Ritalin Abuse and Addiction

Ritalin, a trade name for the prescription drug methylphenidate, is a central nervous system stimulant, and is prescribed frequently to treat children who have been diagnosed with ADHD. Ritalin has also been the focus of much controversy, as the substance is often abused by people for recreational purposes.

Probably the most controversial theme in the Ritalin debate is the question if its use can lead to psychological drug dependence in the long run.

A study in the Archives of General Psychiatry titled “Is methylphenidate like cocaine?” concluded that indeed it was. Its lead author, Nora Volkow, director of nuclear medicine at the Brookhaven National Laboratory in Upton, N.Y., used positron emission tomography scans to look at where and how quickly Ritalin acts in the brain. In Volkow’s study, eight healthy male volunteers were injected with the drug. Their scans were then compared with those subjects in previous studies who had been injected with cocaine. The authors reported that the distribution of Ritalin in the human brain was “almost identical to that of cocaine.” The drugs’ effects also peaked at almost the same time — between four and ten minutes in the case of Ritalin, and two to eight minutes for cocaine. Even the highs were similar.

When Ritalin was given to cocaine users, they said it was “almost indistinguishable.” The only significant difference was that Ritalin took more than four times as long — ninety minutes — to leave the body. “We’re dealing with a drug that does have properties very similar to cocaine,” Volkow concluded.

It is therefore quite understandable why Ritalin — nicknamed “Vitamin R,” “The R Ball,” “The Smart Pill,” “Skittles” or “Smarties” — has become the drug of choice in American middle schools, where kids share their own prescriptions or sell pills to friends who crush them up and snort the powder for a quick high. The result has been increased drug dealing among the young, plus several teen deaths.

The University of Michigan’s Monitoring the Future Survey indicates that four percent of high school seniors in the United States abused the drug at least once in the past year. Although less common, Ritalin is abused among adults as well. The Drug Enforcement Administration has received reports of Ritalin abuse among diverse segments of the population —ranging from healthcare professionals to street addicts.

In Western Canada, “T’s and R’s,” “T’s and Rits,” “One and Ones,” “Crackers,” and “Set” are street names for a mixture of the prescription drugs Talwin (pentazocine) and Ritalin. When combined and injected, Talwin, a painkiller, and Ritalin produce a brief but intense sense of euphoria similar to the effect of heroin mixed with cocaine.

Psychiatric symptoms of stimulant overdose may include hallucinations, delusions, paranoia, confusion, disorientation, and loose association of ideas. Ellingwood studied amphetamine abusers and found that patients developed auditory hallucinations (N = 14), visual hallucinations (N = 15), and experiences of estrangement and/or depersonalization (N = 8). In addition, marked preoccupation with facial features (N = 10) was reported. Psychotic symptoms usually arise with chronic abuse, but may also appear acutely with large doses of stimulants. These psychiatric and physical side effects resolve over a period of hours to weeks. The dose required to produce psychic or motor disturbance varies considerably. Some abusers may experience increasing effects after multiple doses (similar to sensitization), while others experience severe effects from small doses (reverse tolerance).

In addition, homicide related to amphetamine intoxication has been reported. Paranoid ideation, which can be very frightening to the stimulant user, is often present when violence occurs. This suspiciousness combined with impaired judgment and insight can be a catalyst for violence and murder. Ellingwood reported a series of cases in which amphetamines were related to homicide, detailing the amphetamine-induced alterations in behavior and thought that led to homicide. These included reduced impulse control, paranoia, panic, and emotional instability (N = 13).

Although taking a stimulant orally is very different from injecting or snorting it, there are warnings that, even when taken orally, its use has the potential of creating long-term drug dependence. According to psychopharmacologist Susan Schenk of Texas A&M University, children treated with Ritalin are three times more likely to develop a taste for cocaine. She reached this conclusion after teaming up with Nadine Lambert, a developmental psychologist at the University of California, Berkeley, who followed five thousand children with ADHD from adolescence to adulthood.