined technical term not applicable to this discussion. No tolerance to AD/HD stimulant meds has ever been demonstrated.

The commonly reported experience of apparent diminished effect is not tolerance, as it is meant when discussing drugs. Like it or not, we really need to find a different term or phrase to describe this.

Second fact: drug holidays have never been shown to have any particular efficacy. It’s likely that the practice arose as a kind of urban legend among physicians, fed by the mistaken idea that stimulants cause certain ‘speedy’ side effects in kids with AD/HD.

Our own doctor used to tell us to watch Bry’s weight, even as he acknowledged there was no basis for such a worry. The classical appetite suppression seen in normals with amphetamine use doesn’t happen to ADDers, and to confuse matters even more, Ritalin is not an amphetamine.

When I asked, he realized he’d never seen any weight effects in his patients. He just grinned and stuck with the successful model he’d developed, for a while, at least. But he was moving slowly away from drug holidays the last time we talked about it.

Docterin’ is not about the science of medicine; it’s about the patients’ symptoms and quality of life. That’s the focus, and what you’re going to find out there in successful practices is a practical model that works. Most of it will be fact, some of it will be a little bit of voodoo, and occasionally we’ll discover that (for example) stomach ulcers aren’t caused by what we thought, and all that medicine was for naught. A good dose of antibiotics fixes the problem for good.

When ADDers take stimulants in appropriately prescribed therapeutic doses, the effects are entirely different than what you see in meth abuse, diet pill abuse and so on. It’s widely accepted that AD/HD stimulant meds are abused, but there is actually no evidence for this assumption.

As far as we can tell, the origin of the idea our drugs are abused was a 60 Minutes story way back when. Several months after the story broke, the principles reporting abuse of AD/HD meds either withdrew their claims or clammed up, refusing to affirm their on-air stories. Several described being aggressively coached by 60 Minutes production staffers, which may have resulted in an internal shakeup.

Other than a dedicated effort by a self-proclaimed fundamentalist Christian organization to get Ritalin out of schools, no other Big Stories have arisen that we can find. The often cited government stats actually don’t show any statistically significant problems related to AD/HD meds. The data are freely available, if you’d like to check it out for yourself. But it’s a lot of numbers to chew thorough if you’re not used to looking at this sort of study.

The bottom line is this: the ADDer experience occasionally mislabeled as ‘tolerance’ doesn’t have anything to do with actual tolerance as the term is applied to drugs. In our experience, it’s always been related to the normal function of our ADDer minds. We begin our drugs, get some stuff straightened out, and get restless to move on to new areas.

No drug will keep us focused on a problem that seems solved, nor should it. And there’s a natural cyclic rhythm to life, too, that can’t be escaped: we engage something, wrestle it around a bit, and then back off to ponder. No drug can do away with that fallow period, and if it coincides with the recommended drug vacation, it might make some sense.

But it’s not necessary, and we never practiced it. There are completely different practical reasons to use the drugs intermittently; that’s our youngest boy’s standard use, now. Doctor approved, of course, and nothing to do with a drug holiday or any kind of tolerance.

JustinL
10-10-06, 01:22 PM
OK, to disagree with a bit, and make a shorter (much) statement...

You take time off from the medication, you WILL see an increase in the effects when you resume it again. It is true that *technically,* for ppl with ADHD, the medication does not STOP woirking (ever). But your body absolutely will adjust to many of the benifits and it wont be AS effective over time.

There is NOTHING wrong with drug holidays. My doctor told me its a must. Especially if your somebody like me, who is paranoid about going above 20mg/ day. lol.

driver8
10-10-06, 01:34 PM
I suppose I understand the definition of tolerance and reverse tolerance, but I want to know more about the exact mechanisms of it, and how it applies, or even if it applies, to the ADHD patient using stimulants. Sounds like the previous poster is saying that this doesn't apply to ADHD patients using stimulant therapy as perscribed. I guess I'll have to drag my lazy **** to the library and find the literature. I will write an update if I find anything of interest...

LittleD1981
10-10-06, 02:03 PM
I'm not going to get into the debate over whether "tolerance" is the right word to use, but I did want to add some observations based on personal experience:

Any narcotic medication (Vicodin, Ativan, Adderall, etc.), I will build up an "immunity" to within a very short period of time, usually just a couple months. On the other hand, I have a friend who has been taking 0.5mg of Ativan for a couple years and it still has the same effect on her. It obviously is different for everybody, with some people becoming used to the medication's effects over time, and others not. JMTC

LittleD1981
10-10-06, 02:04 PM
Oh, yeah, and with the sedatives and stimulants (but not the opiates), time away from the medication proves, for me, the cure to the tolerance problem.

driver8
10-10-06, 02:08 PM
http://psychservices.psychiatryonline.org/cgi/content/full/53/1/102

Stabile
10-10-06, 02:53 PM
OK, to disagree with a bit, and make a shorter (much) statement...

You take time off from the medication, you WILL see an increase in the effects when you resume it again.
You will, maybe, and that guy over there, and maybe her and him, and… well, you get the idea.

Not everybody shares that experience, and it’s not tolerance. But it does happen. I can pull it up any time I want, if I skip a couple of days. Or not; it depends entirely on my mood and circumstance. The only difference in my case is that I am aware of the experience, and can choose to control it if I care to.


It is true that *technically,* for ppl with ADHD, the medication does not STOP woirking (ever). But your body absolutely will adjust to many of the benifits and it wont be AS effective over time…
Also quite common, although it’s arguably your mind that’s doing the adjusting. There’s really no good data on physical effects for AD/HD use; some people assume that we must experience compensating shifts in neurotransmitters, but that idea’s not really supportable.


There is NOTHING wrong with drug holidays. My doctor told me its a must. Especially if your somebody like me, who is paranoid about going above 20mg/ day. lol.Absolutely nothing wrong with them at all. If we seemed to be arguing against ‘em, our bad.

There’s no reason to expect to require them, though, or to worry about skipping them if you wanted to.

Bry (our youngest boy) stays away from meds because of their effect on his creative impulses – he’s a professional jazz musician, and knows exactly where his head has to be to do what he does correctly. Stimulants are an impediment mainly because his playing relies on communication with other musicians, and they mess with the dynamic, if that makes sense.

But he does use Ritalin occasionally to deal with ordinary life situations, like paying bills or maybe getting to work on time. He doesn’t like Adderall because it lasts too long.

He has the same response reported here, being more sensitive to the effects after a layoff. So he takes little bits, maybe 5mg, and it works for him.

And there’s not a thing wrong with that kind of paranoia. Bry shares it, which is why he likes being able to use tiny bits of a tab…

Stabile
10-10-06, 03:19 PM
I suppose I understand the definition of tolerance and reverse tolerance, but I want to know more about the exact mechanisms of it, and how it applies, or even if it applies, to the ADHD patient using stimulants. Sounds like the previous poster is saying that this doesn't apply to ADHD patients using stimulant therapy as prescribed…
Classical tolerance doesn’t happen to ADDers on stimulants, right. The required changes in brain chemistry are nowhere to be seen, and the most significant related effect, maintaining behavior, is entirely absent.

I don’t know what you’d maintain, anyway. Doing well in school and getting your ‘scripts filled on time? (grins…)


I'm not going to get into the debate over whether "tolerance" is the right word to use…
Right, because there is no debate. The term is already defined when talking about drugs, and there’s nothing we can do about it. Which is why we need a different word, something more appropriate to what we’re describing…


…but I did want to add some observations based on personal experience:

Any narcotic medication (Vicodin, Ativan, Adderall, etc.), I will build up an "immunity" to within a very short period of time, usually just a couple months. On the other hand, I have a friend who has been taking 0.5mg of Ativan for a couple years and it still has the same effect on her. It obviously is different for everybody, with some people becoming used to the medication's effects over time, and others not. JMTC
…like ‘immunity’. That’s pretty good, better than anything we’ve come up with before, I think.


Oh, yeah, and with the sedatives and stimulants (but not the opiates), time away from the medication proves, for me, the cure to the tolerance problem.
Like most of the rest of what we’ve been discussing, that doesn’t work for everyone, either.

The reason a term like ‘immunity’ works for us is that it implies an action on a more conscious level; you get the appropriate kick from the drug’s chemical activity, but you’ve learned to respond to it differently. You’re immune.

Most of what’s been said refers to effects on our conscious experience of being, not any physical drug action. How each of us interacts with our particular response to the drug is what determines the character of the experience.

Choices can change, too, so there are no guarantees things will be the same tomorrow. But generally, you can depend on the effects you’ve got, once you get used to them.

Personally, if I have to deal with the effects of stimulant meds starting to work at the same time I’m dumped into a crowd scene, the combination can start to trigger a common social anxiety response. It’s easy for me to turn it off, but for someone who hasn’t run into it before, the nature of the associated physical response might make it seem like they were suddenly having a dramatic reaction to the drug.

It’s not so, of course, but more than one person has been taken to the emergency room for exactly this sort of thing. All the reactions we’ve been talking about here are similar, in that they rely on interpretation, and that can change from moment to moment.

Stabile
10-10-06, 03:38 PM
http://psychservices.psychiatryonline.org/cgi/content/full/53/1/102
That’s been cited before. Unfortunately, there’s a lot wrong with the study, not the least of which is that the incidence of side effects mentioned is way out of the norm.

That alone should have made them pause and rethink their sample, or at least their data. The kinds of doses the article talks about are extremely unusual, seen in perhaps one or two percent of the cases, if that.

Personally, I don’t think I would put my name on a paper that targeted such a skewed sample, unless that skew was what we were looking at.

The bottom line is that this study apparently only applies to patients taking massive doses of drugs with significant associated side effects. That’s not something most of us have to worry about.

They do mention tolerance, but it seems unlikely they’re using the term correctly; there’s no more reason to state ‘no tolerance existed’ than there is to say ‘no subjects had visited the moon’. As a reference, if I mention ‘tolerance’ to my doctor in conversation, he goes ballistic. He’s not really a stickler for form; it’s just inappropriate, and professionals should know better.

(Did you notice that first citation, with its reference to ‘Minimal Brain Dysfunction’? That’s the term that got my back up and caused me to abandon treatment in college, long ago. It’s long been discredited, along with many of the associated studies. I don’t know if this was one of them, but it seems likely there are fresher sources out there.)

Rayzor
10-10-06, 10:18 PM
sigh...amphetamines people...yes, tolerance. yes, med holiday works. get your facts straight, jeez.

blekko
10-10-06, 11:16 PM
Thank you Rayzor

driver8
10-11-06, 09:36 AM
Is not the definition of tolerance the need for a larger dose to achieve the same effect?
And does this not happen for some people taking Adderall for ADHD? I believe that it does. In theory, it would seem that drug holidays might increase the time for tolerance to develop or prevent it all together. This makes sense to me. However, I want to see literature backing this up. I did link to a study, which another poster said was flimsy evidence. Specifically, it would be interesting to know a specific intermittent schedule or dosing strategy (e.g. how long should a holiday be and how often). The concept of reverse tolerance is also something I seek more information about. There is a lot of literature about amphetamine abuse, but not much for prescribed use. Tolerance is absolutely a feature of abuse, but the evidence for tolerance in prescribed use is very sp****. A previous poster suggests that this is because tolerance is not a problem for people using Adderall as prescribed. However, it may be that the research just hasn't been done.

scuro
10-11-06, 12:39 PM
Thank you Stabile...couldn't agree with you more...grins:) and grins some more :D.

In fact this common misinterpretation of this issue addnoyed me in the past, so a while back I started a thread entitled, "Prove that therapeutic levels of stimulants cause significant dependency or tolerance". Lots of good information there too.

http://www.addforums.com/forums/showthread.php?t=17742

Stabile
10-11-06, 01:44 PM
We get to revisit this debate about every six months or so. About every other time, we do a one or two week search for any new information. I hope we can avoid that this time. We’re looking into the history of Vicks inhaler formulations already, sad to say…


sigh...amphetamines people...yes, tolerance. yes, med holiday works. get your facts straight, jeez.
(grins..) OK, we did that, I think; we’ve both a formal education in these subjects. It’s not tolerance.


Is not the definition of tolerance the need for a larger dose to achieve the same effect?
Nope, sorry.

Tolerance is defined by a physical change in the response to the drug. What we’re describing here is a perceived change in the experience of the drugs effects. They are very much not the same thing.

The pharmaco-physiology of abuse and addiction is where the term is defined, and we can’t grab it arbitrarily to describe our psychological effects.

That doesn’t mean our experiences aren’t due to or accompanied by physical changes in the way our bodies respond to the drugs, but such changes have yet to be documented.

And they’re not the changes associated with abuse and addiction. We know that because the accompanying behavioral changes known as maintenance don’t occur.

The danger of misusing a formal term like tolerance is it’s connection to abuse and addiction, and the possibility that these might mistakenly be associated with our use of stimulant meds.

We occasionally get a little paranoid, and think such misuse is intentionally meant to force that association. But usually we just chalk it up to misunderstanding, and the typical ADDer habit of jumping to obvious conclusions without a net.


And does this not happen for some people taking Adderall for ADHD? I believe that it does. In theory, it would seem that drug holidays might increase the time for tolerance to develop or prevent it all together. This makes sense to me…
Right, it does make a kind of sense, although we don’t think it’s that simple. But it’s not tolerance we’re talking about.


However, I want to see literature backing this up. I did link to a study, which another poster said was flimsy evidence…
That was us, and we stated what bothers us about the study. Unless you take massive doses of Ritalin and have unusual side effects, the study probably doesn’t apply to you. And even if it does, we don’t believe the conclusions are correctly drawn.


…Specifically, it would be interesting to know a specific intermittent schedule or dosing strategy (e.g. how long should a holiday be and how often).
There’s lots of experience with this, and the usual take is it varies from individual to individual, and with circumstance. There isn’t any formula you could apply.


The concept of reverse tolerance is also something I seek more information about…
We assume you refer to the apparent increase in effect over time, correct?


There is a lot of literature about amphetamine abuse, but not much for prescribed use. Tolerance is absolutely a feature of abuse, but the evidence for tolerance in prescribed use is very sp****
It’s non-existent in formal literature. It’s all an urban legend, as far as we’ve been able to determine, and we’ve done some serious looking over the years.

We were able to find the source of most of the misinformation, an organization that purposely spreads false information about AD/HD and our stimulant drugs. Here we’re not being paranoid; these people really are out to get us, and our drugs, and they say so up front.

They use pretty underhanded techniques to do so, though, so we assume they know they’re wrong. If they had a valid point, they could certainly make it. Supposedly, their position is based on fundamental Christianity, but we have our doubts about the legitimacy of that claim, too.

The fundamentalist websites we tracked were owned by a person whose son died suddenly while skateboarding, who had taken Ritalin several years before for a brief period. The divorced parents blamed each other, and pushed the Ritalin as a possible cause (with no evidence at all, of course) until they got a local coroner to sign onto the idea.

The websites were administered by a person with a commercial New York address and phone, most likely a secretary. The whole thing is extremely bogus, but it sure has caused a lot of fuss over the years.

Abuse of the more powerful members of the amphetamine family (which does not include Ritalin) and attendant addiction stands out as somewhat anomalous as compared to classical addiction to alcohol or opiates. The missing element is the physical changes expected to accompany tolerance.

The behavior of a classical addict in maintenance is clearly different than the behavior accompanying his/her descent into addiction. When an addict maintains, s/he doesn’t exhibit the physical effects of the drug or the same social behavior.

True alcohol addicts work right alongside the rest of us; the only difference may be their need to medicate in the morning and periodically during the day. This doesn’t mean their behavior isn’t affected, but they’re not partying; their behavior is outwardly normal.

Many alcoholics manage to maintain for years, as do opiate addicts, although opiate use is less easily woven into ordinary daily life. Tolerance is what allows them to do this; the chemistry of the brain literally adjusts to near normal in the presence of the drug, to the point sudden withdrawal can be fatal, due to the wild rebound in brain chemistry.

Evidence for similar physical tolerance in meth addicts is sketchy at best, and has yet to be accepted as relevant the last we checked. The expected problems with withdrawal are non-existent, and maintaining behavior is rare. Meth addicts most often form quasi-stable behavioral patterns that are different than normal, spiraling down until they crash.

That’s meth, of course. To our knowledge, no verified reports of addiction to AD/HD stimulant meds exist, although there are lots of rumors and urban legends, as usual.


A previous poster suggests that this is because tolerance is not a problem for people using Adderall as prescribed. However, it may be that the research just hasn't been done.
That would probably be us again.

Lots of research has been done, on both Ritalin and amphetamines. Lots more could be done, and likely will, especially if wingnut organizations can keep stirring up faux public debate.

But nothing is likely to address tolerance, because real tolerance has never been observed in an ADDer using his meds as prescribed. Ritalin in particular has one of the longest study periods of any drug, going back to the early Fifties, and it’s considered extremely safe. It’s widely used in long term care, and it has far fewer reported problems than aspirin.

Stabile
10-11-06, 01:45 PM
Thank you Stabile...couldn't agree with you more...grins:) and grins some more :D.

In fact this common misinterpretation of this issue addnoyed me in the past, so a while back I started a thread entitled, "Prove that therapeutic levels of stimulants cause significant dependency or tolerance". Lots of good information there too.

http://www.addforums.com/forums/showthread.php?t=17742
Thank you, dude. We were on hiatus, and missed that thread.

driver8
10-11-06, 02:24 PM
Ok, I actually did a literature search and have come to the conclusion that tolerance to stimulants used as perscribed for ADHD probably does NOT occur. Perception probably accounts for feelings that the drug is less effective. At least this is what the current literature suggests. This study is pretty much a good example of what all the studies are saying:

Solanto MV (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&itool=pubmed_AbstractPlus&term=%22Solanto+MV%22%5BAuthor%5D).
The Mount Sinai School of Medicine, Division of Child and Adolescent Psychiatry, New York, NY 10029, USA.

A working knowledge of the clinical psychopharmacology of the psychostimulants in AD/HD is essential to the development of valid animal models of the disorder. The clinical pharmacokinetics and pharmacodynamics of D-amphetamine (D-AMP) and methylphenidate (MPH) have been well-studied. The plasma half-life of these compounds in children is approximately 5 h, with an onset of therapeutic action within a half-hour, and peak action at 1-3 h. The effective dose range for D-AMP in children is 0.2-0.5 mg/kg, and for MPH 0.3-1.0 mg/kg. In humans, psychostimulants bring about reductions in activity level and impulsivity, and improvement in attention span. Enhancement of executive processes mediated in the pre-frontal cortex in humans (especially tolerance for delay) is believed to mediate these therapeutic effects. There are no long-term remedial effects of the drug on behavior-i.e. symptoms return when the drugs are withdrawn. When used in the therapeutic dose range, there is no evidence of the development of significant tolerance or sensitization. These and other clinical findings to be discussed must guide and constrain the development of animal models of stimulant drug effects in AD/HD.

Drug holidays have only very weak support in the literature. This is not to say that it is of no benefit, but the evidence is not there.

Chastain
10-15-06, 10:31 AM
I just started taking Adderall a couple of weeks ago (10 mg a day) and have already built up a tolerance! If I take a "break," how long will it take for the medication to leave my system so I can start all over? Adderall has been very helpful, but for the past couple of days I seem to be returning to my old ADD self...and fatigued too.

Nova
10-15-06, 11:13 AM
Perception probably accounts for feelings that the drug is less effective.


This is an accurate statement, and without a doubt, the most discounted one.

blekko
10-15-06, 02:58 PM
If someone is perceiving that a drug is less effective, you can't argue with that.

scuro
10-15-06, 03:38 PM
No, but you can argue with calling it drug tolerance.

VickiS
10-15-06, 10:46 PM
I don’t know how to describe it, but it seems more as if my brain is hell bent on outsmarting these drugs.
It just seems different than having to pop an extra Tylenol
My brain really, really likes it old ways. The meds can throw it for a loop for a while.
I picture my brain sort of going along for the ride, humoring me if you will as I organize cabinets and all that grand stuff.
All the while it is gathering info, sort of quietly building new pathways around the ones the meds have been able to block and before you know it, the old behavior/patterns are back.
For me the drugs effectiveness seems to lie in the “throwing it for a loop” part. Once my brain figures out what’s going on it patronizes me, I have had a taste of what it could be like, but it is way beyond my reach.
I have always been resilient in life; troubleshooting and thinking around corners has always been a great strength of mine, maybe there is a connection?
Holidays seem to help with the first dose or two after but again, one the “shock” wears off the drug seems only mildly useful.
Stronger doses make me a zombie so that is not the answer.

KFabulous
10-20-06, 02:37 AM
I took like a week off because I ran out and after I got back on....holy S H I T !!!!!! I was great! But I got that high feeling and my appetite was totally gone. For like a week and now back to the same old crap. :( I miss the mania... I am going to try a day off on the weekend and see how that works. Cross your fingers :)

blekko
10-20-06, 06:31 PM
Don't get addicted.

scuro
10-20-06, 06:45 PM
Don't get addicted.

Ohhh yeah, because...like, this could be like Serpico!!!

DaVis
11-16-06, 10:41 PM
No, but you can argue with calling it drug tolerance.So...regardless of what it's called... does a ______ to Adderall mean that Ritalin will be less effective, or can a person switch to Ritalin until the ______ goes away and Adderall is (or is perceived as) effective again?

I'm a scientist, and while I see that it's (nearly?) impossible to remove the perception idea, I don't really care what the cause is--I want a solution. I am hoping not to lose yet another job, but my Adderall dose is at max already. I need some way to continue being productive until the Adderall works again.

(Is it possible that some people don't develop this _____, and never find their dose ineffective, while others will develop the ______?)

BTW, here's an interesting post that says:"Tolerance and sensitization appear to be related to the interval between doses. Therefore, . . . skipping a day or two over the weekend could worsen tolerance."
http://www.addforums.com/forums/showthread.php?p=180473#post180473

DaVis
11-16-06, 10:43 PM
How does the term "sensitization" fall in the discussion of tolerance and Adderall no longer being effective (or perceived as effective)?

The effect is very real. If it's perception, is there any way to break that from happening? Does switching to Ritalin or something else work?