The History and Science of Stimulant Drugs
The Road to Child Pharmacology
Anonymously contributed by a Biophysicist employed by a major United States University
The most common medications for childhood ADHD, such as Ritalin, Adderall, and Concerta, belong to a class of psychoactive drugs known as stimulants, which also includes methamphetamine and cocaine. While there are minor variations between the properties of each drug, the primary effects on brain chemistry are the same. The stimulant drugs have a long and colorful history, of which their use in children is only the latest chapter.
The oldest of the major stimulants is cocaine, which is found naturally in the coca plant in South America. For thousands of years, the Inca and other natives chewed coca leaves in the belief that doing so gave them heightened strength and wakefulness. After the Spanish conquest in 1533, South America’s new overlords were unsure what to make of the coca leaf; some Spaniards took to chewing it themselves, while others dismissed its use as superstition or witchcraft.
The Spaniards had no means to preserve the leaves during sea voyages, so for more than three centuries cocaine remained confined to South America. While the Inca did not seem to be aware of any harmful effects from coca chewing, it is worth noting that they also had no way to purify the leaf’s active ingredient, so they were getting much smaller doses of stimulant than either a modern cocaine user, or a child taking pills for ADHD.
This changed in 1860, when the German chemist Alfred Niemann discovered a method of extracting pure cocaine from dried coca leaves. Over the next few decades, a wide market developed for the drug throughout Europe and the Americas. Along with other newly discovered wonder drugs like morphine and heroin, cocaine was sold over-the-counter as a cure for a large variety of physical and mental ailments, and it even saw use as an ingredient in the original, pre-1903 recipe for Coca Cola.
But as time passed, more people became aware of the hazards of drug addiction, and this golden age of unregulated pharmacy came to an end. Famous doctors like William Halsted and Sigmund Freud, who had once praised cocaine, now turned against it. Early in the twentieth century, a variety of legislative acts restricted cocaine to the medical profession, where it saw little use except as a local anesthetic. [1]
Even as the cocaine wave receded, the advance of chemistry led to the creation of a number of new and wholly synthetic stimulants. Amphetamine was chemically synthesized in Germany in 1887, though its psychoactive properties were not explored until the 1920s. Since then, it has been marketed under a variety of trade names, including Benzedrine, Dexedrine, Adderall, and Vyvanse. Methamphetamine was first synthesized in Japan in 1893.
While the various stimulant drugs differ in some details, such as the amount of time that the substance remains in the body after taking a dose, the primary set of effects – as well as the virtual guarantee of harmful dependency if the drug is taken regularly for a long time – is the same for each of them.
Stimulant drugs suppress the need for sleep. In consequence, they were soon being marketed as a treatment for narcolepsy and a performance-enhancer for for truck drivers and other laborers who wanted to work longer hours. At the same time, most other stimulant users came to see insomnia as a noxious side effect, since a lack of sufficient sleep will aggravate nearly all mental health problems. [2]
Along with the heightened wakefulness came an increased ability to focus, but at a cost. As noted by the psychiatrist Peter Breggin: “The drugs suppress all spontaneous behavior…. In animals and in humans, this is manifested in a reduction in the following behaviors: (1) exploration and curiosity; (2) socializing, and (3) playing.” [3]
Stimulant use also caused appetite loss and changes in temperament, in the form of irritability, aggressive behavior, and narcissism. Because the drug acts on the brain’s dopamine system, which is associated with rewards/pleasure, coming off a stimulant will result in a severe depressive crash. Similar mood changes occur gradually but inexorably after years of dependence, as the brain’s natural ability to produce dopamine is worn down. This is observable in children who have been dependent on stimulants for several years, when they develop emotional instabilities and frequently break into tears for little or no apparent reason.
The same effect, in reverse, is responsible for the euphoric high when a dose of stimulant is taken rapidly, for instance by injection, snorting, or smoking from a bong. Pills release the drug too slowly to create this feeling, though the broader psychological effects are the same.
But for the early adopters of stimulant drugs, their proven success at staving off sleep, improving concentration, and suppressing appetite were what really mattered. These traits were seen as especially desirable in the military, and soon after the outbreak of World War II, millions of German soldiers and airmen were being drugged with methamphetamine (nickname: “Hermann Göring Pills”) as part of an attempt to produce a superior breed of fighting men.
The Allies, meanwhile, obtained the same effects with Benzedrine, but they were more aware of the drawbacks and employed drugs less often, except in the case of bomber crews who needed to stay awake and alert during long missions. As the war dragged on, even the Germans became more skeptical, and most units cut back on meth use, limiting it to times of extreme stress. It was something to be taken when the men’s lives were in danger, as a “war is hell” sort of thing. [4]
The last of the four major stimulants, methylphenidate, was discovered in Switzerland during the final year of the war. It would later be marketed under the trade names Ritalin and Concerta. [5]
The use of stimulant drugs to suppress hyperactivity in children began around the same time. By 1970, it had become common enough to spark a controversy leading to Congressional hearings on the subject of “Federal Involvement in the Use of Behavior Modification Drugs on Grammar School Children.”
Notwithstanding the controversy, child-drugging continued to grow more common, and by the mid-1970s, between 1 and 2 percent of America’s children were being drugged. In 1987, the American Psychiatric Association created the new label of “Attention Deficit Hyperactivity Disorder” (ADHD) to replace older names like “Hyperkinesis” and “Minimal Brain Dysfunction” for the collection of behaviors which the medication was aiming to suppress.
Since that time, parents of children diagnosed with ADHD have often been told that the condition is a result of an inborn chemical deficiency in the brain. What is usually omitted from the discussion is the fact that this hypothesis – which is not accepted by all neurologists – is not based on any sort of scientific or radiological examination of the brains of children about to be diagnosed with ADHD. Rather, it was formed by working backwards from the fact that modifying brain chemistry with drugs can produce the behavior changes which the school and/or parents desire.
In the United States, the largest increase in the use of stimulant drugs for children came during the 1990s. By the end of that decade, some 10 to 15 percent of American boys, plus a smaller number of girls, were being medicated for ADHD. In addition to the other effects of stimulant dependency, these children also suffered from suppression of their physical growth. This symptom, which was easier to study and measure than the psychological damage done by the drugs, soon became their most well-known adverse effect. [3]
All throughout this process, some parents resisted attempts by the schools to cajole them into medicating their children, seeing it as an assault on common sense. They knew that children are, by nature, more rambunctious and distractible than adults, and that half of them are more so than the average child. Allowing one’s son or daughter to gain the ability to focus naturally and gradually seemed, on the whole, to be a much better option than purchasing a few years of improved childhood behavior at the cost of a long-term drug dependency.
These parents’ fears were supported by the testimony of a number of doctors highly critical of the ADHD diagnosis and the associated medications, the most famous among them being the psychiatrist Peter Breggin. On the opposite side, the most important promotor of child-drugging was Joseph Biederman, Chief of Pediatric Psychopharmacology at Harvard’s main teaching hospital, with Charles Nemeroff and Fred Goodwin also playing key roles. Each of these three doctors was later found to have taken between $1.3 and $2.8 million in consulting fees and other suspicious payments from the pharmaceutical firms whose products they were promoting. [6]
The millions of parents who have yielded to the pressure to drug their children cannot be wholly blamed for what they have done. After all, making child-drugging mainstream did not require its advocates to resort to lying or overt scientific fraud. Rather, the propaganda worked by emphasis and by omission – by emphasizing the overwhelming evidence that Ritalin and Adderall really do produce the desired behavior changes, and by omitting a serious discussion of whether or not they do so at an acceptable cost.
The studies that show (correctly) that stimulants reduce disruptive classroom behavior, and improve short-term test-taking ability, are widely publicized. The studies that find only a negative effect on long-term academic performance get far less attention. [5]
Evidence that diagnoses of ADHD are less common when children have opportunities during the school day to move about and work with their hands – for instance, in recess or woodshop classes – have similarly been neglected. The same has happened with studies showing that children born in December (whose work is always being compared with that of classmates a little older than themselves) are more likely than average to end up being drugged. [7]
The people responsible for this propaganda are usually acting out of a blend of self-interest, conformity, and misplaced idealism. To begin with, those who choose a career in psychopharmacology do so because they believe that chemically modifying a patient’s brain function is more likely to solve problems than to create them. Later on, promotion within the field comes more easily to yes-men who look at only the positive aspects of their work. Meanwhile, other kinds of mental health professionals, who specialize in counselling or behavioral therapy, tend to have dimmer views of drug dependency, especially in children, but their opinion counts for less in the corridors of power. [8]
All of this is especially tragic in light of the fact that improvements in neuroimaging have allowed the present generation of scientists to see the biological effects of long-term drug use more clearly than ever before.
Ritalin and other stimulants work by partially disabling the chemical cycles governing the production and reuptake of several neurotransmitters, most notably dopamine and GABA+. The immediate effect is an increase in the concentration of each chemical in the brain. However, after years of drug dependency, the brain loses the ability to produce these chemicals at the normal rates, leading to deficiencies instead.
The effects are much more severe in patients medicated as children than in those medicated only as adults. Scientists are aware that dopamine is involved with regulating emotions and the reward/pleasure system, while GABA+ plays some role in impulse control, but the exact effects of living with a permanent deficiency in either chemical remain mysterious. [9][10]
Additionally, there is evidence that stimulant drug dependency during childhood leads to underdevelopment of the nucleus acumbens, an area of the brain important to motivation and drive. [11]
It is important to note that these kinds of developmental anomalies do not occur in unmedicated children, whether they have been diagnosed with ADHD or not.
Despite the alarming nature of these findings, they have generally been published in less distinguished journals than drug-positive studies, and they have not generated nearly as much follow-up research as they deserve. It would be naïve not to suspect that this is related to the fact that most research into pharmacology is ultimately funded by pharmaceutical firms, and researchers know that it is easier to receive grants and advance their own careers when they don’t bite the hand that feeds them.
In the end, the success of the psychiatric industry and the school system, in getting so many children onto psychoactive drugs, was not a triumph of outright deceit, but of encouraging people to ask the wrong questions.
If one asks, “Do Ritalin and Adderall work?” then the answer is a clear “Yes.” It is easy enough to see, in medicated children, a reduction in disruptive behavior at home and at school, a reduced ability to become bored or distracted in the classroom, and in many cases, a child who seems happier because the natural desires to move around, play, and socialize, which formerly put him or her into conflict with authority figures, have been chemically suppressed.
But if one asks whether these fleeting benefits are worth the lasting physical and psychological damage that drug dependency will do to a child, then the answer – after taking a candid look at the history and science behind stimulant drugs – will be very different.
[1] www.recovery.org/cocaines/history/
[2] https://www.recovery.org/methamphetamine-recovery/history/
[3] Breggin, Congressional Testimony of 29 Sept. 2000, breggin.com/breggin-testifies-before-congress-re-ritalin-and-adhd/
[4] See Blitzed: Drugs in the Third Reich by Norman Ohler
[5] http://www.digitaljournal.com/article/352650
[6] Leonard Sax, NY Daily News, 13 Dec 2008, https://www.leonardsax.com/child-psychiatry-is-sick-with-hidden-conflicts-of-interest/
[8] See Marilyn Wedge, Ph.D., a behavioral therapist and critic of ADHD medication, and author of a book entitled A Disease Called Childhood
[9] Journal of Nuclear Medicine, https://jnm.snmjournals.org/content/50/supplement_2/1283. In this study, the dopamine transporters were “highlighted” by injecting the patient with a minute amount of radioactive cocaine; this method works because Ritalin and cocaine target the same areas of the brain.
[10] NeuroImage, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5506880/
[11] https://www.leonardsax.com/a-d-h-d-drugs-have-long-term-risks/
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