Why Stimulants Work and Why We Should Be Cautious

Source: Artem Anosov / Pexels

Human fascination with stimulants is deeply rooted in our biology. Whether it’s the energizing buzz of caffeine, the focus sharpened by prescription medications like methylphenidate or amphetamines, or the natural rush of adrenaline during times of danger, stimulants tap into core functions of our brain that evolved to help us survive (Volkow, Wang, Fowler, & Telang, 2009). However, while these substances can offer powerful short-term benefits, their widespread use, particularly in mental health treatment, requires a thoughtful and cautious approach.

The Evolutionary Affinity for Stimulants

Energy, alertness, and quick decision-making were crucial for survival throughout human evolution. Those who could mobilize quickly in the face of danger and stay awake longer to protect a camp or track prey more effectively had a better chance of passing on their genes. The brain evolved to reward and prioritize states of heightened alertness and focus, often mediated by neurotransmitters like dopamine and norepinephrine. These chemicals signal reward, motivation, and preparedness for action (Nieoullon, 2002).

Stimulants artificially enhance these systems. They increase dopamine and norepinephrine activity in the brain, mimicking the natural surge that occurs during critical life-or-death moments. This enhancement feels pleasurable, sharpening attention, energy, and mood—states our brain is evolutionarily wired to prize.

Unlike medications designed to correct a "deficiency" or imbalance (such as antidepressants raising low serotonin levels), stimulants amplify functions that are already present in everyone. They don't "normalize" an abnormality; they enhance what exists, tapping into universally available brain systems that drive action and attention. This is why virtually everyone feels more focused, more energized, and more motivated after using a stimulant, regardless of whether they meet the diagnostic criteria for a disorder or not.

How Stimulants Differ from Other Mental Health Medications

Most psychiatric medications aim to correct or compensate for specific imbalances. Antidepressants, for example, seek to elevate low mood by increasing serotonin and norepinephrine transmission. Antipsychotics work to dampen excessive dopamine activity associated with hallucinations and delusions. Anti-anxiety medications often enhance calming neurotransmitters such as GABA to slow down overactive worry circuits (Stahl, 2013).

Stimulants, however, do not so much "correct" as they "supercharge." They provide a broad, non-specific enhancement of mental energy, impulse control, and motivation. They make brain processes run faster and more effectively, at least in the short term. While for individuals with attention-deficit/hyperactivity disorder (ADHD), this enhancement brings them closer to a neurotypical baseline, for individuals without ADHD, the same stimulant effect can push performance beyond natural levels—hence the widespread non-prescribed use among students, professionals, and even military personnel.

This distinction is critical: stimulants provide performance enhancement, not necessarily a cure. They sharpen the tools; they don't fundamentally change the nature of the toolset. In cases of true dysfunction (such as in ADHD), this sharpening yields life-altering benefits. For those already functioning within a normal range, it can create a tempting shortcut that carries inherent risks.

Why Caution Is Essential

Although stimulants can be profoundly helpful, they come with risks that cannot be overlooked. First, since stimulants act on reward and motivation systems, they have a significant potential for psychological dependence. The brain learns quickly that these chemicals make life feel better, sharper, and more manageable. Over time, the brain may become less capable of generating focus and energy without them (Wilens & Spencer, 2010).

Second, chronic use can push biological systems beyond their evolutionary limits. Our brains were designed for periodic surges of dopamine and norepinephrine, not for constant stimulation. Overuse can dysregulate natural reward systems, lead to tolerance (where higher doses are needed to achieve the same effects), and, in some cases, create patterns of exhaustion, anxiety, or even depression when the stimulant is absent.

Nootropics Essential Reads

Getting High the Cali Sober Way

A Nootropic Hiding in the Urine of Coffee Drinkers

Third, stimulant use can mask underlying issues rather than resolve them. A child who struggles with attention due to anxiety, trauma, or a poor educational fit might temporarily perform better on a stimulant, but the real issues remain unaddressed. Similarly, an adult overwhelmed by a poor work-life balance or untreated emotional challenges might find stimulants make the day manageable—at the cost of delaying necessary life changes.

Why Are There Stimulant Shortages?

In recent years, the U.S. and other countries have faced intermittent shortages of stimulant medications such as Adderall and Ritalin. These shortages arise from a complex intersection of regulatory, manufacturing, and demand-related issues (Shaw, 2023).

One major cause is supply chain fragility. Stimulants are classified as Schedule II controlled substances, which means they have strict production quotas imposed by government agencies to limit potential abuse. These quotas are set annually and do not easily adjust to sudden increases in demand. If more patients are diagnosed with ADHD or more adults seek medication, as has happened post-pandemic, manufacturers cannot quickly ramp up production.

Furthermore, demand has surged significantly. Increased awareness of ADHD in adults, greater acceptance of mental health treatment, and pandemic-driven rises in telehealth prescribing have contributed to a notable increase in stimulant prescriptions. While telehealth services have expanded access, they have occasionally resulted in less stringent diagnostic practices and prescriptions that exceeded the capacity of traditional supply models.

Finally, manufacturing bottlenecks have played a role. Pharmaceutical companies have faced labor shortages, raw material scarcities, and quality control issues that disrupt production. Even a halted production line for a major supplier can create ripples across the healthcare system, resulting in months-long shortages.

Together, these factors indicate that, although stimulants remain critically important for many people, accessing them consistently has become more difficult. This unpredictability further emphasizes the need for thoughtful, careful prescribing—reserving stimulants for cases where they are genuinely needed, not as a quick fix or universal enhancer.

Final Thoughts

The brain’s evolutionary wiring explains why stimulants feel like they "work" for almost everyone. They activate the systems that our ancestors relied on for survival. In clinical settings, particularly for ADHD, they can transform lives by enabling individuals to function at levels that were previously unattainable. However, the power of stimulants is double-edged. They are not a cure-all. They amplify; they do not fundamentally heal. Over-reliance or casual use can lead us to overlook deeper problems. It may cause long-term harm to the very systems they temporarily enhance.

Moreover, recent shortages highlight another reason for caution: stimulants are a finite, tightly controlled resource. As demand continues to rise, responsible prescribing, patient education, and broader public awareness are essential to ensure these powerful tools remain available for those who genuinely need them.

The gift of stimulants must be accompanied by the wisdom to use them thoughtfully, sparingly, and within a framework that prioritizes addressing the whole person—not just boosting performance.