The question of the validity of the use of stimulants for the treatment of attention-deficit hyperactivity disorder (ADHD) is highly connected to the question of attempting to balance the effectiveness of the drugs and the dangers inherent in their use. ADHD is a problematic mental and behavioral disorder especially among children and it is very important that we as a society find an effective method to treat it with the least amount of adverse effects to patients. It is a very good question to ask if a treatment is worth the risks and this definitely the case with the use of stimulants for treating ADHD. The use of stimulants has been rightly controversial and their negatives are very hard to ignore. Keeping this is in mind, it is still much better to prescribe stimulants for the treatment of ADHD. There is overwhelming evidence that which points to the fact that despite the prevalence of opinion against it doctors and parents should, in fact, have no problem prescribing amphetamines to children for the treatment of ADHD. This paper will argue that despite a lot of adverse effects and negative press which the use of stimulants has gotten as the primary method for the treatment of ADHD it is, in fact, one of the best and most effective ways which we have to treat it.
One of the strongest arguments against the use of stimulants and amphetamines as a method for treating ADHD is connected to the belief that we as a society are overprescribing medications for the treatment of the disease. These critics of the use of stimulants for the treatment of ADHD included “leaders affiliated with the Church of Scientology, a number of newspaper reporters and talk show hosts, a few officials in the U.S. Drug Enforcement Administration, a handful of physicians and psychologists, and some conservative legislators.” (Safer 55) These critics of the use of stimulants for the treatment of ADHD have several arguments for why they think that these drugs have been overprescribed. They have seven distinct arguments and they are as follows.
These critics of the use of stimulants in treating ADHD believe that these drugs are being overprescribed and that in doing so they are doing very real harm to children and society. Safer, in this article, argues that there seven distinct reasons cited by these critics for not prescribing stimulants as a primary method of treating ADHD. These arguments are strong prescriptively because they’re all based on things that they believe should change regarding the use of stimulants as a form of treatment for ADHD. First, that doctors are haphazard and in their diagnosis and treatment of ADHD. Second, they believe that alternative programs to deal with hyperactivity in children in schools are being neglected because of the emphasis on the use of medication instead of other interventions. Additionally, they believe that the causes and symptoms of ADHD are social and cultural. There are three primarily medical concerns which these critics have with the use of stimulants as a form of treatment for ADHD these include their limitations as a way of treating it, the belief that stimulants are harmful and can be abused, and that these medicines are overprescribed. Finally, they also believe that the pharmaceutical industry has “profoundly influenced medical researchers and parent support groups to be pro-Ritalin.” (Safer 55-56) These arguments against the use of stimulant are all seemingly valid and they have a place in the conversation they are not the only view and there is much evidence to disprove many of these facts.
The claim that stimulants shouldn’t be used in the treatment of ADHD because of their adverse health effects and their propensity to be abused are easily rebutted. In the course of researching this paper and reading through a lot of academic and medical literature on the topic it is to reach the conclusion that although there are valid criticisms for why the use of stimulants should be limited for the treatment of ADHD there is also and overwhelming amount of evidence which supports it being one of the safest treatment methods. Simply put, the belief that the stimulants shouldn’t be used as a method for the treatment of ADHD is based on two pillars. The first argument against is related to the belief that stimulants are dangerous and they have adverse health effects which are prevalent enough which should make us question the use of these drugs as a treatment for hyperactivity. The second argument against the use of stimulant drugs for the treatment of attention and hyperactivity disorders is connected to the belief that these drugs have a high chance of being abused and that they should not be prescribed because of the dangers inherent with patients becoming dependent on these drugs. The use of stimulants in the treatment of ADHD will be shown should be continued and it is as good as any other alternative for the treatment of ADHD.
One of the common reasons given for why the use of prescription stimulants for the treatment of ADHD is because they are dangerous and they can cause very bad health effects. These fears are somewhat overblown as there is plenty of evidence which points in the direction of stimulant drugs being very safe. While there are adverse effects “listed in drug labels of prescription amphetamines” which include changes in mood and behavior as well as cardiac and gastrointestinal effects. (Berman et al 5) The majority of these adverse events which include “loss of appetite, insomnia, emotional liability and social withdrawal” are “time limited” which means that they improve after drugs are stopped. These side effects are relatively minor and they should not be a deterrent to anyone choosing to give their children on amphetamines as the best possible way to treat ADHD. The potential dangers of these drugs are one factor which may keep people from using them or may keep parents from prescribing them to their children. Another major worry surrounding the use of stimulants as a clinical drug are the chances for patients becoming dependent or abusing them.
A major concern of using prescription stimulants for the treatment of ADHD is connected to the fear that it is a drug which patients can easily become dependent on and is very prone to abuse. This is because these drugs operate in a manner which reinforces the link between use and pleasure through dopamine. Drugs such as “Methylphenidate (like cocaine) increases dopamine by blocking dopamine transporters, and amphetamine (like methamphetamine) increases dopamine by releasing dopamine from the terminal.” (Volkow and Swanson 1909) Both these drugs are also though to increase dopamine level in the nucleus accumbens which is “thought to underlie the reinforcing effects of drug abuse” (Volkow and Swanson 190) These facts are hard to ignore but they are not the only factor which contributes to the potential of abuse of these drugs. There are several mitigating factors which make these drugs difficult to abuse.
There are four primary variables studied by Volkow and Swanson which affect how hard it is for an individual to abuse on these prescription stimulants. These include first dose size; second pharmacokinetics; the differing effects of these drugs on different individuals; and finally, the context of administration. The article argues that these factors combined makes it very hard for one to become dependent on prescription stimulants because of the relatively large dose required, the relative weakness of the drug, the unique pharmacokinetic properties of these drugs, the fact that each individual responds to the drugs differently and finally the fact that the use of these drugs are all very contexted dependent. (Volkow and Swanson 1911-1916) While it is hard to say that there is no risk for abusing these drugs they are not significant enough for physicians to not recommend their use in the treatment of ADHD. A massively interesting study argues that there is a link between the use of stimulants and “protection” against later substance use disorder.
One of the reasons why many are skeptical about the use of stimulants for the treatment of ADHD is because of the connection of these drugs and potential future drug abuse. The section above explains that this class of drug isn’t particularly useful for recreational use or abuse because of its properties there is an interesting case which argues that stimulants may actually “protect” against future substance use disorders. Wilens et. al. argue that clinically “the absence of evidence linking SUD with stimulant medication should reassure clinicians and families when discussing the risks and benefits of medication intervention for ADHD. “ (184) The reasoning for why ADHD treatment with stimulants may “protect” against future substance abuse is linked to the fact that patients see a reduction in their ADHD symptoms, such as “ demoralization, poor self-esteem, and academic or occupational failure” are associated with higher risk factors for substance abuse. (Wilens 183) Alternatively, these findings may be connected to other factors such as socioeconomic status or parent involvement in raising the child which are pertinent because they may actually skew the data and the ultimate reasoning for why ADHD treatment is “protective” of future substance use disorder. (Wilens 183-184) The data provided in the article above makes a very strong case for why the use of prescription stimulants is positive and why doctors and parents should continue to use these drugs in the treatment of ADHD. The cases above all in one way or another try to argue why these drugs and other factors should not dissuade parents and doctors from prescribing these drugs in the treatment of ADHD. There is one case which actually argue for the effectiveness of these drugs for the treatment of ADHD.
In essence, the most important thing to keep in mind when thinking about the reasons why prescription stimulants are prescribed at al for treating ADHD is large because it has been shown that those drugs are as effective if not more so than any other drugs in treating it. A study did Faraone et al shows that the “effect sizes for stimulants are significantly greater than those for other medications,” although there are certain problems with trying to isolate effects of any particular drug, especially in a meta-analysis. (Faraone et al) These results do show that there are a positive effect and reasoning for the use of stimulants for the treatment of ADHD. These are strong enough which suggest that they are reasonable reasons for their continued use.
The reasoning for the continued use of prescription stimulants for the treatment of ADHD is based on plenty of evidence which argues that although there are risks involved especially in patient health and the potential for future substance abuse connected to these drugs. There is enough evidence that these drugs are effective and that there are not significant risks to using them to treat ADHD. The cases shown above are all strong enough which should put aside any fears which parents may have of giving these drugs when treating their children’s ADHD without being worried about possible health effects or fear of drug abuse. As put by Safer, “stimulant treatment is safe and is viewed as clearly useful by most of those involved with the immediate care of hyperactive-inattentive children.” (60) Which should be enough in stating its efficacy and utility in the treatment of ADHD
Works Cited
Berman, Steven, et al. "Abuse of amphetamines and structural abnormalities in the brain." Annals of the New York Academy of Sciences 1141.1 (2008): 195-220.
Faraone, Stephen V., et al. "Comparing the efficacy of medications for ADHD using meta-analysis." Medscape General Medicine 8.4 (2006): 4
Safer, Daniel J. "Are stimulants overprescribed for youths with ADHD?."Annals of Clinical Psychiatry 12.1 (2000): 55-62
Volkow, Nora D., and James M. Swanson. "Variables that affect the clinical use and abuse of methylphenidate in the treatment of ADHD." American Journal of Psychiatry (2003).
Wilens, Timothy E., et al. "Does stimulant therapy of attention-deficit/hyperactivity disorder beget later substance abuse? A meta-analytic review of the literature." Pediatrics 111.1 (2003): 179-185.
