RITALIN AT CENTER OF ADDICTION DEBATE

Ritalin, the embattled stimulant drug prescribed to millions of young people
with attention deficit hyperactivity disorder, is at the center of a new
debate.

Whirlwinds in perpetual motion, children with ADHD have trouble with focus
and impulse control, disrupting their home and school life. But they are
also at high risk for drug abuse.

Now a controversial study from the University of California at Berkeley
contends that Ritalin and other stimulants further raise the risk of drug
abuse. Nadine Lambert, a professor of education, followed almost 500
children for 26 years. She argues that exposure to Ritalin makes the brain
more susceptible to the addictive power of cocaine, and doubles the risk of
abuse.

"This reinforces an old stereotype," retorts David Smith, founder of the
Haight-Ashbury Free Clinic in San Francisco. "It's one of the reasons people
haven't treated children, for fear it would turn them into addicts."

"I very much doubt Ritalin predisposes children to take other drugs of abuse
unless they were abusing it," added Nora Volkow, a psychiatrist at the
Brookhaven National Laboratory on Long Island, N.Y. While Ritalin is
addictive if snorted or injected, oral Ritalin taken in the proper dose
"doesn't produce a pleasurable high."

Other critics contend the study participants who got medication probably had
more severe ADHD to begin with than the untreated group - a factor that
could explain their higher rates of drug abuse. "I stand by our results,"
Lambert said

Stay tuned. Studies heading for publication later this year will reach
exactly the opposite conclusion, finding that Ritalin and other drug
treatments actually reduce the risk of drug abuse. Untreated kids are more
prone to self-medicate and abuse chemicals, they conclude.

Harvard psychiatrist Tim Wilens and his colleagues at Massachusetts General
Hospital studied 500 children from age 10 to age 15 and exonerate Ritalin.

"The unmedicated group of ADHD patients clearly was at risk for substance-
abuse disorder in mid-adolescence," Wilens said. By contrast, kids who were
treated with stimulants such as Ritalin had lower drug-abuse rates, much
like those of a control group that didn't have the disorder.

"Drug therapy," he concluded, "was protective." Wilens' study is scheduled
to be published in the August issue of the journal Pediatrics.

The Harvard study parallels findings by psychologist Jan Loney of the State
University of New York at Stonybrook. She tracked 300 Iowa youths who were
diagnosed with the disorder in the late '60s and '70s. By their 20s, she
said, "we found the medicated kids were less involved with substances of
abuse, less antisocial and generally better off than unmedicated kids were."

James Swanson, professor of pediatrics and cognitive science at the
University of California, Irvine, said ADHD might be rooted in the receptor
for the neurotransmitter dopamine. Ritalin is a dopamine reuptake inhibitor
- - meaning it keeps more of the substance in circulation.

Swanson said Ritalin, while effective for many, fails to help 20 percent to
30 percent of patients. Moreover, it wears off in two hours, requiring
children to take medicine at school. A newer stimulant, Adderal, is active
longer.

Other conventional drug treatments include the stimulants Dexedrine and
pemoline (Cylert), the drug clonidine (Catapres) and a variety of
antidepressants.

Soon, the National Institute of Mental Health will air results of a study
comparing drugs, behavioral therapy and a combination of the two. Peter
Jensen, associate director for child and adolescent research at NIMH, said
the study examined 600 children.

Drugs alone - Ritalin, Dexedrine, Cylert or the antidepressant imipramine -
worked well for simple ADHD, he said. But for many children suffering from
related social problems, anxiety or depression, the combination was
superior. The behavioral therapy combined a system of rewards for meeting
goals with parental education, classroom support and a special summer camp
devoted to building skills.