Stimulant Addiction: Signs

Stimulant Addiction: Signs, Symptoms, Risks, and Treatment Resources

Stimulants are drugs that impact the central nervous system (CNS), increasing brain activity and alertness. This category of substances includes commonly used substances like caffeine and nicotine as well as drugs like amphetamines and cocaine[1].

While some stimulants are commercially available and others can be prescribed to treat certain medical conditions, such as attention deficit hyperactivity disorder (ADHD), they also carry the potential for abuse, and many stimulants are illicitly manufactured for recreational consumption.

What Are Stimulants?

Stimulants are a class of psychoactive drugs which increase brain activity, often impacting both alertness and mood. These drugs encompass a broad array of substances, each with unique chemical properties and mechanisms of action. However, stimulants as a whole include several core commonalities, including:

  • Impacting brain and body functioning
  • Increased alertness
  • Potential changes in focus
  • High potential for addiction

Some stimulants, such as caffeine and nicotine, are widely available for purchase in various forms and are intended to increase energy levels and heighten the senses. Caffeine is considered to be the most widely used drug in the world[2]. Other stimulants are formulated as prescription medication to treat certain physical and psychological disorders, enhancing the effects of dopamine and norepinephrine[3], while still others are manufactured illegally, such as cocaine and methamphetamine.

Stimulant misuse has risen in the United States over the past few decades. According to data from the National Survey on Drug Use and Health (NSDUH), an estimated 4.3 million people aged 12 or older misused prescription-based stimulants in 2022[4]. Meanwhile, deaths involving cocaine more than tripled (from 4,939 to 15,863), and deaths involving methamphetamine more than quadrupled (from 3,616 to 16,127) between 2013 and 2019, according to the National Institute for Healthcare Management[5].

Many prescription-based stimulants are classified as Schedule II controlled substances by the Controlled Substances Act, signifying a high potential for addiction. Caffeine and nicotine are not regulated on a controlled substance schedule, though there are some regulations in place restricting sales to minors and certain forms of advertising[6].

Stimulants are often known by several alternate names, including:

  • Prescription-based stimulants: Addys, Dexies, Bennies, Black Beauties, Skittles, Speed, Uppers
  • Methamphetamine: Crank, Crystal, Glass, Ice, Rocket Fuel
  • Cocaine: Blow, Lines, Rail, Snow, White Rock

Side Effects of Stimulants

Stimulant-based substances can facilitate a rise in anxiety, tension, heart rate, and body temperature in the user (due to their effects on the CNS), along with talkativeness and reduced appetite. Higher doses may result in tremors, seizures, coma, or even death.

How are Stimulants Taken?

Stimulants are taken in various ways, depending on the substance in question. Prescription-based stimulants, such as ADHD medication, can be taken either orally (in pill form) or crushed and snorted to create a more intense and rapid high. Illicit stimulants like meth or cocaine are typically smoked, snorted, or injected, quickly passing through the blood-brain barrier for rapid effect.

Nicotine can be inhaled, as is the case with cigarettes, cigars, and e-cigarettes, or absorbed through the mouth from chewing tobacco or a nicotine pouch. Though nicotine poisoning is unlikely for an adult, so long as they’re not directly eating the nicotine, children are much more susceptible to nicotine poisoning.

Statistics on Stimulant Use, Misuse, and Addiction

Among people aged 12 or older in 2022, 1.5 percent (or 4.6 million people) misused prescription stimulants. The percentage was higher among young adults aged 18 to 25 (3.7 percent or 1.3 million people) than among adolescents aged 12 to 17 (0.9 percent or 226,000 people) and adults aged 26 or older (1.3 percent or 2.8 million people)[7].

Among people aged 12 or older in 2021, 0.9% (or about 2.5 million people) reported using methamphetamine, and also in 2021, 1.7% (or about 4.8 million people) reported using cocaine over the same time frame[8,9].

Effects of Stimulant Abuse

Stimulants, in general, reverse the effects of fatigue both mentally and physically. Taken as intended and prescribed, drugs in the stimulant class can produce extended periods of wakefulness, exhilaration, and a loss of appetite. When taken illicitly or in too large a dose, there is an increased risk of serious physical side effects (dizziness, palpitations, nausea/vomiting), in addition to tolerance, withdrawal, and mortality.

Can You Overdose on Stimulants?

Yes, almost every stimulant carries the potential for overdose. While some substances, such as caffeine, are unlikely to result in death, several types of stimulants require immediate medical intervention during overdose due to the effects a large dose can have on the cardiovascular system.

Dangers of Long-Term Stimulant Use

Misusing stimulants on a long-term basis can leave individuals more vulnerable to a host of psychiatric issues—known as co-occurring conditions—including anxiety and depression. The brain and respiratory system can also suffer long-term damage due to ongoing usage.

Mixing Stimulants with Other Drugs

Using other drugs along with stimulants can increase the risks of adverse effects, including heart problems, respiratory depression, overdose, and death. Combining stimulants with depressants (such as alcohol or opioids) can have dire consequences, as stimulant-based substances increase the body’s level of functioning whereas depressants sedate and ramp down the CNS.

Stimulant Addiction and Abuse

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), addiction to stimulants is clinically referred to as a stimulant use disorder.[10] An individual may be diagnosed with a stimulant use disorder if they meet at least 2 of the following criteria in a 12-month period:

  1. The stimulant is taken in larger amounts or over a longer period than was intended.
  2. There is a persistent desire or unsuccessful efforts to cut down or control stimulant use.
  3. A great deal of time is spent in activities necessary to obtain the stimulant, use the stimulant, or recover from its effects.
  4. Craving, or a strong desire or urge to use the stimulant.
  5. Recurrent stimulant use failing to fulfill major role obligations at work, school, or home.
  6. Continued stimulant use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the stimulant
  7. Important social, occupational, or recreational activities are given up or reduced because of stimulant use.
  8. Recurrent stimulant use in situations in which it is physically hazardous.
  9. Stimulant use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the stimulant.
  10. Tolerance, as defined by either of the following:
    • A need for markedly increased amounts of the stimulant to achieve intoxication or desired effect.
    • A markedly diminished effect with continued use of the same amount of the stimulant.
  11. Withdrawal, as manifested by either of the following:
    • The characteristic withdrawal syndrome for the stimulant.
    • The stimulant (or a closely related substance) is taken to relieve or avoid withdrawal symptoms.

Are Stimulants Addictive?

Stimulants are considered to carry a high potential for addiction in all forms, though some stimulants are more likely to be abused than others.

How Addictive Are Stimulants?

Stimulant-based substances can all become addictive quickly when misused:

  • Nicotine has long been known to be highly addictive, with an unpleasant withdrawal syndrome after tolerance has been established.
  • Caffeine possesses addictive qualities that may lead to physical dependence, though its withdrawal syndrome is not fatal.
  • All medically prescribed stimulants are Schedule II drugs due to their high likelihood of addiction.
  • Drugs such as cocaine and methamphetamine are illegal in large part due to their addictive properties.
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Stimulant Addiction and Mental Health

Frequent misuse of stimulants can cause disruptions in overall mood and functioning, creating vulnerability for potential co-occurring conditions such as depression or anxiety.

Cutting Agents Used for Stimulants

Powdered cocaine, crack cocaine, and methamphetamine are commonly ‘cut’ with other substances to intensify their high or lower their total purity.[11] Some common stimulant-cutting agents include:

  • Other stimulants, such as caffeine
  • Opioids
  • Laundry detergent
  • Laxatives
  • Over-the-counter medications

Stimulant Addiction Treatment

Treatment for stimulant addiction will normally begin with a medically supervised detox program. Providers can monitor and treat any severe withdrawal symptoms in a safe environment, and patients will then move on to engage in a structured inpatient treatment protocol to work on the underlying factors of addiction, along with providing treatment for any potential co-occurring disorders and additional medical needs.

Stimulant Addiction Treatment Levels of Care

Rehab and addiction treatment for stimulants can include:

  • Supervised medical detox: A supervised period of medical monitoring to ensure no complications surrounding cessation.
  • Residential treatment: A structured treatment environment in which several modalities—including individual therapy, group therapy, medication management, and assessment for co-occurring issues—will work to provide new insights and coping strategies for long-term sobriety, typically lasting for at least 30 days.
  • Intensive outpatient (IOP)/Partial Hospitalization Program (PHP): IOP and PHP are programs that do not require an individual to be on-site at all times but rather allow for a mix of in-person treatment services while still being delivered on an outpatient basis.
  • Aftercare: Ongoing therapy, support groups, and potential supportive living environments can help to further integrate the learning and changes undergone during prior phases of treatment in the recovery process.

Therapies Used in Stimulant Addiction Treatment

Several modalities may be utilized in the treatment of stimulant addiction, which include:

  • Motivational Interviewing, which invokes collaboration and curiosity to explore motivations for change, build rapport, and identify goals and motivations for ongoing sobriety.
  • Cognitive behavioral therapy (CBT), which helps people identify negative thought patterns to think more positively and constructively
  • Group therapy: Group therapy allows individuals to process their experiences and gain new insights in the supportive environment of their peers, facilitated by a licensed professional.

Co-Occurring Disorders

Individuals struggling with substance use disorders are also at risk for developing one or more concurrent mental health conditions or chronic diseases[12]. According to SAMHSA’s 2022 National Survey on Drug Use and Health, over 21.5 million adults in the United States have a co-occurring disorder, many of which involve both substances and other mental health disorders.[13]

Some of the more common co-occurring disorders seen in individuals with a diagnosed substance use disorder include:

  • Anxiety disorders
  • Mood disorders (such as depression or bipolar disorder)
  • Post-traumatic stress disorder (PTSD)
  • Attention deficit hyperactivity disorder (ADHD)

Frequently Asked Questions

01

If I have a valid prescription for stimulants but feel like I need to take more, should I do so without telling my doctor?

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No, prescribed stimulants should always be taken as directed, and any changes should be made in collaboration with your prescriber.

02

Will Naloxone undo a stimulant overdose?

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No. Naloxone is an opioid antagonist and can be used to reverse the effects of an opioid overdose, but it will not affect a stimulant overdose. However, Naloxone may help if the stimulant was cut with other opioid-based substances.

03

Are stimulant-based medications safe when taken as prescribed?

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Yes, stimulant-based medications are generally regarded as safe when appropriately used under the care of a medical professional.

References:

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[01]

Stimulants – alcohol and drug foundation. (n.d.). https://adf.org.au/drug-facts/stimulants/ on July 14th, 2023

[02]

Temple, J. L., Bernard, C., Lipshultz, S. E., Czachor, J. D., Westphal, J. A., & Mestre, M. A. (2017). The Safety of Ingested Caffeine: A Comprehensive review. Frontiers in Psychiatry, 8. https://doi.org/10.3389/fpsyt.2017.00080 on July 14th, 2023

[03]

Mental health medications. (n.d.). National Institute of Mental Health (NIMH). https://www.nimh.nih.gov/health/topics/mental-health-medications on July 14th, 2023

[04]

SAMHSA. (2022). Key Substance Use and Mental Health Indicators in the United States: Results from the 2022 National Survey on Drug Use and Health. https://www.samhsa.gov/data/sites/default/files/reports/rpt42731/2022-nsduh-nnr.pdf

 

[05]

Stimulant deaths on the rise, compounded by rise in synthetic opioids. (n.d.). NIHCM. https://nihcm.org/publications/stimulant-deaths-on-the-rise-compounded-by-rise-in-synthetic-opioids on July 14th, 2023

[06]

DEA Diversion Control Division. (2016). Controlled Substances -Alphabetical Order – DEA CSA SUBSTANCE NUMBER SCH NARC OTHER NAMES. https://www.deadiversion.usdoj.gov/schedules/orangebook/c_cs_alpha.pdf on July 14th, 2023

[07]

SAMHSA. (2022). Key Substance Use and Mental Health Indicators in the United States: Results from the 2022 National Survey on Drug Use and Health. https://www.samhsa.gov/data/sites/default/files/reports/rpt42731/2022-nsduh-nnr.pdf

 

[08]

National Institute on Drug Abuse. (2019, October). What is the scope of methamphetamine use in the United States? National Institute on Drug Abuse. https://nida.nih.gov/publications/research-reports/methamphetamine/what-scope-methamphetamine-misuse-in-united-states on July 14th, 2023

[09]

2021 NSDUH Annual National Report. (n.d.). CBHSQ Data. Retrieved from https://www.samhsa.gov/data/report/2021-nsduh-annual-national-report on 2024, June 13.

[10]

Hasin, D. S., O’Brien, C. P., Auriacombe, M., Borges, G., Bucholz, K., Budney, A., Compton, W. M., Crowley, T., Ling, W., Petry, N. M., Schuckit, M., & Grant, B. F. (2013). DSM-5 Criteria for Substance Use Disorders: Recommendations and Rationale. ˜the œAmerican Journal of Psychiatry, 170(8), 834–851. Retreved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3767415/ on 2024, June 17.

[11]

Kudlacek, O., Hofmaier, T., Luf, A., Mayer, F. P., Stockner, T., Nagy, C., Holy, M., Freissmuth, M., Schmid, R., & Sitte, H. H. (2017). Cocaine adulteration. Journal of Chemical Neuroanatomy, 83–84, 75–81. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7610562/ on 2024, June 17.

[12]

Co-Occurring disorders and other health conditions. (n.d.). SAMHSA. Retrieved from https://www.samhsa.gov/medications-substance-use-disorders/medications-counseling-related-conditions/co-occurring-disorders on 2024, June 17.

[13]

Co-Occurring disorders and other health conditions. (n.d.). SAMHSA. Retrieved from https://www.samhsa.gov/medications-substance-use-disorders/medications-counseling-related-conditions/co-occurring-disorders on 2024, June 17.

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