394 CHAPTER 9
Ritalin
Another legally restricted stimulant that is abused is Ritalin(methylphenidate hy-
drochloride), which—like amphetamines—is frequently prescribed for ADHD. Its
neurological effect is similar to, but slower than, that of cocaine. Those who abuse
Ritalin take the stimulant in any of three ways:- swallowing pills, which does not usually lead to dependence;
- inhaling or snorting crushed pills, which leads to a quicker “high” and causes
increased heart rate, stroke, or lung problems; and - injecting the drug in liquid form, which is reported to produce an effect similar to
that of cocaine.
Both inhaling and injecting Ritalin can lead to dependence. People who do not
have ADHD may occasionally swallow Ritalin pills for the stimulant effects—
heightenedalertness, increased attention, and decreased appetite. Although such ca-
sual use does not meet the criteria for abuse or dependence, it still carries the risk of
adverse medical side effects related to heart problems and stroke.MDMA (Ecstasy)
Another stimulant drug that can be abused is methylenedioxymethamphetamine
(MDMA), commonly called Ecstasy or simply “e.” MDMA is usually taken in
tablet form. It is chemically similar to both methamphetamine and the hallucino-
gen mescaline and has the effects of both types of drugs: the stimulant effect of
increased energy and the hallucinogenic effect of distorted perceptions. With the
fi rst use, people report heightened feelings of empathy toward others and a greater
sensitivity to touch. This experience is less pervasive with subsequent use. Other
effects are a sense of well-being and warmth toward others, reduced anxiety, and
distortions of time perception (NIDA, 2007e). Abuse can result in poor mood
and diffi culty regulating emotions, as well as anxiety and aggression, sleeping
problems, and decreased appetite (NIDA, 2008b).
In addition, MDMA users can also develop impaired cognitive functioning,
especially problems with memory, after the drug wears off. These cognitive defi cits
become more severe when the drug is abused (Verkes et al., 2001). One survey of
MDMA users found that almost 60% reported withdrawal symptoms that included
poor concentration, depression, decreased appetite, and fatigue; moreover, almost
half of these users were dependent on the drug (NIDA, 2007e; Stone, Storr, &
Anthony, 2006). Frequent users of MDMA may experience tolerance and with-
drawal symptoms (Leung & Cottler, 2008). Lynn Smith recounts her experience of
MDMA dependence:
Sometimes I stopped eating and sleeping. I worked only two days a week to support
my habit. The rest of the time was spent getting high, almost always on Ecstasy. The
utter bliss of my fi rst Ecstasy experience was a distant memory. Of course, I never
could recapture that fi rst high, no matter how much Ecstasy I took.
In fi ve months, I went from living somewhat responsibly while pursuing my dream
to a person who didn’t care about a thing—and the higher I got, the deeper I sank into
a dark, lonely place. When I did sleep, I had nightmares and the shakes. I had pasty
skin, a throbbing head and the beginnings of feeling paranoid.
(Partnership for a Drug-Free America, 2007)
MDMA’s side effects are similar to those of other stimulants, including increased
blood pressure and heart rate. Excessive sweating, another side effect, can cause
acute dehydration and hyperthermia (abnormally high body temperature). The ef-
fects of MDMA may be diffi cult to predict in part because the tablets often contain
other drugs, such as ketamine, cocaine, or other stimulants; thus, many users’ expe-
riences with MDMA are a result of unintentional polysubstance use (Green, 2004).
In addition, many people who take MDMA also use other substances—intentional
polysubstance use.