Stimulants Methylphenidate (Ritalin, Concerta, Daytrana) Dexmethylphenidate (Focalin) Amphetamine/dextroampheta mine (Adderall) Dextroamphetamine (Dexedrine) Lisdexamfetamine (Vyvanse) Modafinil,amodafinil (Provigil/Nuvigil) Antidyskinetic/Antiviral Amantadine (Symmetrel) Alpha agonists Clonidine, Guanfacine (Kapvay, Intuniv) Non-stimulants Atomoxetine (Strattera) Buproprion (Welbutrin) Tricyclics Imipramine, Desipramine, Nortriptylene SSRIs/SNRIs Fluoxetine (Prozac) Venlafaxine (Effexor) Mood Stabilizers/Antipsychotics

Amphetamine is a stimulant that is primarily used to treat narcolepsy and attention-deficit hyperactivity disorder. It is also used recreationally as a club drug and as a performance enhancer. Prescription amphetamines are subject to diversion and are one of the most frequently- abused drugs in high schools and colleges. A Schedule II drug is classified as one that has a high potential for abuse, has a currently-accepted medical use under severe restrictions, and has a high possibility of severe psychological and physiological dependence.

hr Time After Nicotine % of Basal Release Accumbens Caudate NICOTINE Di Chiara and Imperato, PNAS, 1988

CA PUT Striatum VTA/SN CG PreF OFC nucleus accumbens

(0-10)

(MP - Placebo)

Pl/PL PL/MP MP/MP MP/PL Feel Drug Pl/PL PL/MP MP/MP MP/PL High Pl/PL PL/MP MP/MP MP/PL Like Drug Pl/PL PL/MP MP/MP MP/PL Restlessness Source: Volkow, ND et al., Journal of Neuroscience, 23, pp , December 2003.

Two interviewers had to agree with diagnosis (MD, PhD, PNP) Hx of stimulant abuse not exclusionary unless DOC Initial poor outcomes on Adderall led to switch to “safer” drugs (e.g. Concerta, Vyvanse) One psychiatrist did all med. adjustments Inclusion No discussion on unit 1 year enrollment in treatment Leaving treatment meant no follow- up from providers 1+ prior CD treatments All had CBT manually/workbook driven and special groups with psychiatrist and psychiatric NP Behavioral problems resulted in one verbal warning, then behavioral contract, then discharge N=43 Ages 18-55

100% (43/43) participants were relapsed and/or lost to follow-up. 31% of controls (12/39) relapsed and/or were lost to follow-up Only 25% of the stimulant group had abused stimulants in the past There were many more behavioral discharges in the stimulant vs. control groups though the disease severity was equal. (Some of the control group participants were given Welbutrin or Clonidine. Strattera was not available at the time of the study.) Stimulants do not work in the 1 st year of treatment.

ADD is very difficult to diagnose There is no distinct profile on testing, most of what is used in adults is self-report, and even sophisticated testing can be “fooled” Expectancy effects on self-report of symptoms and treatment (with stimulants) are large Because a person likes having more energy and can “get more done” on stimulants, it does not mean they have ADD. Most experienced practitioners, if they are brutally honest, will probably admit that they are almost never sure about the diagnosis. The best predictor of the likely diagnosis of ADD is the patient deciding they have it. The greatest disability that can be directly linked to the diagnosis is academic difficulty. ADD symptoms and personality traits are difficult to differentiate. People want a quick fix.

Living in the solution One day at a time, easy does it, first things first, keep it simple Acceptance Utilize tools such as smart phones Delegate View the energy and creativity as wonderful gifts Consider safe medications, but don’t expect to be “normal” (False expectation of stimulants as cure.)