Is Ritalin a Gateway Drug?

by Tina Blue
January 26, 2001

        One reader has asked an important question: Will taking Ritalin as a child make a person more likely to use other drugs when he gets older?

          Statistically, the answer is that there is a positive correlation between Ritalin use as a child and the abuse of alcohol and other drugs as an adolescent or adult. But that does not necessarily mean that taking Ritalin as a child is what causes someone to turn to other drugs or to alcohol as an adolescent or adult. The fact is, whether or not one ever uses Ritalin, having ADD/ADHD is in itself positively correlated with drug and alcohol abuse, as well as a number of other maladaptive and socially disastrous behaviors.

          A child with ADD or (even more so) ADHD is likely to get a lot of negative feedback from parents, siblings, and peers, as well as teachers and other authority figures.  By the time they reach adulthood, many ADD/ADHD children have a poor self-image and suffer from depression or engage in antisocial behaviors because of many years' worth of environmentally-induced psychological and emotional difficulties.

          In my article "What About Ritalin?" I tell some stories about how Ritalin has clearly helped children who suffered severe emotional stress as a consequence of their ADHD. To the degree that Ritalin or other ADD drugs can help soften the negative social impacts on a child, using Ritalin when young might actually help some people avoid falling into a pattern of drug or alcohol abuse as they get older.

          Most people who have some sort of psychological maladaptation to their environment will self-medicate in one way or another, either to improve the fit between their own behavior and the demands of the environment, or to dull the pain caused by their maladaptation and the difficulties it creates.

          Sometimes the poor fit is not the fault of the individual but of the social environment, and I believe that is often true for those who have the ADD/ADHD personality type. It is often only a "condition" or a "syndrome" because having ADD/ADHD makes it hard to function successfully in a very complex, demanding, and unforgiving social environment.

          Many people will self-medicate with caffeine and/or nicotine, which operate on the same part of the brain that is affected by Ritalin, Dexedrine, and other such drugs. I have long used caffeine, itself a highly addictive drug, to deal with the symptoms of my own ADHD. But I now have health problems that render caffeine potentially dangerous for me, and I should not use it at all. Unfortunately, though, caffeine is an addictive drug, and though Ritalin has helped me cut way down on it, I still drink coffee in the morning.

          I believe that whether or not a child grows up to abuse alcohol or other drugs has far more to do with how the child was raised and the degree to which our popular culture has influenced him than it does with whether or not he has used Ritalin.

          Our entire culture glorifies excess, including drug and alcohol abuse. The part of the popular culture that is most heavily targeted to young people--especially adolescent males--actively promotes drug and alcohol abuse, and it is very hard for a young person to completely avoid exposure to the drug and alcohol subculture of the young.

          But whether he avoids that subculture or not, or whether he is sucked into it when he is exposed, is likely to depend on whether he was raised in a stable home environment by loving parents, and whether he was protected from suffering psychological and emotional damage as a result of his ADD/ADHD behaviors.

          I would consider divorce, heavy exposure to television, violent video games, and even spending too much of one's childhood in daycare or in a bad school or neighborhood, to be far more potent risk factors for future drug and alcohol abuse than Ritalin could ever be.

          Psychotropic drugs are used in all cultures, and always have been. But problems with drug abuse and addiction usually occur only when people feel so unhappy and so stressed that they cannot cope with normal existence.

          In  my article "Slow Down--You're Moving Too Fast," I point out some of the factors in our stressed-filled environment that lead to drug and alcohol abuse, as well as a host of other problems, among adolescents and adults. I think Ritalin is less dangerous than any of those factors.

          It is also true that Ritalin, with a sixty-year track record, is one of the most thoroughly studied long-term drugs available. Ritalin is, therefore, probably safer than a lot of the medicines that go on the market with a minimum of review these days.

          Having said that, however, I also have to say that I think putting a child on Ritalin--or any other psychoactive medicine, including antidepressants--should be almost the last, not the first, approach to dealing with his difficulties. Toxic substances of any kind, and no medication is entirely free of potential toxicity, have a much greater impact on growing tissue than on mature tissue.

          That's why fetuses in the first trimester are so much more susceptible to the teratogenic effects of certain substances, why children need more protection than adults against environmental toxins, and also why people are so much more likely to become alcoholics if they start drinking during their teen years than if they wait until they are adults.

          The fetus develops at an extraordinary rate, especially during those first three months, and a teenager's growth rate is the fastest of his lifetime, except for the period from birth to one year of age. Furthermore, the brain's development from conception to one year, and then again from the beginning of adolescence to about twenty years of age, is unmatched at any other time in a person's life.

          Since children are therefore more susceptible to potential toxicity, I believe that drugs should be used very carefully with them, and the younger they are, the more carefully those drugs should be administered.

          Some cases of ADD/ADHD could be handled with early behavioral and environmental interventions, without ever having to resort to drugs. But usually, by the time a child has been referred for testing and treatment for ADD/ADHD, his problems in school and at home are pretty severe, so the opportunity for early intervention has already been missed.

          Still, even under those circumstances, behavioral approaches and manipulation of the child's social environment should be tried first, if possible, and the drugs added to the intervention only when it is evident that something more is needed.

          In really severe cases, drug intervention might even be necessary as a first resort, simply because the child is in such a bad situation that it would be impossible to help him through other approaches, unless drugs are also used.

          The two children I described in my stories in "What About Ritalin?" were both in that sort of situation. They were severely depressed and completely out of control--and neither of them had a home environment that would have made it likely that behavioral approaches would be successful, at least not alone.

          Some families are so much a part of the problem that they cannot be recruited as part of the solution, and in such cases, the purpose of treatment will be to mitigate the worst effects for a child in an intolerable situation.

          For the two children in my article, going on Ritalin felt like salvation. They were both measurably happier and more successful after they began taking Ritalin, and since their own behavior was more controlled, they provoked less negativity in the people around them.

          Consequently, the drug actually modified their social environment by producing positive feedback, and then it became possible to enlist the parents and teachers in behavioral modification approaches, which would not have been possible before the children began to take Ritalin.

          In other words, I think you need to take your own child's total situation into consideration before deciding whether he should go on Ritalin. Don't allow yourself to be bullied or pressured by teachers who think the child would be easier to handle on drugs.

          But also don't let your fear that Ritalin could be a gateway drug prevent you from considering it or one of the other ADD/ADHD drugs for your child, if it is clear that behavioral modification and social changes are not doing enough to allow him to be happy and successful among his peers, at school or at home.

          I think genuinely loving and stable parents are likely to make wise choices if they do enough reading on this subject. And if drug intervention is used, they will also monitor the drug's effects on their child, to make sure that those effects are not harming him.

          And I think toxic parents will do all kinds of things that will drive their kids to drugs and alcohol or other self-destructive behaviors--with or without Ritalin.