Identifying Ritalin OD Symptoms and Addiction Treatment Options

Last updated on November 4th, 2019

Ritalin is a prescription stimulant drug that is sometimes abused by students or anyone looking to stay awake, study, or improve performance on tests. Signs of Ritalin abuse include feeling an urge to use it to complete everyday tasks, taking increasingly higher doses to achieve the “high,” and going through withdrawal when use is reduced or stopped.

In the short term, Ritalin can cause reduced appetite, alertness, euphoria, and increased heart rate. Over time, regular abuse of the drug can lead to heart problems, paranoia, and insomnia.Contrary to popular belief, there is no evidence that Ritalin improves academic or professional performance in people who do not have ADHD.


What Is Ritalin (Methylphenidate)?

close-up of white ritalin pills in handRitalin is a brand name for methylphenidate, a central nervous system stimulant medication prescribed to treat attention-deficit hyperactivity disorder, as well as narcolepsy.1  People who have ADHD have a harder time concentrating, sitting still, and controlling their behavior than their peers.6 Ritalin helps improve their attention and lower their impulsiveness and hyperactivity.2

Ritalin is prescribed in water-soluble tablets that can be white, pale green, or pale yellow.1 Stimulants like Ritalin boost attention, alertness, and energy. They also increase blood pressure, heart rate, and respiratory rate.1,3  In the past, doctors prescribed stimulants to treat many conditions, such as obesity, asthma, and neurological disorders. But over time, it became clear that they had a potential for abuse and addiction. They are now only used to treat a small number of conditions, including ADHD.3

Ritalin on the Street

Street names for Ritalin include:4

  • Kiddles and Bits.
  • Kiddy Cocaine.
  • Skippy.
  • Smarties.

Ritalin, along with drugs like Adderall, is often called a “smart drug” or “study drug,” distinctions bestowed on this type of medication for its ability to help people stay awake or increase their energy, for example to study for a test.

Between 1991 and 1999, sales of Ritalin in the U.S. saw a 500% increase.1 Along with this rise in prescriptions came an increase in diversion and abuse of Ritalin. According to the 2015 National Survey on Drug Use and Health:5

  • 979,000 people age 12 and older had misused some methylphenidate formulation, including Ritalin, in the prior year.
  • More than half of these were 25 years old or younger:
    • 126,000 were between the ages of 12 and 17.
    • 485,000 were between the ages of 18 and 25.

Can I Get Addicted?

Ritalin increases the activity of a chemical in the brain called dopamine, which can affect pleasure, movement, and attention. When the drug is taken as prescribed, it elicits a slow and steady increase in active dopamine that approximates that seen with normal brain functioning.7 Used this way, the drug is therapeutic and helps people with ADHD focus their attention so they can sit still and complete schoolwork or assignments on the job.

However, when someone takes the drug without any medical reason and/or takes the drug in a way that it is not prescribed—such as crushing the pills and snorting them—the drug can cause a sharp spike in dopamine that brings feelings of euphoria.7  In fact, some people report that injecting the drug feels like using cocaine.8 Abuse of Ritalin in any form can lead to addiction.

Abuse of Ritalin in any form can lead to addiction.Ritalin abuse can also lead to the development of significant physiological dependence.2 Essentially, a dependent person’s system grows to expect a certain amount of the drug to be present. When the person stops using Ritalin or takes a lower dose than they usually do, the brain and body are thrown off balance and must adjust to the lack of the drug. This adjustment period typically brings about several unpleasant withdrawal symptoms, which may include extreme fatigue and severe emotional distress or depression.1

Dependence usually develops alongside tolerance, where the person’s system adapts to the drug and they must take increasingly higher doses to achieve the desired effect.

Though it is often tied closely to tolerance and dependence, addiction is a separate phenomenon characterized by a compulsive desire to obtain and use a drug. Someone addicted to Ritalin will continue to seek it out compulsively regardless of the drug’s known harm to their health, their relationships, or any other aspect of their life.

Ritalin and Future Drug Abuse: Is There a Connection?

Some believe that prescribing stimulants to children and adolescents can increase their odds of using other drugs later in life. However, studies have not found any evidence that this is the case.7

One study looked at rates of substance abuse in boys with ADHD who were being treated with stimulants, boys with ADHD who did not take medications, and boys without ADHD. Researchers found that 75% of the unmedicated boys with ADHD began to abuse substances over the 4-year course of the study. Only 25% of the boys with ADHD who did take medication abused drugs, and only 18% of the boys without ADHD had abused drugs in the 4-year time span.22

Does Ritalin Make You Smarter?

Because Ritalin increases focus and concentration, many people who do not have ADHD think they can use it to improve academic or work performance. For example, students may attempt to use it to study better, perform better on tests, and improve their grades.7,9

A 2017 survey found that about 29% of students at 9 colleges believed that prescription stimulant drugs such as Ritalin could help them boost their academic performance, and 38% of those surveyed said they weren’t sure. Over 11% had used these drugs for non-medical reasons in the past 6 months.10

However, despite the confidence that some students have in Ritalin’s ability to improve their grades or ability to study, there is no evidence that prescription stimulants provide any real academic benefit for students who do not have ADHD. In fact, students who abuse prescription stimulants tend to have lower GPAs overall in high school and college.7

Potential Side Effects

Ritalin has side effects similar to those seen with other stimulant drugs and which may grow in number and intensity as dosing is increased. These include:1,2

man holding head portraying a ritalin addict suffering from side effects
  • Suppressed appetite.
  • Enhanced alertness.
  • Headache.
  • Rapid heartbeat.
  • Nausea.
  • Vomiting.
  • Drowsiness (not common).
  • Hallucinations.
  • Anxiety.
  • Repeating meaningless tasks.
  • Trouble sleeping.
  • Jitteriness.
  • The feeling of bugs or worms crawling under the skin.

Other less common but serious side effects include:2

  • Slowed weight gain and growth in children.
  • Seizures (most common in people with a history of seizures).
  • Changes in eyesight or blurred vision.
  • Painful, prolonged erections.

People who abuse Ritalin may develop certain signs and symptoms in addition to these side effects. They may:11

  • Experience an inability to cut down on Ritalin use.
  • Feel the need to use Ritalin to complete daily tasks.
  • Have decreased appetite.
  • Feel fatigued but unable to sleep or feel rested after sleep.
  • Become tolerant, or need an increasingly larger dose of Ritalin to feel the same effects as before.
  • Go through withdrawal upon attempts to stop or decrease their use.

Long-Term Effects

Over time, someone who abuses Ritalin will likely start to see effects on their health and well-being:

  • Physical effects: Since Ritalin suppresses appetite, long-term abuse can lead to malnutrition. Abuse of the drug can also lead to altered heart rate and blood pressure, as well as possible heart attack and stroke.4,7
  • Mental health: Long-term users can also develop mental health problems, such as anxiety, hostility, paranoia, insomnia, and hallucinations.7,10
  • Effects of injecting and snorting: People who inject Ritalin to get high are at risk of suffering from an agitated mental state akin to paranoid schizophrenia. The talcum filler on the tablets that these users crush and dissolve in water before injection can also cause tissue inflammation and injury at the injection site.1 Repeatedly snorting Ritalin can lead to nasal irritation, bleeding of the nasal mucosa, and perforated nasal septum.12

Can You Overdose?

It is possible to overdose on Ritalin. Symptoms of an overdose include:6

  • Pronounced pupil dilation.
  • Dry mouth.
  • Uncontrollable shaking.
  • Muscle twitches.
  • Seizures.
  • Loss of consciousness.
  • Confusion.
  • Agitation.
  • Hallucinations.
  • Sweating.
  • Flushing.
  • Vomiting.
  • Irregular heartbeat.

ritalin pills, cocaine, syringe, spoon and other drugs on tableIndividuals with heart problems or defects may be at increased risk of death from Ritalin abuse, and the drug can cause heart attacks.4,6

Combing Ritalin with other drugs increases the risk of overdose and other complications. For example, combining Ritalin with other stimulants, such as methamphetamine or cocaine, can increase the risk of cardiovascular complications as well as substance-induced psychosis, anxiety, and panic attacks.13

Mixing prescription stimulants with alcohol can mask the effects of alcohol and make it harder for someone to know how intoxicated they are. They may continue to drink, increasing their risk of alcohol poisoning. The combination of prescription stimulants and alcohol can also cause muscle twitches, headaches, arrhythmias, dizziness, and vomiting.14

Treatment for Overdose

If you believe you or someone you know has overdosed on Ritalin, call 911 immediately.

No specific antidote exists to treat a stimulant overdose. However, medical professionals in an emergency room may manage the overdose by:15

  • Cooling the person with ice packs, mists, or fans.
  • Providing necessary ventilation and oxygenation.
  • Treating high blood pressure with antihypertensive medications.
  • Controlling seizures with medications such as diazepam (Valium).
  • Administering nitrates for chest pain.

What to Expect in Treatment

Many people who develop an addiction to Ritalin or other stimulants have a hard time quitting on their own. They may come to rely on the drugs to complete their work or continue to take them to avoid withdrawal. Treatment programs, which come in a variety of forms to suit people’s needs, can help users overcome their addiction and recover from drug abuse.

Heavy, long-term users may require detoxification to help manage withdrawal symptoms. Although withdrawal from stimulants is rarely associated with serious medical complications, users may develop some degree of anxiety, paranoia, insomnia (or hypersomnia), dysphoria (negative outlook/dissatisfaction with life), or depression. The emotional turmoil of withdrawal may be accompanied by an increased suicide risk, so having professional support during detox can be an important protective factor against serious self-harm.16 A formal detox period can take place in a free-standing detox clinic, at the start of an inpatient rehab program, or as part of an outpatient substance abuse treatment program.

After detox, users are advised to enter some form of rehabilitation program. Detox helps the person deal with the physical effects of addiction and dependence, but it doesn’t help the person to fully address their thoughts, feelings, and associated behaviors of addiction. These are what drive the addiction, and the person must develop coping skills and new behaviors to avoid relapse.

Types of recovery programs available include:17

  • Partial hospitalization program (PHP): The person participates in treatment at a hospital for up to 20 hours a week, usually during the day. Treatment includes individual and group counseling with medical care, as well as classes about drug use.
  • Intensive outpatient program (IOP): The person visits an outpatient treatment center for 9+ hours per week. Treatment mainly consists of group therapy but may also include individual counseling. IOPs can last from a few weeks to several months and can take place in the daytime or evening.
  • Residential treatment: This type of treatment requires the recovering user to live at the treatment center for a period of time. It offers 24-hour supervision and a substance-free environment. Like outpatient treatment, residential treatment involves group and individual counseling. Stays tend to range between 28 and 90 days but may be shorter or longer depending on the program and the individual’s needs.
  • Standard outpatient: This type of treatment is similar to an IOP, but the person spends fewer hours per week at the treatment center.

Therapies

Treatment for addiction to stimulants such as Ritalin often includes the use of behavioral therapies. Depending on the program, therapies can include:
woman laying on couch portraying a ritalin addict speaking with male therapist taking notes by her side

  • Matrix Model: This type of therapy is designed to treat people struggling with stimulant addiction. The person in treatment works closely with a therapist, who provides direction and support. A Matrix Model program can include individual sessions, family education groups, relapse prevention groups, 12-step programs, and urine testing.18
  • Cognitive behavioral therapy (CBT): A CBT therapist helps a person uncover unhealthy beliefs about themselves and examine how these can lead to drug use. The person learns how to replace these thoughts with healthier ones and how to identify and manage relapse triggers.19
  • Contingency management: This form of therapy is also commonly used to treat stimulant addiction. People receive rewards for certain behaviors, such as a negative urine test or staying sober for a designated period of time. Rewards might include vouchers that the person can exchange for gift cards, movie passes, and other items that align with a sober lifestyle.20
  • Motivational enhancement therapy (MET): The MET approach is often used to help people develop the motivation to engage in treatment. The therapist helps the person identify the pros and cons of continued drug use and work through their resistance to beginning recovery.21

Recovery Support Groups

Recovery support groups use the support and camaraderie of peers to help people establish and maintain their sobriety. Many are 12-step programs, such as Alcoholics Anonymous and Narcotics Anonymous. Pills Anonymous is a 12-step program for people with addictions to prescription drugs. These programs offer an established program of recovery that people complete with the help of a sponsor.

Non-12-step programs such as SMART Recovery and Secular Organizations for Sobriety are an alternative form of support group that forego some of the spiritual aspects of 12-step programs. They use evidence-based treatment approaches and promote self-reliance.

Aftercare

Long-term sobriety takes work, and recovery can be a lifelong process. Completing rehab is a major step toward recovery from Ritalin addiction. But long-term sobriety takes work, and recovery can be a lifelong process. Before a person leaves a rehab center, they should work with their therapist or another staff member to set up an aftercare plan. The plan should include options for ongoing programs that the person can participate in to sustain their recovery.

Common options for aftercare include regular attendance of 12-step meetings, individual counseling, group counseling, and sober living.

Take the First Step

It can be hard to admit that you or someone you love has an addiction. After all, many people believe that prescription drugs are safer than street drugs because they’re prescribed by a doctor. However, these drugs can be dangerous and addictive when not carefully used as prescribed.

Substance abuse tends to get worse the longer it goes untreated. If you think you or someone you know needs help, don’t wait. Begin to explore your treatment options today.


References

  1. University of Maryland Center for Substance Abuse Research. (2013). Ritalin.
  2. Food and Drug Administration. (2013). Medication Guide: Ritalin.
  3. National Institute on Drug Abuse. (2016). What are stimulants?
  4. Royal Canadian Mounted Police. (2013). Prescription Drugs.
  5. Substance Abuse and Mental Health Services Administration. Results from the 2015 National Survey on Drug Use and Health: Detailed Tables.
  6. S. National Library of Medicine: Medline Plus. (2017). Methylphenidate.
  7. National Institute on Drug Abuse. (2014). Stimulant ADHD Medications: Methylphenidate and Amphetamines.
  8. Vastag, B. (2001). Pay Attention: Ritalin Acts Much Like Cocaine. Journal of the American Medical Association, 286(8), 905-906.
  9. Wilde, C. (2017). Nonprescription use of Ritalin linked to adverse side effects, study finds. Science Daily.
  10. S. National Library of Medicine: Medline Plus. (2017). Nearly a Third of College Kids Think ADHD Meds Boost Grades. Health Day.
  11. UCLA Semel Institute for Neuroscience and Human Behavior. Stimulant Addiction: Crystal Meth, Cocaine, and Prescription Stimulants.
  12. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). Washington, D.C.
  13. Australian Government Department of Health. (2014). Polydrug Use: What You Need to Know About Mixing Drugs.
  14. University of California Santa Cruz. (2017). Common Alcohol and Drug Combinations.
  15. Substance Abuse and Mental Health Services Administration. (1999). Treatment for Stimulant Use Disorders: Chapter 5—Medical Aspects of Stimulant Use Disorders. Treatment Improvement Protocol Series, No. 33.
  16. Substance Abuse and Mental Health Services Administration. (2013). Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) 45.
  17. Johns Hopkins Medicine: Center for Substance Abuse Treatment and Research. Treatment Settings.
  18. National Institute on Drug Abuse. (2012). The Matrix Model (Stimulants).
  19. National Alliance on Mental Illness. Psychotherapy.
  20. National Institute on Drug Abuse. (2012). Contingency Management Interventions/Motivational Incentives (Alcohol, Stimulants, Opioids, Marijuana, Nicotine).
  21. National Institute on Drug Abuse. (2012). Motivational Enhancement Therapy (Alcohol, Marijuana, Nicotine).
  22. Stocker, S. (1999). Medications Reduce Incidence of Substance Abuse Among ADHD Patients. NIDA Notes 14(4).
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