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The purpose of the essay is two-fold:

1. to increase your understanding of an issue that is of personal interest or relevance based on empirical, scientific evidence;

2. to demonstrate your ability to synthesize this information into a Cohrent Argument

3. Discuss the pros and cons of legalizing of marijuana.

Types of Stimulants Used for ADHD Treatment

Stimulants are pharmacological drugs that help to uplift the activity of the central nervous system. The main category of stimulants includes caffeine, nicotine, illegal drugs, over-the-counter decongestants and other prescription medication. The common use of prescription stimulants is treatment of attention deficit hyperactivity disorders (ADHD) (Canadian Centre on Substance Abuse, 2019).  Prescription stimulants are mainly taken in the form of pill for medical uses. However, some people tamper with this stimulant pills in order to obtain euphoric effects. This kind of tampering leads to generation of several complications like infection at the site of infection, blockage of the small blood vessels and rapid onset of the blood pressure and heart rate (Canadian Centre on Substance Abuse, 2019). The following essay aims to analyze pros and cons behind the use of the doctors prescribed stimulants (adderall; Lis/Dexamfetmine) among the people with ADHD and stimulants used without doctor’s prescription by people who have no known cases of ADHD or people who use stimulants in the form of drug abuse. The essay thus helps to highlight the harmful or the toxic effect of stimulants among diseased person or individuals who use it as substance abuse along with beneficial effects of stimulants in treating ADHD.

In the domain of stimulants use for treating ADHD, methylphenidate is current regarded as most widely used medication. Numerous studies have used methylphenidate as an active comparator medication in order to evaluate the efficacy of newly discovered stimulant, Adderall. The studies highlighted that Adderall is superior to placebo and thus suggest that it is as effective as standard-release form of methylphenidate. It also has a longer course of action. In order to test the efficacy of the physicians’ prescribed Adderall among the children with ADHD, Narine, Sarwar and Rais (2013) conducted a meta-analysis. The meta-analysis of available research highlighted that Adderall has a small but statistically significant advantage over standard-release form of mthylphenidate. Thus the authors concluded that Adderal can be effectively used for the treatment of ADHD among the children. However, in order to gain a promising outcome and reduction in the side-effects, fixed-dose and best-dose designs must be done under the consideration of the healthcare physicians. The systematic review conducted by Chan, Fogler and Hammerness (2016), highlighted that the use of the Adderall is useful in reducing the severity of ADHD among the children. Adderall,, the slow release medication helps to bring change in the neurological function and thereby reflecting a negative score on ADH Rating scale. The meta-analysis conducted by Coughlin et al. (2015) stated that psychostimulants used for the treatment of ADHD is effective in improving the health-related quality of life of the children by generating significant reduction in the anxiety development.

Efficacy of Prescription Stimulants in Treating ADHD

Kollins et al. (2014) conducted a pilot study in order to test the efficacy of the Lis/Dexamfetamine (LDX) towards the treatment of the ADHD among the adults. The analysis of the results highlighted that LDX helps in the promotion of the significant reduction in the self-reported and clinicians-rated ADHD symptoms. Moreover, LDX was also well tolerated among the chain smokers of ADHD who is attempting to quit smoking. LDX also demonstrated in reducing the tendency of smoking habits among the adults with ADHD. Getahun et al. (2013) are of the opinion the decreasing in the tendency of smoking is effective in reducing the severity of the ADHD among the adults in reducing the negative impact on the nerve impulses upon smoking of tobacco.

However, Chan, Fogler and Hammerness (2016) stated in effective outcome is achieved when stimulants or pharmacological treatments and given along with non-pharmacological treatments for the treatment of the ADHD. Common non-pharmacological treatments used include behavioural contingency management, motivational enhancement and other social skill training techniques.

There is always a concern regarding the use of stimulant medications for ADHD during childhood has adverse effect in promoting vulnerability of development of ASU (adolescent substance use). The controlled longitudinal studies conducted by Groenman et al. (2013) and naturalistic clinic-based studies conducted by Steinhausen and Bisgaard (2014) highlighted that ADHD medication helps to prevent ASU. However, meta-analysis of longitudinal studies highlighted that the use of medication neither increases nor decreases the risk of developing ASU (Humphreys, Eng & Lee, 2013). The majority of the experts underscore the lack of consistent evidence behind the effect of long-term medication and its role in improving the ADHD related problems that mainly direct towards the predisposition of the AUS like social maladjustment and school under-performance (Molina & Pelham, 2014). While the others alert that the longitudinal studies still not comprehensively accounted for important modulating factors of the disease development. These factors include age of the first consumption of the medication, the level of compliance of medication and severity of duration of ADHD along with the presence of psychiatric co-morbidities. Thus Hogue, Evans & Levin (2017) concluded from their review that medications like stimulants for the treatment of ADHD is safe and do not leads to an increase in the likelihood of developing substance misuse. However, whether the use of the stimulants during early childhood for ADHD is helpful in preventing ASD is still not clear.

Efficacy of Non-Prescription Stimulants in Treating ADHD

Cardiomyopathy is associated with stimulant abuse however, cardiomyopathy rates under the therapeutic administration of stimulants for ADHD is being studied poorly. Mosholder et al. (2018) conducted a descriptive study in order to study the occurrence of heart failure and cardiomyopathy after the initiation of the medication for the treatment of the Attention-Deficit/Hyperactivity disorder. The analysis of the results highlighted that heart failure or the rate of cardiomyopathy is not associated with use of stimulants for the treatment of ADHD for tenure of 3 years in comparison to the short-term use of the stimulants. Among the older adults, the higher rates of cardiomyopathy are observed immediately after the initiation of the medication (Mosholder et al., 2018).  

Egan et al. (2013) stated that undergraduate students who has untreated or undertreated ADHD symptoms at times develop academic motives for the misue of the stimulants. Benson et al. (2018) conducted a study in order to evaluate the relationship between the ADHD symptoms for controlling the comorbid oppositional defiant disorder (ODD), to misuse and to explore how these symptoms are associated with the motives to indulging in misuse. Analysis of the 900 students from public university highlighted that rate of prevalence of misuse of the stimulant is around 20%. The participants who satisfied the criteria of ADHs are 2.90 times are more likely to indulge under the misuse the stimulants than those who are not suffering from ADHD. Among the percentage of the mis-users who satisfied the criteria of ADHD are more likely to indulge in the mis-use of the stimulants due to academic motives. The results further highlighted that the misuse of the stimulants is mainly driven by the lack of adequate or absence of care for the executive functioning of the impairments related to ADHD. Thus Benson et al. (2018) recommended a greater focus can be given to the assessment and treatment of students with symptoms of ADHD.

The similar study conducted by Egan et al. (2013) among the 4090 students in the North Carolina universities in fall 2009. The survey based study aimed to determine the prevalence of the simultaneous use of alcohol and non-medical prescription stimulant (NMPS) use and to determine the consequences of simultaneous NMPS use and alcohol abuse among the undergraduate students. The analysis of the survey results highlighted that the simultaneous use of NMPS along with alcohol is mainly high among the NMPS users. Moreover, the NMPS usage among the undergraduate college students increases a sense of the negative emotions within them. This spurge of the negative emotions provokes them to indulge under further intoxication leading to the development of the alcohol abuse. Increased consumption of the alcohol along with the use of NMPS might lead to the development of visual hallucinations, headache, insomnia and other nervous problem. In relation to this, Sweeney et al. (2013) conducted a cross-sectional population based survey among the U.S civilians aged 12 years and above in order to analyze illicit drug use initiation patterns, illicit use of the prescription drugs and lifetime use of the NMPS. The analysis of the results suggested that non-medical use of the prescription ADHD stimulants is not the sole initiating factor leading towards the development of the illicit drug abuse. However, the analysis of the results of this population based study showed that non-medical use of the prescription ADHD stimulants is mainly adopted by the individuals who are already engaged in the alcohol abuse or drug misuse (Sweeney et al. 2013). The tendency of the use of the stimulants for the non ADHD is high when they suffer from the academic stress of their mental depression. Prolong use of the stimulants under unregulated dosage lead to the development of the mental health complications along with the malfunction in the central nervous system. In case of the individuals who are suffering from ADHD, the non-prescribed use of the stimulants might to lead to harmful outcome immediately however, during the course of time, unregulated consumption of the dosage of ADHD leads to the development of further mental health disequilibrium (Deluca et al., 2012).

Use of Non-Pharmacological Treatments Alongside Stimulant Medications

Narine, Sarwar & Rais (2013) stated that over-dosage of “study drugs” Adderall are no less susceptible to the dangers. During 2014 nearly 11.7 million Americans were reported of consuming Adderall for non-medical use during some time in life. There were than 4.8 million adults (18 to 25 years) who were reported to use Adderall under non-prescription mode. This number might grow in future depending upon the increase in the study stress. The overuse or unregulated use of Adderall is a serious concern as it might lead to dangerous healthcare concerns. The overuse or non-prescription use of amphetamine drugs like Adderall or methamphetamine leads to unwanted hospital visits. The main side-effects or the symptoms of the Adderall and LDX abuse include rapid heart rate, uncontrollable shaking, hallucinations, disorientation, depression, blurry vision, panic attack, anxiety and aggression. In some cases it might also lead to stomach upset, diarrhoea, fatigue, fainting seizures and muscle weakness. However, symptoms might vary from person to person depending upon the rate of overdose, the tenure for which the drug is used along with age, gender and body mass (Mooney et al., 2015).

Conclusion

Thus from the above discussion, it can be concluded that, Adderall and LDX are effective reducing severity of the ADHD by increasing the level of concentration of the students and thereby helping to improve the level of the academic performance among them. However, long-term use of this medication or uncontrolled usage of the medication might lead to the development of cardio complications. Such conditions are mainly prevalent among the older adults. The essay also highlighted that non-prescription usage of the stimulants are higher both among the individuals with or without ADHD. The initial outcomes of the non prescription usage of the stimulants among ADHD patients are not severe. However, prolong usage of the medication leads to the development of the several neuronal complications. Among the non ADHD individuals, the usage of the stimulants in the absence of the doctors’ advice leads to unwanted hospital admission. The essay also highlighted that the usage of the stimulants for the treatment of the ADHD must be done under the controlled supervision f the doctor along with dosage regulation based on age, gender and weight. The physicians also proposed the importance of the usage of the both pharmacological and non-pharmacological interventions in order to gain effective outcome while reducing the severity of the developing the side-effects from the pharmacological interventions.

Safety and Efficacy of Medications in Preventing Substance Misuse

References

Benson, K., Woodlief, D. T., Flory, K., Siceloff, E. R., Coleman, K., & Lamont, A. (2018). Is ADHD, independent of ODD, associated with whether and why college students misuse stimulant medication?. Experimental and clinical psychopharmacology, 26(5), 476.

Canadian Centre on Substance Abuse. (2019). Prescription Stimulus. Access date: 16th March 2019. Retrieved from: https://www.ccsa.ca/Resource%20Library/CCSA-Canadian-Drug-Summary-Prescription-Stimulants-2016-en.pdf

Chan, E., Fogler, J. M., & Hammerness, P. G. (2016). Treatment of attention-deficit/hyperactivity disorder in adolescents: a systematic review. Jama, 315(18), 1997-2008.

Coughlin, C. G., Cohen, S. C., Mulqueen, J. M., Ferracioli-Oda, E., Stuckelman, Z. D., & Bloch, M. H. (2015). Meta-analysis: reduced risk of anxiety with psychostimulant treatment in children with attention-deficit/hyperactivity disorder. Journal of child and adolescent psychopharmacology, 25(8), 611-617.

Deluca, P., Davey, Z., Corazza, O., Di Furia, L., Farre, M., Flesland, L. H., ... & Pezzolesi, C. (2012). Identifying emerging trends in recreational drug use; outcomes from the Psychonaut Web Mapping Project. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 39(2), 221-226.

Egan, K. L., Reboussin, B. A., Blocker, J. N., Wolfson, M., & Sutfin, E. L. (2013). Simultaneous use of non-medical ADHD prescription stimulants and alcohol among undergraduate students. Drug and alcohol dependence, 131(1-2), 71-77.

Egan, K. L., Reboussin, B. A., Blocker, J. N., Wolfson, M., & Sutfin, E. L. (2013). Simultaneous use of non-medical ADHD prescription stimulants and alcohol among undergraduate students. Drug and alcohol dependence, 131(1-2), 71-77.

Getahun, D., Jacobsen, S. J., Fassett, M. J., Chen, W., Demissie, K., & Rhoads, G. G. (2013). Recent trends in childhood attention-deficit/hyperactivity disorder. JAMA pediatrics, 167(3), 282-288.

Groenman, A. P., Oosterlaan, J., Rommelse, N. N., Franke, B., Greven, C. U., Hoekstra, P. J., ... & Sergeant, J. A. (2013). Stimulant treatment for attention-deficit hyperactivity disorder and risk of developing substance use disorder. The British Journal of Psychiatry, 203(2), 112-119.

Hogue, A., Evans, S. W., & Levin, F. R. (2017). A Clinician's Guide to Co-occurring ADHD Among Adolescent Substance Users: Comorbidity, Neurodevelopmental Risk, and Evidence-Based Treatment Options. Journal of Child & Adolescent Substance Abuse, 26(4), 277-292.

Humphreys, K. L., Eng, T., & Lee, S. S. (2013). Stimulant medication and substance use outcomes: a meta-analysis. JAMA psychiatry, 70(7), 740-749.

Kollins, S. H., English, J. S., Itchon-Ramos, N., Chrisman, A. K., Dew, R., O’Brien, B., & McClernon, F. J. (2014). A pilot study of lis-dexamfetamine dimesylate (LDX/SPD489) to facilitate smoking cessation in nicotine-dependent adults with ADHD. Journal of attention disorders, 18(2), 158-168.

Molina, B. S., & Pelham Jr, W. E. (2014). Attention-deficit/hyperactivity disorder and risk of substance use disorder: Developmental considerations, potential pathways, and opportunities for research. Annual review of clinical Psychology, 10, 607-639.

Mooney, M. E., Herin, D. V., Specker, S., Babb, D., Levin, F. R., & Grabowski, J. (2015). Pilot study of the effects of lisdexamfetamine on cocaine use: A randomized, double-blind, placebo-controlled trial. Drug and alcohol dependence, 153, 94-103.

Mosholder AD, Taylor L, Mannheim G, Ortendahl L, Woodworth TS, Toh S.J Clin Psychopharmacol. (2018) Incidence of Heart Failure and Cardiomyopathy Following Initiation of Medications for Attention-Deficit/Hyperactivity Disorder: A Descriptive Study.Oct; 38(5):505-508. Retrived from:https://www.ncbi.nlm.nih.gov/pubmed/30102629

Narine, C., Sarwar, S. R., & Rais, T. B. (2013). Adderall-induced trichotillomania: a case report. Innovations in clinical neuroscience, 10(7-8), 13.

Narine, C., Sarwar, S. R., & Rais, T. B. (2013). Adderall-induced trichotillomania: a case report. Innovations in clinical neuroscience, 10(7-8), 13.

Steinhausen, H. C., & Bisgaard, C. (2014). Substance use disorders in association with attention-deficit/hyperactivity disorder, co-morbid mental disorders, and medication in a nationwide sample. European neuropsychopharmacology, 24(2), 232-241.

Sweeney, C. T., Sembower, M. A., Ertischek, M. D., Shiffman, S., & Schnoll, S. H. (2013). Nonmedical use of prescription ADHD stimulants and preexisting patterns of drug abuse. Journal of addictive diseases, 32(1), 1-10.

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