Common Questions About Stimulant Medications

It Can Be Addicting, Can't It?

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.

Doesn't Stimulant Use for ADHD lead
to later Drug use and Dependence?

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 trating 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."

What about long-term effects?

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.

What are the Side Effects?

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.

Won't the medication make the person
 a "zombie" or make them "zonked?"

 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 distractable 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.

How many follow-up visits do I need? 

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 adolesence, 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.

How do I know which medication is best?

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.

Why is there More Attention Deficit Disorder Than There Used to Be?

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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