Common Questions
About Stimulant Medications
Metadate, Concerta, Ritalin and Adderall are
all Schedule II drugs with
street value. In high doses they can be addicting. There is some similarity to
the street drug cocaine, but also some very important differences. The main
thing that makes a medication addicting is how rapidly it leaves your system.
Rapid elimination is more likely to create craving. The stimulants used for ADHD
are longer- acting than the street stimulants, and thus much less likely to have
addictive potential. In addition, the newer formulations of the stimulants are
very even and gradual in the delivery of the stimulant to the body.
In practice, at the dosages given, the biggest danger appears to be that
non-prescribed people abuse the stimulants. (family members, friends).
Sometimes kids who hate taking the medication give it to their friends. Most
people who have ADHD are very careful with their medication and don't want to
run out of it, however.
The biggest problem with children is getting them to take it. Most people with
ADHD forget to take their stimulant medication. Have you ever had to remind a
cigarette smoker that they need to smoke another cigarette? Yet getting a person
with ADHD to take their medication regularly is one of the biggest challenges.
They frequently forget to take it. That is clearly not consistent with a pattern
of addiction.
One of the concerns about
using Schedule II drugs would be that we might increase the chance of drug
addiction later in life. The evidence seems increasingly clear that young adults
who have ADHD and are NOT treated are at a greater risk for substance abuse.
Those on medication are less likely to abuse drugs.
A recent review of many studies by
Russell Barkley (published in The ADHD Report, Feb 2003) concludes,
"Clinicians at this time have no reason to fear that treating ADHD children with
stimulants....are predisposing those children in any way toward later drug use,
dependence, or abuse. Indeed, there is suggestive evidence in some studies of an
actual protective effect against drug use or abuse if stimulant treatment is
continued into adolescence....While it is always possible that future research
may overturn this conclusion, this seems highly unlikely in view of the number
of studies now available and their relatively consiste3nt conclusions against
the stimulant sensitization hypothesis. In sum, the current public and
media concern about treating children with stimulants leading to later
risk for drug use and abuse is without scientific merit at this time."
At this point there are no
major studies that clearly point to any long-term negative consequences. On the
other hand, no one can guarantee that any thing one puts into our body may not
have some unforeseen negative consequence. All of the short-term
negative consequences seem to disappear when you stop taking it.
Appetite suppression is the largest problem. A few
people develop tic disorders. Headaches and stomachaches are sometimes
bothersome. Some people seem to get agitated or worse on the
medication. Some people develop rashes. There are some very rare reports of
psychosis. Reducing the dosage reduces many side effects. Talk to your
physician or pharmacist to learn more about side effects of this and any
medication.
Not when
properly regulated. Any results from taking medication that make a person appear
lethargic is clearly an unwanted and intolerable side effect. This sometimes
happens on some of the older medications such as 20 mg SR
(Sustained Release) Ritalin, since the dosage cannot be adjusted. Many people
think the purpose of the medication is to slow down a hyperactive person.
Rather, the main goal is to stimulate the brain and get certain brain chemicals
to work better.
Many people fear that their child
won't be creative or be their normal self. If being constantly restless and
distractible is what is normal for the child, then their should be a change. My
experience is that 90% of the parents who have well adjusted medication feel
very good about the way their child is doing. Most of them even get frustrated
that the medication doesn't work a bit better after they see the improvement.
That is hard to answer. It is becoming increasing clear at Swank Counseling that
the more often parents and clients return, the more satisfactory the results. In
the Multimodal Study of Attention Deficit Disorder, aggressive follow-up of
patients with ADHD yielded much more favorable results. What the study
discovered is that the average person going to the average physician or clinic
had only a 40% chance of showing any improvement when interviewed a year
later. When there was frequent (at least once a month) follow-up and aggressive
treatment, 90% of the patients were so improved that they no longer met criteria
for ADHD while on medication.
The purpose of the follow-up visits
are to monitor medication, review progress, and continue to learn about the
impact of ADHD on the family. Frequently other family members are identified in
need of treatment. ADHD has a big impact on families, and they need support. And
it is also helpful to take time to reflect on the difference between
pre-treatment and post-treatment. Often family members forget or are not aware
of the impact that medication makes, even though it is being used. Often family
members don't seem to be aware of how much better Saturday goes when they use
medication.
It is also important for the
therapist to communicate with the physician. Most physicians do not have enough
time to thoroughly discuss the various aspects of the person's life. And some
physicians are a reluctant to increase dosages without confirming information.
Feedback from the therapist to the physician often places the physician in a
more comfortable position to change doses.
Follow-up visits also help with
behavioral management for children. In adults it is important for self-esteem
issues. In adolescence, there is often rebellion against taking medication as the
child tests out their independence. So counseling is helpful to get them to
understand their improved functioning with medication, and buy into treatment.
There is no easy way to know which medication will work for a particular person.
Some people seem to respond to any of the medications. Others seem to respond to
only one type. It appears that about 70% of people who take one of the class of
stimulants responds adequately. However that means that 30% do not respond well
to a type of stimulant. However, the good news is that they usually respond to
one of the other medications.
Some experts are increasingly suggesting a trial on the various
types of medication before settling on a particular one. That is a somewhat
annoying and tedious process, but may be worth the effort. If one does not try
the various medications, it is possible to settle for a medication that works,
but not experience another that works even better. If one does not respond
to any of the medications, it is good to reconsider if the diagnosis is correct.
That is a quite complicated
question. It may be that there is more recognition of the disorder. This happens
in many cases of health. There are more diagnosed cases now of high blood
pressure or high cholesterol than there was 50 years ago. That does not mean
that more of these disorders exist. And from time to time we change the cut off
point in which say a disorder is a problem. There has been a lowering of the
point at which we believe high blood pressure should be treated.
Some people think that there is an
actual increase in the number of people who have ADHD symptoms. Some people
think that there may be some yet unknown environment factors that contribute to
the problem.
One possible explanation is that
impulsivity and poor planning may increase the number of people who have ADHD.
Since it is highly genetic, people who fail to plan for pregnancy are more
likely to have more children. Research shows that people with ADHD tend to have
children earlier than those who do not have ADHD. They are more likely to have
unprotected sex. Since the birth control pill was introduced in the 1960's, it
is possible that those people who plan better are more likely to use birth
control, and thus reproduce at a lower rate than those who are impulsive. The
role of abortion could also play some role, since (regardless of your moral
position) having an abortion requires planning as well.
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Swank Counseling
