
How To Take Ritalin Correctly - pw
http://thelastpsychiatrist.com/2007/08/how_to_take_ritalin_correctly.html
======
DanielBMarkham
I'm somewhat amused by all this discussion about brain-enhancing chemicals.
It's different, yet it is strangely the same.

As a vitamin junkie, I truly believe that certain "hacks" allow me to do
better on interviews: caffeine, ginko, SAMe, glutamine, etc. Maybe by a few
percentage points. Nothing to write home about, but worth the investment for
the job interview.

But these kids aren't going for job interviews. And they're not talking about
run-of-the-mill OTC brain hacking. They're talking about using high-
performance brain-targeted stimulants as part of a maximization strategy for
some _test_ in school. As if anybody gives a rat's ass about what you made on
calculus finals six months from now.

Let's see: brain damage versus 10 points less on a test you're never going to
talk about (unless you fail). I think this risk analysis is a no-brainer here,
to use a pun.

I'm concerned that what's really going on is that some people are just wired
to go screw around with their bodies using chemicals. This whole take-to-
maximize-study rationale is just another in a long line of rationales going
back many decades. There was drug use to combat the drudgery of life. Drug use
to protest the system. Drug use to find inner peace. Drug use for religious
exploration. Drug use for sports enhancement. Drug use to prolong life. Now we
have drug use for educational enhancement.

I'm not saying this is wrong -- whatever that means. Perhaps there is an
evolutionary competitive advantage to hacking your brain with chemicals and,
if so, we're seeing a new branch of the human family tree. Or perhaps we're
still four hundred years away from true brain hacking and this is just another
in a long line of reasons to screw around with reality.

Timothy Leary may be dead, but he's far from gone.

~~~
j_baker
The thing is that amphetamines are some of the most well understood
medications prescribed by doctors. They've been prescribed for almost 80
years. Doctors know their effects better than most "conventional" medicines.
And it has never been proven that they have seriously harmful side effects
when taken under appropriate medical supervision. Although it's hard to
objectively diagnose ADHD (just like any other psychiatric condition), doctors
know what they're doing when they prescribe stimulants.

Therefore, the choice isn't "brain damage vs 10 points on a test." It's more
like "performing like a normal human being vs failing at life."

~~~
DanielBMarkham
Is the topic here people that self-medicate in order to gain a few points on a
test over non-medicated folks, or people who have serious, real brain problems
that need some intervention to be more normal?

Because I'm talking about the first case, and you seem to be talking about the
second. The article, to me, was geared toward the first scenario. If you'd
like to talk about the second scenario, that's fair game, but not what I was
talking about at all.

~~~
rms
Amphetamines don't cause brain damage in either case -- look at the military
use, from World War II on.

~~~
tokenadult
Amphetamines are well known to induce mania, which is one reason they are no
longer used, as there were formerly used, to treat depression.

I'd like to see some medical references for the statement "amphetamines don't
cause brain damage," because study of long-term neurotoxicity or
neuroprotective effects of most medicines is still in very early stages. What
medical journal references can you cite on that point for amphetamines?

------
michael_dorfman
Would it sound terribly old-fashioned to suggest that before taking
amphetamines to help study, one ought to figure out what the (non-medical)
obstacles are to effective studying, and remove those?

I think that if somebody were in a position to take the author's advice of
"take a pill, and then study for 4 uninterrupted hours, keeping your attention
keenly focused on the task at hand", they'd do (almost) as well skipping the
pill.

~~~
ivankirigin
Given two similar people that follow the same study good advice, but one takes
coffee (or some other stimulant), the person taking the stimulant will do
better.

That the author suggests good study habits doesn't mean people shouldn't take
them.

Given the risk of addiction, it is probably especially important to recommend
good usage habits.

~~~
kragen
Coffee is a _much_ less effective stimulant for this purpose than amphetamine
or methylphenidate.

~~~
ivankirigin
My point is just about the different between those using and those not - not
the degree. In the long term, more powerful stimulants could prove less
effective.

One good reason to legalize stimulants is to let more people experiment with
them. It would be great to know that taking amphetamine is actually a bad way
to work in the long term.

Either way, I'm more excited about non-stimulant methods of increasing
concentration. Stimulants seem zero sum, at best.

~~~
kragen
I'm not talking about a difference of degree where one stimulant is "more
powerful" than the other, but in the nature of the effects. "CNS stimulant" is
a very vague term which glosses over really major differences between, say,
amphetamine and caffeine.

I'm not sure in what sense you mean "zero sum" but it isn't true of
amphetamine in the senses that come to mind.

------
TravisLS
The conclusion of this article is the most illuminating part. In case you
didn't get there...

 _As a public service announcement, don't worry too much about grades. This is
America, not Germany, where success is determined by the solidity of your goal
and the amount you are willing to work. I know you don't believe it now, but
it's true. Go have a drink._

~~~
jmtame
many students on visas have to maintain a very high cumulative gpa. if they
slip below 3.5 (some have told me they have to maintain a perfect 4.0), they
could be kicked out.

~~~
dandelany
Ditto with scholarships.

~~~
dangrover
I'm actually moving from a private school to a public school because of this.

I went back to school too soon after having a craniotomy to remove a brain
tumor and didn't have the energy to get perfect grades. I'm not sure if I was
impaired as a result of the surgery, or if I just realized, in light of it,
that life is too short to spend too many nights worrying about what rounding
algorithm/grading scale some professor uses.

~~~
jacquesm
There is probably a high correlation between people that have had some
traumatic experience and those that know how to enjoy their lives.

Best of luck to you!

------
sown
I've never been able to focus adequately enough to do well in school. I'm
finished with it now but I found my school years to be disapointing because of
the lower grades which pretty much shut out any chance of doing undergraduate
research or a chance at grad school -- ever. Students rolled their eyes when I
asked a question, professors sighed and shuffled their papers at me when it
was time to return exams. I always felt like I was being judged and looked
down on during school years.

One possible explanation that I can't shake is that I never belonged in
college or grad school anyways. At least it's over now.

Nowadays I get to look forward to being judged by my colleagues. Until I
retire or die.

------
jacquesm
instead of taking stuff to get temporarily smarter how about _NOT_ taking
stuff that is known to cause you damage in the long term ?

So, no drinking, no smoking, no other drugs, just healthy food and a good
rhythm in your life. And preferably a significant other of the same mindset.
You'll be surprized by how well you can perform without any 'additives' when
you're well rested and healthy.

------
ianbishop
I'm still in school and this is one of those things that I have seen countless
people do.

General intake is a snort of half a ritalin pill when your body is beginning
to tire near 12am before your early morning exam or big term paper.

It isn't just ritalin either. I've seen people snort so many wake-ups (an over
the counter caffeine pill) that they are too busy zoning to even study.

~~~
kragen
This is a bad idea. Snorting (instead of swallowing) the pill won't change how
it affects you half an hour out (or further). It will, however, get it into
your bloodstream immediately, giving you a quick high, and by hyperbolic
discounting, it will make the operant-conditioning association between the
pill and the high much, much stronger.

Ritalin or amphetamines are _much_ less addictive if you take them in a pill,
especially a slow-release pill and/or with some food. And if your reason is to
be awake for an all-nighter on a term paper, you don't get any benefit from
snorting.

------
petercooper
This is all well and good but where do you actually _get_ all this shit?
Perhaps I'm too white and middle class but I don't have the first clue as to
where to get any of this crap and I don't know anyone who's using it either.

~~~
Devilboy
Not sure about other countries but in Australia you go to a GP, explain your
problem and he will then send you to a specialist. The specialist will consult
with you and if you do your homework you can ask him to prescribe X and if
you're making sense and there's no contra-indications he'll do it.

~~~
petercooper
It might just be me but I'm getting the impression a lot of the people here
are talking about taking these drugs very much _not_ on a physicist-advised
schedule or dosage ;-)

------
sirfrancisbacon
Suppose that after some time, we become expert brain hackers and we can find a
way to pass these changes onto our children. (through some sort of gene
manipulation; I'm not an advocate of Lamarckian evolution!)

Since at this point, humanity will diverge into two species (those who have
access to technology and those who don't), how exactly should we value those
who's lineage hasn't been benefited by the presence of these drugs?

Just a hypothetical situation of this mentality being taken to an extreme, but
still interesting nonetheless.

~~~
extension
You can value them however you like, but I imagine the enlightened front will
continue to push for token equality amidst the harsh realities of disparate
wealth and opportunity and a small minority of bigots, while society at large
remains unconcerned with intelligence, maintaining its longstanding
fascination with wealth, status and charisma.

Then again, these drugs only cost pennies so they could really even the
playing field. Starbucks needs to hurry up and invent the amphetamine latte.

------
dmg_83
I would love to see a study done comparing the benefits of Ritalin, Adderall
etc. to users diagnosed as having ADD/ADHD against users not diagnosed as
having it. If the former group receives significantly greater benefits that
would be a strong indicator that ADHD is a distinct condition, rather than a
label applied to a set of personality traits. On the other hand, if the
benefits were similar for both groups it would call into question why one of
them is denied (legal) access to the drug.

~~~
tokenadult
I have a lot of medical monographs at hand including descriptions of such
studies. I'm still reading them. But the summaries I've seen so far in my
reading are quite ambiguous as to claimed benefits of taking ADHD drugs (for
anyone), especially for the inattentive subtype of ADD. Subjectively reported
"this drug really helps me" or third-party observation of "this kid doesn't
wiggle around so much in class" is not the same as carefully verified gains in
learning from using the drug versus not using the drug.

------
embeddedradical
Warning: you do this at the detriment of your ability to be creative, have
insights, and go new directions. I'm not suggesting they're horrible in all
situations, but keep that in mind.

If you are using amphetamines please see this article by Jonah Lehrer, editor
of Seed Magazine:
[http://scienceblogs.com/cortex/2009/04/cognitive_enhancement...](http://scienceblogs.com/cortex/2009/04/cognitive_enhancement_and_crea.php)

------
HalcyonMuse
I guess provigil/modafinil is too new to be mentioned in this old article?

------
mahmud
Look, if you're gonna waste your brains on chemicals, do it right: MDMA, a
pair of reeboks, and a bottle of wate give life a rhythm section!

Besides, when did the geeks become pill-popers?

~~~
devin
You're not in college, are you?

There's serious demand for "study aids". It's really not a surprise. If you're
statistically going to score higher than your peers by taking a pill, that's
not too far off from hacking. Code optimization for the brain.

~~~
mahmud
So you're gonna risk your mental health and your brain just to score "higher"
than your peers by some arbitrary benchmark? I thought higher education was
for learning and self-development, not pushing your body like a machine.

If amphetamine use is a mental "hack", then so is cheating or paying someone
to do your work; call it crowd-sourcing, or distributed education, but that
doesn't lend it any legitimacy.

~~~
gnaritas
> So you're gonna risk your mental health and your brain just..

Don't assume it's a risk. The effects of these stimulants are well known and
well studied. Taken safely and in proper doses these are not risky drugs. The
world is not black and white and learning and self development can be aided by
these drugs. It is not cheating.

Artificially enhancing your natural cognitive abilities is a trend that is
only going to continue to increase as we learn more and more about the brain
and how to manipulate it. The body is a machine, and if we learn to make the
machine operate _better_ through chemicals, which is inevitable, then we're
going to take advantage of that. You won't see people complaining when they're
daily regiment of 20 pills lets them live healthy lives well into their 200's.

Some people realize this is already happening and are taking advantage of it.

~~~
GHFigs
The effects are _not_ well-studied for the uses described here. Indication of
amphetamines and similar drugs for cognitive enhancement is primarily based on
anecdotal evidence and drug company PR in the popular press. Much of what we
do know about the supposed benefits is tied in with the already controversial
subject of ADHD.

In my experience, calling the effects "enhancing your natural cognitive
abilities" is extremely inaccurate, as the state of mind created is not one
you can achieve naturally. That alone would not be bad, but there is a trend
toward ignoring the difference. The risk here is that we recalibrate the world
of _normal human functioning_ to the standards of _people high on speed_.

~~~
gnaritas
> The effects are not well-studied for the uses described here.

That doesn't matter, what matters is the affect and side effects of the drug
on people is known. This isn't a roll of the dice on some newly discovered
drug where the long terms effects are unknown.

> In my experience, calling the effects "enhancing your natural cognitive
> abilities" is extremely inaccurate, as the state of mind created is not one
> you can achieve naturally.

Not true, people can and do naturally achieve extreme focus and flow, the drug
isn't giving you new abilities, it's giving you more of an ability you already
have and allowing you to control when you have it.

> The risk here is that we recalibrate the world of normal human functioning
> to the standards of people high on speed.

There's nothing wrong with that as long as people are aware of what they're
doing and it's reasonably safe to do so. People have always used drugs, people
are always going to use drugs, and as the drugs get better and better, more
and more people will use them if they find it beneficial to do so.

~~~
GHFigs
_people can and do naturally achieve extreme focus and flow_

Yes, this is obvious, and I wasn't denying that at all. What is not obvious,
and what there is no evidence for, is that these states are the same as what
is achieved on stimulants. It is my own experience that they are very
distintly different, and I would never refer to the effects of speed as
"natural". The very fact that they are achieved in humans without use of
stimulants should be a strong indication that the stimulants do not recreate
the same effect. Lack of focus is not due to deficiency of Ritalin.

 _it's giving you more of an ability you already have and allowing you to
control when you have it._

This is exactly what I am saying is not true. Taking speed does not do the
same thing to your brain that your brain is ordinarily capable of doing to
yourself. When you take speed, you're not making your brain function like one
of a smarter person, no matter how much smarter you feel. Cognition is
_altered_ , not just enhanced, and I think it is a huge mistake to ignore
that. We don't ignore it when talking about cocaine or any other illegal drugs
that people report similarly positive effects from. Why are we so willing to
ignore that distinction for these drugs?

 _There's nothing wrong with that as long as people are aware of what they're
doing and it's reasonably safe to do so._

That people believe (as you do) that these drugs merely enhance existing brain
function is a sign that people really _aren't_ aware of what they are doing.

~~~
gnaritas
> What is not obvious, and what there is no evidence for, is that these states
> are the same as what is achieved on stimulants. It is my own experience that
> they are very distinctly different

Who cares? Really? People use these drugs because they give you super focus,
both the feeling, and the reality. You're too concerned about the mechanism
rather than the effect.

> The very fact that they are achieved in humans without use of stimulants
> should be a strong indication that the stimulants do not recreate the same
> effect.

That makes no sense at all. Sleep is natural, it doesn't follow that any pill
which also induces sleep is not doing it via the same mechanism. In fact, it's
an indication of nothing, either way.

> Lack of focus is not due to deficiency of Ritalin.

No one claimed it was. You're ignoring the desire for superhuman focus. People
take these when they want more focus than is natural.

> That people believe (as you do) that these drugs merely enhance existing
> brain function is a sign that people really aren't aware of what they are
> doing.

That people such as you are so strongly opposed is a sign that you're not
objective about the issue and you assume others don't know the risks and if
you could just educate them they'd change their behavior; you'd be wrong.

People willingly take far worse and far less safe drugs off the street just to
get high. Those who use prescription drugs like Ritalin off label to enhance
work or study performance are not the people you need to be concerned with.
Drug use is not drug abuse.

~~~
GHFigs
_Who cares? Really?_

I would hope that anybody taking "cognitive enhancers" would care. It seems
entirely relevant that one should know the difference between normal brain
functioning and drug-induced brain functioning. My concern is that there is a
trend towards _not_ knowing the difference, and that this is being applauded.

 _You're too concerned about the mechanism rather than the effect._

I am specifically talking about the effect. It is different. It is not, in
your words, "enhancing your natural cognitive abilities". You cannot honestly
argue that it is the same as a natural state of focus while simultaneously
claiming that the point is to have unnatural kind of focus.

And yes, I regard the distinction between natural and unnatural states as
important when it impacts things like (say) competition for top-tier
education.

 _That people such as you are so strongly opposed is a sign that you're not
objective about the issue_

I have no idea what this means. You seem to be rejecting the validity of my
opinion because it does not agree with yours. That's...deft.

 _People willingly take far worse and far less safe drugs off the street just
to get high. Those who use prescription drugs like Ritalin off label to
enhance work or study performance are not the people you need to be concerned
with._

Taking Ritalin to "enhance work or study performance" _is_ getting high. The
effect of the drug is the same regardless of whether you take it to study or
not. Why have we recently gotten a free pass to class it up by calling it
"cognitive enhancement"?

People have historically taken all kinds of drugs for performance reasons, be
they legal, illegal, or legal but illegally obtained--many to famously great
effect. What changed to allow us to use such different terminiology for the
same act? What is the effect on our culture of continuing to do so? And why
should I _not_ be concerned with changing social norms?

~~~
gnaritas
> Taking Ritalin to "enhance work or study performance" is getting high.

No it isn't. No more so than drinking a cup of coffee gets you high on
caffeine, or eating a candy bar gets you high on sugar, or drinking a bottle
of Jack gets you high on Jack.

Getting "high" is generic slang for the consumption of _some_ mind altering
substances _for fun_. 99% of the time _getting high_ specifically means
smoking marijuana. You do not label the taking of all substances as getting
high, I'm not getting high if I take a percocet, I'm not getting high if I
take a paxil, I'm not getting high if I take an abilify.

You can _tweak_ on Ritalin by taking far more than the prescribed dose which
people usually do by crushing and snorting it. This is not at all comparable
to those taking the pill in the prescribed fashion in the same dose that one
would take for ADD.

> What changed to allow us to use such different terminology for the same act?

What difference, you don't say an athlete is _getting high_ on steroids,
that's not what _getting high_ means. Secondly, you'll note we're against
steroids because they're known to be very damaging to the user, not because
they enhance his muscles. If steroids were as safe as Ritalin they wouldn't be
illegal and they'd be used by the vast majority of athletes just like every
other legal substance they've found that works.

The terminology hasn't changed, you're just mistakenly thinking we use the
same term for every drug and intent. We never have other than the generic
"using drugs". Name a drug and there is specific lingo associated with that
drug.

> And why should I not be concerned with changing social norms?

You should be aware of them, but not concerned because what other people do
shouldn't _concern_ you unless it affects you, I fail to see how it affects
you. Being _concerned_ implies that you feel the right to object to the
behavior and prevent others from doing what they want with themselves, that's
what I'm objecting to.

Social norms change, that's life, they've always been changing. If someone
wants to take a pill - widely considered safe - to make themselves perform
better, who's business is that but theirs?

~~~
GHFigs
_Getting "high" is generic slang for the consumption of some mind altering
substances for fun._

The point is that you're arbitrarily defining which substances and what uses
qualify as fun. If you snort a line of coke and then write a paper is that
getting high or not? If you take Ritalin and play Xbox is that getting high or
not? If you smoke marijuana because you feel it allows you to have better
ideas is that getting high or not?

There is no heuristic here, no fact-based rule for whether we acknowledge the
different states of consciousness or not. We've just taken the exact same
activity that people have been doing with stimulants for decades and given it
a more palatable marketing label.

 _This is not at all comparable to those taking the pill in the prescribed
fashion in the same dose that one would take for ADD._

The drug has the same effect either way, with only slight differences between
methods of delivery. The drug does not care why you take it. In any event, we
are specifically not talking about anyone taking it for the treatment of an
actual deficiency of functioning (controversy over ADHD aside), we're talking
about people taking it for "cognitive enhancement", where the indicated dosage
is none.

 _...they'd be used by the vast majority of athletes just like every other
legal substance they've found that works._

There are plenty of legal substances frequently banned in competitive sports.
For example: Ritalin, Adderal, and modafinil.

 _I fail to see how it affects you._

Exactly. Can you understand why _that_ would bother me? I'm talking about
broad sweeping changes in cultural norms that could potentially redefine what
we expect from individuals in society to standards set by people on drugs that
make them perform certain tasks at superhuman levels -- in essence doing to
our civilization what we've done to professional baseball -- and all you're
doing is arguing with my use of the term "getting high" to include "tweaking".

Social norms effect everyone that desires to participate in society. I want
those norms to be reasonable because I happen to want to participate in
society, and what I see happening with these drugs seems unreasonable,
expecially when seen as a long-term trend.

In ten years, am I going to have to take drugs in order to hold a decent job?
In twenty years, is my child going to have to take drugs in order to get into
college? More generally: what will be the long-term large-scale effect of
using drugs that alter the mesolimbic reward pathway? What reason do I have to
not be concerned about these possibilities?

 _If someone wants to take a pill - widely considered safe - to make
themselves perform better, who's business is that but theirs?_

If everyone were free to take whatever drug they want for whatever purpose
they want, that would be a good point. But that isn't the situation we have. A
person can only take _some_ drugs for _some_ purposes if obtained in _some_
ways. It is already everybody's business and we already have strict laws and
rules specifying which pills you have to take, what kind of performance is
acceptable, and who gets to decide if you can take them.

I don't want more constraints on what people are allowed to do with themselves
than already exist, and in general my preference would be for less, but I do
want less of this irrational exuberance that treats normal baseline human
cognition as a disease to be medicated.

~~~
gnaritas
I can sum up the entire reply on this statement alone...

> but I do want less of this irrational exuberance that treats normal baseline
> human cognition as a disease to be medicated.

Ah, but it is. Some of us feel extremely limited by biology and regardless of
what others feel is or isn't normal, we're going to push biology beyond what
nature provided because we can. This doesn't just apply to drugs, in the next
100 years as biotechnology really takes off, people are going to be augmenting
everything they can. Transhumanism is coming whether you like it or not.

If I can implant artificial memory to surpass the abilities of the brain
nature provided me, I will, and so will many others, and no amount of clinging
to the past or to what nature intended will prevent this from happening.

What you fear, is inevitable, the march of technology will not be stopped
because people who don't want to augment cry foul when augmented people are
out competing them, that's just how it's going to be.

~~~
GHFigs
_I can sum up the entire reply on this statement alone._

You cannot, and I resent your attempt to do so. You're just retreating into
vagueness instead of arguing pertinent points. You're also projecting opinions
on me that I haven't stated, apparently because you're more comfortable with
parrotable dogma than relating your own opinions. Suddenly, instead of arguing
for my own specific statements, you expect me to argue against extremely
general statements about technology and phrophetic claims of inevitibility.
You'd might as well say "God wills it" for all the passivity and coarseness of
thought you've expressed here.

You're making the worst sort of argument that a person can make about
transhumanism when you pretend that everything with turn out perfectly in some
distant future regardless of the actions taken by people in the meantime. That
is faith, not reason, and I'll have no part of it.

Reality is not an implementation detail. We're done here.

------
liuliu
If I do have a great concentration on test day (I usually do) but distracted
much when preparing the test. Should I take any kind of stimulants to help
out?

