Ritalin Versus Adderall Versus Concerta: Which ADHD Drugs Pose the Most Risk for Abuse?

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Ritalin Versus Adderall Versus Concerta: Which ADHD Drugs Pose the Most Risk for Abuse?

Ritalin, Adderall, and Concerta are all popular and effective prescription medications used for the treatment of Attention Deficit Hyperactivity Disorder (ADHD). Unfortunately, however, each drug also brings along a serious risk of abuse.

That comes as a surprise to some people.

Most people hear the term “prescription drug abuse” and think of opioid painkillers such as Vicodin or OxyContin. Sometimes, they might also consider benzodiazepine-class medications such as Xanax or Valium.

But what is often overlooked is that prescription stimulants such as Concerta, Adderall, and Ritalin are also popular drugs of abuse, especially among college students.

What Is ADHD

What Is ADHD?

“Occupying a uniquely bizarre place in American culture, let alone medicine, ADHD has become the brain disorder some choose to fake. Because Adderall, Concerta, and other drugs can instantly boost any person’s motivation and focus, whether for term papers or tax returns, the pills move from medicine to performance-enhancing drugs, steroids for the brain.”

~Alan Schwartz, ADHD Nation: Children, Doctors, Big Pharma, and the Making of an American Epidemic

According to the Centers for Disease Control and Prevention, ADHD is one of the most-common childhood behavioral disorders, affecting approximately 11% of children between ages 4 and 17. This equates to 6.4 million American youth. ADHD rates seem to be on the rise – in 2003, 7.8% of children were diagnosed with the condition.

ADHD is more common in boys than it is in girls – 13% vs 5%.

ADHD – once known as Attention Deficit Disorder (ADD) – is characterized by symptoms of inattention, hyperactivity, and impulsiveness. To qualify for an ADHD diagnosis, four factors must be present:

  • Several symptoms must manifest before the age of 12
  • The symptoms must be present in multiple settings – school, work, at home, etc.
  • The symptoms must interfere with normal everyday functioning.
  • The symptoms cannot be explained by some other condition – anxiety or mood disorders, for example

ADHD is a childhood-onset disorder, and between one-third and two-thirds of children with the condition will “outgrow” it by adulthood. Those who continue to exhibit ADHD symptoms into adulthood frequently experience problems in several areas of life – legal, academic, employment, financial, relationships, etc.

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Because of these difficulties, 80% of adults with ADHD struggle with a co-occurring psychiatric disorder such as anxiety or depression.

The National Institute of Mental Health reports that approximately 8% of adults between the ages of 18 and 44 have a lifetime prevalence of ADHD. Just over 41% of these cases can classified as “severe”.

ADHD Childhood Disorder

ADHD is treated with a combination of behavioral therapy and medication.

ADHD Medication – Prescription Stimulants

ADHD Medication – Prescription Stimulants

Stimulants are the most commonly-used and the most well-known medications for the treatment of ADHD. They are fast-acting and very effective – up to 80% of people with ADHD exhibit fewer symptoms when given a prescription stimulant.

In 1990, only about 600,000 children in America were being given prescription stimulants for their ADHD. By 2013, that number had increased to 3.5 MILLION.

ADHD stimulants are amphetamine-based, and they work by increasing the activity of several neurotransmitters and hormones within the brain:

  • Dopamine – reward, attention, and motivation
  • Norepinephrine – attention, memory, and alertness
  • Epinephrine – stress adaptation and long-term memory
  • Serotonin – well-being and happiness
  • Histamine – decreases stress and lowers blood pressure

According to a 2011 report, when a person with ADHD takes their prescription stimulants properly, not only do they exhibit fewer symptoms, but they also decrease the likelihood of a co-occurring substance abuse disorder.

The problem arises when it ADHD drugs are taken in a matter inconsistent with their prescription, or as is happening with increasing frequency, they don’t have ADHD in the first place.


Adderall –“ADD for All”

“Though I could put more words to the page per hour on Adderall, I had a nagging suspicion that I was thinking with blinders on.”

Joshua Foer, The Adderall Me: My Romance With ADHD Meds

Adderall has become the go-to solution for adult ADHD, and one of the most-preferred prescription drugs of misuse among college students. In 2012, there were 16 MILLION Adderall prescriptions written for people between the ages of 20 and 39.

Adderall is pure amphetamine75% dextroamphetamine and 25% levoamphetamine. As a drug of abuse, Adderall is popular non-medically because of its side effects. Adderall is a(n):

  • Euphoriant – creates feelings of pleasure
  • Aphrodisiac – enhances sexual pleasure
  • Physical performance enhancer – some athletes use Adderall because at therapeutic doses, there are indications that it can improve muscle strength and endurance
  • Cognition enhancer – at low doses, some reviews suggest that Adderall improves attention and memory in healthy adults

Other prescription stimulant ADHD medications similar to Adderall include:

  • Dexedrine (dextroamphetamine)
  • Dextrostat (dextroamphetamine)
  • Vyvanse (lisdexamfetamine)

Adderall As a Study Aid

Adderall As a Study Aid?

It is this last side effect – cognition enhancement – that makes Adderall such a popular choice for older teenagers and college students. Rather than simply using Adderall recreationally, it is also used as a study aid.

However, any supposedly “benefits” are negligible, due to other factors.

For example, in general terms, the students who most tend to use Adderall nonmedically already have lower GPAs. Any “improvement” might simply be due to studying.

Additionally, Adderall, misusers tend to have much higher-than-normal rates of drinking and illicit drug use. Any gains are lost because of that extraneous substance abuse.

Furthermore, students using Adderall as a study aid are often trying to compensate for sacrificing academics earlier for the sake of an active social life that left little time for study. While modest cognitive gains have been seen in a laboratory setting, there is no evidence that compensating with Adderall in the real world is particularly effective.

That assertion is supported by observed behavior. Students who use prescription stimulants such as Adderall nonmedically skip just over 16% of their classes, while those who don’t skip about 9%. Whatever positive “focus” is gained doesn’t seem to carry over.

Finally, according to a study conducted by University of Pennsylvania researchers in 2013, participants showed virtually NO cognitive improvement by most measures.  Despite this, participants receiving Adderall still believed they performed better.

Researchers have a theory that this sense of greater academic productivity might have less to do with any improvement in cognition and more to do with the drug’s euphoric effects. In other words, Adderall may not improve retention or knowledge, but it might make a study session seem more enjoyable.

How Addictive Is Adderall

How Addictive Is Adderall?

Because of its addictive potential, Adderall is a Schedule II controlled substance. At regular therapeutic doses – even over the long term – addiction is unlikely. However, at high recreational doses, drug dependence and addiction are more than just the risk – they are a virtual certainty.

Among high-dose users, 88% experience withdrawal symptoms that present within 24 hours after the last use, and persist up to a month afterwards.

One significant hazard of heavy recreational Adderall abuse is tolerance that leads to greatly increased doses and ends with overdose. Individuals who have built a tolerance to amphetamines have been known to take up to 5 g per day – 100 times the therapeutic dose.


Ritalin – the Grandfather of “Generation RX”

“Though I could put more words to the page per hour on Adderall, I had a nagging suspicion that I was thinking with blinders on.”

Joshua Foer, The Adderall Me: My Romance With ADHD Meds

Ritalin – chemical name methylphenidate – has been around since 1955. Originally, it was used to treat hyperactivity, now known to be a component of ADHD. Over the past 20 years, Ritalin prescriptions have grown significantly. In 2013, there were 2.4 BILLION doses consumed worldwide. This represents a 66% increase from 2012.

The United States uses 80% of the world’s Ritalin.

Unlike Adderall, Ritalin is not an amphetamine, but it is a stimulant. It works by slowing down the transmission of dopamine away from the parts of the brain that regulate attention. In other words, it helps the person focus on the task at hand.

Like Adderall, Ritalin is often used for its euphoric effects. One dangerous trend among teenage and young adult abusers is taking Ritalin and alcohol together. The drug is used to counteract the alcohol’s depressant effects, so the person can stay out longer and drink more. This greatly increases the risk of alcohol poisoning.

Ritalin instant-release has a peak effect duration of 2-4 hours, and the sustained-release formulation will maintain those effects for 3-8 hours.

Other methylphenidate prescription stimulant ADHD medications include:

  • Concerta – basically, an extended-release formulation of Ritalin, with a peak effect duration of 8-12 hours
  • Daytrana – a methylphenidate transdermal system (MTS), or “patch”, with effects that last up to 11 hours
  • Focalin (dexmethylphenidate) – peak effect duration of 4-6 hours, or extended-release up to 12 hours

Vitamin K

A Performance Enhancer with A Dark Side

It’s called “the smart drug”, R-ball, or Vitamin K.

Like Adderall, low doses of methylphenidate taken by people without ADHD may slightly increase their concentration and improve their academic performance. But new research suggests that any improvement may come at an unwanted cost.

According to a 2017 study just published in the Journal of Neural Transmission, illicit use of Ritalin triggers changes within the brain’s chemistry, resulting in:

  • Risk-taking behavior
  • Unhealthy weight loss
  • Disruption in the user’s sleep/wake cycle

Of special relevance, females seem to be more vulnerable to Ritalin’s adverse effects than males.

How Addictive Are Ritalin and Other Methylphenidate Medications?

Because they are stimulants, methylphenidate medications carry risks of dependence and addiction similar to amphetamines, especially when they are used recreationally at high doses. As with other stimulants, prolonged abuse can result in psychosis.

Because of these risks, methylphenidate medications are also classified as Schedule II controlled substances.

Interestingly, methylphenidate shows promise in methamphetamine replacement therapy, resembling the role that methadone plays in heroin replacement therapy.

Statistics about The Abuse of Prescription ADHD Medications

Statistics about The Abuse of Prescription ADHD Medications

The misuse of prescription ADHD stimulants is considerably higher among teenagers and college students than you might suspect. The problem starts in early adolescence and continues through the teenage and college years. At each stage, perceptions and actions change:

  • 15% of 8th graders think that it is “easy” to obtain Adderall or Ritalin for nonmedical use.
  • By 10th grade, that percentage jumps to 28.5%, and it reaches 47% by 12th grade
  • 4 out of 10 teenagers believe it is “safe” to misuse prescription drugs.
  • 29% of teens do not think it is possible to become addicted to prescription medications.
  • Every year, 36% of college freshmen have an opportunity to use ADHD medications nonmedically, and over 13% do so.
  • College sophomores – over 38% have the opportunity, almost 18% use
  • College juniors – over 41% have the opportunity, more than 21% use
  • College seniors – 32% have the opportunity, just over 16% use
  • When all 4 years are considered cumulatively, 62% of college students will have the opportunity to use ADHD prescription stimulants nonmedically, and 31% will use them.
  • College-age students are TWICE AS LIKELY to misuse prescription stimulants than other age groups.
  • Midterms and finals tend to trigger use – 40% of college students who use Adderall, Ritalin, or some other prescription stimulant do so during testing.
  • Greater than 90% of college students who take ADHD medications fake their symptoms to get prescriptions.
  • 9 out of 10 college students who take prescription ADHD drugs without a prescription are “heavy” drinkers and engage in episodic binge-drinking.
  • College students who used prescription ADHD drugs non-medically are:
    • 3X more likely to have smoked marijuana in the 12 months – 80% vs 27%
    • 8X more likely to have used cocaine29% vs 3.6%
    • 8X more likely to have misused benzodiazepines – 24.5% vs 3%
    • 5X times more likely to have misused prescription opioids45% vs 9%

Risks of ADHD Medication Abuse

What Are Some of the Risks of ADHD Medication Abuse?

Mild enjoyment while studying and nominal academic improvement seems a high price to pay for the risks accompanying ADHD stimulant misuse:

  • Sexual dysfunction
  • Anxiety
  • Sleep disturbances
  • Vision changes
  • Blisters on the skin
  • Digestive problems
  • Paranoia
  • Aggression
  • Psychosis
  • Seizures
  • For students – expulsion due to schools’ “zero-tolerance” policy
  • For everyone – Arrest and imprisonment – feigning ADHD symptoms to obtain a prescription fraudulently is a felony
  • Heightened risk of abuse of other substances
  • Dependency
  • Addiction
  • Overdose
  • Death

Because tolerances grow and addiction is progressive, long-term ADHD stimulant abusers may get trapped in a worsening downward prescription spiral—the stimulant medication for “cognitive improvement”, a prescription sedative for the resultant insomnia, and a benzodiazepine tranquilizer for anxiety.

All three types of medications—stimulants, sedatives, and benzodiazepines—are dangerously addictive. This cross-addiction can be one of the unexpected consequences of ADHD medication misuse.

What’s the Bottom Line – Adderall vs Ritalin/Concerta?

In terms of potential for misuse, Adderall seems to pose the biggest risk, for several reasons:

  • Adderall is stronger – One apropos analogy compared Ritalin to cocaine, and Adderall to methamphetamine. Although both illicit drugs are stimulants, meth is by far more powerful.
  • Adderall is ALREADY being abused more – At every monitored grade level, adolescents are misusing Adderall at a greater rate than they are Ritalin.  And the disparity grows with each passing year:
    • 8th grade – 1.7% vs 1.3%
    • 10th grade – 4.6% vs 2.6%
    • 12th grade – 6.5% vs 2.6%

But, at its core, the debate over which drug is more addictive is simply a matter of degree – both types of medications are highly addictive when used at high doses or nonmedically. Both profoundly affect the brain of abusers in negative ways. And, perhaps most dangerous of all, both are associated with a much higher likelihood of multi-substance abuse.

Why is that so dangerous?

75% of overdoses involve more than one substance, as do 98% of fatal overdoses.

The real bottom line is this – if you or someone you care about is misusing ADHD medication recreationally or for their supposed academic benefits, then you/they need specialized professional help so they can safely return to a balanced, substance-free life.

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Ritalin Vs Adderall Vs Concerta

July 8th, 2017|Comments Off on Ritalin Versus Adderall Versus Concerta: Which ADHD Drugs Pose the Most Risk for Abuse?
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