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group_3_presentation_1_-_adderall [2020/01/31 20:52]
mehmoodm [Attention Deficit Hyperactivity Disorder (ADHD)]
group_3_presentation_1_-_adderall [2020/02/13 23:36] (current)
mehmoodm
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 +====== Presentation Slides ======
 +
 +{{::​group_3_-_presentation_1_-_adderall_1_.pdf|}}
 +
 ====== Adderall ====== ====== Adderall ======
 <box 55% round center|> {{ :​test.jpg?​550 |}} </box| Figure 1. Image of Adderall pills (The Recovery Village, 2020)> <box 55% round center|> {{ :​test.jpg?​550 |}} </box| Figure 1. Image of Adderall pills (The Recovery Village, 2020)>
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 === History of Adderall === === History of Adderall ===
-Adderall is a prescribed medication that consists of a mixture of two different molecular ​structure ​of amphetamine. Amphetamine was first synthesized in 1887 by a Romanian chemist, Lazăr Edeleanu. The drug’s first pharmacological appearance was in 1934 as an inhaler for congestion under the trade name Benzedrine. It was not until World War II, the Allied and Axis forces discovered the performance-enhancing effect of the drug and began widely consumed by the soldiers to boost combat morale and concentration. The discovery of amphetamine’s stimulant properties widely expanded its applications,​ from focus enhancement drug to promoting its effects on weight loss. Pharmaceutical companies began to market the drug to the general public as a weight loss pill and even as a medication for depression (Rasmussen, 2008).+Adderall is a prescribed medication that consists of a mixture of two different molecular ​structures ​of amphetamine. Amphetamine was first synthesized in 1887 by a Romanian chemist, Lazăr Edeleanu. The drug’s first pharmacological appearance was in 1934 as an inhaler for congestion under the trade name Benzedrine. It was not until World War II, the Allied and Axis forces discovered the performance-enhancing effect of the drug and became ​widely consumed by the soldiers to boost combat morale and concentration. The discovery of amphetamine’s stimulant properties widely expanded its applications,​ from being a focus enhancement drug to promoting its effects on weight loss. Pharmaceutical companies ​also began to market the drug to the general public as a weight loss pill and even as a medication for depression (Rasmussen, 2008).
  
 <box 35% round center|> {{ :​soldiers.jpg?​nolink&​350 |}} </box| Figure 2. Image of soldiers during World War II (Nix, 2018)> ​ <box 35% round center|> {{ :​soldiers.jpg?​nolink&​350 |}} </box| Figure 2. Image of soldiers during World War II (Nix, 2018)> ​
  
 === Current Use of Adderall === === Current Use of Adderall ===
-Today, amphetamine is sold under the brand Adderall. It is commonly used as a treatment for attention deficit hyperactivity disorder (ADHD) to increase focus and reduce impulsive behaviors. Adderall also showed ​effeteness ​in increasing daytime wakefulness for people with narcolepsy (WebMD, n.d.). However, the drug is not without consequences. Adderall ​contained ​a boxed warning from the Food and Drug Administration (FDA), indicating a significant risk of serious or even life-threatening effects when consuming ​inappropriately. However, because of Adderall’s ability to improve attention and performance,​ people often abused ​the drug by using it as a performance and cognitive enhancer. Students and professionals use Adderall to help them stay awake and focus for a longer period of time in the face of ever-increasing demand from school and work (Juergens, 2019). Professional players in the eSport industry take Adderall to boost their concentration and help them perform better in tournaments (The Recovery Village, 2019). People also abuse Adderall for recreational purposes due to its stimulative and addictive properties. As a result, Adderall abuse is a prevalent issue in today’s society, and the public needs to be better educated about the drug to make an informed decision when considering it.+Today, amphetamine is sold under the brand Adderall. It is commonly used as a treatment for attention deficit hyperactivity disorder (ADHD) to increase focus and reduce impulsive behaviors. Adderall also showed ​effectiveness ​in increasing daytime wakefulness for people with narcolepsy (WebMD, n.d.). However, the drug is not without ​its consequences. Adderall ​contains ​a boxed warning from the Food and Drug Administration (FDA), indicating a significant risk of serious or even life-threatening ​side effects when consumed ​inappropriately. However, because of Adderall’s ability to improve attention and performance,​ people often abuse the drug by using it as a performance and cognitive enhancer. Students and professionals use Adderall to help them stay awake and focus for a longer period of time in the face of ever-increasing demand from school and work (Juergens, 2019). Professional players in the eSport industry take Adderall to boost their concentration and help them perform better in tournaments (The Recovery Village, 2019). People also abuse Adderall for recreational purposes due to its stimulative and addictive properties. As a result, Adderall abuse is a prevalent issue in today’s society, and the public needs to be better educated about the drug to make an informed decision when considering it.
  
 <box 40% round center|> {{ :​esport.jpg?​nolink&​400|}} </box| Figure 3. Image of professional eSport players (Itani, 2017)> ​ <box 40% round center|> {{ :​esport.jpg?​nolink&​400|}} </box| Figure 3. Image of professional eSport players (Itani, 2017)> ​
  
 === Statistics on the Use of Adderall by Students === === Statistics on the Use of Adderall by Students ===
-The reliance on Adderall by students has been a concern for some time, especially due to the number of students who are unaware of the potential negative health impacts of Adderall abuse. The only legal method of obtaining Adderall is through prescription, however, many students continue to use Adderall illegally by borrowing them from someone they know, such as a friend. ​+The reliance on Adderall by students has been a concern for some time, especially due to the number of students who are unaware of the potential negative health impacts of Adderall abuse. The only legal method of obtaining Adderall is through ​prescription. However, many students continue to use Adderall illegally by borrowing them from someone they know, such as a friend. ​
  
 <box 30% round center|> {{ :​adderall30.png?​300 |}} </box| Figure 4. Percentage of students who have used Adderall for their studies (American Addiction Centers, 2019)> ​ <box 30% round center|> {{ :​adderall30.png?​300 |}} </box| Figure 4. Percentage of students who have used Adderall for their studies (American Addiction Centers, 2019)> ​
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 ====== Attention Deficit Hyperactivity Disorder (ADHD) ====== ====== Attention Deficit Hyperactivity Disorder (ADHD) ======
  
-Attention Deficit Hyperactivity Disorder (ADHD) is classified as a mental health condition in which an individual has difficulty paying attention, focusing on tasks, ​acts without thinking, and has trouble sitting still. ADHD is most commonly diagnosed between the ages of 6 and 12 via an intensive analysis of the child’s distractibility,​ impulsivity,​ and hyperactivity (Husney, 2018). The exact cause of ADHD is yet to be determinedbut it is generally understood that both genetic and environmental factors play a role in the disruption of normal brain function and development.+Attention Deficit Hyperactivity Disorder (ADHD) is classified as a mental health condition in which an individual has difficulty paying attention, focusing on tasks, ​acting ​without thinking, and has trouble sitting still. ADHD is most commonly diagnosed between the ages of 6 and 12 with an intensive analysis of the child’s distractibility,​ impulsivity,​ and hyperactivity (Husney, 2018). The exact cause of ADHD is yet to be determined but it is generally understood that both genetic and environmental factors play a role in the disruption of normal brain function and development.
  
-<​box ​40% round right|> {{ :​sleep-apnea.jpg?​nolink&​400|}} </box| Figure 7. Image of young students in class (CITATION NEEDED**)>+<​box ​20% round right|> {{ :​sleep-apnea.jpg?​nolink&​290|}} </box| Figure 7. Image of young students in class>
  
 ADHD has a mean worldwide prevalence of 2.2% of cases in all children and adolescents (younger than 18 years of age). The mean prevalence in adults in Asia, Europe, North and South America, and the Middle East is 2.5%. It has also been noted that ADHD is more often reported in males as compared to females (ADHD Institute, 2019). ADHD has a mean worldwide prevalence of 2.2% of cases in all children and adolescents (younger than 18 years of age). The mean prevalence in adults in Asia, Europe, North and South America, and the Middle East is 2.5%. It has also been noted that ADHD is more often reported in males as compared to females (ADHD Institute, 2019).
  
-Previous studies on individuals with ADHD have demonstrated that parts of the ADHD brain mature at a much slower pace and do not reach the same level of maturity when compared to the brain of an individual who does not have ADHD (Hoogman et al, 2017). A previous 2010 study found that ADHD children do not have the same neural connections between the frontal cortex of the brain and the visual processing area, suggesting that the ADHD and non-ADHD brains process information differently (Mazaheri et al, 2010). Furthermore,​ the ADHD brain has shown an inability to regulate the homeostatic dopamine system. Such individuals are not able to produce enough dopamine and its complementary receptors, resulting in the dopamine in their brains unable to be efficiently utilized (Campo et al, 2011). Despite these noticeable differences in the brain, ADHD is not diagnosed with the use of a PET of fMRI scan because such screening tests are only able to provide information about how an individual’s brain is functioning at the moment of the test, whereas a clinical interview and behavioral ​questionnaire coordinated by a registered physician will take into account how the brain functions in different situations to allow for a more concrete diagnosis.+Previous studies on individuals with ADHD have demonstrated that parts of the ADHD brain mature at a much slower pace and do not reach the same level of maturity when compared to the brain of an individual who does not have ADHD (Hoogman et al, 2017). A previous 2010 study found that ADHD children do not have the same neural connections between the frontal cortex of the brain and the visual processing area, suggesting that the ADHD and non-ADHD brains process information differently (Mazaheri et al, 2010). Furthermore,​ the ADHD brain has shown an inability to regulate the homeostatic dopamine system. Such individuals are not able to produce enough dopamine and its complementary receptors, resulting in the dopamine in their brains unable to be efficiently utilized (Campo et al, 2011). Despite these noticeable differences in the brain, ADHD is not diagnosed with the use of a PET or fMRI scan because such screening tests are only able to provide information about how an individual’s brain is functioning at the moment of the test, whereas a clinical interview and behavioural ​questionnaire coordinated by a registered physician will take into account how the brain functions in different situations to allow for a more concrete diagnosis.
  
-<box 70% round center|>​{{ :​adhd_brain.jpg?​nolink&​700 |}}</​box| Figure 8. The difference between a healthy brain and a brain with ADHD (CITATION NEEDED**)>+<box 70% round center|>​{{ :​adhd_brain.jpg?​nolink&​700 |}}</​box| Figure 8. The difference between a healthy brain and a brain with ADHD (Joshya, n.d.)>
  
  
-Due to the dysregulation of dopamine in the ADHD brain, stimulant medications are often used as treatments in order to promote increased levels of dopamine in the brain. One such stimulant in Adderall, with vast research in support of its ability to improve attention, focus, and reduce impulsive behavior. Between 75-80% of children see improved symptoms with the use of Adderall (Kolar et al, 2008).+Due to the dysregulation of dopamine in the ADHD brain, stimulant medications are often used as treatments in order to promote increased levels of dopamine in the brain. One such stimulant ​is in Adderall, with vast research in support of its ability to improve attention, focus, and reduce impulsive behavior. Between 75-80% of children see improved symptoms with the use of Adderall (Kolar et al, 2008).
  
 ====== Mechanisms of Adderall ====== ====== Mechanisms of Adderall ======
  
-Adderall is taken orally, meaning it is initially absorbed by the gastrointestinal (GI) tract (Sherzada, 2012). The effects of Adderall are at maximum efficiency after 3 hours upon taking the drug (Sherzada, 2012). Adderall is made of small molecules known as amphetamines,​ that have the ability to overcome an obstacle for many types of molecules, being able to cross the blood-brain-barrier (BBB) (Sherzada, 2012). Being able to cross the BBB allows amphetamine’s effects to reach the central nervous system. Dextroamphetamine salts account for 75% of the salt content of Adderall, and levoamphetamine salts account for the other 25% (Sherzada, 2012). Dextroamphetamine targets the prefrontal cortex of the brain and increases levels of the neurotransmitter dopamine, whereas levoamphetamine targets the peripheral nervous system and increases levels of another neurotransmitter,​ norepinephrine (Sherzada, 2012). ​+Adderall is taken orally, meaning it is initially absorbed by the gastrointestinal (GI) tract (Sherzada, 2012). The effects of Adderall are at maximum efficiency after 3 hours upon taking the drug (Sherzada, 2012). Adderall is made up of small molecules known as amphetamines,​ that have the ability to overcome an obstacle for many types of molecules, being able to cross the blood-brain-barrier (BBB) (Sherzada, 2012). Being able to cross the BBB allows amphetamine’s effects to reach the central nervous system. Dextroamphetamine salts account for 75% of the salt content of Adderall, and levoamphetamine salts account for the other 25% (Sherzada, 2012). Dextroamphetamine targets the prefrontal cortex of the brain and increases levels of the neurotransmitter dopamine, whereas levoamphetamine targets the peripheral nervous system and increases levels of another neurotransmitter,​ norepinephrine (Sherzada, 2012). ​
  
-<box 50% round center|> {{ :​updated.png?​500 |}} </box| Figure ​x. Chemical composition of Adderall (Roedersheimer,​ 2018)>+<box 50% round center|> {{ :​updated.png?​500 |}} </box| Figure ​9. Chemical composition of Adderall (Roedersheimer,​ 2018)>
                                                 ​                                                 ​
 Although amphetamines such as dextroamphetamine are capable of increasing levels of dopamine, the mechanism by which this change occurs is relatively unknown (Freyberg et al., 2016). However, some mechanisms have been proposed for the regulation of dopamine levels. One example involves the interaction of amphetamines in vitro with the vesicular monoamine transporter (VMAT) (Freyberg et al., 2016). In this mechanism, amphetamines behave as non-substrate inhibitors that work to block the collection of dopamine into vesicles, thereby allowing more dopamine to exit rather than being stored (Freyberg et al., 2016). ​ Although amphetamines such as dextroamphetamine are capable of increasing levels of dopamine, the mechanism by which this change occurs is relatively unknown (Freyberg et al., 2016). However, some mechanisms have been proposed for the regulation of dopamine levels. One example involves the interaction of amphetamines in vitro with the vesicular monoamine transporter (VMAT) (Freyberg et al., 2016). In this mechanism, amphetamines behave as non-substrate inhibitors that work to block the collection of dopamine into vesicles, thereby allowing more dopamine to exit rather than being stored (Freyberg et al., 2016). ​
 Neurotransmitters are chemicals that are released from presynaptic nerve terminals which serve as a communication tool by sending messages along cells to perform an action in the body, by using the power of action potentials (Rizo, 2018). The neurotransmitter dopamine is responsible for increasing levels of motivation and motor function (Wise, 2004). The associated increase in dopamine can induce a feeling of euphoria when stimulants are taken nonmedically (Varga, 2012). The neurotransmitter norepinephrine is responsible for increasing blood pressure and heart rate, which makes individuals feel more alert and energized (Strawn, Ekhator, Horn, Baker, & Geracioti Jr, 2004). Norepinephrine has also been shown to promote memory consolidation in the earlier stages of memorization (Murchison et al., 2004). The third neurotransmitter targeted by Adderall is serotonin, which promotes mood and can also help the body maintain a circadian rhythm, or waking up and sleeping at about the same time each day (Ursin, 2002). ​ Neurotransmitters are chemicals that are released from presynaptic nerve terminals which serve as a communication tool by sending messages along cells to perform an action in the body, by using the power of action potentials (Rizo, 2018). The neurotransmitter dopamine is responsible for increasing levels of motivation and motor function (Wise, 2004). The associated increase in dopamine can induce a feeling of euphoria when stimulants are taken nonmedically (Varga, 2012). The neurotransmitter norepinephrine is responsible for increasing blood pressure and heart rate, which makes individuals feel more alert and energized (Strawn, Ekhator, Horn, Baker, & Geracioti Jr, 2004). Norepinephrine has also been shown to promote memory consolidation in the earlier stages of memorization (Murchison et al., 2004). The third neurotransmitter targeted by Adderall is serotonin, which promotes mood and can also help the body maintain a circadian rhythm, or waking up and sleeping at about the same time each day (Ursin, 2002). ​
  
-<box 35% round center|> {{:​00001.png?​350|}} </box| Figure ​x. Structure of Dopamine (Aslanoglu & Öge, 2005)>+<box 35% round center|> {{:​00001.png?​350|}} </box| Figure ​10. Structure of Dopamine (Aslanoglu & Öge, 2005)>
  
-<box 35% round center|> {{:​serotonin.png?​350|}} </box| Figure ​x. Structure of Serotonin+<box 35% round center|> {{:​serotonin.png?​350|}} </box| Figure ​11. Structure of Serotonin
 (Nichols & Nichols, 2008)> (Nichols & Nichols, 2008)>
  
-<box 35% round center|> {{:​00002.png?​350|}} </box| Figure ​x. Structure of Norepinephrine (Ojimelukwe,​ 2019)>+<box 35% round center|> {{:​00002.png?​350|}} </box| Figure ​12. Structure of Norepinephrine (Ojimelukwe,​ 2019)>
  
 The key mechanism of Adderall is to prevent neurotransmitters such as dopamine, norepinephrine and also serotonin from being uptaken by the presynaptic neuron and instead be released into the synaptic space (Sherzada, 2012). This ultimately results in an increase in the levels of these neurotransmitters which work to reduce symptoms of ADHD, such as hyperactivity,​ impulsive actions and a minimized attention span (Sherzada, 2012). There are also enzymes in the body that work to inhibit the levels of these neurotransmitters by breaking them down, also known as monoamine oxidase (Sherzada, 2012). Amphetamine in Adderall can inhibit the action of this enzyme to maintain a high level of neurotransmitters in the body (Sherzada, 2012). ​ The key mechanism of Adderall is to prevent neurotransmitters such as dopamine, norepinephrine and also serotonin from being uptaken by the presynaptic neuron and instead be released into the synaptic space (Sherzada, 2012). This ultimately results in an increase in the levels of these neurotransmitters which work to reduce symptoms of ADHD, such as hyperactivity,​ impulsive actions and a minimized attention span (Sherzada, 2012). There are also enzymes in the body that work to inhibit the levels of these neurotransmitters by breaking them down, also known as monoamine oxidase (Sherzada, 2012). Amphetamine in Adderall can inhibit the action of this enzyme to maintain a high level of neurotransmitters in the body (Sherzada, 2012). ​
  
-<box 40% round center|> {{ :​presynaptic.png?​400 |}} </box| Figure ​x. An illustration depicting the presynaptic neuron and postsynaptic neuron (Socratic, 2017)>+<box 40% round center|> {{ :​presynaptic.png?​400 |}} </box| Figure ​13. An illustration depicting the presynaptic neuron and postsynaptic neuron (Socratic, 2017)>
  
  
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 The study by Ahmann et al. (2001) looked at the efficacy and side effects of Adderall for young children with ADHD. They found that Adderall was effective and its side effect profile was consistent with other psychostimulants. Other studies also found that Adderall for children with ADHD had minimal side effects in the short and long term (Manos et al., 1999; Findlin et al., 2005). The study by Ahmann et al. (2001) looked at the efficacy and side effects of Adderall for young children with ADHD. They found that Adderall was effective and its side effect profile was consistent with other psychostimulants. Other studies also found that Adderall for children with ADHD had minimal side effects in the short and long term (Manos et al., 1999; Findlin et al., 2005).
  
-<box 20% round right|> {{ :​sideeffects.png?​200 |}} </box| Figure ​x. An image of prescribed Adderall ​(CITE)>+<box 20% round right|> {{ :​sideeffects.png?​200 |}} </box| Figure ​14. An image of prescribed Adderall>​
  
 === Illicit/​Recreational Use === === Illicit/​Recreational Use ===
 Short terms of Adderall abuse include gastrointestinal problems, blurred vision, increased body temperature,​ increased blood pressure, increased heart rate, reduced circulation,​ irritability,​ and insomnia. Long-term and excessive use of Adderall may result in hallucinations,​ psychotic episodes, cardiac arrest, a comatose state, or even death. Intense mood changes and physical and mental cravings are common symptoms long-term users can also experience. Furthermore,​ drug tolerance increases with continual use resulting in heightened physiological dependency, which intensifies the impact of withdrawal symptoms when usage ceases. Individuals entering withdrawal can experience violent mood swings, extreme fatigue, and uncontrollable cravings (Varga, 2012). Short terms of Adderall abuse include gastrointestinal problems, blurred vision, increased body temperature,​ increased blood pressure, increased heart rate, reduced circulation,​ irritability,​ and insomnia. Long-term and excessive use of Adderall may result in hallucinations,​ psychotic episodes, cardiac arrest, a comatose state, or even death. Intense mood changes and physical and mental cravings are common symptoms long-term users can also experience. Furthermore,​ drug tolerance increases with continual use resulting in heightened physiological dependency, which intensifies the impact of withdrawal symptoms when usage ceases. Individuals entering withdrawal can experience violent mood swings, extreme fatigue, and uncontrollable cravings (Varga, 2012).
  
-<box 40% round center|> {{ :​sideeffect.png?​400 |}} </box| Figure ​x. Serious side effects of consuming Adderall ​(CITE)+<box 40% round center|> {{ :​sideeffect.png?​400 |}} </box| Figure ​15. Serious side effects of consuming Adderall> ​
  
 Clinical signs of Adderall overdose in humans include hyperactivity,​ hyperthermia,​ tachycardia,​ tachypnea, mydriasis, tremors, and seizures. Amphetamine and its analogues stimulate the release of norepinephrine affecting both α– and β–adrenergic receptor sites (Fitzgerald & Bronstein, 2013). Clinical signs of Adderall overdose in humans include hyperactivity,​ hyperthermia,​ tachycardia,​ tachypnea, mydriasis, tremors, and seizures. Amphetamine and its analogues stimulate the release of norepinephrine affecting both α– and β–adrenergic receptor sites (Fitzgerald & Bronstein, 2013).
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 ''​“Adderall wiped away the question of willpower. Now I could study all night, then run 10 miles, then breeze through that week’s New Yorker, all without pausing to consider whether I might prefer to chat with classmates or go to the movies. It was fantastic.” ''​“Adderall wiped away the question of willpower. Now I could study all night, then run 10 miles, then breeze through that week’s New Yorker, all without pausing to consider whether I might prefer to chat with classmates or go to the movies. It was fantastic.”
-''​+'' ​(Schwartz, 2015).
  
-<box 40% round center|> {{:​la-la-ca-casey-schwartz-045-jpg-201508261.jpg?​nolink&​400|}} </box| Figure ​x. Casey Schwartz, a staff writer at Newsweek/​The Daily Beast, where she covered neuroscience,​ psychology, and psychiatry. Her writing has also appeared in The New York Times and The New York Sun (Schwartz, 2015).>+<box 40% round center|> {{:​la-la-ca-casey-schwartz-045-jpg-201508261.jpg?​nolink&​400|}} </box| Figure ​16. Casey Schwartz, a staff writer at Newsweek/​The Daily Beast, where she covered neuroscience,​ psychology, and psychiatry. Her writing has also appeared in The New York Times and The New York Sun (Schwartz, 2015).>
    
 Then, the good side of adderall stops here: Casey in the library realizes she has difficulties to breathe, accompanied by the bright room shining too bright and the light dilating around her. Casey was immediately taken to the emergency room and was diagnosed with: anxiety, adderall induced panic attack, a reaction induced by taking too much adderall (adderall overdose). Along with this, Casey was unable to sleep properly, with nights where she was  Then, the good side of adderall stops here: Casey in the library realizes she has difficulties to breathe, accompanied by the bright room shining too bright and the light dilating around her. Casey was immediately taken to the emergency room and was diagnosed with: anxiety, adderall induced panic attack, a reaction induced by taking too much adderall (adderall overdose). Along with this, Casey was unable to sleep properly, with nights where she was 
 “craving “ adderall, to the extent where one medication of the drug was not “suffice”. In other words, she has developed tolerance. Although she wanted to stop taking the drug after the emergency department incident, she admitted that it was difficult to not get her hands on it.  “craving “ adderall, to the extent where one medication of the drug was not “suffice”. In other words, she has developed tolerance. Although she wanted to stop taking the drug after the emergency department incident, she admitted that it was difficult to not get her hands on it. 
  
-<box 30% round center|> {{ ::​screen_shot_2020-01-23_at_12.30.57_pm.png?​nolink&​300 |}} </box| Figure ​x. Quote by Casey Schwartz (Schwartz, 2016)>+<box 30% round center|> {{ ::​screen_shot_2020-01-23_at_12.30.57_pm.png?​nolink&​300 |}} </box| Figure ​17. Quote by Casey Schwartz (Schwartz, 2016)>
  
 Martha Farah, a cognitive neuroscientist at the University of Pennsylvania,​ studied the effect of Adderall on subjects taking a host of standardized tests that measure restraint, memory and creativity. On balance, Farah and others have found very little to no improvement when their research subjects confront these tests on Adderall. Ultimately, she says, it is possible that “lower-performing people actually do improve on the drug, and higher-performing people show no improvement or actually get worse.” In fact, a study found that the average GPA of students taking Adderall to be 3.071, and for students not taking Adderall to be 3.267 (Girer, Sasu, Ayoola, & Fagan, 2011). Adderall complicates the usual dynamic of drug addiction by being squarely associated with productivity,​ achievement and success. It is very hard to go off it because it leads individuals to think that they will no longer be able to produce the great works they used to with adderall without it. Plenty of people are still able to do well when they go off adderall, but Dr. Farah claims that it is the fear in going off Adderall more than anything. ​ Martha Farah, a cognitive neuroscientist at the University of Pennsylvania,​ studied the effect of Adderall on subjects taking a host of standardized tests that measure restraint, memory and creativity. On balance, Farah and others have found very little to no improvement when their research subjects confront these tests on Adderall. Ultimately, she says, it is possible that “lower-performing people actually do improve on the drug, and higher-performing people show no improvement or actually get worse.” In fact, a study found that the average GPA of students taking Adderall to be 3.071, and for students not taking Adderall to be 3.267 (Girer, Sasu, Ayoola, & Fagan, 2011). Adderall complicates the usual dynamic of drug addiction by being squarely associated with productivity,​ achievement and success. It is very hard to go off it because it leads individuals to think that they will no longer be able to produce the great works they used to with adderall without it. Plenty of people are still able to do well when they go off adderall, but Dr. Farah claims that it is the fear in going off Adderall more than anything. ​
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 While Casey thought she was having total control over herself through Adderall, she realized that it was exactly the opposite: The Adderall made her life unpredictable. While Casey thought she was having total control over herself through Adderall, she realized that it was exactly the opposite: The Adderall made her life unpredictable.
 ==== =====  ==== ===== 
-''"​I was terrified I had done something irreversible to my brain, terrified that I was going to discover that I couldn’t write at all without my special pills.” - Casey'' ​=====+''"​I was terrified I had done something irreversible to my brain, terrified that I was going to discover that I couldn’t write at all without my special pills.” - Casey'" (Schwartz, 2015) =====
  
  
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   * Getting plenty of sleep (e.g. 8 hours)   * Getting plenty of sleep (e.g. 8 hours)
   * Limiting daily screen time from phones, computers, and TV to improve sleep quality, have all been proven remedies.   * Limiting daily screen time from phones, computers, and TV to improve sleep quality, have all been proven remedies.
-<box 50% round center|> {{ :​healthy-eating-ingredients-1296x728-header.jpg?​nolink&​500 |}} </box| Figure ​x. Image of healthy food (Gunnars, 2019)>+<box 50% round center|> {{ :​healthy-eating-ingredients-1296x728-header.jpg?​nolink&​500 |}} </box| Figure ​18. Image of healthy food (Gunnars, 2019)>
  
 ====== References ====== ====== References ======
 +
 +Adderall: Side Effects, High, Abuse, Withdrawal. (n.d.). Retrieved February 1, 2020, from https://​www.findatopdoc.com/​Healthy-Living/​adderall-side-effects-abuse-withdrawal
  
 ADHD Epidemiology. (n.d.). //ADHD Institute//​. Retrieved January 25, 2020, from http://​adhd-institute.com/​burden-of-adhd/​epidemiology/​ ADHD Epidemiology. (n.d.). //ADHD Institute//​. Retrieved January 25, 2020, from http://​adhd-institute.com/​burden-of-adhd/​epidemiology/​
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 American Addiction Centers. (2019). Adderall Addiction - From Abuse to Treatment. Retrieved from https://​americanaddictioncenters.org/​adderall American Addiction Centers. (2019). Adderall Addiction - From Abuse to Treatment. Retrieved from https://​americanaddictioncenters.org/​adderall
 +
 +Aslanoğlu, M., & Öge, N. (2005). Voltammetric,​ UV absorption and viscometric studies of the interaction of norepinephrine with DNA. //Turkish Journal of Chemistry//,​ //29//(5), 477-485.
  
 Attention Deficit Hyperactivity Disorder (ADHD). (n.d.). //​HealthLink BC//. Retrieved January 25, 2020, from https://​www.healthlinkbc.ca/​health-topics/​hw166083 Attention Deficit Hyperactivity Disorder (ADHD). (n.d.). //​HealthLink BC//. Retrieved January 25, 2020, from https://​www.healthlinkbc.ca/​health-topics/​hw166083
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 Itani, H. (2017). eSports: Are they here to stay? Retrieved from https://​www.sotrender.com/​blog/​2017/​06/​esports-are-they-here-to-stay/?​fbclid=IwAR3INtfXApN3Ml8DEOrkSm6xSAlPn14C4CleWaJvf8t_QoefeFOJ8BxpPXw Itani, H. (2017). eSports: Are they here to stay? Retrieved from https://​www.sotrender.com/​blog/​2017/​06/​esports-are-they-here-to-stay/?​fbclid=IwAR3INtfXApN3Ml8DEOrkSm6xSAlPn14C4CleWaJvf8t_QoefeFOJ8BxpPXw
 +
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