Drugs and Behavior
Abstract
Ritalin (Methylphenidate) is a mild CNS stimulant. In medicine, Ritalin's primary use is
treatment of Attention Deficit /Hyperactive Disorder (ADHD). The mode of action in humans
is not completely understood, but Ritalin presumably activates the arousal system of the
brain stem and the cortex to produce its stimulant effect. Recently, the frequency of
diagnosis for ADHD has increased dramatically. More children and an increasing number of
adults are being diagnosed with ADHD. According to the Drug Enforcement Agency (DEA)
(Bailey 1995), prescriptions for Ritalin have increased more than 600% in the past five
years. Ritalin has a long history of controversy regarding side effects and potential for
abuse, however it greatly benefits those with ADHD.
Ritalin Research Paper
Psychological effects of Ritalin
Ritalin (Methylphenidate) is manufactured by CIBA-Geigy Corporation. It is supplied in 5
mg., 10 mg., and 20 mg. tablets, and in a sustained release form, Ritalin SR, in 20 mg.
tablets. It is readily water soluble and is intended for oral use. It is a Schedule II
Controlled Substance under both the Federal and Vermont Controlled Substance Acts.
Ritalin is primarily used in the treatment of Attention Deficit/Hyperactive Disorder
(ADHD) (Bailey 1995).
ADHD is a condition most likely based in an inefficiency and inadequacy of Dopamine and
Norepinephrine hormone availability, typically occurring when a person with ADHD tries to
concentrate. Ritalin improves the efficiency of the hormones Dopamine and Norepinephrine,
increasing the resources for memory, focus, concentration and attention (Clark 1996).
Ritalin has been used for more than 30 years to treat ADHD. Nervousness and insomnia are
the most common adverse reactions reported, but are usually controlled by reducing dosage
or omitting the afternoon or evening dose. Decreased appetite is also common but usually
transient (Long 1996).
According to Clark (1996), children, adolescents and adults diagnosed with ADHD usually
report the following effects when successfully treated with Ritalin:
?Improved concentration.
?Better "focus".
?Improved ability to complete their work.
?Improved intensity of attention and longer attention span.
?Reduced distractibility.
?Reduced impulsivity.
?Reduced restlessness and overactivity.
?Improved patience.
?More elaborate expressive vocabulary.
?Better written expression and handwriting (especially in children).
?An improved sense of "alertness".
?Improved memory for visual as well as auditory stimuli.
Ritalin's Effect on Neurotransmitter Systems
Ritalin exhibits pharmacological activity similar to that of amphetamines. Ritalin's
exact mechanism of action in the CNS is not fully understood, but the primary sites of
activity appear to be in the cerebral cortex and the subcortical structures including the
thalamus. Ritalin blocks the reuptake mechanism present in dopaminergic neurons. As a
result, sympathomimetic activity in the central nervous system and in the peripheral
nervous system increases. Ritalin-induced CNS stimulation produces a decreased sense of
fatigue, an increase in motor activity and mental alertness, mild euphoria, and brighter
spirits. In the PNS, the actions of Ritalin are minimal at therapeutic doses (Clinical
Pharmacology Online 1997).
Ritalin is the quickest of all oral ADHD stimulant medications in onset of action: it
starts to achieve benefit in 20 - 30 minutes after administration, and is most effective
during the upward 'slope' and peak serum levels. Ritalin's effect is brief: Most people
experience 2-3 hours of benefit, but after 3 hours, benefits drop off rapidly. Some
individuals, especially children, may obtain 4 or even 5 hours of positive effect (Clark
1996).
Social Factors Leading to increased use of Ritalin
Recently, there has been a dramatic upsurge of interest in using stimulants (mainly
Ritalin) for children and adults for the increasingly popular diagnosis of ADHD.
According to Persky (1996), the high frequency of the diagnosis of ADHD is a uniquely
American phenomenon. Children and adults are now under greater pressure to perform and to
do well academically or in the workplace. The chilling message in school and at work is
"Perform or Else." Because of this high intensity atmosphere, the use of Ritalin has
become attractive. This has resulted in an acute "epidemic" of ADHD and the treatment of
choice is Ritalin (Persky 1996).
For example, after education reforms spearheaded by Ross Perot in Texas in 1984, Ritalin
use in the state doubled. One Texas mother says she is being hounded by teachers to put
her two boys on Ritalin against their psychologist's advice. Another mother says she had
to ask a school board member to intervene when teachers at her child's school also
pressed for Ritalin use("Critics say Ritalin," Houston Chronicle, May 1996).
Ritalin is an effective treatment for people with ADHD. Because it allows them to filter
out distractions and improve concentration, some schools and parents force Ritalin on
children who may have nothing more than a severe case of childhood. At a popular church
preschool, approximately 20 percent of children are on Ritalin. Even a Little League
coach urged Ritalin for a 9-year-old catcher to improve his performance. Ritalin's safety
and efficacy is what has turned it into teachers' and parents' little helper. It solves,
or in some cases masks, children's behavioral problems ("Critics say Ritalin," Houston
Chronicle, May 1996).
Social Impact of Ritalin
According to Clark (1996), people who have ADHD come from every imaginable social,
vocational, educational and emotional background. ADHD is a condition which may afflict
physicians, attorneys, carpenters, actors, politicians, casino employees, executives, and
homemakers. While Ritalin is a very important aspect of treatment, in many or most cases
it is only part of the overall treatment effort. Stimulants (mainly Ritalin) specifically
affect attention span, concentration, focus, and distractibility. No alternative
medications, nor any other form of treatment, address these symptoms of ADHD as well as
stimulants like Ritalin.
Learning disabilities, such as reading difficulties or anxiety, are sometimes
misdiagnosed as ADHD or co-exist with ADHD. Ritalin will help the child sit still in
class, but may not deal with the real culprits keeping the child from learning. Many
pediatricians believe children younger than 6 -- even if they have ADHD -- should wait to
be medicated until they learn basic rules of behavior. Yet while liberal estimates are
that six out of 100 children suffer from the disorders, six out of 30 preschoolers in one
group at a Day School in Houston take Ritalin. Teachers are often the only ones who get
an inkling that a child may have ADHD, and are within their rights to call a parent and
suggest the child be evaluated for the disorder. No teacher should be permitted to
suggest a specific medication or pursue the topic once the parent demurs. ("Critics say
Ritalin," Houston Chronicle, May 1996).
After a slowdown of Ritalin use in the 1970's, the pendulum began to swing back in the
1980's. It has swung so far, that in 1994 about 9 tons of Ritalin was produced (DEA in
Persky 1996).
Patterns of Abuse
According to Bailey (1995), epidemiologists at the National Institute on Drug Abuse
(NIDA) describe Ritalin abuse over the last two decades as "sporadic but persistent," and
rates of use fluctuate over time. When purchased in pharmacies with a valid prescription,
Ritalin tablets cost 25 cents to 50 cents each. In the illicit street drug market,
tablets sell for $3 to $15 each. While street prices in the Midwest are now at the low
end ($3 to $5 per tablet) compared with some West Coast locations, they have been rising
over the past few years. In 1994, an upsurge in illicit street use of Ritalin was
reported on the U.S. West Coast and in the Midwest. Non-medical use consisting of
snorting crushed Ritalin tablets or dissolving the powder in water and "cooking" it for
intravenous injection was reported at Chicago and Detroit. Anecdotal reports suggest that
suburban, white abusers are more likely to snort Ritalin, while African American
inner-city abusers are more likely to inject it (Bailey 1995).
Conclusion
Ritalin is an extremely useful medication. It has minimal side effects after the first
few months. It works quickly, wears off quickly, and because of this targets some ADHD
issues optimally. No other stimulant medication impacts so specifically on alertness,
concentration and focus.
Individuals with ADHD may respond well to psychotherapy, behavior modification, and
other interventions. Successful treatment of ADHD begins with careful diagnosis, followed
by proper prescription of medications. An accurate diagnosis, in conjunction with
carefully developed and targeted treatment, should limit abuse and ensure continued
success in treating ADHD.
References
Bailey, W. J. (1995). Factline on non-medical use of Ritalin. Factline Number 9
November 1995, [on-line], pp. 1-7. Available: Http://www.drugs.indiana.edu/.
Clark, C. G. (1996). Stimulant Medications. Diagnosis and Treatment of Attention Deficit
Disorder, [on-line], pp. 1-12. Available: Http://www.ADDCLINIC.com/.
Clinical Pharmacology Online, Ritalin.. (1997). Clinical Pharmacology Online. Gold
Standard Multimedia Inc., [On-line], Available: Http://www.gsm.com/., p. 1.
Critics say Ritalin has become panacea for children's scholastic,
behavioral problems. (1996, May 23). Houston Chronicle via Nando.Net, [on-line], pp.
1-3. Available: Http://www.Nando.net/.
Long, P. W. (1996). Methylphenidate, Brand name Ritalin, Drug Monograph. In, Internet
Mental Health Drug Monograph.
[On-line], Available: Http://www.mentalhealth.com/. (pp. 1-7). Ottawa, Canada.
Persky, M. (1995, May). LISTENING TO RITALIN: The New Epidemic.. The Northern California
Psychiatric Physician, 5, 43-45.
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