Central nervous system stimulant medications (CNS stimulants) have numerous medicinal uses.

    In general, stimulants can be used to:

  • Increase cognitive functioning in individuals who have a medical condition that results in significant lethargy or cognitive compromise, such as a stroke, head injury, or some metabolic issue
  • Help individuals who are obese to lose weight
  • Assist individuals who have sleep disorder, such as narcolepsy
  • Help individuals who have certain types of mental health disorders, particularly attention deficit hyperactivity disorder (ADHD)

What Is Concerta?

An important finding in treating ADHD was the discovery that stimulant medications can help someone with this disorder to focus, reduce impulsivity, and reduce hyperactive behaviors (the three major signs/symptoms of ADHD). A CNS stimulant that has been used extensively in the treatment of ADHD is methylphenidate.

Ritalin contains the immediate-release form of methylphenidate, whereas Concerta contains an extended-release form. Both drugs are typically taken orally, and the use of Concerta reduces the need for multiple administrations of the medication throughout the day. Another medication, Daytrana, is a patch form of methylphenidate that can be used by some individuals for the treatment of ADHD, narcolepsy, etc.

Methylphenidate is the active ingredient in very recognizable medications, such as Ritalin and Concerta.

The CNS stimulant methylphenidate works by blocking the reuptake of the excitatory neurotransmitters dopamine and norepinephrine. This mechanism of action also has residual effects. For instance, dopamine is a neurotransmitter that is associated in the development of nearly every type of addictive behavior. Massive releases of dopamine cause increased feelings of euphoria that are associated with reinforcement or repeating a particular action or behavior.

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. 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?

The Substance Abuse and Mental Health Services Administration (SAMHSA) publishes some of the most reliable figures regarding the abuse of prescription drugs. According to the latest data in 2015, nearly 3.5 million individuals reported using drugs containing methylphenidate, and nearly 1 million individuals reported misusing methylphenidate at least one time. Misuse of a drug is not the same as abuse; however, the cycle of a substance use disorder (chronic abuse and/or addictive behavior) involves repetitive misuse of the drug. Research provided by The University of Michigan reported that in the same year about 2% of high school seniors reported abusing methylphenidate products.

Other research studies have suggested that the CNS stimulants like methylphenidate are most often abused by a particular demographic sector.

  • These individuals are most often Caucasian males who are younger than 30.
  • College and high school students who are under the mistaken impression that the use of the drug is a form of cognitive enhancement are at risk to abuse the drug. Because stimulants can increase attention at low doses, this misconception is quite popular.
  • College students and young college graduates often abuse the drug along with other drugs, such as cannabis products, prescription medications, and alcohol, in order to extend their ability to party.
  • Young college graduates who are employed in positions where there is perceived pressure to perform, such as business management, business consultants, stockbrokers, etc., often abuse the drug.
  • Although these represent the demographic features of individuals who are most likely to abuse drugs like Concerta, the drug can be abused by anyone.

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SAMHSA and numerous research studies have also investigated other factors associated with the abuse of stimulants like methylphenidate and have concluded the following:

  • Individuals who abuse CNS stimulants are typically not those who have a prescription for the medication.
  • Most often, these individuals get the drug from a friend or relative.
  • Some may purchase the drug illegally.
  • They often begin using the drug in an effort to improve their academic or work performance.
  • They very often feel as if they are under tremendous pressure to perform.
  • They are more likely to combine the drug with other drugs, such as cannabis products, alcohol, narcotic pain medications, etc.
  • Most often, they abuse the CNS stimulant by grinding up the pills and either snorting them or mixing them in liquid and drinking them in large quantities. In rare cases, they may inject the solution.

Signs of Concerta Abuse

A person who abuses Concerta may qualify for an actual diagnosis of a substance use disorder (a stimulant use disorder) as defined by the diagnostic criteria presented by the American Psychiatric Association (APA). Only a trained mental care clinician can diagnose a stimulant use disorder; however, the diagnostic criteria for a stimulant use disorder and other information provided by organizations such as SAMHSA are helpful in helping individuals to recognize signs and symptoms of Concerta abuse. Some of these include:

  • 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 by anyone
  • Anyone with a prescription who frequently uses their Concerta in a manner that is inconsistent with the prescribed instructions for the medication
  • Signs that an individual has difficulty controlling their use of Concerta, such as:
    1. Often using it in greater amounts than originally intended
    2. Using the drug more frequently than prescribed instructions suggest
    3. Making numerous unsuccessful attempts to either stop or cut down on the amount of the drug they use
    4. Continued use of the drug 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.)
    5. Continuing to use the drug even though it is causing them physical or psychological damage
    6. Giving up other important activities in order to use the drug
    7. Failing to maintain important personal obligations as a result of their drug use
  • Romanticizing use of Concerta, such that the person believes it is 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 is 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

Adverse Effects of Concerta Abuse

There is no such thing as a drug that does not have some type of side effect profile. Because drugs alter chemicals in an individual’s body, the alteration results in numerous effects, some of which can be medicinal and others that can be oppositional to normal functioning. Individuals who use drugs under the supervision of a physician and according to their prescribed instructions often experience side effects that can be controlled by the physician or remit over time. Individuals who abuse drugs do not use them according to their prescribed dosages, frequencies, etc., and are far more susceptible to numerous side effects as a result of both short-term and long-term use.

    Individuals who abuse CNS stimulants like Concerta are at risk for numerous side effects that include:

  • Cardiovascular problems, such as hypertension, irregularities of heart rhythms (heartbeat), increased risk of arterial sclerosis, increased risk of heart attack, and increased risk for stroke
  • Significant liver damage, kidney damage, and other organ damage
  • The development of tics or tremors (nonfunctional motor movements)
  • Increased potential to develop other neurological conditions, such as seizures
  • Decreased cognitive functioning, most likely as a result of chronic changes in neural pathways
  • Psychological issues, such as chronic depression, anxiety, and even psychosis
  • Inattention to self-care or behavior, which can increase vulnerability to numerous conditions like those mentioned above, infectious diseases, and risky behaviors that can result in serious ramifications, such as unprotected sex, automobile accidents, becoming a victim of a crime, engaging in criminal behavior, etc.

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Treatment for Concerta Addiction

It was once believed that abuse of stimulant medications resulted in a relatively mild and easily treatable condition compared to the abuse of other drugs, such as opiates. However, this misconception has long been abandoned in favor of the notion that any type of substance use disorder, including a stimulant use disorder, represents a severe manifestation of a mental health disorder that requires a targeted intervention.

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 to address cravings and withdrawal symptoms, and to help them get on the road to recovery. Most often, withdrawal management for stimulant medications (medical detox) 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
  • Substance use disorder therapy as the mainstay of substance use disorder treatment, typically 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 in the individual case
  • 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

Success is often just a matter of remaining in treatment and trying to improve one’s condition despite experiencing inevitable setbacks that occur as a result of living in the world. 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 is a strong relationship between successful recovery from any 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.

Conclusions

Concerta contains the CNS stimulant methylphenidate. Methylphenidate is a controlled substance and a significant potential drug of abuse. Individuals who abuse Concerta are often younger, well-educated, and abuse it in conjunction with other drugs. Chronic abuse of Concerta can lead to the development of a stimulant use disorder.

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.