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Stimulant-Related Disorders

Stimulant-related disorders include stimulant intoxication, stimulant withdrawal, and Stimulant Use Disorder. They result from abuse of a class of medications known as stimulants, which include a wide range of drugs such as amphetamines, methamphetamine, and cocaine. These drugs increase energy, attention, and alertness and have a wide range of effects on the body, such as increased respiration and heart rate.

Stimulants may be prescribed to treat obesity, attention-deficit/hyperactivity disorder, narcolepsy, and depression; they may also be obtained illegally.

Symptoms

Stimulant intoxication is diagnosed when recent exposure to a stimulant causes significant problematic behavioral or psychological changes. These may include:

  • euphoria
  • hyper-vigilance
  • anger
  • interpersonal sensitivity
  • auditory hallucinations
  • paranoid thoughts
  • repetitive movement

Physical symptoms may also be present, and can include:

  • abnormally fast or slow heartbeat
  • dilation of the pupils
  • elevated or lowered blood pressure
  • sweating or chills
  • nausea or vomiting
  • weight loss
  • muscle weakness

Effects such as sadness, decreased heart rate, and decreased blood pressure are generally seen only with chronic high-dose use.

According to DSM-5, in order for a diagnosis of Stimulant Use Disorder to be made, an individual must demonstrate a pattern of amphetamine, cocaine, or other stimulant use leading to clinically significant impairment or distress, as manifested by at least two of the following symptoms within a 12-month period:

  • Taking the stimulant in larger dosages and/or for a longer period of time than intended
  • Desiring to reduce stimulant use, and/or making failed efforts to do so
  • Spending a large amount of time procuring, using, or recovering from the effects of the stimulant
  • Experiencing a strong desire or urge to use the stimulant
  • Demonstrating the inability, due to stimulant use, to maintain obligations for one's job, school, or home life
  • Continuing to use the stimulant in the face of social/interpersonal problems that result from, or are made worse by, the use of the stimulant
  • Prioritizing stimulant use to such an extent that social, occupational, and recreational activities are either given up on completely or are reduced drastically
  • Repeatedly using the stimulant in situations in which it is physically hazardous
  • Continuing to use the stimulant even when the individual knows that it is causing or exacerbating physical and psychological problems
  • Tolerance, as shown by one of the following:
    • Intoxication requires considerably greater amounts of stimulant use than it did previously
    • The same dose of the stimulant over the same amount of time results in considerably weaker effects
  • Withdrawal, as shown by one of the following:
    • Individual displays withdrawal symptoms and characteristics of the stimulant
    • Symptoms of withdrawal diminish as a result of the use of the stimulant (or similar substances)

The tolerance and withdrawal criteria are not considered to be met if the stimulant is used only under appropriate medical supervision.

Withdrawal symptoms include:

  • fatigue
  • vivid, unpleasant dreams
  • insomnia or hypersomnia
  • abnormally slow heartbeat

These symptoms typically develop within a few hours to several days after stimulant use has stopped. Drug craving and an inability to feel pleasure (anhedonia) may also be present.

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Causes

Stimulant drugs are classified as controlled substances because they have high potential for addiction and abuse. People who are exposed to cocaine or amphetamine-type stimulants can develop Stimulant Use Disorder in as little as one week, although the onset is not always this fast. Considerable changes in behavior can rapidly develop with the disorder. Long-term use of stimulants may lead to chaotic or aggressive behavior, social isolation, and sexual dysfunction. Symptoms of withdrawal from stimulants can set in after a reduction in use following heavy and prolonged use of the substance.

Treatment

Stimulant addiction treatment involves non-confrontational behavioral counseling that provides general information about the addiction process and specifics about the individual treatment plan. Counseling may be offered to family and significant others. In addition to initial individual counseling, a treatment plan for a stimulant-related disorder usually includes setting up abstinence goals, attending group therapy, encouraging family support, and establishing long-term support and follow-up.

References
Treatment Improvement Protocols (TIP) Series No. 33. Treatment for Stimulant Use Disorder. Center for Substance Abuse Treatment. Rockville MD. December 2001. 
American Psychiatric Association. Understanding Mental Disorders: Your Guide to DSM-5. 2015. American Psychiatric Publishing.
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
Last updated: 08/03/2017