ADHD Meds' Effects Remain Uncertain
> 6/19/2007 12:57:43 PM

The scientific community largely accepts the conclusion that children who suffer from attention deficit hyperactivity disorder are, due to various neurological and social challenges endgendered by the condition, more likely to abuse drugs in adolescence and adulthood. ADHD children often come into contact with illicit substances at earlier ages and display a greater propensity to use alcohol, nicotine, and stimulants such as cocaine and methamphetamine as opposed to other, more popular sedative drugs such as marijuana. Research also clearly demonstrates a higher incidence of bipolar and conduct disorders, often comorbid with substance abuse, among ADHD patients.

The most oft-referenced drug in this debate is cocaine; studies have posited that many chronic cocaine users were undiagnosed ADHD children and that maternal cocaine use can predicate ADHD in offspring. Projected statistics estimate that as many as 1 in 3 to 6 inner-city children undergo some form of prenatal cocaine exposure widely due to the low cost and accessibility of its "crack" rock variety. Drug abuse thereby creates ADHD children, who are themselves more likely to use the very same substances. The cycle perpetuates itself in impoverished communities even though diagnosis is more common among the middle and upper classes (most likely due to their increased access to general practitioners willing to offer prescriptions).

But can popular ADHD drugs such as Ritalin and Adderall lead patients to devleop a taste for such illegal substances? Are they themselves addictive?

On the first front, one meta-analysis of several ADHD/drug abuse studies found that unmedicated patients were nearly twice as likely to fall into later patterns of substance abuse than those who took relevant medications in childhood/adolescence. Several independent studies, including recent work with lab rats, methylphenidate (Ritalin), and cocaine, have confirmed this conclusion. The project in question began with researchers administering varied levels of the medication to young rats at the same approximate age that such treatment would begin among human children. During the length of the experiment, researchers provided the rats with apparatus offering self-administered doses of cocaine at the push of a lever. The rats who were ingesting the highest levels of methylphenidate also showed the lowest propensity for choosing the cocaine.

Cocaine and methylphenidate are both stimulants, and they act on the brain in a similar way: by effectively blocking the dopamine transporters responsible for removing excessive levels of dopamine from the system, these substances increase the amount of dopamine receptors in the brain. With drugs like Ritalin, such a reaction takes approximately one hour, whereas in cocaine users the desired effect strikes exponentially faster: it's almost instantaneous. For this reason, Ritalin does not provide the addictive rush that characterizes the inhaled cocaine experience. Conversely, Ritalin does not lead to the crash created by the near-total absence of dopamine in a brain weathered by the effects of cocaine. For these reasons, the cocaine high experienced by individuals taking Ritalin in prescribed doses will not be as extreme as in their non-medicated peers. There's no question that many have abused methylphenidate, attracted to its ability to enhance focus and wakefulness while acting as a powerful appetite suppressant. And, if used over long periods in increasingly larger doses, it can become a very unhealthy habit as one's tolerance rises. But its effects are, again, not nearly as extreme as those created by cocaine, and comparing the two is inaccurate. Additionally, newer ADHD medications often come surrounded by gel in order to prevent the non-oral ingestion common among abusers.

While research indicates that regular exposure to methylphenidate does not facilitate the same degree of dependence and neurological instability brought on  by recreational cocaine use, questions remain about the necessity of and negative side effects associated with Ritalin and related amphetamines. Are they truly harmless aides for ADHD-affected children, or do they serve a "lesser of two evils" role, substituting as a weaker version of the illicit substances that patients may seek out in their absence? Unfortunately, very little empirical research has explored the effects of methylphenidate on the developing brain. Surely the brain adapts to the accomodate the presence of such stimulants. Certain children on Ritalin display symptoms reminiscent of classic drug addiction, including withdrawal-related irritability and pronounced loss of appetite. In an earlier, near-identical version of the study mentioned above, rats who demonstrated a reduced desire for cocaine when dosed with prescription amphetamines were also more likely to develop signs of depressive behavior and dysfunctional reward systems in the brain during adulthood. Would the same not hold true for humans? The issue is especially important when applied to children who are incorrectly diagnosed with ADHD - those who don't need the drug in the first place and may suffer from unexpected side-effects under its influence. Some anti-amphetamine activists claim that the drug can be fatal even in standard prescription doses. But Ritalin and similar drugs like ADDerall are not the only treatment routes for kids afflicted with ADHD. Behavioral and homeopathic treatments, as well as alternative medications, are also available. Parents should informedly weigh all available options after diagnosis.

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