ad/hd medication abuse

AD/HD Medication

AbuseHannah Jayne Harris, M.A.

andRoss Barr

The School of Professional Psychology at Forest Institute

DSM-IV-TR Diagnostic Criteria

O A. Either (1) or (2): O (1) Inattention: six (or more) of the following symptoms of

inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level: O (a) often fails to give close attention to details or makes careless

mistakes in schoolwork, work, or other activities O (b) often has difficulty sustaining attention in tasks or play activities O (c) often does not seem to listen when spoken to directly O (d) often does not follow through on instructions and fails to finish

school work, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)

O (e) often has difficulty organizing tasks and activities O (f) often avoids, dislikes, or is reluctant to engage in tasks that require

sustained mental effort (such as schoolwork or homework) O (g) often loses things necessary for tasks or activities (e.g., toys, school

assignments, pencils, books, or tools) O (h) is often easily distracted by extraneous stimuli O (i) is often forgetful in daily activities


O (2) hyperactivity-impulsivity: six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level: O Hyperactivity

O (a) often fidgets with hands or feet or squirms in seat O (b) often leaves seat in classroom or in other situations in which

remaining seated is expected O (c) often runs about or climbs excessively in situations in which it is

inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)

O (d) often has difficulty playing or engaging in leisure activities quietly (e) is often "on the go" or often acts as if "driven by a motor"

O (f) often talks excessively O Impulsivity

O (g) often blurts out answers before questions have been completed (h) often has difficulty awaiting turn

O (i) often interrupts or intrudes on others (e.g., butts into conversations or games)


O B. Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years.

O C. Some impairment from the symptoms is present in two or more settings (e.g., at school [or work] and at home).

O D. There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.

O E. The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder and are not better accounted for by another mental disorder (e.g., Mood Disorder, Anxiety Disorder, Dissociative Disorders, or a Personality Disorder).

State-Based Prevalence Data of AD/HD Diagnosis

http://www.cdc.gov/ncbddd/adhd/prevalence.html

Comprehensive Treatment Approach

O Multimodal Treatment PlanO EducationalO BehavioralO Psychological O Medical

State-Based Prevalence Data of AD/HD Medication Treatment

http://www.cdc.gov/ncbddd/adhd/medicated.html

AD/HD MedicationsO Amphetamine Stimulants

O AdderallO DexedrineO Vyvanse

O Methylphenidate StimulantsO FocalinO MethylinO RitalinO Concerta

O Non-StimulantsO StratteraO Intuniv

O AntidepressantsO Wellbutrin

Why amphetamines and methylphenidate???

O Increase the activity of dopamine in the nucleus accumbens and the ventral tegmental area of the midbrain (Babcock & Byrne, 2000)

O These areas are part of the reward pathway

http://ibgwww.colorado.edu/cadd/a_drug/essays/essay4.htm

Mouse PartyO Cocaine also blocks dopamine

reuptake leading to increased excitationO http://

learn.genetics.utah.edu/content/addiction/drugs/mouse.html

http://learn.genetics.utah.edu/content/addiction/drugs/mouse.html



Some numbers…O In the United States, approximately 8% of

children ages 4 – 17 have been diagnosed with AD/HD

O In 2007, 66.3% of children age 4 – 17 diagnosed with AD/HD were receiving some form of medication as a part of their treatment

O From 1998 – 2005, calls to the American Association of Poison Control Center’s National Poison Data System related to adolescent abuse of AD/HD medication rose 76%

(Setlik et al, 2009)

Monitoring the Future (www.monitoringthefuture.org)

O Yearly assessment of the extent of drug use among high school students, college students and young adults

O Asks about the use of amphetamines and methylphenidate in the year preceding the survey

O 2003 Results: O 5.7% of college students reported non-

medical use of methylphenidate compared to 2.5% of non-college students of the same age

http://www.monitoringthefuture.org/

McCabe, Knight, Teter & Wechsler, 2005

O 10,904 college students from 119 four-year colleges in the United StatesO 6.9% reported non-medical use of

prescription stimulants in their lifetime

O 4.1% in the last yearO 2.1% in the last month

McCabe, Knight, Teter & Wechsler, 2005

O Groups more likely to report non-medical use of prescription stimulantsO Men O Caucasian students O Fraternity and sorority members O Students with a B average or lower O Students at colleges in the Northeastern

United States O Students at colleges with competitive or

highly competitive admissions criteria

Jardin, Looby & Earleywine, 2011

O 43 undergraduate students O All with prescriptions for Ritalin or

AdderallO GOAL: Determine characteristics of

students with AD/HD who were likely to abuse their prescription medications

Jardin, Looby & Earleywine, 2011

O Findings:O 45% misused prescriptions

O 27.9% altered route of administrationO 62.8% took dose higher than

recommendedO 23.3% mixed medications with alcoholO 48.8% gave or sold medication

O Misusers were significantly more likely to report lifetime use of nicotine, marijuana, cocaine, hallucinogens, and opiates

Upadhyaya, et. al., 2010

O Primary Motivation for misuse among nonmedical users aged 18-25O 64.7% - performance enhancement

O 23.7% - to stay awakeO 40.9% - to be more productiveO 2.9% - relaxation

O 31.1% - recreational funO 8.8% - for fun, kicks or excitementO 16.7% - to feel good or get highO 5.6% - to have a good time with friends

College students are able to justify

their illegal use of AD/HD

medications.

DeSantis & Hane, 2010 O In-depth interviews O 175 undergraduate students at a

large Southeastern universityO GOAL: Identify how students view

ADHD stimulants and their illegal useO Discovered that there seemed to be

a “popular, socially constructed storyline” created by students

Four Basic ArgumentsO Comparison and ContrastO All Things in ModerationO Self MedicatingO Minimization Arguments

DeSantis & Hane, 2010

Basic Arguments

O “I’m doing it for the right reasons”

O It comes from a medical establishment

O There’s no highO There aren’t any

internal or physical side effects

1. Comparison and Contrast

2. All Things In Moderation

3. Self Medicating4. Minimization

Arguments


Basic Arguments

O Non-medical use was occasional and students felt little or no anxiety over it

O Primarily use during periods of high academic stress

O “I don’t use as much as…”




Arguments


Basic Arguments O Students claim to

have AD/HD and believe that taking stimulants is morally and physiologically okay




Arguments


Basic Arguments

O Minimizing severity of the non-medical use of stimulantsO HarmlessO BenignO Socially

acceptable anti-fatigue aid

O It’s just as safe as coffee




Arguments


What happens when you overdose?

O High blood pressure

O Irregular heart beat

O SeizuresO TwitchingO Uncontrolled

movements

O Sweating O Dry mouthO Dry eyesO VomitingO Death

http://kidshealth.org/teen/drug_alcohol/drugs/ritalin.html#

Large Doses Over Long Periods of Time

O Increased heart rate

O Increased blood pressure

O TremorsO Irregular

Breathing

O Changes in moodO ConfusionO ParanoiaO HallucinationsO Delusions

http://kidshealth.org/teen/drug_alcohol/drugs/ritalin.html#

http://youtu.be/kW0gqTIY3mQ

http://youtu.be/kW0gqTIY3mQ

So what should we do?O AttackO AddressO TargetO EducateO Dispel


So what should we do?O Attack

O Attack the illusion that the use of prescription medication is safe


So what should we do?O AttackO Address

O Address the erroneous belief that AD/HD stimulants have no harmful physical side effects


So what should we do?O AttackO AddressO Target

O Target the misconception that illegally using or distributing a Schedule II amphetamine in moderation is safe.


So what should we do?O AttackO AddressO TargetO Educate

O Educate illegal users as to what AD/HD actually is.


So what should we do?O AttackO AddressO TargetO EducateO Dispel

O Dispel the belief that AD/HD medications are nothing more than a stiff cup of coffee or a can of coke.


And finally…O “Appropriate diagnosis, treatment and

therapeutic monitoring of college students who are receiving prescription psychostimulants is crucial, not only to improve clinical outcomes but also to help prevent the abuse of these medications within a population that is largely responsible for their own medication management.” (McCabe et al, 2005, p. 104)

Questions???

ReferencesCenter for Disease Control and Prevention. (n.d.) Attention-deficit/hyperactivity disorder. Retrieved from http://www.cdc.gov/ncbddd/adhd/

Babcock, Q. & Byrne, T. (2000). Student perceptions of methylphenidate abuse at a public liberal arts college. Journal of American College Health, 49, 143-145. doi: 10.1080/07448480009596296

DeSantis, A.D. & Hane, A.C. (2010). “Adderall is definitely not a drug”: Justifications for the illegal use of ADHD stimulants. Substance Use & Misuse, 45, 31-46. doi: 10.3109/10826080902858334

Frauger, E., Pauly, V., Natali, F., Pradel, V., Reggio, P., Coudert, H., … Micallef, J. (2011). Patterns of methylphenidate use and assessment of its abuse and diversion in two French administrative areas using a proxy of deviant behavior determined from a reimbursement database. CNS Drugs, 25(5), 415-424. doi: 10.2165/11587640- 000000000-00000

Giardino, W.J., Pastor, R., Anacker, A.M.J., Spangler, E., Cote, D.M., Li, J., …Ryabinin, A.E. (2011). Dissection of corticotropin-releasing factor system involvement in locomotor sensitivity to methamphetamine. Genes, Brain and Behavior, 10, 78-89. doi: 10.1111/j.1601- 183X.2010.00641.x

ReferencesJardin, B., Looby, A., & Earleywine, M. (2011). Characteristics of college students with attention- deficit/hyperactivity disorder symptoms who misuse their medications. Journal of American College Health, 59(5), 373-377. doi: 10.1080/07448481.2010.513073

Looby, A. & Earleywine, M. (2011). Expectation to receive methylphenidate enhances subjective arousal but not cognitive performance. Experimental and Clinical Psychopharmacology, 19(6), 433-444. doi: 10.1037/a0025252

McCabe, S.E., Knight, J.R., Teter, C.J. & Wechsler, H. (2005). Non-medical use of prescription stimulants among US college students: Prevalence and correlates from a national survey. Addiction, 99, 96-106. doi: 10.1111/j.1360-0443.2004.00944.x

National Institute on Drug Abuse. (2009). Stimulant ADHD medications: Methylphenidate and amphetamines. Retrieved from http://www.drugabuse.gov/publications/infofacts/stimulant-adhd-medications-methylphenidate-amphetamines

National Resource Center on AD/HD. (2011). Managing Medication for Children and Adolescents with AD/HD. Retrieved from http://www.help4adhd.org/documents/WWK3.pdf

ReferencesSetlik, J., Bond, G.R., & Mona, H. (2009). Adolescent prescription ADHD medication abuse is rising along with prescriptions for these medications. Pediatrics, 124, 875-880. doi: 10.1542/peds.2008-0931

Upadhyaya, H.P., Kroutil, L.A., Deas, D. Durell, T.M., Van Brunt, D.L. & Novak, S.P. (2010). Stimulant formulation and motivation for nonmedical use of prescription attention- deficit/hyperactivity disorder medications in college-aged population. The American Journal on Addictions, 19, 569-577. doi: 10.1111/j.1521-0391.2010.00078.x

Williams, R.J., Goodale, L.A., Shay-Fiddler, M.A., Gloster, S.P., & Chang, S.Y. (2004). Methylphenidate and dextroamphetamine abuse in substance-abusing adolescents. The American Journal on Addictions, 13, 381-389. doi: 10.1080/10550490490483053

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