Stimulant medications have a number of medicinal uses. One of the significant breakthroughs in the treatment of attention deficit hyperactivity disorder (ADHD) was the discovery that stimulant medications help these individuals curb their behaviors and impulsivity, and focus better. As a result, a number of medications have been used to treat ADHD.
Uses of Methylphenidate
One such medication is Concerta, which contains the extended-release form of the central nervous system stimulant methylphenidate. Ritalin is also a drug that is used to treat ADHD and also contains methylphenidate; however, Ritalin is an immediate-release form. Both Ritalin and Concerta are taken orally. In addition, Daytrana is a medicated patch form of methylphenidate that may be used by some individuals for the treatment of ADHD.
The difference between Concerta and Ritalin is that Concerta is released over time, and Ritalin releases all of the methylphenidate into the system at once. Because the effects of Ritalin will wear off, individuals need to take several doses during the day. This can be problematic for children in school because teachers need to administer the medication around lunchtime to these children. The use of Concerta takes any responsibility off the teacher for maintaining the child’s dosage of the medication.
Methylphenidate has other uses, such for narcolepsy, and it may have utility in helping individuals who work at very long and tenuous tasks to remain focused.
Methylphenidate intensifies levels of norepinephrine and dopamine in the central nervous system. The activation and facilitation of dopamine is also associated with a number of reinforcing and pleasant effects. Dopamine is a neurotransmitter that is involved in almost all forms of drug abuse, either as a result of the substance directly acting on dopamine or indirectly activating dopamine. As a result, methylphenidate is categorized as a controlled substance by the United States Drug Enforcement Administration (DEA).
It is classified as a Schedule II controlled substance. This is the highest category of drugs in the DEA classification that can be legally used for medicinal purposes but still has the potential for abuse and the development of physical dependence. Other drugs in this category include powerful narcotic medications, such as morphine or Vicodin, and even stimulants like cocaine. Drugs classified at the next and highest level, as Schedule I substances, are designated as having no medicinal value, and they cannot be legally obtained except under special circumstances and with special permissions by the government (usually for research purposes). Thus, as a Schedule II controlled substance methylphenidate, while having medicinal purposes, is considered to be a substance with significant risks and should only be used under the strict supervision of a physician. Concerta can only be legally obtained with a prescription from a physician.
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), in 2015, about 1.7 million Americans over the age of 12 admitted to misusing prescription stimulant medications. The University of Michigan’s 2015 Monitoring the Future survey results indicate that 2 percent of 12th graders reported abusing methylphenidate within the year prior to the survey.Several research studies have investigated the demographics associated with individuals who are most likely to abuse Concerta, Ritalin, and similar stimulants like Adderall. The findings suggest that abusers of prescription stimulants:
- Very often get the drug from a relative or friend
- Commonly begin abusing drugs like Concerta in an effort to improve their grades in school
- Are often college students or college graduates who feel that they work under tremendous pressure, and stimulant medications allow them to work at their studies or job for lengthy periods of time
- Are likely to use drugs like Concerta in conjunction with alcohol, marijuana, and other prescription medications, particularly narcotic pain medications
- Use the drugs in a manner that is inconsistent with their prescribed uses, commonly grinding up the pills and snorting them
An individual who abuses Concerta is in danger of developing a stimulant use disorder as defined by the American Psychiatric Association (APA). Symptoms of a stimulant use disorder are outlined below.
- The person frequently uses the stimulant for nonmedicinal reasons.
- Use of the stimulant leads to distress in the person’s life or difficulty carrying out the normal routine of their life.
- The use of the stimulant (Concerta) is associated with a loss of control, such that the individual:
- Uses it more frequently or in greater amounts than they often intend to use it
- Continues to use the drug even though its use results in problems with their personal relationships, school, occupation, or in other important areas of their life
- Is unable to cut down or stop use of the drug
- Begins to neglect important obligations as a result of using Concerta
- Continues to use Concerta even though they are aware that their use of the drug is negatively impacting their health or emotional functioning
- Gives up activities that were once important to them as a result of using Concerta or in favor of using Concerta
- Spends a significant amount of time trying to get Concerta, using it, or recovering from its use
- The person experiences very frequent urges to use Concerta.
- The person frequently uses Concerta in situations where it is dangerous, such as while operating machinery, in conjunction with other potentially dangerous drugs, with alcohol, while driving a car, etc.
- The person develops tolerance to Concerta, meaning they have to take higher doses to feel its effects.
- When the person stops using Concerta, they experience withdrawal symptoms.
Prolonged use or abuse of Concerta is associated with the development of physical dependence on the drug. Individuals who are using Concerta under the supervision of a physician and according to the instructions of use will also develop physical dependence on Concerta; however, these individuals do not qualify for diagnosis of a stimulant use disorder because they are not using the drug for nonmedicinal reasons.
Some other signs are not formal diagnostic symptoms, but they are associated with an individual who is abusing Concerta.
- The individual frequently obtains Concerta illegally.
- The individual uses Concerta in a manner that is inconsistent with its prescribed uses, such as grinding up and snorting it, taking it in amounts greater than would normally be prescribed, mixing it with other drugs, etc.
- The individual displays alternating periods of energy, talkativeness, and increased sociability, and/or decreased need for sleep, followed by periods of lethargy, sleepiness, isolation, and depression.
- Empty prescription bottles are frequently found on the individual’s person or in their belongings.
- When someone attempts to discuss the individual’s use of Concerta with them, they become very angry and/or defensive.
- Signs of snorting Concerta are present, such as frequently having a runny nose, redness around the nose, nosebleeds, etc.
Side Effects of Concerta Abuse
Central nervous system stimulants like Concerta have important medicinal uses when taken at low doses and within therapeutic range; however, individuals who abuse them may develop a number of untoward side effects that include:
- Cardiovascular problems: Long-term abuse of Concerta can potentially result in issues with increased blood pressure, heartbeat abnormalities, and an increased potential to develop stroke or heart attack.
- Other organ damage: Long-term use of Concerta may result in issues with the stomach, liver, and/or kidneys.
- Neurological complications: Long-term use of Concerta may lead to issues with tremors, engaging in repeated but nonfunctional motor actions (e.g., tics), increased potential to develop seizures, and cognitive issues that can include issues with attention, problem-solving, and memory.
- Psychiatric issues: Aside from developing a substance use disorder, individuals may also develop severe apathy or depression; delusional behavior, such as delusions of grandeur or paranoid delusions; increased hostility; and hallucinations.
- Inattention to self-management: Individuals with chronic substance use disorders often fail to totally maintain their personal hygiene, and this may result in increased susceptibility to illness and disease.
Treatment for a Stimulant Use Disorder
Individuals with chronic substance use disorders, such as a stimulant use disorder, most often require some form of professional intervention to recover. Initially, this may include medical detox in order to help them safely negotiate the withdrawal symptoms they are likely to experience once they stop using Concerta and to avoid relapse associated with the cravings that occur during withdrawal. Medical detox can help the individual get through the process of withdrawal comfortably and avoid relapse; however, the program has no utility in avoiding relapse once the individual has completed it. Instead, the individual must become involved in a professionally organized substance use disorder treatment program. Such a program should consist of:
- The identification of any co-occurring psychiatric disorders or health issues, typically done through a comprehensive assessment in the beginning stages of the treatment process
- Medical and psychological treatment and management of any co-occurring issues, as needed
- Formal substance use disorder therapy, typically Cognitive Behavioral Therapy that assists the individual in understanding their own substance use disorder, and changing their thinking patterns and behaviors in a manner consistent with a positive recovery
- Social support via family support and participation in peer support groups, like 12-Step meetings
- Any other special interventions, as needed
Individuals often report that they get more satisfaction from their lives in recovery than they ever did from abusing their substance of choice. Many of these recovering individuals report the following:
- Even though they abused drugs like Concerta to gain control over their lives, they find they have more control over their lives without using the drug.
- They are better able to experience pleasure, even though they thought their substance abuse was giving them pleasure.
- They are better able to define their goals and other long-term desires, such as career goals, relationship goals, etc.
- They are able to improve relationships with those they harmed during addiction, and they are able to form new relationships with others who are supportive of their recovery.