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Stimulant Drugs Overview

What Is a Stimulant?

Cocaine in person's hand

Stimulants are drugs that stimulate and speed up the body’s central nervous system. They elevate the heart rate, respiration rate, and brain function.1 This helps to increase focus, alertness, and energy levels. Stimulants also increase dopamine, the brain’s feel-good neurotransmitter, which can lead to feelings of euphoria. 1,2,3

Many illicit stimulants are purchased on the street by people looking for a “high.” These include cocaine, methamphetamine, amphetamines and khat, an evergreen shrub containing cathine and cathinone and which produces a stimulant-like effect.1,4

In recent years, synthetic cathinones (“bath salts”) have become a popular synthetic stimulant that people can purchase with relative ease as “research chemicals” or “plant food” online.5 Though the name sounds harmless, bath salts are associated with very serious side effects including delusions, suicidal thinking, seizures, heart attack, and stroke.5

Are Prescription ADHD Drugs Stimulants?

The most common prescription drugs used in the management of attention deficit hyperactivity disorder (ADHD) are stimulant medications. These drugs are prescribed to both children and adults to help increase focus and alertness. While these drugs can be an effective source of treatment when used as prescribed, they have many of the same effects as illicit stimulants and also have the potential for addiction and abuse.3

Prescription stimulants include: 3

  • Methylphenidate—This central nervous system stimulant, which is commonly sold under the brand names Ritalin and Concerta, is prescribed in both immediate-release and extended-release forms.6
  • Dextroamphetamine—This stimulant medication is sold under the brand name Dexedrine and is prescribed for narcolepsy in addition to ADHD.7
  • Dextroamphetamine/amphetamine combination—This combination is also prescribed for narcolepsy in addition to ADHD and is sold under the brand name Adderall. It has been associated with rising levels of abuse in young adults and adolescents.8,9
  • Lisdexamfetamine—Sold under the brand name Vyvanse, this prescription stimulant used to control symptoms of ADHD has a high potential for abuse.10

Side Effects of Stimulants

Depending on the specific stimulant drug, physical side effects may include: 3,5,6,11,12

  • Headache.
  • Nausea.
  • Insomnia.
  • Pupil changes.
  • Dry mouth.
  • Decreased appetite.
  • Weight loss.
  • Stomach pain.
  • Vomiting.
  • Diarrhea or constipation.
  • Heartburn.
  • Itching.
  • Muscle tightness.
  • Restlessness.
  • Changes in sex drive.
  • Muscle twitching/tremors.
  • Increased respiratory rate.
  • Elevated body temperature.
  • Rapid heart rate.
  • Elevated blood pressure.
  • Dizziness.
  • Cardiovascular system failure.

Effects of Stimulants on The Brain

In addition to their primary intended effects of heightened alertness, energy, and focus, stimulants can also produce a long list of psychological side effects that, depending on the substance, may include:3,5,6,11,12

  • Release of social inhibitions.
  • Increased talkativeness.
  • Period of initial euphoria followed by irritability at comedown.
  • Mood swings.
  • Hostility.
  • Agitation.
  • Nervousness.
  • Paranoid thoughts.
  • Unrealistic or grandiose feelings of power, intelligence, and capability.
  • Panic attacks.
  • Suicidal thoughts.
  • Delusions.
  • Hallucinations.

“Come-down” effects are also characteristic of illicit stimulant use. The “come down” refers to temporary unpleasant effects experienced as the drug wears off, and users may be short-tempered and behave unpredictably. The duration of the come-down period is influenced by the type of stimulant used.13 Common come-down effects from stimulants include:14

  • Agitation.
  • Irritability
  • Anxiety.
  • Restlessness.
  • Sleep problems.
  • Confusion.
  • Paranoia.
  • Hyperarousal.

Stimulant Withdrawal Symptoms

Getting help for addiction often starts with detox. While stimulant withdrawal is not usually dangerous, it can be emotionally and mentally distressing and may lead some users to relapse when trying to quit.

Common stimulant withdrawal symptoms include:16,17

  • Fatigue.
  • Increased appetite.
  • Anxiety.
  • Irritable mood.
  • Depression.
  • Aches and pains.
  • Insomnia or hypersomnia.
  • Vivid and potentially unpleasant dreams.
  • Psychosis.
  • Psychomotor agitation or retardation.
  • Intense drug cravings.

Signs of Stimulant Overdose

People can overdose on any stimulant, even those that are prescribed to them, if they are misusing them. Each stimulant is unique. Some stimulants, like methamphetamine and cocaine, are more notorious for their dangers than others, but they all have the potential to be deadly, especially if combined with other illicit drugs, certain prescribed medications or alcohol.

If you suspect someone has overdosed on a stimulant, contact 911 immediately. Some signs and symptoms that a person may have overdosed on a stimulant include: 3,6,11

  • Fever.
  • Muscle pains and weakness.
  • Sweating.
  • Flushing.
  • Headache.
  • Dark urine.
  • Nausea.
  • Vomiting.
  • Diarrhea.
  • Restlessness.
  • Hyperreflexia.
  • Uncontrollable shaking of the body.
  • Rapid breathing.
  • Irregular heart rate.
  • Panic.
  • Confusion.
  • Aggressive behavior.
  • Agitation.
  • Hallucinations.
  • Seizures.
  • Coma.

Help for Stimulant Addiction

Compulsive stimulant use may indicate a stimulant use disorder (SUD). Diagnostic criteria for SUD, as outlined in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM–5), include:w15

  • Taking larger and/or more frequent doses than originally intended.
  • Physical and psychological dependence on the drug. Needing the drug to feel normal and having withdrawal symptoms if use is stopped.
  • Needing higher doses of the drug to achieve the initial effect.
  • Persistent failed attempts to cut back on use.
  • Strong cravings for the drug.
  • Obsession or preoccupation with obtaining and consuming the drug that interferes with daily life.
  • Reduced or discontinued participation in family life, hobbies, social activities, and professional pursuits.
  • Continued substance abuse despite knowing the adverse effects physically, emotionally, mentally, socially, and professionally.

Other signs include:12

  • Binge and crash cycle. (When a user attempts to maintain high by taking more of the drug and eventually crashes with a heavy comedown [severe depression, anxiety, and irritability, extreme fatigue, and drug cravings]).
  • Violent or erratic behavior.
  • Signs of psychosis, including paranoia, hallucinations, and picking at the skin.

Detoxing from stimulants becomes more complicated when users have combined use with alcohol or sedatives, both of which are associated with potentially deadly withdrawal syndromes. In these cases, detoxing may require medical assistance or supervision.18

Patient making a treatment plan

Common Stimulant Addiction Treatment Options

After detoxification, a variety of treatment options are available for those struggling with stimulant addiction. For severe cases of stimulant addiction or polysubstance abuse, inpatient treatment may be the preferred option. Inpatient treatment takes place in a residential facility 24 hours a day for a designated period and usually ranges from 30 to 90 days, but can extend to 6 months or 3 or more years when necessary. Inpatient treatment facilities provide a wide range of treatment options including medically supervised detox, individual and group counseling, peer support programs such as Narcotics Anonymous (NA), and holistic therapeutic options such as yoga and meditation, art therapy, massage, biofeedback, nutritionist services, spirituality and religious programs, etc.

Some programs, such as the one at Desert Hope, will provide treatment for co-occurring mental health disorders. For someone struggling with addiction alongside issues like anxiety or depression, this can be a necessity because an untreated mental health disorder may put the individual under significant distress and lead to relapse.

Outpatient treatment is also effective and may be an appropriate option for those with less severe stimulant disorders or those who have already completed a higher-intensity program. Each outpatient program is different and may consist of daily, biweekly, or weekly individual and group therapy sessions depending on the program. Outpatient programs may also include holistic options and support groups.

Some of the most common psychotherapies for stimulant addiction treatment include:

  • Cognitive-behavioral therapy (CBT): Cognitive-behavioral therapy helps people suffering from substance use disorder recognize the connection between their thoughts, feelings, sensations, and behaviors. Specific techniques taught in CBT include:3,16,19
    • Self-monitoring for cravings at earliest onset.
    • Creating strategies to cope with cravings in high-risk situations.
    • Exploring both the positive and negative consequences of substance use.
  • Contingency management: Contingency management provides patients with motivational incentives for remaining drug-free and other positive behaviors. Motivational incentives may include vouchers or small cash rewards. This therapeutic approach focuses more on positive reinforcement to help change behavior over time. 3,16
  • Matrix model: This evidence-based treatment approach for stimulant addiction is an integrative treatment model that includes components of many different therapeutic approaches. Patients will work closely with a therapist who will provide them with drug education, self-esteem building, recovery skills, and relapse prevention strategies. They will also participate in group therapy, peer support, and/or self-help programs. The Matrix Model treatment is typically part of an intensive outpatient program, which means several hours of treatment each day for several weeks. During treatment, patients are given urine tests to monitor drug use and hold patients accountable.20

If stimulant addiction is keeping you or someone you love from living the life you want, explore your treatment options. There is hope for recovery from drug addiction.

References:

  1. United States Drug Enforcement Agency. (n.d.). Stimulants.
  2. U.S. National Library of Medicine. (2019). Stimulants.
  3. National Institute on Drug Abuse. (2018). Prescription stimulants.
  4. United States Drug Enforcement Administration (n.d.). Khat. 
  5. United States Drug Enforcement Administration. Bath salts.
  6. U.S. National Library of Medicine. (2019). Methylphenidate.
  7. U.S. National Library of Medicine. (2019). Dextroamphetamine.
  8. Johns Hopkins Bloomberg School of Public Health. (2016). Adderall Misuse Rising Among Young Adults.
  9. Chen, L. Y., Crum, R. M., Strain, E. C., Alexander, G. C., Kaufmann, C., & Mojtabai, R. (2016). Prescriptions, nonmedical use, and emergency department visits involving prescription stimulants. The Journal of clinical psychiatry77(3), e297–e304.
  10. New River Pharmaceuticals, Inc. (2019). VyvanseTM (lisdexamfetamine dimesylate).
  11. U.S. National Library of Medicine. (2017). Methamphetamine.
  12. Center for Substance Abuse Research. (2013). Amphetamines.
  13. Center for Substance Abuse Treatment. Treatment for Stimulant Use Disorders. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1999. (Treatment Improvement Protocol (TIP) Series, No. 33.) Chapter 5—Medical Aspects of Stimulant Use Disorders.
  14. Substance Abuse and Mental Health Services Administration. (1999).Treatment Improvement Protocol (TIP) Series, No. 33. Chapter 2: How Stimulants Affect the Brain and Behavior. Center for Substance Abuse Treatment. Rockville, MD.
  15. American Psychological Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th Ed- DSM-V. Washington, DC.
  16. National Institute on Drug Abuse. (2019). Methamphetamine.
  17. Australian Government Department of Health. The amphetamine withdrawal syndrome. Models of Intervention and Care for Psychostimulant Users, 2nd Edition. Monograph Series No. 51.
  18. Center for Substance Abuse Treatment. Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, No. 45. HHS Publication No. (SMA) 15-4131. Rockville, MD: Center for Substance Abuse Treatment, 2006.
  19. National Institute on Drug Abuse. (2018). Cognitive-behavioral therapy (alcohol, marijuana, cocaine, methamphetamine, nicotine).
  20. National Institute on Drug Abuse. (2018). The matrix model (stimulants).

 

 

About The Contributor
Ryan Kelley, NREMT
Medical Editor
Ryan Kelley is a nationally registered Emergency Medical Technician and the former managing editor of the Journal of Emergency Medical Services (JEMS). During his time at JEMS, Ryan developed Mobile Integrated Healthcare in Action, a series... Read More