June 2009 Page 1 of 4

 Stimulant ADHD Medications: 

Methylphenidate and Amphetamines

Stimulant medications (e.g., methylphenidate and amphetamines) are often 

prescribed to treat individuals diagnosed 

with attention-deficit hyperactivity 

disorder (ADHD). ADHD is characterized 

by a persistent pattern of inattention 

and/or hyperactivity-impulsivity that is 

more frequently displayed and more 

severe than is typically observed in 

individuals at a comparable level of 

development. This pattern of behavior 

usually becomes evident in the preschool 

or early elementary years, and the 

median age of onset of ADHD symptoms 

is 7 years. For many individuals, ADHD 

symptoms improve during adolescence 

or as age increases, but the disorder 

can persist into adulthood. In the 

United States, ADHD is diagnosed 

in an estimated 8 percent of children 

ages 4–17 and in 2.9–4.4 percent of 

adults.1,2,3

How Do Prescription 

Stimulants Affect the Brain?

All stimulants work by increasing 

dopamine levels in the brain—dopamine 

is a brain chemical (or neurotransmitter) 

associated with pleasure, movement, 

and attention. The therapeutic effect 

of stimulants is achieved by slow and 

steady increases of dopamine, which 

are similar to the natural production of 

the chemical by the brain. The doses 

prescribed by physicians start low and 

increase gradually until a therapeutic 

effect is reached. However, when taken 

in doses and routes other than those 

prescribed, stimulants can increase 

brain dopamine in a rapid and highly 

amplified manner—as do most other 

drugs of abuse—disrupting normal 

communication between brain cells, 

producing euphoria, and increasing 

the risk of addiction. 

What Is the Role of 

Stimulants in the Treatment 

of ADHD? 

Treatment of ADHD with stimulants, often 

in conjunction with psychotherapy, helps 

to improve the symptoms of ADHD, as 

well as the self-esteem, cognition, and 

social and family interactions of the 

patient. The most commonly prescribed 

medications include amphetamines (e.g., 

Adderall—a mix of amphetamine salts) 

and methylphenidate (e.g., Ritalin and 

Concerta—a formulation that releases 

medication in the body over a period 

of time). These medications have a 

paradoxically calming and “focusing” 

effect on individuals with ADHD. 

Researchers speculate that because 

methylphenidate amplifies the release of 

dopamine, it can improve attention and 
June 2009 Page 2 of 4

What Adverse Effects Does 

Prescription Stimulant 

Abuse Have on Health? 

Stimulants can increase blood 

pressure, heart rate, body temperature, 

and decrease sleep and appetite, 

which can lead to malnutrition and 

its consequences. Repeated use of 

stimulants can lead to feelings of 

hostility and paranoia. At high doses, 

they can lead to serious cardiovascular 

complications, including stroke. 

Addiction to stimulants is also a very 

real consideration for anyone taking 

them without medical supervision. This 

most likely occurs because stimulants, 

when taken in doses and routes other 

than those prescribed by a doctor, can 

induce a rapid rise in dopamine in the 

brain. Furthermore, if stimulants are used 

chronically, withdrawal symptoms—

including fatigue, depression, and 

disturbed sleep patterns—can emerge 

when the drugs are discontinued.

How Widespread Is 

Prescription Stimulant 

Abuse?

Monitoring the Future Survey †

Each year, the Monitoring the Future 

(MTF) survey assesses the extent of drug 

use among 8th-, 10th-, and 12th-graders 

nationwide. For amphetamines and 

methylphenidate, the survey measures 

only past-year use, which refers to use 

focus in individuals who have dopamine 

signals that are weak.4

One of the most controversial issues in 

child psychiatry is whether the use of 

stimulant medications to treat ADHD 

increases the risk of substance abuse in 

adulthood. Research thus far suggests 

that individuals with ADHD do not 

become addicted to their stimulant 

medications when taken in the form and 

dosage prescribed by their doctors. 

Furthermore, several studies report that 

stimulant therapy in childhood does not 

increase the risk for subsequent drug and 

alcohol abuse disorders later in life.5,6,7

More research is needed, however, 

particularly in adolescents treated with 

stimulant medications.

Why and How Are 

Prescription Stimulants 

Abused? 

Stimulants have been abused for both 

“performance enhancement” and 

recreational purposes (i.e., to get 

high). For the former, they suppress 

appetite (to facilitate weight loss), 

increase wakefulness, and increase 

focus and attention. The euphoric 

effects of stimulants usually occur when 

they are crushed and then snorted or 

injected. Some abusers dissolve the 

tablets in water and inject the mixture. 

Complications from this method of use 

can arise because insoluble fillers in the 

tablets can block small blood vessels.
June 2009 Page 3 of 4

is declining in this group, when asked, 

“What amphetamines have you taken 

during the last year without a doctor’s 

orders?” 2.8 percent of all 12th-graders 

surveyed in 2007 reported they had 

used Adderall. Amphetamines rank third 

among 12th-graders for past-year illicit 

drug use. 

Other Information Sources

For more information on treating ADHD, 

visit the Web site for the National 

Institute of Mental Health, National 

Institutes of Health, at 

www.nimh.nih.gov.

For street terms searchable by drug 

name, street term, cost and quantities, 

drug trade, and drug use, visit 

www.whitehousedrugpolicy.gov/

streetterms/default.asp.

at least once during the year preceding 

an individual’s response to the survey. 

Use outside of medical supervision was 

first measured in the study in 2001; 

nonmedical use of stimulants has been 

falling since then, with total declines 

between 25 percent and 42 percent at 

each grade level surveyed. MTF data for 

2008 indicate past-year nonmedical use 

of Ritalin by 1.6 percent of 8th-graders, 

2.9 percent of 10th-graders, and 3.4 

percent of 12th-graders. 

Since its peak in the mid-1990s, annual 

prevalence of amphetamine use fell 

by one-half among 8th-graders to 4.5 

percent and by nearly one-half among 

10th-graders to 6.4 percent in 2008. 

Amphetamine use peaked somewhat 

later among 12th-graders and has 

fallen by more than one-third to 6.8 

percent by 2008. Although general 

nonmedical use of prescription stimulants 

Data Source

† These data are from the 2008 Monitoring the Future survey, funded by the National Institute on Drug Abuse, 

National Institutes of Health, Department of Health and Human Services, and conducted annually by the 

University of Michigan’s Institute for Social Research. The survey has tracked 12th-graders’ illicit drug use and 

related attitudes since 1975; in 1991, 8th- and 10th-graders were added to the study. The latest data are online 

at www.drugabuse.gov.

References

1Centers for Disease Control and Prevention. Mental health in the United States: Prevalence of diagnosis and 

medication treatment for attention-deficit/hyperactivity disorder—United States, 2003. Morb Mortal Wkly Rep 

54(34):842–847, 2005.

2 Kessler RC, Adler L, Barkley R, et al. The prevalence and correlates of adult ADHD in the United States: Results from 

the National Comorbidity Survey Replication. Am J Psychiatry 163(4):716–723, 2006.
June 2009 Page 4 of 4

National Institutes of Health – U.S. Department of Health and Human Services

This material may be used or reproduced without permission from NIDA. Citation of the source is appreciated.

3 Faraone SV, Biederman J. Prevalence of Adult ADHD in the United States. Paper presented at the American 

Psychiatric Association annual meeting, New York, 2008.

4 Volkow ND, Fowler JS, Wang G, Ding Y, Gatley SJ. Mechanism of action of methylphenidate: Insights from PET 

imaging studies. J Attention Disorders 6(Suppl. 1):S31–S43, 2002.

5 Wilens TE, Faraone SV, Biederman J, Gunawardene S. Does stimulant therapy of attention-deficit/hyperactivity 

disorder beget later substance abuse? A meta-analytic review of the literature. Pediatrics 111(1):179–185, 2003. 

6 Mannuzza S, Klein RG, Truong NL, et al. Age of methylphenidate treatment initiation in children with ADHD and 

later substance abuse: Prospective follow-up into adulthood. Am J Psychiatry 165(5):604–609, 2008. Available at: 

http://www.ncbi.nlm.nih.gov/pubmed/18381904?dopt=Abstract.

7 Biederman J, Monuteaux MC, Spencer T, Wilens TE, MacPherson HA, Faraone SV. Stimulant therapy and risk for 

subsequent substance use disorders in male adults with ADHD: A naturalistic controlled 10-year follow-up study. 

Am J Psychiatry 165(5):597–603, 2008. Available at: 

http://ajp.psychiatryonline.org/cgi/content/abstract/appi.ajp.2007.07091486v1.