AD/HD Medication Abuse Hannah Jayne Harris, M.A. and Ross Barr
The School of Professional Psychology at Forest Institute
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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
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DSM-IV-TR Diagnostic Criteria 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)
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DSM-IV-TR Diagnostic Criteria 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).
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State-Based Prevalence Data of AD/HD Diagnosis
http://www.cdc.gov/ncbddd/adhd/prevalence.html
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Comprehensive Treatment Approach O Multimodal Treatment Plan O
Educational O Behavioral O Psychological O Medical
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State-Based Prevalence Data of AD/HD Medication Treatment
http://www.cdc.gov/ncbddd/adhd/medicated.html
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AD/HD Medications O Amphetamine Stimulants O Adderall O
Dexedrine O Vyvanse O Methylphenidate Stimulants O Focalin O
Methylin O Ritalin O Concerta O Non-Stimulants O Strattera O
Intuniv O Antidepressants O Wellbutrin
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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
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Mouse Party O Cocaine also blocks dopamine reuptake leading to
increased excitation O http://learn.genetics.utah.edu/content/addic
tion/drugs/mouse.html http://learn.genetics.utah.edu/content/addic
tion/drugs/mouse.html
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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 Centers National
Poison Data System related to adolescent abuse of AD/HD medication
rose 76% (Setlik et al, 2009)
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Monitoring the Future
(www.monitoringthefuture.org)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
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McCabe, Knight, Teter & Wechsler, 2005 O 10,904 college
students from 119 four-year colleges in the United States O 6.9%
reported non-medical use of prescription stimulants in their
lifetime O 4.1% in the last year O 2.1% in the last month
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McCabe, Knight, Teter & Wechsler, 2005 O Groups more likely
to report non-medical use of prescription stimulants O 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
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Jardin, Looby & Earleywine, 2011 O 43 undergraduate
students O All with prescriptions for Ritalin or Adderall O GOAL:
Determine characteristics of students with AD/HD who were likely to
abuse their prescription medications
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Jardin, Looby & Earleywine, 2011 O Findings: O 45% misused
prescriptions O 27.9% altered route of administration O 62.8% took
dose higher than recommended O 23.3% mixed medications with alcohol
O 48.8% gave or sold medication O Misusers were significantly more
likely to report lifetime use of nicotine, marijuana, cocaine,
hallucinogens, and opiates
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Upadhyaya, et. al., 2010 O Primary Motivation for misuse among
nonmedical users aged 18-25 O 64.7% - performance enhancement O
23.7% - to stay awake O 40.9% - to be more productive O 2.9% -
relaxation O 31.1% - recreational fun O 8.8% - for fun, kicks or
excitement O 16.7% - to feel good or get high O 5.6% - to have a
good time with friends
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Slide 19
DeSantis & Hane, 2010 O In-depth interviews O 175
undergraduate students at a large Southeastern university O GOAL:
Identify how students view ADHD stimulants and their illegal use O
Discovered that there seemed to be a popular, socially constructed
storyline created by students
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Four Basic Arguments O Comparison and Contrast O All Things in
Moderation O Self Medicating O Minimization Arguments DeSantis
& Hane, 2010
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Basic Arguments O Im doing it for the right reasons O It comes
from a medical establishment O Theres no high O There arent any
internal or physical side effects 1. Comparison and Contrast 2. All
Things In Moderation 3. Self Medicating 4. Minimization Arguments
DeSantis & Hane, 2010
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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 dont use as much as 1. Comparison and
Contrast 2. All Things In Moderation 3. Self Medicating 4.
Minimization Arguments DeSantis & Hane, 2010
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Basic Arguments O Students claim to have AD/HD and believe that
taking stimulants is morally and physiologically okay 1. Comparison
and Contrast 2. All Things In Moderation 3. Self Medicating 4.
Minimization Arguments DeSantis & Hane, 2010
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Basic Arguments O Minimizing severity of the non-medical use of
stimulants O Harmless O Benign O Socially acceptable anti-fatigue
aid O Its just as safe as coffee 1. Comparison and Contrast 2. All
Things In Moderation 3. Self Medicating 4. Minimization Arguments
DeSantis & Hane, 2010
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What happens when you overdose? O High blood pressure O
Irregular heart beat O Seizures O Twitching O Uncontrolled
movements O Sweating O Dry mouth O Dry eyes O Vomiting O Death
http://kidshealth.org/teen/drug_alcohol/drugs/ritalin.html#
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Large Doses Over Long Periods of Time O Increased heart rate O
Increased blood pressure O Tremors O Irregular Breathing O Changes
in mood O Confusion O Paranoia O Hallucinations O Delusions
http://kidshealth.org/teen/drug_alcohol/drugs/ritalin.html#
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http://youtu.be/kW0gqTIY3mQ
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So what should we do? O Attack O Address O Target O Educate O
Dispel DeSantis & Hane, 2010
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So what should we do? O Attack O Attack the illusion that the
use of prescription medication is safe DeSantis & Hane,
2010
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So what should we do? O Attack O Address O Address the
erroneous belief that AD/HD stimulants have no harmful physical
side effects DeSantis & Hane, 2010
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So what should we do? O Attack O Address O Target O Target the
misconception that illegally using or distributing a Schedule II
amphetamine in moderation is safe. DeSantis & Hane, 2010
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So what should we do? O Attack O Address O Target O Educate O
Educate illegal users as to what AD/HD actually is. DeSantis &
Hane, 2010
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So what should we do? O Attack O Address O Target O Educate O
Dispel O Dispel the belief that AD/HD medications are nothing more
than a stiff cup of coffee or a can of coke. DeSantis & Hane,
2010
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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)
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Questions???
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References Center 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
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References Jardin, 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
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References Setlik, 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