Thursday, June 21, 2012

Amphetamines, Good Grades, ADHD, Addiction, and Drug Abuse

Alan Schwarz has provided a troubling article in the New York Times: Risky Rise of the Good-Grade Pill. Schwarz investigates the growing practice of teenagers who feel threatened by academic expectations to turn to amphetamines and methylphenidates as study aids.
"....there is no reliable research on how many high school students take stimulants as a study aid. Doctors and teenagers from more than 15 schools across the nation with high academic standards estimated that the portion of students who do so ranges from 15 percent to 40 percent."

The drugs of choice are the ones dispensed for children deemed to be suffering from ADHD (Attention Deficit Hyperactivity Disorder). That suggests a partial explanation for this datum:

"The number of prescriptions for A.D.H.D. medications dispensed for young people ages 10 to 19 has risen 26 percent since 2007, to almost 21 million yearly, according to IMS Health, a health care information company — a number that experts estimate corresponds to more than two million individuals."

The phenomenon of students turning to dangerous drugs in order to enhance their academic success is a story of considerable moment, and that is where Schwarz turns his focus. But like all good reporters he provides needed background information.

The drugs the students have chosen to use are, for good reasons, controlled substances.

"The D.E.A. lists prescription stimulants like Adderall and Vyvanse (amphetamines) and Ritalin and Focalin (methylphenidates) as Class 2 controlled substances — the same as cocaine and morphine — because they rank among the most addictive substances that have a medical use. (By comparison, the long-abused anti-anxiety drug Valium is in the lower Class 4.) So they carry high legal risks, too, as few teenagers appreciate that merely giving a friend an Adderall or Vyvanse pill is the same as selling it and can be prosecuted as a felony."

Schwarz also contributes this observation:

"While these medicines tend to calm people with A.D.H.D., those without the disorder find that just one pill can jolt them with the energy and focus to push through all-night homework binges and stay awake during exams afterward."

Schwarz seems to have bought into two conclusions, each of which would border on the miraculous if true. If you have trouble believing in one miracle, two coincident miracles will definitely be hard to accept.

The first is the notion that there is a distinct difference between the response of the brains of people supposed to be suffering from ADHD and those assumed not to be suffering from ADHD. The issue of ADHD and the drugs prescribed for the condition has been discussed in Psychiatrists, ADHD, Teachers, and Ritalin: The Path to Mental Illness. A drug like Ritalin performs as a dopamine reuptake inhibitor. The brain is constantly issuing and absorbing certain chemicals such as dopamine. Ritalin inhibits the re-absorption, thus causing an elevated dopamine level. This is the exact same response the brain has to cocaine, which helps explain why Ritalin can also be highly addictive.

One might say that ADHD children have a dopamine deficiency, or some related chemical imbalance that would cause a different response to a drug like Ritalin. That may be true, but psychiatrists have been searching for such a connection for decades and have yet to prove chemical imbalance is associated with mental illness. But that has not stopped them from making the claim.

It is time for a brief aside on the state of psychiatric science. If you give someone a pill that increases the dopamine level in a person’s brain and a beneficial behavior modification occurs, then you can assume that the condition causing the unacceptable behavior was caused by a deficiency of dopamine. If that logic makes sense to you, you have all the qualifications necessary for a successful career in modern psychiatry. If a person has a fever and you give him aspirin and the fever diminishes, then you can assume that fevers are caused by a deficiency of aspirin in the body. If that does not make sense to you, then you have flunked and will have to seek a less remunerative career.

The second miracle is only implied by Schwarz. He mentions how dangerous these drugs are for the students who would use them, but he says nothing about any danger to all those children described as suffering from ADHD and who take them continuously for years—as if they are somehow protected from ill effects. If addiction is limited to only those who take the drug under false premises, and is harmless to "true" ADHD sufferers, that would indeed be a miracle.

Wow! Does that mean that ADHD renders you safe from cocaine addiction as well?

Drugs like Ritalin do seem to help children focus on simple tasks, particularly those involving repetition? There does not seem to be any long-term academic benefit. In fact, there is evidence of diminished capability when complex reasoning is required. That is consistent with the drug helping students to focus on studying for a test, but it would be interesting to see if mental function is actually enhanced—or diminished—or students merely study longer than they would otherwise.

Children who try to stop taking Ritalin often suffer withdrawal symptoms making their behavioral mannerisms worsen. If they continue to take the drug for years their condition also worsens. What a curious position in which to put a child.

Many of the students that Schwarz writes about have ended up in drug rehabilitation. Uncontrolled use of addictive drugs inevitably leads to a crash.

It is perhaps too early to know what the controlled use of addictive, brain-altering drugs for many years will have done to our children.

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