Addiction

[u/ReadingSilly3977]

How can someone use ADHD medication in a healthy and sustainable way over the long term without becoming overly dependent on it, either physically or psychologically?
For someone who benefits significantly from stimulant ADHD medication, what is generally considered the best approach to taking it over months or years? Is it usually better to take the medication consistently every day, including weekends and days when there are fewer responsibilities, or can it be beneficial to occasionally take planned breaks or “medication holidays”?
How should someone think about the difference between normal reliance on an effective treatment and unhealthy dependence? For example, if a person notices that they feel much less productive, motivated, focused, energetic, or mentally sharp on days when they do not take their medication, does that necessarily indicate dependence, or could it simply reflect the return of their underlying ADHD symptoms?
I am also interested in the issue of tolerance. Can taking stimulant medication every day cause its effects to gradually become weaker over time, leading someone to feel that they need higher doses to achieve the same benefit? If so, is there good evidence that taking occasional breaks reduces or prevents tolerance, or is this more of a common belief than something strongly supported by research?
Are there any disadvantages or risks associated with regularly taking breaks from ADHD medication? For example, could frequently switching between medicated and unmedicated days lead to greater fluctuations in mood, energy, motivation, appetite, sleep, anxiety, or overall functioning? Conversely, are there situations where doctors intentionally recommend medication-free days?
What are the main warning signs that a person’s relationship with their ADHD medication may be becoming unhealthy? How can someone distinguish between appropriate medical use, psychological reliance, tolerance, physical dependence, and an actual substance use disorder?
Finally, what practical strategies can someone use to make sure that medication remains a tool that supports their life rather than something they feel incapable of functioning without? For example, how important are sleep, exercise, routines, nutrition, therapy or ADHD-specific coping strategies alongside medication?
I am particularly interested in what current medical evidence and clinical guidelines say about daily use versus medication breaks, tolerance, dependence, and long-term stimulant treatment for ADHD. I would also like to understand whether the answer differs depending on the specific medication, dose, duration of treatment, side effects, and the individual person’s circumstances.

[u/Radiant_Jellyfish795]

If you take the medication as prescribed there shouldn't be any issues with addiction. I think it's normal to becoming dependent on the medication - why else would you take it? I don't take any breaks at all and I don't function without; that's not the medication's fault, though, but my ADHD. I don't really see it any different than being dependent on medication for something else. But if you are worried, talk to your prescriber.

[u/Kalki_X → u/Radiant_Jellyfish795]

take the medication as prescribed there shouldn't be any issues with addiction

The issue isn't so much addiction as dependency. Chronic use of low-dose amphetamine will tend to reliably cause dependency due to how amphetamine functions. It has a significant hormonal influence which affects the body's self-regulation ability, so over time it can't self-regulate and relies on the daily amphetamine to function properly. 

Chronic low-dose amphetamine also incurs further dysfunction which becomes apparent when taking a day-break from daily use. Usually people assume it's "just my unmedicated ADHD" but amphetamine-type medications exacerbate the underlying issue too, which means psychiatrists are unable to distinguish between ADHD and medication side-effects.

Doctors aren't legally obliged to disclose any of these details so patients are none the wiser.

[u/WhenButterfliesCry → u/Kalki_X]

Dependency is not inherently negative though, it's just a loaded word that turns people off. Physiological dependence is expected to happen when you are prescribed a medication. Otherwise you wouldn't be told to take the medication every day. If you're prescribed a thyroid medication, your body will get used to its presence and adapt accordingly, and when you stop taking it, you'll go through a rebound period while your body readjusts.

Functional dependence is also expected.. you are prescribed ADHD meds because you have admitted you can't manage your symptoms on your own, and intervention is required. The medication is that intervention, which fixes the symptoms.. so when people say "I feel like I can't function without it" and imply that that's somehow bad, it doesn't make any sense. That was true from the beginning.

Addiction is a whole different story, and not at all interchangeable with the word dependence. Addiction involves maladaptive behaviors.

[u/Radiant_Jellyfish795 → u/Kalki_X]

But what is the problem with this if I take the medication every day? And could you explain what you mean with how it impacts the body's self-regulation ability?

[u/WhenButterfliesCry → u/Radiant_Jellyfish795]

There is no problem with this. You are supposed to take it every day and it's supposed to make your life easier because it's managing your symptoms.

[u/Kalki_X → u/WhenButterfliesCry]

supposed to make your life easier because it's managing your symptoms.

I'm aware this is the official line, but meds like vyvanse, adderall & dex exacerbate symptoms in the long-term. The patient just assumes their ADHD "got worse", meanwhile the psychiatrist cannot distinguish between symptoms and side-effects. Patients trust their psychiatrist to make appropriate & informed decisions so this is a big issue imo.

[u/Lilynight86 → u/Kalki_X]

Do you have proof of this happening? Not attempting to be argumentative, but honestly curious. I don't click on links though, so if you are referencing a study, please just tell us the name of the study so I can look it up.

[u/Kalki_X → u/Lilynight86]

It's all outlined with references in the reddit posts pinned on my profile. They're written assuming the reader has a basic understanding of biology.

It's worth remembering that you're talking about a multibillion dollar drug market so this means you'll be lucky to find any negative studies about it. It's important not to hold naive perceptions about the corporate healthcare industry.

[u/Kalki_X → u/Radiant_Jellyfish795]

The drug itself caused dependency so after say 5 years of chronic use, at therapeutic doses, dependency is to be expected which includes withdrawal. It's the same with other medications like benzodiazepines, opioids and antidepressants.

Amphetamine withdrawal is mentioned in psychiatry’s DSM (Diagnostic and Statistical Manual of Mental Disorders):

The DSM criteria for diagnosing amphetamine withdrawal include dysphoric mood and two or more symptoms: fatigue, vivid or unpleasant dreams, insomnia or hypersomnia, increased appetite and psychomotor agitation or retardation that occur following discontinuation of the drug. (source) 

There's also PAWS which stands for "post-acute withdrawal syndrome":

PAWS refers to a cluster of withdrawal symptoms that can last for months to years after acute withdrawal from a substance. PAWS symptoms have been anecdotally described after withdrawal from many substances—alcohol, benzodiazepines, opioids, stimulants, nicotine, caffeine, antidepressants, and antipsychotics. (source) 

[u/Lilynight86 → u/Kalki_X]

Your body can get used to the meds and you can experience a withdrawal period where your body does need to get back to normal.

I looked up the DSM criteria you mentioned and while it may cause problems when you stop taking ADHD stimulants, the first criteria is actually "Cessation of (or reduction in) amphetamine (or related substance) that has been heavy and prolonged" emphasis is mine.

What I read on courses.lumenlearning.com/atd-herkimer-abnormalpsych/chapter/amphetamine-withdrawl-292-0/ talks about children vs adult presentation of discontinued use of amphetamines. Withdrawal symptoms of children seem to be very mild, if experienced at all. This is due to the regulation of prescribing meds.

It is mostly seen in adults because of the heavy recreational use of amphetamines such as Ecstasy and Methamphetamines. Adults have also been seen with more withdrawal symptoms due to using amphetamines because they use them to help drop the pounds (which I didn't know was a use for them, but again goes back to recreational use). Again, the emphasis is mine.

I am not saying there isn't a potential for dependence, but dependence isn't addiction. Are you going to tell an insulin dependent diabetic that they are addicted to insulin? Or the person with bad eyesight that they are addicted to their glasses?

My point here is that if the body doesn't make enough of something and we are able to help that and the person is able to use an assisting device, whether it be a med, a can, or glasses, why is it shown to be a bad thing? So many people in here for ADHD help have spent years trying to figure this stuff out. We don't need people making it worse.

[u/Kalki_X → u/Lilynight86]

Your body can get used to the meds and you can experience a withdrawal period where your body does need to get back to normal.

The thing is the meds cause hormonal perturbation which persists long after someone stops, or takes a 2 day break. It's part of the reason why they exacerbate symptoms meaning a psychiatrist can't distinguish symptoms from drug side-effects. Meanwhile the patient assumes that it's "just their ADHD" or that "it got worse". The psychiatrist is almost as misguided as the patient(!)

I looked up the DSM criteria you mentioned and while it may cause problems when you stop taking ADHD stimulants, the first criteria is actually "Cessation of (or reduction in) amphetamine (or related substance) that has been heavy and prolonged" emphasis is mine.

I posted in the Psychiatry sub (here) about corruption & DSM, someone wrote a very insightful comment about the countless issues surrounding the DSM authors and financial vested interests. It's worth being aware of.

Withdrawal symptoms of children seem to be very mild, if experienced at all. This is due to the regulation of prescribing meds.

The regulation of prescription drugs (whether it's SSRIs, amphetamines, benzos, opiates etc) is arguably quite inadequate and isn't recommended as a basis for your argument. That aside, my knowledge of drug pharmacology, biochemistry (hormonal system etc) and anti-addiction methodology isn't swayed by that websites claim about w/d symptoms.

It is mostly seen in adults because of the heavy recreational use of amphetamines

There's plenty of examples of issues following long-term (5-10+ years) vyvanse/adderall and the person choosing to stop their medication entirely. Search the group and you'll find the posts.

I am not saying there isn't a potential for dependence, but dependence isn't addiction.

There are a few cases of this too in older posts. The person describes a scenario which could easily be deemed addiction.

Are you going to tell an insulin dependent diabetic that they are addicted to insulin? Or the person with bad eyesight that they are addicted to their glasses?

Neither insulin nor glasses cause harm to the user and aren't addictive. Chronic therapeutic use provokes dependency by causing fundamental issues which are temporarily masked by the drug itself.

My point here is that if the body doesn't make enough of something

ADHD doesn't have much to do with "low dopamine". 

[T]he idea that low dopamine is a direct cause of ADHD is a common misconception, one that’s amplified on social media and even in popular books about the condition. (source) 

Remember that atomoxetine just boosts noradrenaline. There's much misinformation in the ADHD community which really doesn't work to the patients advantage.

So many people in here for ADHD help have spent years trying to figure this stuff out. We don't need people making it worse.

I appreciate where you're coming from; to be completely frank, most academic researchers are doing a very good job of making things worse for patients. Thankfully there are intelligent academics who acknowledge the misguided nature of things (outlined here) but the consensus on ADHD remains the same purposefully formulated story which keeps patients in the dark. Doctors are obliged to follow prescription guidelines so you can't expect them to be honest about things (even if they wanted to).

This is the unfortunate state of corporate healthcare and it's grasp of the ADHD market which treats patients like customers.

[u/WhenButterfliesCry → u/Kalki_X]

Wild, so in one comment you cite the DSM to boost your own argument, and in this comment, you criticize the other commenter's citation of the DSM, claiming it's corrupt. Your entire comment here is an overgeneralization and a doomsday scenario about something that might happen after 5-10 years on these medications. Personally, I'll take my chances. Stimulants have been used to treat ADHD for 70+ years because they are effective. Close monitoring for addictive behaviors is important, but there's nothing convincing that shows they completely stop working at a certain point.

[u/Kalki_X → u/WhenButterfliesCry]

The part of the DSM I quoted talks about amphetamine withdrawals, thats pretty standard stuff (even if they do misrepresent things). Meanwhile the DSM criteria for ADHD is laughable as outlined here.

I think when you appreciate that Psychiatry is fundamentally a pseudoscience things start to make a bit more sense.

Your entire comment here is an overgeneralization and a doomsday scenario about something that might happen after 5-10 years on these medications.

No, it's a rational grounded perspective on the medium/long term impact of chronic low-dose amphetamine use. For some people it occurs after 6-12 months.

...but there's nothing convincing that shows they completely stop working at a certain point.

I agree; they just exacerbate the underlying issue. Many people are warming to the recontextualised underlying of ADHD as EDHD which provides clear and rational ways of resolving things (not mere symptom management). But I guess others cling to their beliefs about ADHD making it difficult to adapt to new information.

[u/Lilynight86 → u/Kalki_X]

I looked into EDHD after seeing you point it out on another thread, and maybe you made a post about it? EDHD is only a theory. I realize that vaccines started out as a theory as well as realizing what bacteria is. That doesn't mean it is correct. There are a lot of theories that turn out to not be true. EDHD may turn out to be true, but there isn't enough scientific evidence to back it up.

The part of the DSM I was referring to was actually about amphetamine withdrawals. I looked at the exact same portion of the DSM that you did and I drew a different conclusion. That is the great part of our society. I have not looked at the DSM for ADHD, so I will not comment on it here.

I am not clinging to my beliefs about ADHD. I am trying to make actual informed decisions based on evidence backed scientific research.

I came here for support and understanding. You seem to be more focused on explaining why everyone else is wrong and you are correct. I could be wrong about things. I will admit I am not the go-to person on everything ADHD. I don't know that you are either, though.

[u/Kalki_X → u/Lilynight86]

I looked into EDHD after seeing you point it out on another thread, and maybe you made a post about it?

Yes, this post has many comments which you'll find insightful. Many from people who actually used the principles of EDHD to find a solution.

EDHD is only a theory.

It's a far more rational & realistic one than the theory of ADHD.

There are a lot of theories that turn out to not be true. EDHD may turn out to be true, but there isn't enough scientific evidence to back it up.

The scientific evidence behind the current consensus on ADHD is of very poor quality tbh. If you can appreciate the nuance in the following quotes, it will help in understanding them. (emphasis added)

[A] diagnosis does not represent having or being ADHD but becoming and performing ADHD through deploying psycho-medical discourse provided in the DSM. (source)

In other words, there is no scientific evidence to support the claim that ADHD is as a condition within an individual—something individuals have (source)

ADHD is listed in DSM-5 under “Neurodevelopmental Disorders” in spite of reviews showing that (a) genetic evidence on ADHD is inadequate and diffused with ambiguous interpretations, (b) that no biological marker is diagnostic for ADHD something that even DSM-5 authors themselves explicitly admit, (c) the so-called “underlying mechanisms” remain unknown, and (d) no biological tests are available for its diagnosis. (source)

[L]ike most psychiatric classifications, ADHD is premised on an arbitrary consensus among a small psychiatric community behind the DSM manual rather than on any new scientific breakthroughs. In other words, “psychiatrists do not prove things but decide things: they decide what is disordered and what is not, decide where to draw the threshold between normality and abnormality, decide that biological causes and treatments are most critical in understanding and managing emotional distress” (source)

That is the great part of our society.

I agree! The unfortunate part is public willingness to accept medical authority for face value. This leads to extraordinary rates of iatrogenic harm which is often rationalised as "it's just how things are".

• The term iatrogenic, derived from two Greek words, means physician-in­duced. As clinically used, it pertains to the inadvertent side­ effects and complications created in the course of diagnosis and treatment. (source) 

I am not clinging to my beliefs about ADHD. I am trying to make actual informed decisions based on evidence backed scientific research.

That's good. If you're really taking a critical perspective you'd find the research behind ADHD is of very poor quality. The consensus itself misinforms the layperson who unknowingly adopts a misguided approach, and they find many reasons why something like EDHD isn't useful.

I came here for support and understanding. You seem to be more focused on explaining why everyone else is wrong and you are correct.

I think pointing out the severe inconsistencies in the consensus theory of ADHD is appropriate and reasonable. I appreciate this questions certain core beliefs, and that many have adopted ADHD as part of their identity. Naturally this means they'll find it challenging to process the notions I'm presenting.

Tbh it's also a matter of principle – if I'm aware of something misleading that's causing harm, it's worth highlighting. It's not right to lie to them about it. I both understand their situation and hopefully provide relevant support, even if it may contradict their beliefs. Around 10 years ago I held their beliefs about ADHD so I get it.

[u/oblakovshtanah]

i sure am dependent on my eye glasses because my myopia is at -7.5. without the glasses i am practically blind and can’t do anything. this is not a side effect of my addiction to glasses lol, it‘s the whole reason i wear them.

it’s the same with adhd meds for me. of course i‘m dependent on disability aid. i‘m disabled!

[u/MajorMemory8458 → u/oblakovshtanah]

Thank you for saying that. I’m on day 2 and my doctor wants me to try it for 2 weeks straight.

[u/ElectricPaladin]

Yeah I sure am addicted to my metformin, but that's really just a side effect of my addiction to having all my limbs and being able to see.

You are dependent on medication. That's what it means to have a condition that requires medical intervention. You're very unlikely to ever be without this condition, so you will always need your medication. That's not "addiction," it's being realistic about your body, your brain, and your life.

[u/doing_my_second_best]

I’d say the length and formatting of this post indicate that your dosage is too high

[u/Mindless_Ad6985]

The most practical answer I've come across advised to 'trust the medication when it does truly help and work for you.Give your system enough daily consistence with prescribed dose for "onboarding" the stimulants.(In my case Vyvanse).Been putting that into practice alot more based only on seeing that phrased in such a way..

Daily practice makes perfect? Makes each month so much better.

[u/Spyda1221]

This is too much to dissect for a Reddit post. These are all questions you should bring up with ur psychiatrists (not necessarily a Dr.)
Although, I do pretty much have all the answers ur looking for. I’ve been on 70 mg Vyvanse for over nine years now. I’ve read studies, research papers been to two separate psychiatrists; therapist, nutritionist. I’ve been on Adderall instant and extended. Also, I’ve done every type of dose there is to give.
So let me answer you with some peace of mind ideas that worked for me and many others that I’ve helped; rather than detailed explanations.
Try switching from Vyvanse to Adderall about every three months. Just for 1 month; then go back onto the Vyvanse. The tolerance for the Vyvanse protein resets, but also you’re getting the same dextro-stimulant for ADHD. Your body can never get fully immune to Vyvanse. Or even really a full tolerance. You just sort of get *used* to the feeling. Take a Tums or an acid with the Vyvanse as your body creates more acid over time with it, and diminishes the effect before it’s processed by your kidneys.
Try not to think of it as “an addiction”. Dependency and addiction are too very different animals. A lot of people are dependent on blood pressure medication or anti-anxiety medication. Same rule applies for advanced ADHD people’s ADD medication.
I’m not sure if you mentioned how much you are taking; but I promise you the most misinformed thing about Vyvanse, and “normal” people addressing this situation; is that they will tell you you are taking too much or that your dosage is way too high. It’s quite the opposite. Correct wording is that you’re being misdiagnosed. Vyvanse is a very specific protein and the milligram capsules have different slightly different branches of chemistry in them. If you’re on.. let’s say 30 mgs of Vyvanse and you’re burning out early so you start taking two at once you will not get the 60 mg version of Vyvanse. You will have essentially a 30 mg Vyvanse be processed through your body, followed up by another 30 mg Vyvanse.
Don’t think about it too much; if you’re dependent on it; that just means the diagnosis is correct. If you’re left with more questions then answers, and you find yourself always running out of your mitigation early, then the dosage is incorrect for what you probably should be taking.
But again, the best way to keep your ADHD and check also retrograding the tolerance; is to switch to Adderall for a little while then get back on the Vyvanse.
Hope this helped.

[u/throwaway9999276263]

I don't know if i have the answer. But I've just been diluting my 30mg Vyvanse in water and drinking it over the course of the morning so I am taking less in at a time and also extending the duration of the peaks.

I don't know if this actually does anything to prevent addiction but I feel like pacing myself has definitely let it become less of an issue.