Adderall is a commonly prescribed drug that treats attention deficit hyperactivity disorder (ADHD) in children and adults. The active ingredients in Adderall are amphetamine and dextroamphetamine, both of which are central nervous system (CNS) stimulants. Like other prescription stimulants, Adderall is a Schedule II controlled substance, meaning that the U.S. Drug Enforcement Administration (DEA) recognizes a valid medical use for Adderall while also cautioning that it is associated with a high potential for abuse.
In the context of pharmacology, tolerance refers to the diminishing effectiveness of a drug that is taken regularly. Dependence is the presence of manageable physical or psychological withdrawal symptoms that become evident when a drug dose is reduced or eliminated. Addiction is the extension of dependence and is characterized by compulsive, potentially dangerous drug-seeking behavior. Although tolerance does necessarily not indicate that dependence or addiction is present, tolerance and dependence are frequently observed together.
Adderall Tolerance Symptoms
The hallmark symptom of Adderall tolerance is the need for higher or more frequent doses to achieve the same level of effect that was initially experienced. Tolerance is often a driver of Adderall misuse, which occurs when someone takes it in any way other than as prescribed. Increasing the dose or the frequency of use or saving doses so a larger quantity can be taken in the future all constitute Adderall misuse. Misuse is different from abuse, which occurs when someone uses Adderall with the express intent to get high.
How Fast Does Adderall Tolerance Develop?
Some factors influence how fast tolerance develops, including intrinsic factors (e.g., your metabolism and genetics) and extrinsic factors (e.g., your Adderall dose, whether you take any other medications). While some people who take Adderall as prescribed begin to experience symptoms of tolerance within as little a few weeks, tolerance is more commonly experienced after several weeks or months of regular use.
Causes of Adderall Tolerance
Although several factors influence the development of tolerance, the phenomenon of tolerance itself is a consequence of brain adaptation to the persistent presence of a chemical. When Adderall is regularly administered, the brain becomes accustomed to its presence. Over time, the physical and psychological effects are blunted because Adderall is not able to elicit the same degree of reaction from cells in the brain.
Specific factors that influence tolerance development include:
- Dosage: Lower doses of Adderall are generally associated with tolerance developing more slowly.
- Frequency of use: People who use Adderall infrequently will not develop tolerance as quickly as people who use the drug regularly — although this factor is influenced by the Adderall formulation (i.e., immediate-release versus extended-release).
- Duration of use: Generally speaking, the longer you used Adderall, the higher your risk for developing tolerance. However, irregular use (taking Adderall on an “as needed” basis or taking “holidays” from its use) is associated with a reduced risk of tolerance developing.
- Form of Adderall: Adderall immediate-release (IR) versus extended-release (XR) formulations can have different impacts on tolerance. Someone who takes 20 mg IR once a day may experience reduced tolerance compared to someone who takes 20 mg XR once a day because IR is available in the brain for a shorter amount of time.
- Interactions with other drugs: Drugs that affect neurotransmitter levels in the brain may impact Adderall tolerance. Generally, drugs that increase the release of dopamine or norepinephrine from cells in the brain (or inhibit the reuptake of these neurotransmitters) will cause Adderall tolerance to develop quickly. Some antidepressants and many drugs of abuse fall into this category.
- Other factors: Several other extrinsic and intrinsic factors can influence the development of Adderall tolerance. Extrinsic factors may include exercise, diet and how you respond to stress; intrinsic factors may include genetics, physiology, and how well your body absorbs and excretes Adderall, vitamins and other compounds.
Potentiation refers to combining Adderall with other substances in an attempt to enhance the effects of Adderall. It is important to understand that even though the Adderall dose is not being increased, by potentiating its effects you are increasing the effect of Adderall’s active ingredients, amphetamines, in the brain. In some cases, potentiation may contribute to an overdose.
Some evidence suggests that potentiating low doses of Adderall may offer the same therapeutic benefit of higher doses while reducing tolerance development. However, it is highly recommended that you avoid potentiating Adderall. If you are considering low-dose potentiation, consult with your doctor.
Adderall potentiators include:
- Alkalinizing agents: Compounds that increase the pH of your gastrointestinal tract, such as antacids, may allow for more rapid absorption of Adderall, making it available more quickly.
- Caffeine: Like Adderall, caffeine is a stimulant that increases dopamine availability in the brain. Thus, combining caffeine and Adderall may increase the effect of Adderall.
- Nicotine: Nicotine may increase the response of brain cells to dopamine, which essentially increases the effects of dopamine. Since increased dopamine enhances the effects of Adderall, increasing the response to dopamine will have a similar effect.
- L-Tyrosine: Dopamine synthesis depends on the presence of tyrosine. Some believe that increasing the availability of dopamine building blocks may increase overall levels of dopamine.
How to Prevent Adderall Tolerance
Unfortunately, there is no single way to effectively prevent the development of Adderall tolerance. Low doses are less likely to lead to tolerance. Some people have had success by working with their doctors to devise a potentiating tolerance-avoidance strategy. However, due to the unique physiology and genetic makeup of each person, tolerance development is not universal.
Always discuss concerns with a medical professional before altering a prescription.
Getting Help With Adderall Addiction
Even people who take Adderall exactly as prescribed can become dependent or addicted. If you are concerned about your Adderall use, help is available. Discuss your concerns with your doctor or, if you are unable to reduce or quit taking Adderall, schedule an appointment with an addiction specialist who can give you an evaluation and recommendations for treatment.
Contact The Recovery Village Ridgefield to speak with a representative about how professional addiction treatment can address a substance use disorder and any co-occurring mental health conditions. Take the first step toward a healthier future, call today.
U.S. Food and Drug Administration. “Adderall.” January 2017. Accessed September 14, 2019.
Caporuscio, Jessica. “What are the side effects of Adderall?” Medical News Today, May 2019. Accessed September 14, 2019.
Yanofski, Jason. “The Dopamine Dilemma-Part II: Could Stimulants Cause Tolerance, Dependence, and Paradoxical Decompensation?” Innovations in Clinical Neuroscience, January 2011. Accessed September 14, 2019.