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ADHD RITALIN AND ADDICTION

Biopsychosocial Effects of Substances Victoria Hargan BA Psychology 2008

What is Attention Deficit Hyperactivity Disorder (ADHD)


According to the Diagnostic Statistical Manual of Mental Disorders ADHD criteria is as follows:

DSM-IV Criteria for ADHD I. Either A or B:


Criteria A requires: Six or more of the following symptoms of inattention have been present for at least 6 months to a point that is disruptive and inappropriate for developmental level:

DSM-IV Criteria A A. Inattention

Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities. Often has trouble keeping attention on tasks or play activities. Often does not seem to listen when spoken to directly. Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions). Often has trouble organizing activities. Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework). Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools). Is often easily distracted. Is often forgetful in daily activities.

DSM-IV Criteria B

Six or more of the following symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level: Hyperactivity Impulsivity

DSM-IV Criteria Hyperactivity


Hyperactivity Often fidgets with hands or feet or squirms in seat. Often gets up from seat when remaining in seat is expected. Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless). Often has trouble playing or enjoying leisure activities quietly. Is often "on the go" or often acts as if "driven by a motor". Often talks excessively.

DSM-IV Criteria B- Impulsivity


Impulsivity Often blurts out answers before questions have been finished. Often has trouble waiting one's turn. Often interrupts or intrudes on others (e.g., butts into conversations or games). Some symptoms that cause impairment were present before age 7 years. Some impairment from the symptoms is present in two or more settings (e.g. at school/work and at home). There must be clear evidence of significant impairment in social, school, or work functioning. The symptoms do not happen only during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder. The symptoms are not better accounted for by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).

What is Ritalin?

Ritalin is a central nervous system stimulant that is used to treat children with attention deficit hyperactivity disorder or ADHD (Iannelli, V., M.D., 2008). Is it addictive? Ritalin can be very potent, addictive and abused. The drug must be monitored and taken as prescribed by your physician.

Is Ritalin Addictive

Ritalin can be addictive if used for recreational purposes. Those who abuse the drug may crush the tablets to either inhale the powder or inject it into a vein. (Karch, 2002; Volkow & Swanson, 2003).

Prescription Drugs
Is a drug safe simply because it is by prescription?

All drugs have side effects that can be potentially harmful. The drug should be taken as prescribed to avoid complications. If adverse reactions do occur, contact your Doctor. Prescribed drugs become unsafe when they are used for purposes other than what they were prescribed for, such as recreational use.

Ritalin Side Effects


Nervousness Insomnia Hypersensitivity Anorexia Nausea Dizziness Palpitations Headache Drowsiness Blood pressure and pulse changes

Tachycardia Angina cardiac arrhythmia Abdominal pain Weight loss. These side effects are typically short term.

Ritalin Myths and Facts


From the ADHD Information Library
MYTH: "Drug treatment should not and need not be indefinite and usually may be discontinued after puberty." FACT: Most children with ADD ADHD will still benefit from medications through their teenage years, and more than 50% of children with Attention Deficit Hyperactivity Disorder will still benefit from stimulant medications into adulthood.

MYTH: "Start with 5 mg twice daily, before breakfast and lunch." FACT: Studies show that the medications work better if taken with or after meals. Just be consistent as to when you take it. MYTH: "Administration of amphetamines for prolonged periods may lead to drug dependence and must be avoided." FACT: While this is one aspect of treatment to be concerned about, another side of this is that studies show, over and over again, that (1) ADD ADHD kids who are never treated will have higher rates of drug use than non-ADHD kids, (2) ADD ADHD kids that ARE treated, whether with medications, or biofeedback, or other treatment, will have LOWER rates of drug us than non-ADHD kids. FACT: There is no evidence that using stimulant medications increases rates of drug use among adolescents or adults. Rather, the opposite is true.

How are abused drugs thought to work?

The abuse potential of a drug is affected by a number of biopsychosocial factors. Drugs have to meet several criteria to have the potential for abuse. (Argosy, 2008). One reason people abuse drugs is to alter consciousness, and produce euphoria(Argosy, 2008). In order for this to happen, the drug needs the cross the BBB- The blood-brain-barrier.

What is the Blood Brain Barrier (BBB)?

The BBB is a complex layer of endothelial cells designed to keep potentially harmful substances out of the brain. If a drug is prevented from crossing the blood-brain-barrier, it will not have a significant potential for abuse. An abused drug, however, possesses unique characteristics that allow it to pass through this barrier.(Argosy, 2008).

What effects are typical with abused drugs particularly in the brain?

Ritalin is becoming an illicit street drug. Drug users looking for a high will crush Ritalin into a powder and snort it like cocaine, or inject it like heroin; making a much more powerful effect on the body. It can causes severe headaches, anxiety, paranoia, delusions and cardiac arrest. Ritalin is a stimulant prescription drug taken for medical reasons, like ADHD. Only a doctor can prescribe Ritalin. For people who dont need to take Ritalin as a medicine, it can have similar effects as cocaine: increased heart rate, sleeping problems, and loss of appetite, and cardiac arrest. (DrugAbuse.gov, 2008).

Is it possible that consuming an addictive drug might change a childs brain chemistry?

Taking any mind altering substance will change the brain chemistry while taking the substance, in this case Ritalin. It increases dopamine and norepinephrine, which are important neurochemicals, in regions where those chemicals are being released normally. (Koplewicz, H., (2008). These neurotransmitters are what help your child concentrate. There is no evidence of long term use of the use of Ritalin in a child and permanent change in brain chemistry.

References
Argosy Lecture Notes www.myeclassonline.com Brainsource.com http://www.brainsource.com/brain_on_drugs.htm DEA REPORT ADD/ADHD Statement of Drug Enforcement Administration Conference on Stimulant Use in the Treatment of ADHD (ADD/ADHD, AD(H)D, ADD-ADHD, Attention Deficit Hyperactive Disorder, Attention Deficit Hyperactivity Disorder, Attention Deficits, Attention Deficit Disorders, Hyperactivity) San Antonio, Dec. 10-12, 1996 http://www.add-adhd.org/ritalin.html DSM-IV-TR (2000) Diagnostic Statistical Manual of Mental Disorders Koplewicz, H., (2008). What is known About These Drugs. PBS. http://www.pbs.org/wgbh/pages/frontline/shows/medicating/experts/wonderdrugs.ht ml Iannelli, V, M.D., March 2008. Ritalin; About.com Pediatrics. http://pediatrics.about.com/od/adhdmedications/p/05_ritalin.htm NIH-National Institute of Health; Drugabuse.gov. Ritalin (2008). http://www.drugabuse.gov/JSP3/MOD4/cards_bw.pdf The ADHD Information Library http://newideas.net/adhd/medication/ritalin