There are so many kinds of chemical stimulants why are amphetamines the thing ADHD patients need?
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I typed this out and realized this might not be the answer you are looking for, but here is the ELI5 for why we use stimulants to treat ADD/ADHD:
Low dose amphetamines are used to target the brain’s executive functioning. The executive function of the brain is essentially the part of the brain that tells you *what* to think about. Executive functions of the brain is how we switch from one task to another and how we stay focused.
Imagine your brain is a classroom. The executive function is the teacher, making sure the kids (other mental processes) are doing their work and staying on track. In a brain with ADD/ADHD, the teacher is asleep at their desk. The rest of the kids are still active, but they are disorganized and not as productive because of it. The medication prescribed acts as a cup of coffee for the teacher so they can better keep things focused and organized.
Imagery of trying to be functional on coke, from a former coke head.
You can’t stop talking, or moving, or thinking about sex or drama. You could do the test, but Vanessa has a huge butt and chad is looking at you kinda funny. Suddenly, you have vicious diarrhea. You tell the teacher, she says no leaving during the test. FUCK THAT BITCH, I’m leaving anyway. *gags from nasal drip*
Amphetamines prescribed specifically for ADHD are not ‘safe’ versions, they’re just modified so that users cannot get high off them. Vyvanse for example can only be absorbed via the gastrointestinal tract, which prevents people from just crushing up the pills and snorting them. The side effects and withdrawal symptoms are still potentially dangerous if the drugs are misused.
There are two stimulants currently used to treat ADHD. Methylphenidate(Ritalin/concerta) and amphetamine salts(adderall/vyvanse). Methylphenidate works by telling your brain to slow down its reuptake of dopamine. After dopamine is released into the synapse, a transport molecule will come by after a little while and retrieve that dopamine and put it back into a storage area called a vesicle. Methylphenidate slows down the transport of dopamine out of the synapse which is proven to increase activity in areas of the frontal lobe of the brain(the areas that adhd effects most). Amphetamine works similarly but also effects norepinephrine and not only slows the reuptake of dopamine but actually seems to reverse reuptake and release some of the stored dopamine back into the synapse. Cocaine effects dopamine and norepinephrine as well I believe but the main reason it wouldn’t work as an adhd med is because it’s got an insanely short window of usable effects. I’m ADHD and I’ve tried cocaine and I’d say it is semi effective at clearing the noise from my mind in a similar way as amphetamine but only for about a 30 minute window before you have to redose. The real problem with adhd isn’t moment to moment fidgeting and forgetfulness. That’s a problem too but not life crippling, the real issue is the ability to sustain motivation over months or even years at a time. Before I started medication it was sort of like I was constantly chasing this window of motivation throughout the year. For example I’d get really inspired all of the sudden to finally go back to school and work really hard on it for 3-6 weeks and then one day I’d wake up and my motivation would be 100% gone. No matter how hard I tried I could not get my brain to properly devote itself to this task any longer, not in any meaningful way. So I’d spend a week or two feeling aimless and then all of the sudden I’d feel really inspired to start working out again and get back in shape. I’d chase the window for a few weeks and rinse and repeat. I knew that the only way I’d ever get anything done is if I just went with the flow and followed those motivational windows. With medication I determine those windows myself because every day when I wake up and that stimulant starts to kick in that motivation is mine to use however I want. I’m not chasing windows of motivation any more. Basically cocaine wouldn’t work because therapeutic stimulants need to be long lasting.
I can only speak from experience. I’m a former meth addict that got into meth from doing copious amounts of cocaine. I also was diagnosed ADHD as a kid and have been (and am actively on) many different stimulants. The closest experience I had to my stimulants being very similar to meth/coke was when I was on Vyvanse. Before anyone gets upset, everyone’s brain is different and reacts differently to meds.
When I was on Vyvanse, once it hit my system, all I could do was hyperfixate and hyperfocus on “urges.” That is, I had no control over where my attention went to and I had no control over what I wanted to focus on. The Vyvanse would hit and I’d be stuck hyperfocusing on ONE thing for the next 8-10 hours with no way out, and it was rarely ever things that were productive or helpful to focus on. Yes, it helped the factor of my ADHD where my attention was constantly bouncing around different things, but it made the whole “I can’t choose what to focus on” somehow 10x worse.
That’s how cocaine/meth was for me. I’d get high and do one single thing for however many hours and get completely lost in it. Often it was whatever thing fit the most with dopamine-seeking. But I didn’t have any actual relief from the inability to control my focus. Of course I wasn’t taking it to get work done, I was taking it to get high. It was also just so incredibly easy for me to get addicted to these drugs compared to any of the stimulants I’ve been on simply just don’t provide enough of a rush of endorphins/dopamine for me to want to abuse them.
I take a set of stimulants now where I actually feel like I’m in control of my own mind/brain when I’m on them. I have authority of what I want to do, what I want to focus on, and can go about changing tasks accordingly to how I need. I can’t do that without stimulants, and I couldn’t do that on coke/meth.
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