Modafinil vs Adderall
Potential for Addiction, Risks, Effects on the Brain and Body, Dangers, Off-Label Uses & Rehab Treatment
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Modafinil vs Adderall: Adderall
Adderall is a prescription stimulant drug used to treat attention deficit hyperactivity disorder or ADHD. It may also be regularly abused as a “study drug” to enhance focus and increase wakefulness; as a “crash diet drug” for its appetite-suppressing effects; and recreationally as a “party drug” for the heightened euphoria, energy, and excitability it can promote. A study at the University of Kentucky found that 30 percent of its students had abused an ADHD medication like Adderall at some point in their lives, CNN reports, which may represent a microcosm of a larger picture of college campuses around the country.
Adderall is a combination of amphetamine and dextroamphetamine that is available in immediate-release (IR) or extended-release (ER) formulations. The U.S. Food and Drug Administration (FDA) has issued warnings regarding the possible dangerous side effects of the drug, including the potential for a life-threatening overdose when the medication is not taken as prescribed.
Adderall may be abused by taking it without a medical need, for recreational purposes, taking more of the dosage than prescribed, or by altering the drug to use in a way other than intended.
The Drug Enforcement Administration (DEA) categorizes Adderall as Schedule II since it has a high potential for abuse, diversion, and addiction, even though it does have legitimate medical uses as well. Abusing Adderall in any manner can be dangerous. The Drug Abuse Warning Network (DAWN) reported that in 2011, more than 17,000 people sought emergency department (ED) treatment for a negative reaction to an amphetamine-dextroamphetamine medication.
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Modafinil vs Adderall: Modafinil
Modafinil, better known by the brand name Provigil, is also a central nervous stimulant drug. Modafinil is often referred to as a eugeroic medication, which is a medication that promotes alertness and wakefulness. Modafinil is approved by the FDA to treat daytime sleepiness in people who have several different conditions, including:
- Shift work disorder is a formal disorder that involves a disruption of normal sleeping hours when one is working nights
- Sleepiness that occurs in other medical conditions like obstructive sleep apnea
Modafinil is also a controlled substance but classified at a much lower level of control/severity than Adderall. Modafinil is classified as a Schedule IV controlled substance. The difference in the formal classification of Adderall and modafinil indicates that the overall general research and the opinion of the federal government are that Adderall is a significantly more dangerous drug of abuse than modafinil.
All stimulant drugs share similar mechanisms of action. Because of this, even when prescription stimulants that are considered to be relatively mild like modafinil are compared to stimulants that have a significant potential for abuse (e.g., cocaine), the findings indicate that there is a similar mechanism of action between these drugs. Some sources will attempt to capitalize on this finding and state that similar mechanisms of action indicate similar potentials for abuse; however, this is not always true.
Adderall is believed to exert its effects by both blocking the reuptake of the excitatory neurotransmitters dopamine and norepinephrine, and by actually increasing the intracellular concentration of these neurotransmitters by releasing them from storage units in neurons. Modafinil is also believed to affect several different neurotransmitters, including excitatory neurotransmitters like dopamine and glutamate (increasing their availability) and decreasing the availability of inhibitory neurotransmitters like gamma-aminobutyric acid (GABA).
How Does Modafinil Work?
Modafinil is an oral drug that is used for improving wakefulness in patients with excessive sleepiness. It is similar to armodafinil (Nuvigil). Like amphetamines, modafinil promotes wakefulness by stimulating the brain. The exact mechanism of action of modafinil is unknown. It may work by increasing the amount of dopamine (a chemical neurotransmitter that nerves use to communicate with each other) in the brain by reducing the reuptake of dopamine into nerves. Modafinil was approved by the FDA in December 1998.
How Does Adderall Works?
Adderall is a combination of two stimulant substances, dextroamphetamine, and amphetamine. These stimulants increase the activity of the central nervous system, which controls pathways in your brain and spinal cord that are responsible for most of your bodily functions.
So, when you take a stimulant medication like Adderall, you may have mind and body effects such as:
- Increased alertness
- Higher energy levels
- Improved focus
- Faster heart rate
- Higher blood pressure
- Decreased restlessness and fidgeting
- Longer attention span and ability to finish tasks
Adderall is one of the most commonly prescribed medications for ADHD. But it may also be prescribed for other conditions like narcolepsy, a rare sleep disorder that causes daytime sleepiness.
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Which has the most side effects?
Adderall High Side Effects
Physical side effects of Adderall can emerge shortly after use. Adderall triggers the release of dopamine and other neurotransmitters in the brain. Prescribed users get a therapeutic benefit from it while recreational users who abuse this stimulant can get high. The following are some of the effects that may be experienced right after Adderall abuse:
- The illusion of wellness
- A desire to work
- Feeling social
- Getting insights into the meaning of life
- A sensation of excitement or being hyperactive
- Being talkative
- Thinking about things more than usual
- A feeling of impatience, worry, nervousness, and anxiety
These symptoms would be perceptible to someone in the immediate environment of the person who is abusing Adderall. However, the people who are most likely to be concerned about the Adderall abuse may not be around when it’s going on. For this reason, it can be helpful to know the short-term effects of Adderall, which can linger long enough to be perceived by family, friends, work colleagues, and classmates. Some of the more commonly reported side effects of Adderall abuse are:
- Sleep difficulties (falling asleep or staying asleep)
- Shaking uncontrollably in an area of the body, such as a leg
- Changes in one’s level of sexual interest
- Dry mouth
- Weight loss or malnutrition
In addition, a person may experience mental health side effects. Some of these symptoms are hallucinations and believing things that aren’t true. Serious side effects may be less common, but they can happen and it’s best to know what’s possible. The following are some of the most severe side effects associated with Adderall abuse:
- Pounding heartbeat or fast heart rate
- Chest pain
- Feeling faint, dizziness, or changes in vision
- Numbness in the arms or legs
- Slowed speech
- Exhaustion, fever, rash, or itching
- Shortness of breath, difficulty swallowing or breathing, or hoarseness
- Verbal or muscular tics
- Blistering or peeling skin, swelling of the throat, face, tongue, or eyes
Adderall abuse is also associated with long-term side effects. This drug is exceptionally addictive, which means abuse runs the risk of developing into a stimulant use disorder. It has also been noted that when an individual stops using Adderall (goes into withdrawal), they may experience suicidal thoughts, mania, panic, or nightmares.
There does not appear to be extensive information available about the impact of Adderall or other stimulants on the major organs or the brain in the long term. Note, however, that the way Adderall is administered can impact one’s health on a long-term basis. A person who crushes, liquefies, and injects the drug may experience collapsed veins. Those who crush and sniff Adderall may damage their nasal cavity.
Modafinil Common Side Effects
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
- Muscle stiffness
- Sores, ulcers, or white spots on the lips or in the mouth
- Sour stomach
- Stomach discomfort upset or pain
- Stuffy or runny nose
- Tingling, burning, or prickling sensations in the skin
- Back pain
- Decrease in appetite
- Difficulty having a bowel movement
- Dryness of the mouth
- Dryness of the skin
- A feeling of constant movement of self or surroundings
- Flushing or redness of the skin
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
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Although the drugs have approved uses, the prescription of these drugs is often made according to uses that they are not formally approved to address. This is true for many different types of medications. Off-label uses for Adderall are designed to take advantage of its stimulant effects. Adderall may be used for weight control, to increase alertness, and to address issues with obesity.
Modafinil is also prescribed to address conditions that its stimulant effects may treat, including treating fatigue and lethargy in individuals with numerous neurological disorders such as multiple sclerosis or Parkinson’s disease, in cancer patients, and even the fatigue that occurs in patients with clinical depression.
Modafinil is a much milder stimulant than Adderall, and its mild stimulant properties allow for using it in varied situations to address lethargy and sleepiness without the potential for inducing anxiety, and jitteriness, irritability, or agitation. Adderall is a more powerful stimulant, and its use must be tempered.
Modafinil is not approved for the treatment of ADHD; however, it may be prescribed off-label for this use. At the time of this writing, some small controlled studies suggest that modafinil is a useful treatment for ADHD. Research studies have indicated that modafinil:
- May be significantly more effective in treating the symptoms of ADHD than a placebo.
- May have comparable efficacy for treating ADHD to methylphenidate (e.g., Ritalin, Concerta) and fewer side effects.
- May have comparable efficacy for treating ADHD compared to dextroamphetamine (one of the ingredients in Adderall).
It should be noted that modafinil is not an approved medication for ADHD. Insurance companies may not approve its use for this purpose and therefore may not pay for the medication when it is prescribed for this purpose.
Stimulant Abuse Potential
Stimulant abuse is a serious problem in the United States. The abuse of stimulants has received quite a bit of publicity, particularly regarding the abuse of methamphetamine (meth), cocaine, and medications designed to treat ADHD like methylphenidate (e.g., Ritalin and Concerta) and Adderall. Over-the-counter stimulants may be abused in conjunction with other drugs to assist in weight loss, to produce euphoria, and for other reasons. Long-term stimulant abuse can have significant ramifications on physical and emotional health.
The Substance Abuse and Mental Health Services Administration (SAMHSA) conducts yearly surveys and releases yearly estimates on the use and abuse of numerous prescription medications, over-the-counter medications, and illicit drugs. According to the latest available data from SAMHSA:
- In 2015, 11.3 million individuals reported some use of an amphetamine product; in 2016, this figure was 12 million individuals; SAMHSA reports overall figures for amphetamine use/misuse and not specific figures for Adderall or others.
- In 2015 4.8 million individuals reported at least one misuse of an amphetamine product; in 2016, this figure was 5.1 million.
The National Institute on Drug Abuse (NIDA) reports that stimulant abuse is a significant problem in the United States and that nearly 170,000 individuals under the age of 18 reports some form of stimulant abuse (abusing a stimulant at least once). NIDA does not report figures on abuse of specific stimulants and does not include modafinil in its estimates. However, stimulant abuse is a significant problem for young people.
The abuse potential of these two medications is considered to be quite different. Adderall is known to be a significant potential drug of abuse. Motivation for abusing Adderall typically consists of trying to capitalize on its stimulant properties as a form of a “cognitive enhancer,” abusing it to lose weight, or abusing it with other drugs for its psychoactive effects. Modafinil abuse appears to be mostly associated with attempting to use its stimulant properties as a form of cognitive enhancer.
The term cognitive enhancer refers to the notion that a particular substance makes an individual smarter; hence, the term smart drug is often used to describe these drugs. However, there are no drugs that make people smarter. Stimulants like caffeine, Adderall, and modafinil can increase the ability of a person to pay attention and concentrate; however, when taken in moderate to large amounts, they may inhibit this ability.
The perception that Adderall and modafinil are smart drugs is a misperception, even though in small doses, they may help a person with their ability to pay attention. The long-term effects of these drugs regarding their ability to increase a person’s academic performance are highly overstated. The majority of individuals who abuse drugs like Adderall have lower academic achievement than individuals who do not use these drugs as cognitive enhancers.
Numerous research studies documented the abuse potential of Adderall, particularly in high school students and college students, younger individuals in high-performance occupations, and individuals attempting to lose weight (mostly females). Adderall has been demonstrated to be a significant drug of abuse, is most often abused in conjunction with other drugs like alcohol, and has a significant potential to produce physical dependence by producing tolerance rapidly in chronic users.
The abuse potential of modafinil is far lower than it is for Adderall. This is not to say that modafinil cannot be abused, but it is less likely to be a potential drug of abuse. Research studies indicate that there is very little evidence that modafinil use produces significant tolerance, that withdrawal symptoms associated with modafinil are rare, and there are only a few case studies in the literature that have identified evidence of dependence on modafinil.
The drug does not appear to produce the significant euphoria that is often associated with other stimulants, and in the few case studies where the development of physical dependence was suspected, the symptoms of withdrawal were primarily emotional such as apathy, lethargy, and cravings.
Thus, the research data and the survey data (SAMHSA) suggest that both drugs do have a potential for abuse, but the potential for abuse is far higher for Adderall than it is for modafinil.
Mixing Adderall and Modafinil
Can modafinil and Adderall be taken together? This is something commonly asked because people feel like doubling up on these drugs can improve their ability to study or perform at a high level. The idea among many people wondering “can modafinil and Adderall be taken together,” is that if you use both simultaneously, you’ll get double the benefits. That’s not necessarily true, however, and there can be risks to modafinil and Adderall taken together.
Modafinil, which isn’t a stimulant but acts similar to one in many ways, can be risky when taken with Adderall. If you combine two stimulant-like substances at once, it may cause overstimulation, and it can increase the risk of the side effects of one or either of these drugs. For example, you may be more likely to feel nauseous, anxious, or have a headache if modafinil and Adderall are taken together.
Some doctors may prescribe a combination of modafinil and Adderall taken together for people with ADHD, but this is something that should only be left up to a doctor, and you should never try to self-medicate.
Is Modafinil Addictive?
Some research suggests that modafinil (Provigil) may have some potential for addiction and abuse. One study from the Journal of the American Medical Association found that modafinil’s method of action is similar to that of very addictive drugs like meth and cocaine. This suggests that people with a history of substance abuse problems may be more prone to modafinil abuse as well.
Research has also proven that modafinil dependence is possible, although rare. The case study’s findings provide evidence that Provigil can produce mild tolerance, which means some people may abuse it to achieve the same effects they felt at lower doses. As a result, they might develop feelings of psychological or physical dependence.
Also, more and more high school and college students, working professionals, and others are beginning to abuse modafinil as a cognitive enhancer. Unfortunately, modafinil has gained a reputation as another smart drug with the ability to improve cognitive performance. However, although Provigil will increase concentration, much like a few cups of coffee can, it is not a wonder drug. When it’s abused in large doses, it can have the opposite effect and may make a person more distractible.
How Addictive is Adderall?
Adderall Addiction is a well-known condition in America. However, the fact that a prescription medication that is used to treat attention deficit hyperactivity disorder and narcolepsy can cause a severe addiction may be slightly surprising nonetheless. Despite being a prescription drug, in some cases, Adderall is abused by users who don’t have a prescription for the medication because it contains amphetamine, a potent stimulant.
The group of individuals who abuse Adderall can be subdivided into at least two groups. Some obtained this drug as a result of having a medical condition for which it is indicated. This group typically will not develop a substance use disorder, provided they follow the prescribing doctor’s orders. Some do not have a medical need for Adderall and, through different means, obtain pills and abuse them to get high. The format of Adderall pills is often manipulated to potentiate the high. For instance, individuals who abuse Adderall may crush the pills and snort them, to deliver the stimulant faster to the brain and get a more intense euphoric rush.
Co-Occurring Treatment Centers
There has been a steady growth in the treatment of co-occurring disorders since the 1990s, and rates are expected to continue to rise as we move into the next decade. One of the pioneers of co-occurring disorders, Dr. Kenneth Minkoff, has written an article in Psychiatric Services containing standards of best practices, including the following:
- Rather than excluding co-occurring individuals because of their mental illness, welcoming them into treatment
- Providing equal attention and care during the rehabilitation process to the addictive and co-occurring psychiatric disorders.
- Both psychiatric and substance addiction disorders may seem to be temporary conditions, but they require long-term assistance
- A treatment team with expertise in treating co-occurring disorders must be working to ensure that treatment is delivered.
- Provide treatment to clients who are suffering from psychiatric disorders early on, which will allow them to be treated more quickly.
- Whether the client is experiencing a mental health crisis or is acutely intoxicated, all clients should be treated with dignity and respect.
A co-occurring treatment program should address the needs of the mentally ill, including the treatment for substance abuse along with addiction treatment. Therapy sessions and group therapy meetings should address the needs of those who are mentally ill.