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 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.
Caffeine and nicotine use are not included among the drugs that constitute stimulant-related disorders.
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
Side 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 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, where intoxication requires considerably greater amounts of the stimulant.
- Withdrawal, as shown by one of the following:
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.
The tolerance and withdrawal criteria are not considered to be met if the stimulant is used only under appropriate medical supervision.
Stimulants such as Adderall and Ritalin are sometimes used by students, particularly college students, to improve their work, as stimulants are commonly associated with wakefulness and focus, though their use may also result in increased impulsivity.
Several studies have shown that the use of stimulants by people without ADD or ADHD does not generally enhance cognitive abilities. Students score roughly the same on tests in the placebo and stimulant-taking groups. It has been noted that those taking stimulants feel as if they worked better or harder.
The estimated prevalence of stimulant use disorder lasting longer than 12 months is 0.2% of the population in the United States. In reality, many more likely suffer from stimulant-related disorders, but if they are prescribed stimulants under the care of a doctor, they do not fit the diagnostic criteria for stimulant use disorder, and so are not included in its prevalence.
Stimulant-related disorders affect all racial/ethnic, socioeconomic, age, and gender groups.
ADHD can make it harder for people to stay awake during the day and to fall asleep at night. The use of prescribed stimulants, particularly in adults with ADHD, helps keep patients awake during the day, which can help them sleep better at night. A similar pattern is seen in those with narcolepsy.
Stimulant drugs are classified as controlled substances because they have a 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.
Many parents are concerned that their children could become dependent on their ADHD medication (Ritalin, Adderall, and Vyvanse, each of which are made with different forms of amphetamine salts, are the most common). When taken in the amount prescribed, there is little risk that children or teens will develop a stimulant-related disorder.
Other times, parents worry that having their children’s experience in life improved by ADHD medication will increase the likelihood that their children will experiment with other drugs. Several studies have found no evidence of this.
If a person, child or adult, is prescribed stimulants by a doctor, they are not considered eligible to fit the criteria for stimulant-related disorders.
Stimulants are prescribed primarily to treat ADHD and narcolepsy. The drugs affect the central nervous system in such a way as to improve alertness and brain function and reduce sleepiness.
The average age for those in first-time treatment for stimulant-related disorders is 23 years old. It’s important to note that this age reflects only those in treatment, not the overall population of people taking prescribed stimulants.
Stimulants can induce feelings of energy and self-confidence. Some people begin using stimulants to lose weight, to try to improve in school, or to improve performance in athletic activities. Others may use them if their job requires shift work that can run late into, or through, the night. In none of these cases do people use stimulants to “get high” (although people do this), but it is nonetheless possible that these users develop stimulant-related disorders, particularly if they take the substances regularly. This is why stimulants are controlled substances.
Amphetamines were first introduced to the market to treat asthma and nasal congestion in the United States. As recognition of the drug’s effects on vigilance became better understood, amphetamines and methamphetamines were used by militaries, most notably during World War II. In the 1950s, amphetamines became popular as weight-loss drugs. Since then, amphetamines have been used as a drug of abuse. The United States designated amphetamines a controlled substance in 1971, under the Controlled Substances Act.
Stimulant addiction treatment involves non-confrontational behavioral counseling that provides general information about the addiction process and specifics about the individual treatment plan. One such method, contingency management, gives patients rewards for positive behaviors, aiding their efforts to stop using stimulants. 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.
Withdrawal is a major part of stimulant-related disorders. Those who have built a tolerance for the drugs and stop taking them are likely to feel unpleasant feelings, including anxiety, restlessness, and insomnia. Those withdrawing from methamphetamine or cocaine may experience additional headaches, emotional lability, and depressive feelings. Depending on the stimulant, the dose, and the duration of use, these depressive feelings can include suicidal ideation. In most cases, however, withdrawal from stimulants is not a medically dangerous endeavor.
There are no approved medications to treat stimulant dependence, despite decades of research.
Several randomized clinical trials have shown disulfiram, developed to treat alcohol abuse, can decrease cocaine use by inhibiting enzymes that metabolize cocaine in the bloodstream. One large trial, however, found that low doses of disulfiram actually increased cocaine use, while large doses reduced it.
Bupropion, commonly used as an anti-depressant, has shown mixed results in treating stimulant-related disorders in clinical trials. The most effective trials of bupropion have been on subjects with mild stimulant-related disorders.
The development of effective medications for stimulant-related disorders remains a research priority.