Adderall vs. Modafinil: How Do They Compare?

Adderall

Adderall is the brand name of a combined form of two drugs: amphetamine and dextroamphetamine. This combination of drugs has been approved by the Food and Drug Administration (FDA) for the treatment of attention deficit hyperactivity disorder (ADHD) and the sleep disorder narcolepsy (a disorder where a person may experience sleep attacks during the day and during activities such as driving). Both of the main ingredients in Adderall are central nervous system stimulant medications.

Adderall comes in an immediate-release form (Adderall IR) and an extended-release form (Adderall XR). The immediate-release form of the drug lasts for about 4–6 hours; the extended-release form typically lasts for about 12 hours.

Adderall is classified as a Schedule II controlled substance. It is therefore considered to have a significant risk for abuse and the development of physical dependence.

Modafinil

Modafinil, better known by the brand name Provigil, is also a central nervous stimulant drug. Modafinil is often referred to as an eugeroic medication, which is a medication that promotes alertness and wakefulness. Modafinil is approved by the FDA to treat daytime sleepiness in people who have several different conditions, including:

• Narcolepsy
• Shift work disorder, a formal disorder that involves a disruption of normal sleeping hours when one is working nights
• Sleepiness that occurs in other medical conditions like obstructive sleep apnea

Modafinil is also a controlled substance but classified at a much lower level of control/severity than Adderall. Modafinil is classified as a Schedule IV controlled substance. The difference in the formal classification of Adderall and modafinil indicates that the overall general research and the opinion of the federal government is that Adderall is a significantly more dangerous drug of abuse than modafinil.

All stimulant drugs share similar mechanisms of action. Because of this, even when prescription stimulants that are considered to be relatively mild like modafinil are compared to stimulants that have a significant potential for abuse (e.g., cocaine), the findings indicate that there is a similar mechanism of action these drugs. Some sources will attempt to capitalize on this finding and state that similar mechanisms of action indicate similar potentials for abuse; however, this is not always true.

Adderall is believed to exert its effects by both blocking the reuptake of the excitatory neurotransmitters dopamine and norepinephrine, and by actually increasing the intracellular concentration of these neurotransmitters by releasing them from storage units in neurons. Modafinil is also believed to affect several different neurotransmitters, including excitatory neurotransmitters like dopamine and glutamate (increasing their availability) and decreasing the availability of inhibitory neurotransmitters like gamma-aminobutyric acid (GABA).

Off-Label Uses

Although the drugs have approved uses, the prescription of these drugs is often made according to uses that they are not formally approved to address. This is true for many different types of medications.

Off-label uses for Adderall are designed to take advantage of it stimulant effects. Adderall may be used for weight control, to increase alertness, and to address issues with obesity.

Modafinil is also prescribed to address conditions that its stimulant effects may treat, including treating fatigue and lethargy in individuals with numerous neurological disorders such as multiple sclerosis or Parkinson’s disease, in cancer patients, and even the fatigue that occurs in patients with clinical depression.

Modafinil is a much milder stimulant than Adderall, and its mild stimulant properties allow for using it in varied situations to address lethargy and sleepiness without the potential for inducing anxiety, jitteriness, irritability, or agitation. Adderall is a more powerful stimulant, and its use must be tempered.

Modafinil is not approved for the treatment of ADHD; however, it may be prescribed off-label for this use. At the time of this writing, there are some small controlled studies that suggest that modafinil is a useful treatment for ADHD. Research studies have indicated that modafinil:

• May be significantly more effective in treating the symptoms of ADHD than placebo.
• May have comparable efficacy for treating ADHD to methylphenidate (e.g., Ritalin, Concerta) and fewer side effects.
• May have comparable efficacy for treating ADHD compared to dextroamphetamine (one of the ingredients in Adderall).

It should be noted that modafinil is not an approved medication for ADHD. Insurance companies may not approve its use for this purpose and therefore may not pay for the medication when it is prescribed for this purpose.

Stimulant Abuse Potential

Stimulant abuse is a serious problem in the United States. The abuse of stimulants has received quite a bit of publicity particularly regarding the abuse of methamphetamine (meth), cocaine, and medications designed to treat ADHD like methylphenidate (e.g., Ritalin and Concerta) and Adderall. Over-the-counter stimulants may be abused in conjunction with other drugs to assist in weight loss, to produce euphoria, and for other reasons. Long-term stimulant abuse can have significant ramifications on physical and emotional health.

The Substance Abuse and Mental Health Services Administration (SAMHSA) conducts yearly surveys and releases yearly estimates on the use and abuse of numerous prescription medications, over-the-counter medications, and illicit drugs. According to the latest available data from SAMHSA:

• In 2015, 11.3 million individuals reported some use of an amphetamine product; in 2016, this figure was 12 million individuals; SAMHSA reports overall figures for amphetamine use/misuse and not specific figures for Adderall or others.
• In 2015 4.8 million individuals reported at least one misuse of an amphetamine product; in 2016, this figure was 5.1 million.

The National Institute on Drug Abuse (NIDA) reports that stimulant abuse is a significant problem in the United States and that nearly 170,000 individuals under the age of 18 report some form of stimulant abuse (abusing a stimulant at least once). NIDA does not report figures on abuse of specific stimulants and does not include modafinil in their estimates. However, stimulant abuse is a significant problem for young people.

The abuse potential of these two medications is considered to be quite different. Adderall is known to be a significant potential drug of abuse. Motivation for abusing Adderall typically consists of trying to capitalize on it stimulant properties as a form of a “cognitive enhancer,” abusing it to lose weight, or abusing it with other drugs for its psychoactive effects. Modafinil abuse appears to be mostly associated with attempting to use its stimulant properties as a form of cognitive enhancer.

The term cognitive enhancer refers to the notion that a particular substance makes an individual smarter; hence, the term smart drug is often used to describe these drugs. However, there are no drugs that make people smarter. Stimulants like caffeine, Adderall, and modafinil can increase the ability of a person to pay attention and concentrate; however, when taken in moderate to large amounts, they may actually inhibit this ability.

The perception that Adderall and modafinil are smart drugs is a misperception, even though in small doses, they may help a person with their ability to pay attention. The long-term effects of these drugs regarding their ability to increase a person’s academic performance is highly overstated. The majority of individuals who abuse drugs like Adderall actually have lower academic achievement than individuals who do not use these drugs as cognitive enhancers.

Numerous research studies documented the abuse potential of Adderall, particularly in high school students and college students, younger individuals in high-performance occupations, and individuals attempting to lose weight (mostly females). Adderall has been demonstrated to be a significant drug of abuse, is most often abused in conjunction with other drugs like alcohol, and has a significant potential to produce physical dependence by producing tolerance rapidly in chronic users.

The abuse potential of modafinil is far lower than it is for Adderall. This is not to say that modafinil cannot be abused, but it is less likely to be a potential drug of abuse. Research studies indicate that there is very little evidence that modafinil use produces significant tolerance, that withdrawal symptoms associated with modafinil are rare, and there only a few case studies in the literature that have identified evidence of dependence on modafinil. The drug does not appear to produce the significant euphoria that is often associated with other stimulants, and in the few case studies where the development of physical dependence was suspected, the symptoms of withdrawal were primarily emotional such as apathy, lethargy, and cravings.

Thus, the research data and the survey data (SAMHSA) suggests that both drugs do have a potential for abuse, but the potential for abuse is far higher for Adderall than it is for modafinil.

Conclusions

Adderall and modafinil are central nervous system stimulant medications with similar mechanisms of action and practical applications, but different potentials for abuse. Adderall is considered to be a much more serious potential drug of abuse than modafinil. However, there are case studies that suggest that modafinil can be a potential drug of abuse, particularly when it is used in high amounts.