Overview

Methylphenidate, often known by its brand name “Ritalin” when in instant-release form, is an addictive prescription stimulant that has medical use in treating hyperactivity disorders such as ADD and ADHD, as well as narcolepsy, and is one of the most commonly abused stimulants available. Ritalin abuse is common in the U.S and abroad due to the increasing frequency of ADHD diagnoses each year, with there being a 50% increase in the use of these drugs in a matter of six years.¹ Ritalin is so addictive due to its close interaction with dopamine production in the brain. Ritalin remains one of the more popular recreational drugs found today due to its ability to increase focus and energy when abused, and commonly develops into an addiction due to how easy it is to build a tolerance to it. While overdoses are relatively uncommon on Ritalin, death can occur from a variety of issues such as respiratory failure and cardiac problems well below the quantity usually considered high enough to overdose. Ritalin exhibits short-term effects similar to other prescription stimulants including alertness, euphoria, decreased appetite, and mood shifts. Long term abuse of Ritalin can lead to a variety of physiological and mental ailments including depression, skin deterioration, cardiovascular problems, and respiratory damage. While there are no drugs specifically for Ritalin addiction, there are currently many effective pharmaceutical drugs that can be used in treatment of Ritalin addiction, and rehabilitation facilities offer extensive resources for recovering from Ritalin addiction in a safe, stable, and comfortable manner.

What is Ritalin?

Ritalin is among some of the most popular stimulant drugs available today, and has both legal medical usage in treating ADD and ADHD, as well as illegal use as an upper. Ritalin holds a reputation for its long lasting feelings of energy and euphoria, its potent addictiveness, and its commonality. Stimulants are a class of drugs that include dangerous street drugs like cocaine, common prescription drugs such as Adderall, and even your ordinary cup of coffee. More specifically, Ritalin is a drug consisting of Methylphenidate, a central nervous system stimulant. Methylphenidate is a specific central nervous system stimulant that is chemically related to drugs such as methamphetamine, and is notable for its potent stimulating effects as well as its strong addictiveness. Methylphenidate has been in regular use throughout the 20^th century, but has reached much greater use starting in the 1990s. This increased rate of Ritalin usage can be attributed primarily to the drastic increase of ADHD diagnoses at the time. This increase in drugs prescribed for ADHD has been considered a serious contributor to the increase in pharmaceutical addiction in the United States, and the NHS reports that the use of these drugs has increased 50% in only 6 years. For example, Ritalin prescriptions rose from 420,000 to 657,000 in a single year. Usage of Ritalin has been steadily and quickly increasing as the drug becomes more popular, particularly in college-aged groups due to Ritalin’s use as a study aid. This is a troubling trend as Ritalin usage has shown significant increase in the likelihood of using other drugs such as cocaine, and participating in dangerous habits like binge drinking. While it is somewhat difficult to overdose on Ritalin, death can still occur on Ritalin significantly below the amount required to overdose due to Methylphenidate’s strong effect on the heart. Cardiac arrest, heart attack, and other heart-related conditions can occur on any amount of Ritalin, with the risk increasing with the dose and in those with pre-existing heart conditions.

How Does Ritalin Addiction Work?

Ritalin’s deadly addictiveness can be attributed primarily to its effectiveness as a central nervous system stimulant, which stimulates dopamine production in the brain. This forces the dopamine out of the cell, trapping it in the synapse and leading to severe overstimulation of dopamine receptors in the brain. Dopamine is a neurotransmitter that is colloquially known as the ‘happiness drug’ due to its purpose in producing feelings of well-being and pleasure when released into the brain. When the body is hurt, the brain produces natural opiates that allow dopamine to be released in the areas of the brain commonly responsible for feelings of pain and stress, which works to reduce overall feelings of pain. However, once dopamine has done its job, it must be taken back out of the synapse to avoid overstimulating the cell. Ritalin disables this preventative measure in the brain by taking the place of dopamine. Because the brain isn’t capable of handling such frequent binding of dopamine, dopamine receptors become damaged and make it more difficult to feel pleasure, leading users to use more and more Ritalin to chase the fleeting euphoria it once offered them. Ritalin is particular addictive because, once ingested, it concentrates in the area of the brain known as the reward pathway. These numerous issues compound to create a very strong addiction potential for Ritalin, which becomes more and more difficult to feed the more it is abused. This deadly self-feeding cycle of addiction is at the root of Ritalin’s effectiveness at becoming addictive.

Short and Long Term Effects

Ritalin is usually taken in the form of compressed tablets. Ritalin is considered a quick-release form of methylphenidate and thus has a relatively rapid onset with effects reaching their strongest point at around 2-4 hours.

Users report short-term mental effects such as feelings of:

• • Increased energy

• • Increased alertness

• • Euphoria

• • Sexual stimulation

• • Excessive talking

• • Increased motivation

• • Aggressiveness

• • Paranoia

• • Rapid mood shifts

And physical effects such as:

• • Dizziness

• • Numbness

• • Excessive sweating

• • Severe dryness of the mouth

• • Insomnia

• • Restlessness

Repeated long-term use of Ritalin leads to physical side effects such as:

• • Decay in skin health – Regular usage of Ritalin has been linked to a variety of skin conditions including those associated with both excessively oily and excessively dry skin. Ritalin has been linked with a significant increase in acne, as well as dry, irritated, and itchy skin with chronic use.

• • Anorexia – Because of Ritalin’s effect of appetite suppression, Ritalin has been linked to unhealthy weight loss. This can result in anorexia, as well as a host of illnesses and conditions brought about from malnutrition including muscle atrophy and immune disorders.

• • Respiratory damage – Chronic Ritalin usage has been shown to begin and cause a number of respiratory issues. This can include respiratory depression, irregular breathing, and chronic shortness of breath.

• • Insomnia – Due to Ritalin’s stimulating effect, a general decay in personal health, as well as frequent interruptions in ordinary circadian activity, Ritalin users often experience worsening sleeping problems that can develop into insomnia.

Long-term use of Ritalin also carries several mental side effects including:

• • Severe addiction – Because of Ritalin’s addictiveness, both mental and physical addiction are developed very quickly, leading to a complete dependency on the drug.

• • Depression – Due to overstimulation of dopamine receptors, Ritalin frequently leads to depression due to the brain’s inability to properly manage its circadian rhythm and dopamine production.

• • Anxiety – Anxiety is a frequent symptom of drug abuse in general, and is common in Ritalin abuse due to internal factors from the psychological and physical effect of the drug itself, as well as external factors such as pressure family, friends, and work that may all be affected by addiction. This can compound and develop into chronic paranoia.

Other risks posed by Ritalin abuse include:

• • Risk of overdose – Ritalin overdose is a sometimes understated but dangerously frequent occurrence. Because Ritalin tolerance is so volatile, and deadly effects can take place well under the accepted limit that can be taken, Ritalin has caused a significant number of deaths from taking doses too high or too often. Death by heart failure is common, and survival rates of overdoses are low.

Ritalin withdrawal is notoriously difficult to go through, and includes symptoms such as:

• • Psychosis

• • Fatigue

• • Respiratory failure

• • Fever

• • Anxiety

• • Depression

• • Heart palpitations

• • Tremors, muscle aches and cramps

• • Insomnia

Methods of Treatment

Pharmacological:

There are a large number of drugs that can be used for Ritalin addiction and the drug or drugs used depend upon the circumstances of the addiction and the condition of the patient. Some drugs such as baclofen, a GABA antagonist, work by reducing Ritalin’s effect on the dopamine reward pathway in the brain. By lessening this effect, baclofen is able to dissociate the drug from its associated feeling of pleasure. Other drugs such hydroxyzine work by reducing the negative effects of withdrawal, allowing the patient to go through detox and likely rehabilitation while minimizing the difficulty of no longer using the drug. This helps not only to reduce the pain of withdrawal, but makes it easier to maintain sobriety afterward as well. Drugs such desipramine, a tricyclic antidepressant, can increase the quantity of norepinephrine in the brain, allowing it to replenish naturally and maintain abstinence. This drug may be particularly useful for drugs like Ritalin because despiramine has been used in the treatment of ADHD, and may be able to treat or reduce the effects of hyperactivity disorders that may have led to the use of Ritalin in the first place.

Therapeutic:

Other forms of treatment for Ritalin addiction come in the form of psychological and behavioral therapies. These treatments focus on the behaviors and habits that led to addiction in the first place in an attempt to remove the root of addiction. Amongst these forms of treatment, Cognitive Behavioral Therapy (CBT) is one of the most common, and is growing in support from the scientific and clinical communities all the time. Cognitive Behavioral Therapy sees substance abuse such as Ritalin addiction as a symptom of a greater psychological issue, and not a cause in and of itself. By utilizing reflective and analytic techniques, an addict is better able to understand what led them to addiction in the first place, change bad habits, and avoid behaviors that may trigger cravings. The twelve-step program, which is utilized by Alcoholic Anonymous, is a long-established method of treating drug and alcohol addiction. The twelve-step program works as a gradual method of guiding principles and pragmatic steps that can be taken to go from the depths of addiction and unhealthy habits to sobriety. These twelve steps are aimed at effectively recovering from compulsive and addictive behaviors, and addressing mental and behavioral problems that led to addiction in the first place. These twelve steps include both internal and external actions aimed at making amends for past mistakes, accepting responsibility for the actions that led to addiction, and moving forward to establish healthy habits and a positive mindset.

Rehabilitation

There are two main types of rehabilitation: inpatient and outpatient. Inpatient rehabilitation refers to programs that require patients to check themselves into a facility where they will undergo all rehabilitation treatment. Although inpatient rehabilitation requires a greater level of commitment, the facilities, environment, and support offered by these facilities are conducive to a stable and effective recovery. Inpatient facilities generally offer services such as psychiatrists, counselors, group therapy, and all of the living facilities necessary for a comfortable stay. The extensive support offered by these facilities, combined with an environment that is focused on self-improvement and wellness is a great combination for providing the motivation to push through the difficulties of withdrawal and to establish good healthy habits to prevent relapsing once you leave. This form of rehabilitation is effective for those who would benefit from a stricter more scheduled recovery in which the outside distractions and temptations of life won’t get in the way of focusing on recovery.

Outpatient rehabilitation is based on the principle of spending only part of your time in recovery programs while offering you the freedom to continue daily living on your own. Generally these programs will require ten to twelve hours of commitment per week spent in a treatment facility participating in similar activities to those done in an inpatient facility such as group therapy, counseling, and even detox. While this does offer easier access to drugs, some may find being able to maintain their normal daily schedule more beneficial. This form of rehabilitation is effective for those who require more freedom and contact with friends and family.

Both forms of rehabilitation are effective solutions at combatting Ritalin addiction, and there is a variety of different types of both inpatient and outpatient rehabilitation to suit the personal needs of each individual.

References

1. 1. BBC Health. “Use of ADHD Drugs ‘Increases by 50% in Six Years’.” BBC News, BBC, 13 Aug. 2013, www.bbc.com/news/health-23674235.