June 2008 Page 1 of 4

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 this country, ADHD is diagnosed in an estimated 8 percent of 

children ages 4–17 and 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 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’s 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); methylphenidate (e.g., Concerta,

a formulation that releases medication in

the body over a period of time); and

Ritalin, which is generally less potent

than amphetamine. 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

Stimulant ADHD Medications:

Methylphenidate and Amphetamines
June 2008 Page 2 of 4

attention and 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. The research so far suggests

that individuals with ADHD do not

become addicted to their stimulant 

medications when taken in the form and

dosage prescribed by doctors. And,

there have been several studies that

report stimulant therapy in childhood

does not increase the risk for subsequent

drug and alcohol abuse disorders.5,6,7

However, more research in this area is

clearly needed, particulaly 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 and

facilitate weight loss, increase wakefulness, and increase focus and attention.

Their euphoric effects usually occur

when stimulants are crushed and snorted

or injected. Some abusers dissolve the

tablets in water and inject the mixture;

however, complications can arise from

this because insoluble fillers in the

tablets can block small blood vessels.

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. At high doses, they can lead 

to serious cardiovascular complications,

including stroke. Repeated use of stimulants can lead to feelings of hostility 

and paranoia. 

Addiction to stimulants is also a very

real consideration for anyone taking

them without medical supervision, and is

more likely to occur when the stimulant

induces a rapid rise in brain dopamine,

as is the case when they are taken in

doses and routes other than those prescribed. If 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 at

least once during the year preceding an
June 2008 Page 3 of 4

individual’s response to the survey. Use

outside of medical supervision was first

measured in the study in 2001; it has

been falling since then, with total

declines of between 25 percent and 42

percent at each grade level. MTF data

for 2007 indicate past-year non-medical

use of Ritalin by 2.1 percent of 8th

graders, 2.8 percent of 10th graders,

and 3.8 percent of 12th graders. 

Since its peak in the mid-1990s, annual

prevalence of amphetamine use has fallen by more than half among 8th graders

to 4 percent and by a third among 10th

graders to 8 percent in 2007.

Amphetamine use peaked somewhat

later among 12th graders, and has fallen by about a third to almost 8 percent

in 2007. When asked, “What amphetamines have you taken during the last

year without a doctor’s orders?” 2.8 percent of all 12th graders reported they

had used Adderall. Amphetamines rank

fourth 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/

default.asp.

Data Source

† These data are from the 2007 Monitoring the Future survey, funded by the National Institute on Drug Abuse,

National Institutes of Health, DHHS, 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.monitoringthefuture.org/

References

1

Anon. Mental health in the United States. Prevalence of diagnosis and medication treatment for attentiondeficit/hyperactivity disorder–United States, 2003. Morb Mortal Wkly Rep 54:842–847, 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 163:716–723, 2006.

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 111:179–185, 2003. 
June 2008 Page 4 of 4

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. Epub April 1,

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. Epub March 3, 2008. Available at: http://www.ncbi.nlm.nih.gov/pubmed/

18316421?ordinalpos=8&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

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.