Vyvanse (lisdexamfetamine dimesylate) is a central nervous system stimulant drug (CNS stimulant) that is approved for the treatment of attention deficit hyperactivity disorder (ADHD) and for individuals with moderate to severe binge eating disorders. Its use is approved for people over the age of 6. Vyvanse is included in the classification of amphetamine-type products because the active ingredient in the drug, lisdexamfetamine, is metabolized by the system into dextroamphetamine, which is a potent CNS stimulant.
Vyvanse is not approved to be used in the treatment of obesity and/or for weight loss. It offers an alternative to using drugs like Adderall and Ritalin for the treatment of ADHD. While it is not a time-release medication, it only needs to be taken once in the morning by individuals with ADHD as opposed to having to take multiple doses throughout the day. Other off-label uses for CNS stimulants include treating issues with lethargy, other problems with focus and attention, and even counteracting conditions that result in an individual becoming abnormally sleepy. It is unclear how often Vyvanse is used in such cases clinically.
Most CNS stimulants like Vyvanse are classified as Schedule II controlled substances by the Drug Enforcement Administration (DEA). This classification indicates that while these drugs do have medicinal uses, they also have a significant potential for abuse and the development of physical dependence in individuals who abuse them. Drugs in this classification are considered to be highly addictive, and all controlled substances require a prescription by a physician in order to be legally obtained.
Abuse of Vyvanse
Clinical research has suggested that Vyvanse is less likely to be abused than other similar drugs, such as Ritalin, Concerta, Adderall, etc. Nonetheless, Vyvanse abuse does occur and, prescription drug abuse is a major concern in the United States.
Signs of abuse of Vyvanse include the following:
- Taking the drug without a prescription
- Taking the drug in a manner inconsistent with its prescribed uses (whether one has a prescription or not)
- Taking the drug for its psychoactive effects
- Taking more of the drug than prescribed
- Taking the drug more often than prescribed
- Administering the drug in manners that are inconsistent with its prescribed use, such as grinding it up and snorting or injecting it
- Taking the drug in combination with other drugs of abuse, such as alcohol, central nervous system depressants, other stimulants or other prescription drugs when one is not prescribed the drugs
The Substance Abuse and Mental Health Services Administration (SAMHSA) annually collects figures on the number of individuals who report using or abusing different categories of medications. Specific numbers for abuse of Vyvanse are not collected in these figures; however, SAMHSA keeps tabs on the abuse of prescription stimulant medications. SAMHSA categorized CNS stimulants in the five groups. One group was classified as amphetamine-type products, such as Ritalin, Concerta, Adderall, and Vyvanse. The latest figures indicate that in 2015:
- A total of 5.3 million people over the age of 12 reported abusing prescription stimulants.
- Amphetamine-type products were the largest group of abused prescription stimulant medications.
- Of the 5.3 million people reporting misusing prescription stimulant medications, 4.8 million reported abusing amphetamine-like medications. The majority of these people abused methamphetamine products (e.g., Ritalin, Concerta).
- The majority of individuals who abuse amphetamine-type products are between the ages of 18 and 35.
Abuse of Vyvanse can result in a number of negative ramifications. Because Vyvanse is classified as a CNS stimulant, individuals chronically abusing this drug might be considered to have a stimulant use disorder according to the current diagnostic scheme regarding addictive behaviors.
Signs of a Stimulant Use Disorder as a Result of Vyvanse Abuse
The current diagnostic criteria for stimulant use disorders allow for clinicians to designate whether the individual is abusing amphetamine-type substances, such as Vyvanse, cocaine, or other CNS stimulants. In addition, clinicians can rate the severity of a stimulant use disorder based on the number of formal symptoms that an individual displays during the diagnostic process. This allows for the development of an individualized treatment plan based on the severity of the individual’s substance use disorder.
A formal diagnosis of a substance use disorder can only be made by a licensed mental health clinician. According to the diagnostic criteria put forth by the American Psychiatric Association (APA) in its current diagnostic manual, the DSM-5, the formal signs of a stimulant use disorder include the following:
- Use of the drug violates its prescribed purposes and results in the individual experiencing significant impairment or distress in life.
- The main symptoms of substance use disorders include issues with controlling use of drugs/alcohol.
- Taking more of the substance than originally intended or taking it for longer periods than the person originally wanted to
- Continuing to use the drug in spite of its use resulting in negative effects in the person’s relationships, at work, in school, or other important areas of life
- Wanting to cut down or stop using the drug but not doing so
- Failing to meet important obligations due to use of the drug
- Repeated use of the drug in situations where it is dangerous to do so
- Spending significant amounts of time using the drug, trying to get the drug, or recovering from its use
- Continuing to use the drug in spite of knowing use is causing physical or emotional problems
- Frequent cravings to use the drug.
In addition, a person struggling with a substance use disorder may experience tolerance to the substance of abuse and physical dependence, which is signified by withdrawal symptoms when they stop using the drug.
Consideration of a formal substance use disorder should take place when an individual presents with at least two of the above signs or symptoms within a 12-month period. Great care and understanding need to be taken in a formal diagnostic setting; however, any individual who is using stimulant medications with or without a prescription and experiencing concern or distress as a result should consider getting formal help.
Data presented by SAMHSA and APA indicate that the development of substance use disorders is far less likely to occur in individuals who use prescription medications under the supervision of a physician and according to their prescribed purposes. The abuse of prescription stimulants like Vyvanse typically occurs in individuals who use these drugs specifically for their psychoactive effects and combine them with other drugs of abuse, such as alcohol, other stimulants, central nervous system depressants, etc. Even though individuals using Vyvanse medicinally under the supervision of a physician may develop physical dependence on the drug (displaying both tolerance and withdrawal), these individuals would not be considered to have a substance use disorder as long as they continue to use the medication according to its prescribed purposes. When individuals use drugs for their psychoactive effects (e.g., stimulation, euphoria, to increase feelings of energy, etc.) and combine them with other drugs, they are far more likely to develop serious issues.
Treatment for Vyvanse Addiction
The first issue to address when an individual is suspected of having a Vyvanse addiction is to undergo a full physical and mental health assessment by a licensed professional. Because many individuals with addictions often have co-occurring mental health disorders as well as potential physical disorders, it is important to identify all problematic conditions and address these issues concurrently. Attempting to isolate and treat an addiction while ignoring other issues, such as clinical depression, a personality disorder, severe arthritis, neurological issues, etc., may result in an increased potential for relapse, dropping out of treatment, and other complications.
Once these co-occurring issues are identified and a plan is put into place to address them, it is important that the client is placed in a formal medical detox program. According to APA, withdrawal symptoms from a stimulant use disorder often include:
- Issues with mood, such as depression, anxiety, irritability, and aggressiveness: Individuals who have chronically abused stimulant medications and then abruptly stop using them often refer to these experiences as “the crash.” This is a period of severe depression and apathy that may be serious enough to spark suicidal or bingeing behavior that can result in significant physical consequences.
- Lethargy, fatigue, and issues with attention/concentration
- Decreased need for sleep or an increased need for sleep: Most often, individuals discontinuing amphetamine-type substances become very lethargic and sleepy.
- Significantly increased appetite
- Very vivid and often unpleasant dreams
- Physiological issues, such as jitteriness, agitation, nervousness, or the opposite of these (psychomotor retardation)
Other issues can occur such as delusional behavior and hallucinations. Individuals who chronically mix Vyvanse or other stimulants with other drugs may develop seizures. Even though the withdrawal process from Vyvanse is not normally considered to be potentially physically dangerous, individuals should be placed in a formal medical detox program. In these programs, supervising physicians will administer medications to ease the symptoms of withdrawal and slowly help the individual negotiate the withdrawal period while at the same time reducing relapse potential by treating other co-occurring conditions. Often, inpatient detox offers significant advantages over outpatient detox; however, the choice of inpatient or outpatient detox is made based on the specifics of the case and the desires of the client.
Individuals with addictions will benefit from participation in social support groups, such as 12-Step groups and other peer support groups. These groups are typically not run by a formal therapist; rather, they are peer-led. They can be very therapeutic, as they provide members with support, information, and coping strategies that can be useful in recovery. Another major advantage of social support groups is that they can be used indefinitely, whereas therapy is typically a time-limited intervention.
Treatment for any substance use disorder should include medical management of individual’s symptoms, co-occurring disorders, and other issues as needed. Other interventions may be used, depending on the specific case, such as initial placement in a sober living residence, vocational rehabilitation, tutoring for school, etc.