Name Calling, Insults and Teasing

A Guide To Anger, Conflict and Respect

The Myth of Ritalin’s Effectiveness

In a recent post titled ADHD and Psychiatric Name Calling, I reviewed studies documenting how much is currently being spent annually on ADHD drug treatments. Here are some new numbers provided by Healthline: ADHD-Costs What are we getting for this? For students placed on Ritalin or other stimulant drugs, in short term studies teachers and parents report some improvement in behavior. However, even in the short term, there is no improvement on academic functioning. At the end of 14 months, drug treatment was not superior than no-drug treatment on the following measures: classroom observed behaviour, parent- and teacher-rated social skills, parent-rated parent–child relationships, peer sociometric ratings, and academic achievement. By the end of three years there was no significant effects of the drugs on any measure. stomach and head painAnd yet, parents who undeniably care about their children, regularly expose their children to the side effects of these drugs, as well as potential long term risks.  Why?  Because they are convinced that the helpfulness of the drugs outweigh those negatives.

What is it about these drugs that create the myth that the drugs are really helping their children? To understand how this myth is created, it will help if we first take a quick look at how people come to believe smoking cigarettes helps them to deal with stress, and drinking caffeinated coffee helps them to be more productive.

The Myth that Cigarette Smoking Reduces Stress.

In a study published in the American Psychologist, researchers found the following:

smokingSmokers often report that cigarettes help relieve feelings of stress. However, the stress levels of adult smokers are slightly higher than those of nonsmokers, adolescent smokers report increasing levels of stress as they develop regular patterns of smoking, and smoking cessation leads to reduced stress. Far from acting as an aid for mood control, nicotine dependency seems to exacerbate stress. This is confirmed in the daily mood patterns described by smokers, with normal moods during smoking and worsening moods between cigarettes. Thus, the apparent relaxant effect of smoking only reflects the reversal of the tension and irritability that develop during nicotine depletion. Dependent smokers need nicotine to remain feeling normal. The message that tobacco use does not alleviate stress but actually increases it needs to be far more widely known. 

This paragraph just provides a summary of the research article that leads to its conclusion.  In my view, the whole article lays out a very convincing argument that the relief from a drug withdrawal reaction that occurs each time a person ingests the drug can create the illusion that a drug is helpful.  Moreover, I believe that this same argument can also be used to explain how a stimulant such as Ritalin can appear to be helpful even when it is not. Before we get to Ritalin, however, let’s first turn our attention to America’s favorite stimulant, caffeine.

My Personal Experience with Caffeine

coffeeWhen I was 18, I started college.  My first class began at 8 a.m.  Ugh!  That meant waking up around 6 a.m. so I could wash up, have breakfast, and take the hour train ride.

Sitting down for breakfast, I decided to have my first cup of coffee.  Both my parents drank coffee in the morning and throughout the day, too.  I had heard that it gave you a boost when you were tired, and man, I was tired.

My first sip tasted rather bitter, so I dumped a couple of teaspoons of sugar in.  Much better.  Then came a little pleasant “up” sensation, but it was accompanied with a little stomach distress.  Oh, well.  Off I went and it wasn’t long after that I was drinking coffee regularly.

coffee3As I entered into my twenties, I began to notice that in the morning before I got my first cup, I was irritable and struggling with sleepiness. With the first sips, ahhhh, relief.

In addition to my morning cups, I’d have a cup typically around 10 a.m., a cola with lunch, which has some caffeine in it, and a couple of cups after supper with dessert.

During my thirties, I began to develop headaches.  I attributed them to stress.

coffee2By the time I was forty, the headaches became so bad that I went to a physician who prescribed some pills.  I don’t like taking pills, but the headaches were so bad that I thought maybe I should give them a try.

Before filling the prescription, I looked up information about it and found the prescribed pills were made entirely of caffeine.  Then, I looked at the side effects and found that one of them was headaches. This surprised me.

Since I was already consuming caffeine throughout the day, and a side effect of caffeine was headaches, I thought maybe instead of taking the pills, the first thing I should try was to stop consuming caffeine.

Wow!  Giving up coffee was not easy.  For several days I went through a very rough period of headaches, feelings of depression, difficulty sleeping, and my brain seemed to be meandering through thick mud.

In retrospect, perhaps I should have tried tapering off coffee, reducing each week one cup at a time.  But I did make it through the morass, and in a couple of weeks I was fine.  And ever since, I no longer get any headaches.

coffee4More surprising is that when I wake up in the morning, by the time I wash up and sit down for breakfast, I’m every bit as awake as I used to become when I had finished my morning coffee.  It is now clear to me that the exhausted, irritable feelings that I used to have before I gave up coffee was due to a caffeine withdrawal effect from going a whole night without having any.  Throughout the day, I now find that I have a smoother ride and I am every bit as productive as I used to be when I was a coffee drinker.

The Myth of Ritalin’s Effectiveness

Ritalin, and most other drug treatments for “ADHD” are stimulants.  And just as I came to mistakenly believe coffee helped me to be more productive, I think Ritalin’s effects lead to the same mistaken conclusion.  And just like I didn’t attribute the side effects of caffeine to my coffee drinking, I think parents don’t realize how much of their child’s sleeping problems, headaches, late afternoon miseries are due to the drugs. And when parents try to withdraw their children from the drugs to see if it is really helping, as the withdrawal effects begin to become worse and worse, parents come to think that this is how their children naturally are when they don’t take the drugs.

Now, there is more to this story than I can reveal in a single post.  For example, other factors that lead to parents thinking these drugs are more effective than they actually are is the clever advertisement of the drug companies.  Moreover, in some cases, children, as they become older, typically mature at a certain pace.  Thus, some children viewed as having ADHD problems completely grow out of these problems without any drug treatment.  If this growth in maturity occurs shortly after a child begins to take the drugs, the improvement from natural maturity growth can be easily attributed to the effects of the drugs. When this happens, parents rave to their family members and friends that Ritalin saved their child, and they push other parents to do what they did–get their children on Ritalin. myths

And so, this is how I think the myth of Ritalin’s effectiveness is created. An initial improvement in behavior once the drug treatment begins; a slow tolerance develops to the drug so it becomes less and less effective, but this occurs over a period of time during which the child is naturally maturing. As a result, some parents don’t notice that the drug is becoming less effective.  When parents do notice the decreased effectiveness of the drug, they often take the child to the doctor to get an increased dose.  Again there is a boost in apparent improvement.  As tolerance to the drug once again begins to occur, more time goes by, and of course there is more growth in the child’s natural maturity.  This may lead to less attention problems, but the improvement is attributed to the drugs, rather than improved maturity.  Whenever parents try to see if their child can do just as well without the drugs, the withdrawal reactions convince them that their child really needs the drug. Negative side effects of the drugs are attributed to other causes.  Couple all of this with the clever advertisement campaign of drug companies, and we end up with a pretty impressive myth.

———————

Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on.  This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional intelligence.  To begin at the very first post you can click HERE.

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16 thoughts on “The Myth of Ritalin’s Effectiveness

  1. Hi Monica. I’m pleased to hear that you found the post worthy of reblogging on your fine blog. Happy holidays!

  2. I like lots of your stuff! thank you!

  3. Marv Brilliant A.A. on said:

    Is it just Ritalin, or all drugs with the same characteristics?

  4. Hi Marv. I’m pretty sure that most psychiatric drugs suffer from the same effectiveness myth. There is some short term perceived benefit, the body down regulates the drug’s initial effects, and when people try to withdraw from the drugs, they end up feeling worse than normal, but think the new worse is their normal self. They then come to think the drug is helping them from feeling so uncomfortable. There is strong evidence for this with the so called “antidepressants.” These drugs have for many people a particularly harsh withdrawal reaction and people end up trying to avoid the reaction thus creating an addiction to the drug.

  5. As much as I enjoy your blog, I’m disappointed to see yet another inadequately informed opinion about stimulant medications. My bias, yes, is that they have changed my life for the better. But it is fact that academic performance is just one area of life impacted by ADHD, and this medication. Interpersonal relationships, executive functioning skills and more bear the mark. Not to mention the neuroprotective benefits – meaning stimulant meds can actually help to get a kid’s brain development back on track. Yup…really. I’m understand your overall perspective, Monica, and appreciate it, but black and white application is also harmful.

  6. Hi 18channels. I see your comment is directed at a comment written by Monica, so I hope you don’t mind if I chime in. It is my opinion that the effects of stimulants can lead people to think that they are effective for improving some particular area of functioning when they actually don’t. I gave the example of caffeinated coffee, which created the impression that I was benefitting from and I now see that I had not. It is well documented that stimulants, in the short term, can get the heart to beat faster than usual and on tasks that are experienced as boring, people will focus longer on completing it initially while the drug is making the heart beat faster. But somehow the body recognizes that it can’t keep beating that fast or harm will occur, so it figures out a way to make the drug less effective. This reaction to the drug is called tolerance to the drug, or down regulation. Once the body does this, it no longer has the same perceived positive effects that were apparent in the short term, but an illusion is created that the effect lasts longer because when the drug level in the body begins to fall below its usual dose, the body goes through a withdrawal phase, causing the user to perform below how he or she ever performed before starting the drug program. This lower level fools people into thinking that the drug has been helping because they incorrectly conclude that the withdrawal experience is how they would typically feel if they were not regularly consuming the drug.

  7. I don’t think in black and white terms actually and I do present what is true for many people and myself….and acknowledge that other interpretations of personal experience may also be valid. There is very little in life that we really know and context is everything. And given the context of every life is different then interpretations of things like drug effects are going to be different and valid too with some frequency.

    Also we as individuals always have the right to interpret out reality in a way that allows for our own personal growth and well-being. So I have no trouble with your interpretation 18 channels…but my own personal experience is like Jeffrey’s…and i advocate for folks like us. This is our reality.

    I’m totally into the both/and sort of thing rather than the either or…more inclusion rather than less…and yeah, that gets me into trouble with everyone with some frequency.

  8. I guess I should add I think that what we believe impacts how medicines work to some extent and that given these drugs are neurotoxic regardless of therapeutic effect I do think that it’s wise to find other methods if at all possible and that is why I concentrate on helping people find other methods…it’s my experience that in the end other methods are healthier for everyone if at all possible.

    right now too many people don’t believe that alternative methods can work…and systems therefore don’t offer them nor train anyone to know how to offer options…this is all criminal and I do my work in the face of this…

    that doesn’t mean that I have any interest in convincing any single human being that they’re experience isn’t exactly as they see it…that is all it can be until they no longer see it that way…

    I’ve reframed my experience 1,000 times now…I find it to be the only way I grow. I don’t attach to what I believe…and I move on when it’s time.

  9. Marv Brilliant A.A. on said:

    Why do folks believe that Ritalin is effective, when in fact it creates an illusion of effectiveness. What are the main chemicals and other ingredients within Ritalin? Are there any other medications which induce a felling of wellness, beside Ritalin. Finally does Ritalin have the effect of a placebo.

  10. Hi Marv. I think relief from a drug withdrawal reaction that occurs each time a person ingests the drug can create the illusion that a drug is effective. Ritalin’s chemical name is methylphenidate. I think the drugs referred to as
    antidepressants and benzodiazepines such as Valium and Xanax create the same illusion. I think any drug can have a placebo effect, but so too can some human personal contact, which I personally like better.

    • Katherine Wolfe on said:

      Hello Jeffrey –

      I could list study after study that proves methylphenidate’s effectiveness relative to placebo in raising measured levels of attention on a standardized test. It is significantly better than placebo in every study conducted.

      There isn’t a dearth of research on ADHD, either. While there are some interventions that do help that aren’t stimulant medication (Omega3, intense exercise, meditation), there isn’t anything that has been proven to be nearly as effective as stimulant medication.

      My personal experience, and the experience of people I know personally who have ADHD (that has to be over a hundred), is that it isn’t a myth that stimulant medication works for them. It’s a reality.

  11. Pingback: Treating ADHD: If Not Drugs, Then What? | Name Calling, Insults and Teasing

  12. Hi Katherine Wolfe, you wrote in your comment that you “could list study after study that proves methylphenidate’s effectiveness relative to placebo in raising measured levels of attention on a standardized test. It is significantly better than placebo in every study conducted.” I know this is true for some short term studies. I’ve studied the research on this topic and found that tolerance to the drug begins to happen after awhile, and after a great deal of money has been spent and side effects suffered, there is no improvement in academic outcomes or social functioning. If you know of a study or studies that convinces you that after three or more years of stimulant treatment students on stimulants have learned more or are doing better socially than a matched group of students on a placebo, please provide us with the citations.

  13. Pingback: Treating ADHD: If Not Drugs, Then What? | From Insults To Respect

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