In fact much of what Schwarz relays, like Dr. Just as uncanny, it reaches the same results that appeared in my more limited experiment back in Other essays here and there have mapped related human ground. And the moral hazard assumed by college kids and others who sell their own pills to people who end up in emergency rooms has barely been touched. All of which raises a question that might finally get a fair hearing now: Given these and other questions related to the prescription explosion, why do psychotropics still rule?
Some people who study drugs make the commonsensical point that every age has its chemical remedies of choice. A study in the Canadian Medical Association Journal , for instance, found that divorce essentially doubles the likelihood that a given child will be prescribed stimulants.
They, too, have smaller margins for domestic error than they did before. So many women perceive, and frequently report. Forget the debate about having it all. And the drug companies feel their pain. Not all of them, obviously enough, but many. Thus, school under the new family regimen becomes longer than ever before before- and after-care programs have exploded in tandem with stimulant use.
Districts overburdened by their role as parent substitutes respond by reining in whatever they can recess and exercise hours have been cut back in tandem with stimulant use. And so goes the continuing and mostly unseen squeeze on childhood.
Many are also without fathers, as everyone knows. Other products of interest Contact us. National Drug Intelligence Center a component of the U. Department of Justice. Ritalin, a trade name for the prescription drug methylphenidate, is a central nervous system stimulant. Its effects are similar to, but more potent than, caffeine and less potent than amphetamine. Ritalin often is prescribed to treat individuals mostly children who are diagnosed with ADD attention deficit disorder or ADHD attention deficit hyperactivity disorder.
Ritalin is abused for the stimulant effects it produces, including appetite suppression, wakefulness, euphoria, and increased focus and attentiveness. Ritalin is available in 5-, , and milligram tablets. The tablets typically are white or yellow in color. Ritalin 5 mg. DEA How is Ritalin obtained? The Ritalin that is abused in the United States typically is diverted from legitimate sources. In some cases abusers obtain the drug from peers, friends, or family members. Often individuals who have legitimate prescriptions sell or give away their supply.
To the contrary: Abuse statistics have flourished alongside the boom in Ritalin prescription-writing. Though it is quite true that elementary schoolchildren are unlikely to ingest extra doses of the drug, which is presumably kept away from little hands, a very different pattern has emerged among teenagers and adults who have the manual dexterity to open prescription bottles and the wherewithal to chop up and snort their contents a method that puts the drug into the bloodstream far faster than oral ingestion.
For this group, statistics on the proliferating abuse of methylphenidate in schoolyards and on the street are dramatic. According to the dea, for example, as early as Ritalin was the fastest-growing amphetamine being used "non-medically" by high school seniors in Texas.
In , reports DeGrandpre in Ritalin Nation , "children between the ages of 10 and 14 years old were involved in only about 25 emergency room visits connected with Ritalin abuse. In , just four years later, that number had climbed to more than visits, which for this group was about the same number of visits as for cocaine. From to , the dea reports, there were about 2, thefts of methylphenidate, most of them night break-ins at pharmacies — meaning that the drug "ranks in the top 10 most frequently reported pharmaceutical drugs diverted from licensed handlers.
Because so many teenagers and college students have access to it, methylphenidate is particularly likely to be abused on school grounds. He also runs, without comment, scores of individual abuse stories from newspapers across the country over several pages of his book. In Running on Ritalin, Diller cites several undercover narcotics agents who confirm that "Ritalin is cheaper and easier to purchase at playgrounds than on the street. In short, methylphenidate looks like an amphetamine, acts like an amphetamine, and is abused like an amphetamine.
Perhaps not surprisingly, those who value its medicinal effects tend to explain the drug differently. To some, Ritalin is to children what Prozac and other psychotropic "mood brightening" drugs are to adults — a short-term fix for enhancing personality and performance. But the analogy is misleading. Prozac and its sisters are not stimulants with stimulant side effects; there is, ipso facto, no black market for drugs like these.
Even more peculiar is the analogy favored by the advocates in chadd: that "Just as a pair of glasses help the nearsighted person focus," as Hallowell and Ratey explain, "so can medication help the person with add see the world more clearly.
What is methylphenidate "really" like? In some ways, one can argue, that after-lunch hit of low-dose methylphenidate is much like the big cup from Starbucks that millions of adults swig to get them through the day — but only in some ways. There is no dramatic upswing in hospital emergency room visits and pharmacy break-ins due to caffeine abuse; the brain being jolted awake in one case is that of an adult, and in the other that of a developing child; and, of course, the substance doing the jolting on all those children is not legally available and ubiquitous caffeine, but a substance that the dea insists on calling a Schedule II drug, meaning that it is subject to the same controls, and for the same reasons of abuse potential, as related stimulants and other powerful drugs like morphine.
T his mention of Schedule II drugs brings us to a second reason for the Ritalin explosion in this decade. That is the extraordinary political and medical clout of CHADD, by far the largest of the add support groups and a lobbying organization of demonstrated prowess. Founded in , chadd had, according to Diller, grown by to include 35, families and chapters nationally. Like most support groups in self-help America, CHADD functions partly as clearing-house and information center for its burgeoning membership — organizing speaking events, issuing a monthly newsletter Chadderbox , putting out a glossy magazine named, naturally enough, Attention!
Particular scrutiny is given to every legal and political development offering new benefits for those diagnosed with add. Diller quotes as representative one fundraising letter from , where the organization listed its chief goals and objectives as "conduct[ing] a proactive media campaign" and "challeng[ing] negative, inaccurate reports that demean or undermine people with add.
Certainly it was with missionary fervor that chadd, in , mounted an extraordinary campaign to make Ritalin easier to obtain. Methylphenidate, as mentioned, is a Schedule II drug.
That means, among other things, that the dea must approve an annual production quota for the substance — a fact that irritates those who rely on it, since it raises the specter, if only in theory, of a Ritalin "shortage.
Doctors, particularly those who prescribe Ritalin in quantity, are inconvenienced by this requirement. This petition was co-signed by the American Academy of Neurology, and it was also supported by other distinguished medical bodies, including the American Academy of Pediatrics, the American Psychological Association, and the American Academy of Child and Adolescent Psychiatry.
Nevertheless, he found himself dissenting strongly from the effort to decontrol it — an effort that, as he writes, was "unprecedented in the history of Schedule II substances" and "could have had a profound impact on the availability of the drug. The response from the dea, which appeared in the background report cited earlier, was harsh and uncompromising.
Instead, methylphenidate is routinely portrayed as a benign, mild stimulant that is not associated with abuse or serious effects. In reality, however, there is an abundance of scientific literature which indicates that methylphenidate shares the same abuse potential as other Schedule II stimulants. Sweden, for example, had methylphenidate withdrawn from the market in following a spate of abuse cases. Today, 90 percent of Ritalin production is consumed in the United States.
Yet whatever public embarrassment chadd and its supporters may have suffered on account of this setback turned out to be short-lived. Though it failed in the attempt to decontrol Ritalin in the end, the group withdrew its petition , on other legislative fronts CHADD was garnering one victory after another.
By the end of the s, thanks largely to chadd and its allies, an add diagnosis could lead to an impressive array of educational, financial, and social service benefits. In elementary and high school classrooms, a turning point came in with a letter from the U. Department of Education to state school superintendents outlining "three ways in which children labeled add could qualify for special education services in public school under existing laws," as Diller puts it.
As a result, add-diagnosed children are now entitled by law to a long list of services, including separate special-education classrooms, learning specialists, special equipment, tailored homework assignments, and more. The idea also means that public school districts unable to accommodate such children may be forced to pick up the tab for private education. In the field of higher education, where the first wave of Ritalin-taking students has recently landed, an add diagnosis can be parlayed into other sorts of special treatment.
Diller reports that add-based requests for extra time on sats, lsats, and mcats have risen sharply in the course of the s. A article in Forbes cites the example of Whittier Law School, which was sued by an add-diagnosed student for giving only 20 extra minutes per hourlong exam instead of a full hour. The school, fearing an expensive legal battle, settled the suit. It further undertook a preventive measure: banning pop quizzes "because add students need separate rooms and extra time.
Concessions have also been won by advocates in the area of college athletics. Today a letter from the team physician will suffice to allow an athlete to ingest Ritalin, even though that same athlete would be disqualified from participating in the Olympics if he were to test positive for stimulants.
Nor are children and college students the only ones to claim benefits in the name of add. With adults now accounting for the fastest-growing subset of add diagnoses, services and accommodations are also proliferating in the workplace. The enabling regulations here are guidelines from the Equal Employment Opportunity Commission EEOC which linked traits like chronic lateness, poor judgment, and hostility to coworkers — in other words, the sorts of traits people get fired for — to "psychiatric impairments," meaning traits that are protected under the law.
As one management analyst for the Wall Street Journal recently observed and as CHADD regularly reminds its readers , these eeoc guidelines have already generated a list of accommodations for add-diagnosed employees, including special office furniture, special equipment such as tape recorders and laptops, and byzantine organizational schemes color coding, buddy systems, alarm clocks, and other "reminders" designed to keep such employees on track.
Most of the benefits now available, as even this brief review indicates, have come to be provided in principle, on account of the diagnosis per se. Seen this way, and taking the class composition of the add-diagnosed into account, it is no wonder that more and more people, as Diller and many other doctors report, are now marching into medical offices demanding a letter, a diagnosis, and a prescription.
The pharmacological charms of Ritalin quite apart, add can operate, in effect, as affirmative action for affluent white people. A nother factor that has put Ritalin into millions of medicine cabinets has to do with the protean nature of the disorder for which it is prescribed — a disorder that was officially so designated by the American Psychiatric Association in , and one that, to cite Thomas Armstrong, "has gone through at least 25 different name changes in the past century.
Despite the successful efforts to have add construed as a disability like blindness, the question of what add is remains passionately disputed. To CHADD, of course, it is a "neurobiological disorder," and not only to CHADD; "the belief that add is a neurological disease," as Diller writes, also "prevails today among medical researchers and university teaching faculty" and "is reflected in the leading journals of psychiatry.
Nonetheless, the effort to produce such evidence has been prodigious. Research on the neurological side of add has come to resemble a Holy Grail-like quest for something, anything, that can be said to set the add brain apart — genes, imbalances of brain chemicals like dopamine and serotonin, neurological damage, lead poisoning, thyroid problems, and more.
The most famous of these studies, and the chief grounds on which add has come to be categorized as a neurobiological disability, was reported in The New England Journal of Medicine in by Alan Zametkin and colleagues at the National Institute of Mental Health NIMH. These researchers used then-new positron emission tomography PET scanning to measure differences in glucose metabolizing between hyperactive adults and a control group.
Diller and DeGrandpre are only the latest to argue, at length, that the Zametkin study established no such thing. For starters — and from the scientific point of view, most important — a series of follow-up studies, as Diller documents, "failed to confirm" the original result. DeGrandpre, for his part, details the methodological problems with the study itself — that the participants were adults rather than children, meaning that the implications for the majority of the Ritalin-taking population were unclear at best; that there was "no evidence" that the reported difference in metabolism bore any relationship to behavioral activity; that the study was further plagued by "a confounding variable that had nothing to do with ADD," namely that the control group included far fewer male subjects than the add group; and that, even if there had been a valid difference in metabolism between the two groups, "this study tells us nothing about the cause of these differences.
Numerous other attempts to locate the missing link between add and brain activity are likewise dissected by Diller and DeGrandpre in their books. So too is the causal fallacy prevalent in add literature — that if a child responds positively to Ritalin, that response "proves" that he has an underlying biological disorder. This piece of illogic is easily dismissed. As these and other authors emphasize, drugs like Ritalin have the same effect on just about everybody. Give it to almost any child, and the child will become more focused and less aggressive — one might say, easier to manage — whether or not there were "symptoms" of ADD in the first place.
In sum, and as Thomas Armstrong noted four years ago in The Myth of the ADD Child , ADD remains an elusive disorder that "cannot be authoritatively identified in the same way as polio, heart disease, or other legitimate illnesses.
To cite Armstrong again: "there is no prime mover in this chain of tests; no First Test for add that has been declared self-referential and infallible. A popular CPT is the Gordon Diagnostic System, a box that flashes numbers, whose lever is supposed to be pressed every time a particular combination appears. In the absence of any positive medical or scientific test, the diagnosis of add in both children and adults depends, today as a decade ago, almost exclusively on behavioral criteria.
To read the list is to understand why boys are diagnosed with add three to five times as often as girls. The diagnostic latitude offered by this list is obvious; as Diller understates the point, "what often strikes those encountering dsm criteria for the first time is how common these symptoms are among children" generally. The dsm criteria for adults are if anything even more expansive, and include such ambiguous phenomena as a sense of underachievement, difficulty getting organized, chronic procrastination, a search for high stimulation, impatience, impulsivity, and mood swings.
Their questions range from the straightforward "Are you impulsive? Thus the business of diagnosing add remains, as Diller puts it, "very much in the eye of the beholder. This conference, as newspapers reported at the time, broke no new ground, and indeed could not reach agreement on several important points — for instance, how long children should take drugs for add, or whether and when drug treatment might become risky.
Even more interesting, conference members could not agree on what is arguably the rather fundamental question of how to diagnose the disorder in the first place. As one panelist, a pediatrician, put it succinctly, "The diagnosis is a mess. In a stab at methodological soundness, I had equal numbers of males and females take the test.
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