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Concerta Addiction

Concerta is a brand name for the extended-release form of the drug methylphenidate—a synthetic central nervous system stimulant medication primarily used to treat attention deficit hyperactivity disorder (ADHD) in adults, adolescents and children aged 6 and higher.1,2

Ritalin is the brand name of the immediate-release form of methylphenidate. Both drugs are typically taken orally, and the use of Concerta reduces the need for multiple administrations of the medication throughout the day. Methylphenidate is also available as a transdermal patch under the brand name Daytrana.2

What are Stimulants?

Stimulants are drugs that stimulate activity in the central and sympathetic peripheral nervous systems, typically by enhancing neurotransmitter activity.

Methylphenidate and other synthetic stimulant medications, such as amphetamine and Adderall, help those diagnosed with ADHD to increase focus, reduce impulsivity, and reduce hyperactive behavior.

Methylphenidate, the active ingredient in Concerta, works by blocking the reuptake of neurotransmitters dopamine and norepinephrine. This mechanism of action also has residual effects.. Massive releases of dopamine cause increased feelings of euphoria that are associated with reinforcement or repeating a particular action or behavior. Dopamine is a neurotransmitter that’s associated in the development of most addictive behavior.1

Drugs that directly increase the availability of dopamine, such as cocaine, methamphetamine, and methylphenidate, are also significant drugs of abuse, and many of these are classified by the United States Drug Enforcement Administration as Schedule II controlled substances. The drugs in this category represent the highest level of control for substances that are available with a prescription from a physician.3 These drugs are considered to have significant potentials for abuse and for the development of physical or psychological dependence. These drugs also have numerous potential side effects and long-term effects; as a result, they can only be safely used under the supervision of a physician.

Who Abuses Concerta?

According to the 2018 National Survey on Drug Use and Health, about 3.1 million individuals reported using drugs containing methylphenidate, and nearly 747,000 million individuals reported misusing methylphenidate at least one time in the last year.4 The 2018 Monitoring the Future Survey reported that in the same year about 1% of high school seniors reported using methylphenidate products without a doctor’s orders (0.2% used Concerta and 0.8% used Ritalin).5

A systematic review of the scientific literature suggests that college students are at higher risk of non-medical use of CNS stimulants like methylphenidate, with increased risk associated with the following:6

  • White male.
  • GPA less than 3.5.
  • Use of alcohol and/or marijuana (often alongside methylphenidate).
  • Member of sorority or fraternity.

In nearly every survey, college students cited academic motivations at rates of 50-89% as the primary reason for their non-medical use.6 Enhanced academic or work performance was cited by 38-57% for adult non-medical use.6 The evidence does support that those without ADHD may experience a small to moderate cognitive benefit from taking prescription stimulants, however, it also shows that misuse of prescription stimulants by college students is associated with a lower GPA, indicating that it actually hinders academic performance.7

Unlike other potent stimulants, like methamphetamine, there are no clandestine labs that produce methylphenidate. This means that those who are using it without a prescription are using products being illegally diverted.8 Studies have reported that 50-90% of individuals who use prescription stimulants for non-medical use obtain the medication from family or friends. Some (4-35%) are legitimately prescribed a prescription stimulant and then misuse the medication. Still others (around 20%) feign symptoms of ADHD to obtain a prescription from a doctor.6

Effects of Concerta Abuse

Initial effects, which are usually desired by those misusing the medication, after taking 5-20 mg of methylphenidate include:1

  • Increased energy, alertness, and sociability.
  • Elation or euphoria.
  • Decreased fatigue
  • Decrease in appetite.

Adverse side effects commonly experienced with methylphenidate include:1,2

  • Headache.
  • Dry mouth.
  • Insomnia.
  • Rapid/exaggerated changes in mood.
  • Nausea/vomiting.
  • Nervousness.
  • Palpitations.
  • Elevated blood pressure.
  • Rapid heart rate.

Rare but serious adverse effects include:1,2

  • Severe high blood pressure (hypertension).
  • Seizures.
  • Psychosis.
  • Heart attack or stroke.

Concerta is a sustained-release preparation of methylphenidate, which means the drug is released slowly into the bloodstream. This slows the rate of onset of the drug’s effect and lessens the subjective drug effects (both desired effects and side effects) when compared to immediate-release methylphenidate (Ritalin).1

Signs of Concerta Abuse

Though its abuse potential may not be as pronounced as other prescription stimulants such as cocaine or methamphetamine, problematic patterns of misuse may develop even with a drug like Concerta. A number of signs can point to a problem with compulsive Concerta use—either alone or in combination with other substances.

Some signs, symptoms, and behavioral changes associated with substance addiction, or a substance use disorder, include:9

  • Repetitive use of Concerta by an individual who does not have a prescription for the drug.
  • Frequent use of Concerta in conjunction with other potential drugs of abuse.
  • Anyone with a prescription who frequently uses their Concerta in a manner that is inconsistent with the prescribed instructions for the medication, such as using it in greater amounts or more frequently than originally intended or than prescribed instructions suggest.
  • Making numerous unsuccessful attempts to either stop or cut down on the amount of Concerta.
  • Continued use Concerta even though its use has resulted in impairment in one or more areas of life (e.g., personal relationships, performance at school, performance at work, etc.).
  • Continuing to use the drug even though its use has caused physical or psychological damage.
  • Giving up other important activities in order to use Concera.
  • Failing to maintain important personal obligations as a result of using Concerta.
  • Romanticizing use of Concerta, such that a person believes it’s essential for normal functioning.
  • Spending significant amounts of time trying to get Concerta.
  • Spending a significant amount of time using Concerta or recovering from its use.
  • Frequently using Concerta in situations where it’s dangerous to do so.
  • Frequent urges to use Concerta.
  • Obvious uses of the medication that are inconsistent with its intended use, such as grinding up pills and/or using significantly high amounts of the drug.
  • Significant tolerance to Concerta.
  • Withdrawal symptoms when Concerta cannot be used.

Treatment for Concerta Addiction

Because individuals can develop physical dependence on Concerta (having both tolerance and withdrawal), anyone who has abused the drug for more than a few weeks should consult with a physician before discontinuing it. Chronic abusers will benefit from a formal physician-assisted withdrawal management program (medical detox) to address cravings and withdrawal symptoms, and to help them get on the road to recovery. This can be successfully completed in an inpatient treatment setting, a residential treatment setting, or even an outpatient treatment setting, depending on the needs of the individual.

Following withdrawal management, individuals should become involved in a formal substance use disorder treatment program that should include the following components:

  • A thorough assessment of their psychological, physical, and social functioning.
  • Medical management and psychological treatment of any co-occurring issues, such as depression, that are identified in the assessment.
  • Psychotherapy that involves some form of cognitive-behavioral approach and that can be performed in group therapy, individual therapy, or a combination of group and individual sessions.
  • Social support, particularly from family and friends, including family therapy.
  • Participation in social support groups such as 12-step groups, community support groups, and other groups that are not technically therapy groups but typically run by others with the same disorder/issue.
  • Complementary and adjunctive alternative therapies as needed.
  • Continued involvement in treatment-related activities even after formal substance use disorder therapy has been completed, most often involvement in some form of social support group.
  • Continued involvement in treatment-related activities for a period of 5-7 years following initial abstinence and the maintenance of abstinence over this period of time.

Relapses occur frequently, even in individuals who are involved in the most comprehensive forms of treatment. Remaining involved in treatment helps individuals learn from their experiences, develop stronger plans of recovery, and eventually experience success. There’s a strong relationship between successful recovery from a substance use disorder and the length of time that one remains actively involved in treatment-related activities, such that those who remain in treatment-related activities for longer periods of time have far greater rates of success in recovery.

Any individual who has developed a stimulant use disorder as a result of Concerta abuse requires formal intervention and long-term treatment. The potential for successful recovery increases as a result of maintaining involvement in treatment-related activities for years following initial abstinence from Concerta.

References

  1. Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition. Philadelphia: Wolters Kluwer.
  2. Food and Drug Administration. (2017). Concerta (methylphenidate HCl) Extended-Release Tablets.
  3. United States Drug Enforcement Administration. Drug scheduling.
  4. Center for Behavioral Health Statistics and Quality. (2019). Results from the 2018 National Survey on Drug Use and Health: Detailed Tables.Substance Abuse and Mental Health Services Administration, Rockville, MD.
  5. National Institute on Drug Abuse (2019). Monitoring the Future national survey results on drug use, 1975-2018: Volume I, Secondary school students. Ann Arbor: Institute for Social Research, The University of Michigan.
  6. Faraone, S. V., Rostain, A. L., Montano, C. B., Mason, O., Antshel, K. M., & Newcorn, J. H. (2019). Systematic Review: Nonmedical Use of Prescription Stimulants: Risk Factors, Outcomes, and Risk Reduction Strategies. Journal of the American Academy of Child & Adolescent Psychiatry, Aug. 26, 2019, [ePub ahead of print].
  7. Weyandt, L. L., Oster, D. R., Marraccini, M. E., Gudmundsdottir, B. G., Munro, B. A., Rathkey, E. S., & Mccallum, A. (2016). Prescription stimulant medication misuse: Where are we and where do we go from here? Experimental and Clinical Psychopharmacology, 24(5), 400–414.
  8. Diversion Control Division; United States Drug Enforcement Administration. (2019). Methylphenidate.
  9. Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). (2013). Washington, D.C.: American Psychiatric Association.
About The Contributor
Ryan Kelley, NREMT
Medical Editor, American Addiction Centers
Ryan Kelley is a nationally registered Emergency Medical Technician and the former managing editor of the Journal of Emergency Medical Services (JEMS). During his time at JEMS, Ryan developed Mobile Integrated Healthcare in Action, a series... Read More