The Ethicality of Sustained ADHD Medication

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40 mg of Vyvanse every morning —often before breakfast—, 20 mg of Adderall before homework, and, don’t forget, a hearty dose of melatonin before bed to wear off the stimulants. It’s the daily standard for millions of students with ADHD. Every. Single. Day. Initially a characterization of neurodivergent individuals, the label of “ADHD” has quickly become the basis of desensitization for the greater public. Tolerance, addiction, and withdrawal are among the most addressed implications of substance abuse. Yet, when it comes to ADHD, we turn a blind eye to the devastations of heavy stimulant intake, waving it off as “just a routine”. But the truth is, children with ADHD are just as prone to dependance to these powerful chemicals, and thus, it is imperitive that we don’t use their functionality as an excuse to ignore the long-term effects of sustained use.

Before we discuss potential solutions to dependance in children with ADHD and establish a stance on the ethicality of the strenuous medication regimes, it is important to first consider the neurological processes they influence. As a testament of their strength, let’s figure out exactly how they work:

A Deep Dive into ADHD Stimulants

Stimulant medications essentially work by expediting the activity of dopamine and norepinephrine, which are neurotransmitters involved in regulating focus, attention, and arousal among other facets of mood, through a multitude of ways. In particular, the specific circuits they alter are from the prefrontal cortex, the primary center of decision making, impulse control, and memory in the brain. In regular neurons, when dopamine or norepinephrine is released by a neuron into its corresponding synaptic cleft, they bind on to the receptors waiting for them on the subsequent neuron. This binding process occurs for only a split second, though, before transport proteins (dopamine transporter DAT and norepinephrine transporter NET) engage in a process known as reuptake, where excess neurotransmitters are rapidly evacuated from the site. This prevents an influx of activity in the synaptic cleft, ensuring the neurons aren’t overstimulated. This reuptake process is completely inhibited by methylphenidate medications like Ritalin and Concerta, which block DAT and NET enzymes from carrying out their protocols. Adderall, Vyvanse, and other amphetamine medications, on the other hand, amplify the effects of these neurotransmitters by interfering with how much of them are stored inside neuron vesicles. This interference yields significantly higher concentrations of them within the neuron itself, which in turn results in their influx in the synaptic cleft, where they take effect. The increased stimulation of the D1 dopamine receptors and the alpha-2A adregenic receptors that both types of medication cause stronger, longer-lasting signals to the brain to lengthen attention span, filter distractions from the environment, and maintain a goal. It’s important to note that a curated dose amount for each prescribed user is of utmost importance, since too little stimulation will hardly see any effect, while too much will cause an overload that may lead to anxiety, agitation, and actually worse concentration and cognitive performance.

The consequences of long-term stimulant use and the potential to establish tolerance are heightened in children, whose pre-frontal cortexes and the neural pathways that are housed in them are still developing. It becomes increasingly important to monitor side effects like physical growth, weight-loss, sleep disruption, elevated heart rates, and changes in blood pressure in children, whose neural circuits are not yet mature and thus prone to developmental modifications.

Drugs like Adderall, especially in unregulated use, are notoriously addictive. So naturally, a measure we should adopt is a more tapered dose system in which doctors systematically lower prescribed intake amounts as conditions improve. This ensures a smooth transition into productivity without medication rather than a dependance on it.

No one is denying the functionality of this medicine. These drugs allow for a more regulated and ideal learning environment for children around the world. That being said, by keeping a sustained or even increasing dose, we are perpetuating dangerously high levels of tolerance to these strong chemicals. Children wishing for the mitigation of the disorder and better executive control in all conditions are instead sucked into a vicious cycle —a feedback loop of medication— in which their intake only goes up. The more they take, the more they build up tolerance and require more to feel the same degree of regulation. The substances that were prescribed to help with productivity end up snatching any chance they have to function without them.