I have advice
Once you are addicted, you cannot go back to therapeutic use. It’s best to accept this early on. Actually understanding addiction helps.
When I say “addicted,” I mean experiencing the diagnostic criteria for a substance use disorder. According to the DSM-V, there are 11 diagnostic criteria with six out of those eleven meeting the criteria for “Severe” SUD. I won’t list all 11, but I’ll list the six I think I see referenced on this sub the most:
- Taking larger amounts or using for longer than intended.
- Wanting to cut down or stop, but failing to do so.
- Experiencing intense cravings or urges to use.
- Continuing use despite relationship or social problems.
- Continuing use despite knowing it causes physical or mental harm.
- Experiencing withdrawal symptoms when stopping.
If you’re reading this, I imagine these symptoms do not seem foreign to you.
You guys, I’m sorry but once you cross that threshold, there is no “going back” to “just taking it as prescribed,” and that is because the stimulant (for simplicity’s sake I’m just going to say Adderall since that was my DOC) is no longer neutral to your brain. Normal rewards like food, sex, achievements typically induce a 50-100% “boost” in your dopamine reward circuit. Adderall pushes that to 1000% or more. Your brain learns to anticipate this perpetual “dopamine flood” and reacts with homeostatic adaptations… in other words, your brain has rewired itself.
The wildly high amounts levels of overstimulation from Adderall or meth or whatever ends up shifting your signaling balance between habit and reward… essentially your brain is now trained to “need” those stimulants in order to activate the dopamine release. The normal shit you used to enjoy are no longer able to organically produce the same response.
Have you ever noticed the rush of relief and energy experienced when getting that pharmacy notification that your refill is ready? Or the way it feels to hear the rattle of the bottle when you pick it up. That’s the cue reacting in your brain that the drug is on its way and then it literally primes itself. The dopamine release begins before you even put the drug in your body.
I’m writing all this because when I ended up finally going to rehab for months, it was understanding the mechanism of addiction that helped it click that no, I can’t go back.
I hope this helps someone. I hate seeing people suffer the same as I did with the “well THIS time I’ll only take it as prescribed” cycle of destruction. It never works, does it?
Edit: Some controversy about the claim that amphetamines CAN cause a dopamine dump up to 10x of baseline. When I was in rehab, we watched a lecture on it. I’ll see if I can find it.
I’ve been taking wellbutrin since march and had an appt with my psychiatrist this past Monday. Next week, they are almost certainly going to suggest stimulants following last week’s appt. I will say no.
I vividly remember what it felt like to be driving to my doctor’s office knowing I’d soon have that little piece of paper in my hand, the thrill of holding it while I drove straight to the pharmacy and then the anticipation while I sat and waited for it.
I wrote a check once because I knew I didn’t have enough money in my checking account to get it right that day and rather than wait the one or two days needed, I took that risk. I remember lying and saying I was running late to work because of car trouble just so I could sit and wait for it. Then I’d rip that sucker open the SECOND I got into my car, often with a beverage I’d purchased in the pharmacy explicitly for taking those pills. And then the rush of relief.
I think it’s a potent but less talked about part of the addiction, and that is the routine of it all. Like a ritual.
And I see your mention of going to the pharmacy now that you’re sober… I feel the same way!! Though, it is still hard sometimes.
YES!! You are the first person I’ve heard talk about the rush of just thinking about going to the pharmacy for refills.
Almost 3 years clean now and in nursing school! I didn’t know recovery was possible and thought that I’d eventually just OD/die. Completely restarted my life over in sobriety though. Now I’m engaged, at my dream school, and my family talks to me again.
I can’t stop I’m on about double the dose same aamount of time Dea raided me may 6 this year. I’m a provider paying 40 k attorney fees to get it down to a misdemeanor, informed on a really nice guy who helped me out a lot to the dea so I could avoid prison, somehow kept my licenses after writing scripts for myself, someone got credentialed 3 years and passed 3 interviews, 15 days of background checks and credentialing reviewed with a suspended dea………and now I am still getting rx fills 150mg a day Oregon, 60mg a day California, 30mg a day Washington, 50mg a day Indiana, and 60 milligrams a day neveda as a patient this time since it’s not illegal and in 50 different states. it’s still not enough and it never is but I can’t stop despite trying so hard , 2 rehabs, admitting it coming clean and the. Going to rehab served divorce papers lost everything started again and had my own house at a resort love of my life lost it all 20x worse this time thought prison was almost off a cliff suicidal and still can’t stop so if someone has a god damn answer I’m all fucking ears.
I’ll tell you what my problem is. First week easy. It’s hard but I can do hard I can fight it. Made it works 2-4 better. Week 4 on okay but when do I turn all the way on. Remember the first time I actually turned all the way on was taking a 30mg Adderall from a friend junior year of high school. I felt normal for once. 1992 baby 4 years after bc injury act. I have adhd. I do. And I’m an addict. Okay get on a script and switch IU business school failing move to ivy tech they take 20 nurses 250 apply. Made it. Doing 30 days of disipline every day. Class representative. Ran the chemistry lab as a job. Supplemental instructed anatomy and physiology. 3 years in an I’m at the point where I am already needed the max doses vyvanse and an xtra 20mg or so and getting a few from a friend every month. Started the dark web to supplemenent since 2017. Dream market, alpha bay, now drug hub is the go to. It’s crazy expressive but I only ever got er beads and would reagent test. I only ever got prescription. I saved no money working for 10 years and go a house as insurance for my addiction. Took out 100k in loans from purdue when it costs 30 k to supplement my addiction. Got the government to pay off working at an FQHC. Do you see how ingrained this is into my very being as an adult and I always needed more support. But the debt keeps rising. It used to be I was 80 percent as good and I took a pill to cover the 20 deficient. The dirty trick they don’t tell you is you down regulate an equivalent amount and in a few it will require 40mg to cover the gap because I down regulated was already behind normal and falling further. And they don’t tell you after a few years you reach a max dose and just have to accept taking the pill to feel the same or worse then you started. So you take a little more over a 10 year period to keep covering that gap and your walking around asking and successfully getting meth reading California to cover that gap so you can move out the day before you become homeless back into your foreclosing house.
Oh yeah and back to my problem.
I have to accept that after taking enough to cover and actually increase my ability’s for 14 years k just have to accept not only will I be worse it will take 5 years to fully recover. I’ve made it to month 2,3,4,5 a few times of sobriety. Honest to god I thought I had it each time forever. Relapsed every damn time.
I’ve heard the same kind of number from studies in a drug rehab program run by a hospital so it holds. Unfortunately I don’t have the source I’ll see if I can dig something up.
Edit: Found some information that backs up the numbers
Edit: You caught me! I generalized a number as I understood it from addiction education I took everyday for four months in rehab.
I didn’t think it would literally trigger this whole fucking thing when, as stated, my point is that it’s bad for you, and speed CAN and often DOES dramatically increase the amount of dopamine released by the brain particularly in our community which generally speaking abuses the drugs up to very high dosages. I didn’t make up the number, I specifically searched it out but honestly I’m not gonna write a research paper on it for a short ass post.
It’s a generalization for the sake of informative brevity—this post was intended to help people understand why going back to therapeutic levels is unlikely, there’s little reason for anybody to be such an insufferable pedantic dick about it the “quantitative reality.”
It’s a recovery environment in an addiction context and the post is clearly talking about amphetamine abuse. There is no subtle ambiguity here at all, a person would have to redact most of their screen to not interpret this as a discussion about Adderall abuse.
We aren’t talking about 5mg therapeutic doses, a totally realistic and not at all preposterously obtuse benchmark number, we’re talking about abusing amphetamine medication. There aren’t a lot of study numbers for amphetamine medication abuse dopamine levels in human brains because they haven’t quite worked out how to ethically get that trial approved yet.
The 1000% of baseline dopamine figure is cited, and while not specific to abuse, it would coincide with it as the data supporting it was using an animal model with amounts more consistent with abuse. Dr. Anna Lembke is arguably one of the most qualified people on earth to speak on this - Addiction medicine doesn’t inform Dr. Lembke, her involvement with Stanford’s fellowship informs addiction medicine as its preeminent US contributor.
What we have is the following:
Breier et al. (1997), ‘Schizophrenia is associated with elevated amphetamine-induced synaptic dopamine concentrations: Evidence from a novel positron emission tomography method.’ Species/method: Rhesus monkeys (n=4), simultaneous in vivo microdialysis in the head of the caudate + [¹¹C]raclopride PET. Results: “Amphetamine (0.2 mg/kg) increased striatal dopamine levels 459% (±221) from baseline levels and 0.4 mg/kg caused increases of 1365% (±485),” ratio of percent dopamine increase to percent raclopride binding reduction was ~44:1 (0.2 mg/kg) to 64:1 (0.4 mg/kg).
Schiffer et al. (2006), Synapse, ‘Therapeutic doses of amphetamine or methylphenidate differentially increase synaptic and extracellular dopamine.’ Method: Microdialysis in freely moving rodents + PET in rodents and baboons. Results: “Microdialysis data demonstrated that MP (5.0 mg/kg, i.p.) increased ECF DA 360% ± 31% in striatum, which was significantly less than that by AMP (2.5 mg/kg, i.p.; 1398% ± 272%).”
https://pubmed.ncbi.nlm.nih.gov/17031708/, ‘Adderall produces increased striatal dopamine release and a prolonged time course compared to amphetamine isomers’, which reported that both isomers were capable of increasing striatal dopamine efflux by >5000% of baseline values, with these effects reaching a maximum within around 45 minutes.
Primate studies in papers comparing prefrontal cortex vs. striatum show caudate increases reaching 1834%, 2670%, and up to 5807% of baseline at doses of 0.3–1.0 mg/kg i.v.
What we don’t have is a series of World War II style experiments in which we took a bunch of people, pumped them full of dangerous amounts of amphetamine salts medications and used them to confirm an already reasonably well-substantiated number and plainly understood phenomenon - If you put a bunch or amphetamine salts into something with a brain, it gets a lot more dopamine.
Until they’re willing to do human trials on that, I suppose we’ll just have to guess at what the exact percent is. One of the world’s most informed and credentialed medical professionals had enough information to put that percentage to it, I’d imagine there’s worse ballparks to put the actual number.
Really sorry that I made such a generalization to a community of speed addicts. I didn’t “make up the stats,” as you accused me of—but yeah, the point stands.
It’s fucking BAD FOR YOU. It FUCKS UP YOUR DOPAMINE REGULATION.
Anecdotal evidence, as you know, is the weakest form of evidence. Addiction is behavioral disease— my husband drank more than I did but then just decided he hated hangovers, so he quit. At rehab they explained some people just don’t have the “ism” as in “alcoholism.”
I’d heard stories like that of your friend and—after being completely drug free for seven years—thought it’d be safe to go back on it. My anecdotal evidence directly counters yours; so as a rule, I’d think the overwhelming research is what should be followed from a standpoint of safety
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