자료 1: 인간 뇌의 신경과학적 향상은 윤리적으로 잘못인가?
지은이: 이상헌(가톨릭대학교), 서강대학교 철학연구소 논문집 《철학논집》2009. 06
(... ...) 신경전달물질 체계를 약리적으로 조작함으로써 주의력, 지각력, 기억력 등의 인지 능력에 변화를 줄 수 있다. 과거에는 나쁜 아이 정도로 생각되었던 것이 오늘날은 신경학적 기능장애로 이해되는 것이 있다. 바로 주의력결핍과다활동장애(attention-deficit hyperactivity disorder: ADHD)이다. 이 장애는 학교에서든 집에서든 과도하게 파괴적인 행동을 유발하는 것이 특징이다. 신경학적으로는 충동을 제어하고 주의력을 조절하는 뇌의 영역에 이상이 있기 때문으로 보이는데, 행동 특성만 놓고 본다면 다양한 원인이 지적되고 있다. 주의력은 일차적으로 도파민과 노르에피네프린(norepinephrine)에 의해서 조절된다. 메틸페니데이트(리탈린)와 암페타민(아데롤)은 두 호르몬 체계에 모두 영향을 미치며, ADHD에 효과적이다.
이 약물들을 정상인에게 사용하면, 각성 상태와 반응 시간에 의미 있는 변화가 생기며, 문제해결이나 기획 등 고급 인지 기능의 향상 효과가 있다. 미국에서는 메틸페니데이트가 상당히 널리 보급되어 있는 것으로 알려져 있다. 조사에 따르면, 미국 고등학생의 10%, 대학생의 20% 정도가 리탈린과 같은 신경 자극제를 사용하고 있는 것으로 나타났다.[주9] (... ...)
자료 2: 마약류 용어해설
지은이: 국가정보원
리탈린(Ritalin)= 메틸페니데이트(Methylphenidate)
리탈린은 非암페타민계 중추신경 흥분제로 주의 산만 및 수면 발작 치료제로 사용된다. 순한 각성제, 항 우울제로 약효가 지속되는 동안 지나친 흥분을 일으키지 않고 약효가 사라진 후에도 우울증을 남기지 않으며 기분과 능력을 향상시켜 준다. 의존증이나 금단증상은 암페타민류와 유사하나 발생빈도는 현저히 낮다.
자료 3: Maybe Your Child Has ADD and Needs Ritalin
지은이: Lawrence Diller, Saturday, October 17, 2009
What You Should Do When Someone Tells You: "Maybe Your Child Has ADD and Needs Ritalin"
Perhaps you feel panic, anger or relief. Wait. All they're really telling you is that your child isn't meeting their expectations of behavior or performance. Attention Deficit Disorder (ADD or ADHD for hyperactivity) has become the all too inclusive umbrella term for a variety of childhood (and increasingly adult) problems.
However, given current views on behavior, if they're suggesting ADD they're implying that they think the problem is because of your child's brain - and that may be only be part of the problem or not be the case at all.
Before you pursue investigating a "chemical imbalance"consider the possibilities of a "living imbalance." Are the expectations for your child's behavior and performance too high or reasonable in all their settings? Is his/her performance all that much worse than the other children? These days to be considered "average" is almost pejorative. A vast group of children perform "below"average without being abnormal. These children may be good at certain tasks and less good at others. A living imbalance can also exist when supports for the child and the family are too low. Have there been more stresses (emotional, educational, financial) on the child or his/her family? Has there been less family time for positive attention or immediate and consistent discipline? Maybe changing classes or teachers, getting extra help from an aide or resource teacher is enough to restore the balance between performance, expectations and support.
If the problems are long standing (say more than three months) consider as a start speaking with your pediatrician or family doctor. He/she should be familiar with your child and should be able to offer initial opinions, advice and direction. Be cautious, however, when after a 15 or 20 minute interview Ritalin is offered. No evaluation that short could possibly address the myriad factors involved in a child's behavior. [하지만 15~20분 정도의 면담만으로 리탈린을 처방하겠다고 하면 주의하셔야 합니다. 그렇게 짧은 진단만으로 아이의 행동에 관련된 수많은 요인들을 고려할 수는 없는 일입니다.] Ritalin improves the performance of both normal and ADD children so a positive response to Ritalin says nothing about the causes. A quick Ritalin-only approach may mask learning, emotional or relational problems and delay their being addressed.
Remember that there are no definitive biological or psychological tests for ADD. Despite attempts to standardize criteria for ADD it remains a diagnosis very much "in the eye of the beholder." Some people and doctors see ADD in virtually every problem situation; others, including some doctors, don't believe that ADD even exists! If you are referred to or find a professional who specializes in ADD (child psychiatrist, behavioral pediatrician, educational psychologist), ask about the doctor's ideas and beliefs on ADD and Ritalin. Find out how they arrive at their diagnosis, opinions and conclusions. If you're not comfortable with their approach, find someone else. If you're not sure ask other professionals in the area their opinions about the specialist you've picked.
A good ADD evaluation should address all the areas of a potential living imbalance. Both parents should give their versions of the problem to the evaluator. Some doctors prefer to use written symptom questionnaires. They are not a replacement for face to face talking between the parents and evaluator or calling the teacher on the telephone. An interview with your child should include an assessment of his/her emotional status, temperament and learning abilities. Someone should meet the child's entire family one time.
After the possible emotional, family or school problems have been evaluated and are being addressed, there may be a role for a medication intervention. Ritalin or similar drugs have been used safely in children for fifty years. No parent is immediately eager to start medicating their child but they should not feel guilty when after a thorough evaluation and multipartite treatment plan, they decide to try Ritalin for their child.cf. Running on Ritalin: A Physician Reflects on Children, Society and Performance in a Pill
cf. Beyond Ritalin: Facts About Medication and Other Strategies
자료 4: http://www.sportnest.kr/tag/Nest?page=11#recentComments
지은이: 김흥태 (대진대학교 스포츠과학부 교수)
(... ...) 뉴스위크에 따르면, 운동은 늙은 신경세포 간에 연결된 망을 만들어내며, 뇌 세포에 혈액과 영양을 공급한다. 특히 운동을 할수록 뇌에서 생기는 신경세포 영양인자(BDNF)는 지적 능력을 향상시킨다고 한다.
하버드대 정신과 의사 존 래티는 "운동은 집중력과 침착성은 높이고 충동성은 낮춰 (우울증 치료제인) 프로작과 리탈린을 복용하는 것과 비슷한 효과가 있다"고 설명했다. 또 운동을 중간에 그만두면 신경세포가 잘 작동하지 않으며, 효과를 유지하려면 지속적으로 운동해야 한다고 말했다.
이 같은 연구에 따라 미국 교육당국은 학생들의 운동 시간을 늘리려 하고 있다. 켄터키주 상원은 8학년(중학교 2학년에 해당)까지 매일 30분씩 운동을 하도록 하는 법안을 통과시켰다. (... ...)
BBC News, 23 October 2008
People are well used to seeing performance enhancing drugs in the world of sport, but now chemical enhancement is spreading to the world of academia as students go to extreme lengths to get the right grades.EPO. Nandrolone. THG. Ephedrine. Anybody who follows sport will have heard of these performance enhancing drugs, usually accompanied by the word "cheat". Now students are taking the same route, using illicit drugs to gain an advantage over their peers in the exams that will shape their lives. Students have long used plentiful cups of coffee, as well as caffeine in pill form, to stay up revising late into the night. But now some are going a step further and taking "study drugs".At the top of the list of study drugs are Ritalin, a drug prescribed to children who suffer from Attention Deficit Hyperactive Disorder (ADHD), and Modafinil, a narcolepsy drug. If not prescribed, Ritalin is a class B drug in the UK, meaning possession can lead to a five-year prison sentence and dealing could put you behind bars for 14 years. Modafinil is also not available over the counter.So why are students taking them? Modafinil and Ritalin are drugs that stimulate the brain. They make people feel more awake and alert, and help control the behaviour and concentration of children with ADHD.'Pulling all-nighters'"It helps me stay awake and stimulates my mind," says Linda - not her real name - who graduated from Manchester University in June. The 22-year-old psychology graduate took Modafinil with a group of friends several times while working on her dissertation. She used the drug to help her "pull all-nighters" and said that it allowed her to focus on her work for hours at a time."It's a stimulant, similar to caffeine or Red Bull although I didn't get distracted and feel jumpy like you sometimes do on caffeine. You don't feel wired but I did lose my appetite... I found it dificult to eat afterwards. "It's easy to buy and very cheap," says Linda, who bought the drug online, for, she claims, 40p per tablet.A recent study published in the Pharmacotherapy journal shows that Linda is not alone. At the US university surveyed, 18% of 1,253 first year students had used non-prescribed stimulants, primarily to help with their studies. Other studies have found similar results.After a few clicks the drugs can easily be found for sale on the internet at affordable prices. This is the source of the pills used by many UK students, although some say they buy their tablets from friends who are prescribed them. Carson, an 18-year-old high school student, takes Ritalin and Adderall, another drug with similar effects, two or three times a week to help him study and socialise. Studying in Utah, US, he buys the pills for $4 (£2.50) each from a friend at college.Poor results"When I take Ritalin, I can stay awake in class, concentrate on the subject matter, and even take notes during class. I have more energy, I am more outgoing, and more sociable," says Carson. Carson began taking Ritalin - one every other school day - after a run of poor exam marks, and says that his grades improved dramatically as a result."By the end of the school year I was passing every class I was taking." But Carson's reliance on performance-enhancing drugs has spilled over from his study life to his social life. "I now take it recreationally, to help myself be more outgoing and socially at school. This morning I took two Adderall capsules. Subsequently, I talked with more people than I would have otherwise and I spent about five hours studying mathematics, which is completely out of my nature."While the drugs are considered simply as another study aid to those who use them, there are hidden and potentially very dangerous health hazards, according to Dr Ros Maycock, a general practitioner in Poole. "[These drugs] put a rush of adrenalin into the blood. Your pulse rate and blood pressure increase and your pupils dilate," she says. "There can be potentially very dangerous physical side effects if you have an underlying cardiac disorder. The effects could lead to a heart attack or similar."When the drugs are prescribed, a doctor usually carries out checks on a patient's blood pressure and susceptibility to side effects and a careful risk verses benefit calculation is made, says Dr Maycock. But for the students, none of these checks are performed and the taker may not know that they are at risk.Long term effects"If you had a hidden aneurysm in your brain, it could blow it apart. People never think that they are the ones at risk."In the short term, Ritalin users can suffer from an array of side effects - anxiety, insomnia, loss of appetite, irritability and headaches and all common. The long-term effects of the drug are largely unknown. But potential health risks aside, some will feel the use of illegal stimulants gives an unfair advantage in exams and essays.While caffeinated drinks and other legal stimulants are available to everybody, amphetamines such as Ritalin are not, says Hazel Biggs, professor of medical law at Lancaster University. "If people need the drug, it levels the playing field, but if they do not, it may give people an unfair advantage," she says.There is very little that universities can do to police the use of these substances, short of performing a drugs test on every student entering the exam hall. Manchester University, where Linda studies, has no policy about the use of such drugs.But did Linda, who got a first for her dissertation, not feel she had been dishonest? No. "I didn't feel like I was cheating. If it was that good, everyone would be doing it," she says. While the practice was not condemned by her university friends, she concedes that her parents probably wouldn't approve. And of course, whatever the rights and wrongs of Ritalin as a "study drug", students are still going to have to do the work and perform in the exams. A good night's sleep might not be a bad idea.
Newsweek, February 06, 2008
Are players using an ADD diagnosis to evade the amphetamine ban?As Major League Baseball begins to dig out from its steroids scandal, new kinds of performance-enhancing substances are sweeping big-league clubhouses: Ritalin, Adderall and other drugs designed to help with Attention-Deficit Disorder. According to records MLB officials turned over to congressional investigators as part of George Mitchell's probe into steroid use in baseball, the number of players getting "therapeutic use exemptions" from baseball's amphetamines ban jumped in one year from 28 to 103—which means that, suddenly, 7.6 percent of the 1,354 players on major-league rosters had been diagnosed with ADD.One possible reason for this increase: in 2005 baseball banned the use of "greenies," amphetamines that help players remained focused and energetic through the rigors of a 162-game season. Amphetamines were once as common as deli spreads in big-league clubhouses—in some, greenies were used to spike the coffee. Players are now seeking doctors' prescriptions for ADD medications, usually Ritalin and Adderall, apparently to replace the now-illegal energy boosting drugs. (Ritalin is the trade name for the drug methylphenidate, and Adderall is an amphetamine-dextroamphetamine; they are both considered stimulants.)Certainly, some of the players getting prescriptions for ADD medications may have a legitimate medical need, says David Goodman, a Johns Hopkins University doctor who has been invited to help Major League baseball develop a new strategy for amphetamines. But he calls the ADD drug spike "troubling," since it inevitably raises suspicion that players have simply found a way to evade the amphetamine ban. No cases of abuse have been reported. Determining which cases might be bogus would require a thorough study of both the prescribing doctors and the thoroughness of their examination process. Baseball commissioner Bud Selig says the league is investigating the ADD diagnoses to determine which ones are legitimate medical problems and which ones might be attempts to evade the amphetamines ban.Separating the legitimate users from the abusers won't be easy. Estimates of ADD vary widely, from as little as 4 percent among adults to as much as 16 percent among adolescents and young adults. A diagnostician needs to assess a variety of behaviors—some of which may seem like ADD but in fact be other conditions. (The medical establishment often uses the term ADHD—attention-deficit hyperactivity disorder—interchangeably with ADD). A diagnosis of ADD requires not only evaluating an adult's behavior and mental state but also looking into the individual's childhood and family background. ADD is a genetic condition that makes its first appearance early in life. The symptoms of other conditions—bipolar disease, anxiety disorder, depression, developmental or learning differences—can make ADD diagnoses tricky and subjective.Complicating the issue is that sports can both strengthen and undermine a person's mental well-being. The intense physical activity fosters a level of focus and commitment that helps the athlete improve the functioning of the brain. In fact, athletic competition can be the best cure for ADD, says Dr. John J. Ratey, an associate professor of psychiatry at Harvard Medical School and the author of "Spark: The Revolutionary New Science of Exercise and the Brain." Ratey has treated athletes who suddenly displayed the symptoms of ADD after injuries sidelined them. He prescribed medications during the down time, then weaned the athlete once he got back into action.(... ... continued on the source link above)
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