Ritalin: A Misclassified Drug According

Ritalin: A Misclassified Drug According to Science

Ritalin should be included in the DSM V because it meets the criteria for a medication that may cause substance dependence, misuse and abuse. Symptoms including intoxication and withdrawal symptoms are not uncommon with long-term use of this medication. As with many other medications, patients on Ritalin may need increasingly higher doses with time as their body adjusts to the medication, so it no longer works as well as it did before, or because the user no longer feels the drug is working as optimally as possible.

First & Pincus (2002) note the longer the interval between "major revisions of the DSM" will result in information that is "increasingly out of step with the psychiatric database" (p.288). The Text Revision that the APA published in 2000 was meant to help correct some of the problems associated with this. First & Pincus (2002) note that one of the more important parts of the DSM-IV is the text that accompanies the criteria for disorders and treatments for named disorders (p. 289). This textual information is important because it contains among other things, the "clinical presentation, course, prevalence" and other important matters including treatment of each disorder listed (First & Pincus, 2002, p.289).

The DSM-IV currently provides a list of 11 formulations for "substance abuse and dependency" which align with many practitioners experiences with the drug in question (Spitzer & Wakefield, 1999), however the list of drugs is not always complete as new information is increasingly introduced that impacts the text of the DSM-IV, hence the several modifications the DSM has undergone. Substance abuse for the most part according to the DSM-IV TR (2000) states that a drug that is capable of qualifying as one that might pose "substance abuse risk" is one that among other things results in behavioral problems, syndromes or other phenomenon leading to dependency and withdrawal. The DSM-IV-TR does not include a diagnosis for Ritalin withdrawal at this time; however there are many that suggest Ritalin withdrawal and substance abuse addition is important enough to warrant proper categorization in the DSM-IV. Withdrawal symptoms suggest the individuals using the drug may develop a tolerance for the medication or physical "need" for the substance as defined as a mental disorder or intolerance.

It is important to note the DSM-IV TR notes that to qualify for inclusion as a dependent drug the drug must create dependence inclusive of cognitive, behavioral and physiological symptoms (DSM-IV TR, 2000). The DSM-IV TR also notes that "diagnosis of dependence (for medication) can be made and applied to every class of substances except caffeine" (Sadock & Sadock, 2007, p.124). For this reason alone Ritalin should fall into the substance dependence category of medications used to treat mental disorders because it meets this criteria. Ritalin would qualify as substance abuse and substance misuse according to the U.S. Department of Health in a study noting the effects of Ritalin and other medications that may cause dependency and withdrawal (U.S. Department of Health and Human Services, 2006, p.2).

Ritalin is covered more in the way of a substance rather than a substance of abuse or a substance of misuse. Under this categorization it might as well be classified as a food supplement because the DSM-IV TR does not recognize the potential for misuse and abuse of the drug Ritalin. Despite this there is ample evidence that especially among children and young adults Ritalin abuse is quite high (Sadock & Sadock, 2007; Spitzer & Wakefield, 1999; U.S. Department of Health and Human Services, 2006). There are similar medications in the DSM-IV that are categorized as substance abuse or misused medications, because there is clear evidence that users can abuse the substance or misuse it.

Why is Ritalin an "at risk" medication? Because it is easy to obtain and those that misuse it often do so without realizing the hazards associated with its use. Those that misuse it will do so for many reasons, which may include to feel less tired, to gain energy, or to get "high." Physical dependence and psychological dependence are common in drugs like Ritalin that affect certain core areas of the brain that can relate to the medication or chemical in a way that causes withdrawal symptoms if the medication is stopped abruptly.

Most doctors that prescribe Ritalin today caution patients to talk with them prior to discontinuation, and most will use a tapering system to wean patients from the medication so they do not experience withdrawal symptoms.

What I would like to see presented in the DSM-V work group committee members is a change in language so that Ritalin is classified as an agent that can result in dependency, misuse and abuse. This is especially true given the fact that it is often used as a street "drug" that has an amphetamine like reaction in individuals that use it without the need for it. People that use Ritalin that have a justified need for it may feel nothing except they are better able to concentrate, if the medication is working properly; however the medication is not tolerated the same in all people that use it. The work group committee members need simply to read and review the dozens of studies available that link misuse and abuse of Ritalin. The U.S. Department of Health and Human services note that even people that are legitimately prescribed a drug can develop physiological dependence especially when the medication is used over the long-term. Psychological dependence is more likely of individuals that have a history of addiction or related problems (U.S. Department of Health and Human Services, 2006, p.3). Some people realize they need an escalating does to increase their productivity or any sense of "euphoria" a drug may create.

Others may want to misuse the drug as an appetite suppressant, a habit that can be especially dangerous because Ritalin stimulates the central nervous system. Overuse of this medication by individuals that have or do not have a prescription may result in cardiovascular problems including heart attacks or stroke (U.S. Department of Health and Human Services). Doctors have an obligation to monitor patients for these effects. However, the DSM V and membership committee also have a duty to inform doctors of the danger of clinical dependency because many doctors including psychiatrists rely on the DSM-IV for information regarding a drug's uses. If doctors recognize the potential for harm they are less likely to prescribe the medication unless there is ample evidence the patient needs it to sustain the quality of their life.