Stimulant Use Disorder: Signs, Diagnosis, & Treatment

What Is Stimulant Use Disorder?

Stimulant Use Disorder can be described as a substance use disorder that involves a class of drugs that prompt an increased sense of well-being, euphoria, excitement, alertness, and motor activity, similar to what would be seen in a manic state. Cocaine, methamphetamine, and prescription stimulants are among the stimulant drugs. People struggling with stimulant use disorder experience difficulty decreasing or stopping the use of the stimulant due to cravings and withdrawal symptoms. Users will find difficulty with life responsibilities such as school, work, or relationships.

Stimulants are used to change the electrical and chemical activity in the brain by flooding the central nervous system with dopamine, epinephrine, and norepinephrine. Users report a “rush” as the natural energy chemicals in the body are forced out when they are not needed. The user may inject, snort, or ingest stimulants. Stimulant use disorder is a less-stigmatizing term for stimulant addiction.

What Are Stimulants?

Stimulant drugs increase energy, attention, alertness, respiration, and heart rate, among other physical effects. Stimulants have a variety of medical uses and may be prescribed to treat obesity, attention-deficit/hyperactivity disorder, narcolepsy, and depression. Examples of prescription stimulants are Adderall, Concerta, Dexadrine, and Ritalin. Street stimulant drugs are cocaine and cocaine products, Ecstasy, methamphetamine, and illegally produced amphetamines. While caffeine and nicotine are also considered stimulants, they are not included in the category of stimulant-use disorder. These have their own diagnostic category.

Stimulants may produce short-term improvements in physical function, mental function, or both. They are known as “uppers” in contrast to the depressant class of drugs, known as “downers.” Stimulants tend to be drugs of abuse because of the feelings of euphoria that accompany their use. Many users are seeking an increase in mood and energy. Stimulants can be in the form of tablets, capsules, powders, and small chunky clear crystals or crystal-like powder and may have an astringent odor and bitter taste. Large doses can result in anxiety, panic, seizures, headaches, stomach cramps, aggression, and paranoia.

How Are Stimulants Physically Addictive?

“Stimulants facilitate the activity of the monoamine neurotransmitters, i.e., dopamine, norepinephrine, and serotonin, in the central (CNS) and peripheral nervous systems.”¹ “Animal and human studies support the role of dopaminergic activity, particularly in these pathways, as mediating the behavioral effects of stimulants.”¹ Repeated use reduces the euphoric effect, requiring additional doses of the drug in order to produce the same effect. Commonly, stimulants are used on binges and at high doses. This may result in anger, paranoia, and in some cases, stroke or heart attack. Symptoms of Adderall psychosis, a rare side effect, may develop in some people.

Long-term use of stimulants changes the user’s brain, causing greater negative effects and damage over time. They are particularly damaging to developing brains. “Research in primate models has found that methamphetamine alters brain structures involved in decision-making and impairs the ability to suppress habitual behaviors that have become useless or counterproductive. “² One of the greatest concerns is the potential permanence of some of the effects of long-term stimulant abuse, “exposure to amphetamine, cocaine, nicotine or morphine produces persistent changes in the structure of dendrites and dendritic spines on cells in brain regions involved in incentive motivation and reward (such as the nucleus accumbens), and judgment and the inhibitory control of behavior (such as the prefrontal cortex).”³

How Are Stimulants Psychologically Addictive?

People may use stimulants to reduce physical or emotional fatigue, reduce their appetites, and increase mental focus. When users find that they do achieve the desired effect from the drug, they may become emotionally dependent upon the drug and experience a decreased self-efficacy to manage their own focus or weight management. Evidence suggests that some of the effect of stimulants arises from the expectations the user has about experiencing the positive effects of the drug. “Findings provide evidence that expectation amplifies the effects of methylphenidate in the brain and its reinforcing effects.”⁴

Is Stimulant Addiction Common?

“Among U.S. adults, 6.6% (annual average) used prescription stimulants overall; 4.5% used without misuse, 1.9% misused without use disorders, and 0.2% had use disorders.”⁵ It is important to note, that addiction differs from dependence. The stimulant class of drugs includes drugs that have therapeutic uses, such as those used for the treatment of ADHD. While treating ADHD with medication, the user may not be able to stop using the prescribed stimulant without experiencing withdrawal symptoms. This is a mark of dependence, but they are not experiencing the negative consequences of dependencein their lives. While the use of certain classes of drugs decreased in recent surveys, the prevalence of polysubstance use and abuse has increased, especially the use of fentanyl. This has markedly increased the seriousness of the addictions many people are experiencing.

What Are Stimulant Use Disorder Symptoms?

The severity of stimulant use disorder may vary between mild, moderate, or severe. Symptoms of stimulant use disorder include:

• Taking more stimulants than prescribed or planned
• Experiencing cravings or urges to take stimulants
• Becoming irritable when not on stimulants
• Poor performance at work
• Relationship problems
• Depressed Mood
• Symptoms of anxiety
• Inappropriate anger
• Being caught lying
• Unexplained weight loss
• Excessive energy or jitteriness
• Racing thoughts
• Paranoia
• Periods of hyperfocus
• Flights of ideas
• Changes in sleep pattern

What Are Symptoms of Stimulant Withdrawal?

Voluntary or forced withdrawal from stimulants has a variety of emotional and physical effects. The severity of the symptoms will relate to the drug of choice and the seriousness of the addiction. The onset of withdrawal depends upon the drug of choice. Cocaine withdrawal can occur within hours, whereas methamphetamine withdrawal has a slower onset. Initial withdrawal after a period of binging on stimulant drugs will produce dysphoria and feelings of anxiety. Typically, this will be followed by fatigue and exhaustion. It is common for someone to attempt to ease their withdrawal symptoms with alcohol or other drugs.

Over a more protracted period of withdrawal, depression symptoms predominate, sometimes becoming serious, including suicidality. Around the one-month mark of abstinence, some people experience a period of euphoria which is due to the temporary overproduction of dopamine as their system normalizes. By 3 – 6 months into the withdrawal that dopamine production subsides, and the person may feel depressed again and is at risk for relapse.

Symptoms of stimulant withdrawal include:

• Depression
• Anxiety
• Irritability
• Paranoia
• Sleep disturbances
• Fatigue
• Labile mood
• Confusion
• Impulsive self-harm or expressions of remorse
• Anhedonia
• Disinterest in surroundings

Risk Factors & Causes of Stimulant Use Disorder

Risk factors that can contribute to developing stimulant use disorder include:

• Family history of substance abuse and addiction: Genetic predisposition seems to increase susceptibility to substance abuse in general and this is true for stimulant use as well.
• Peer pressure: Peer pressure can lead to stimulant use disorder, especially in younger people. Some stimulant drugs are widely available to experimenting youth, making peer pressure a likely avenue of introduction to stimulants.
• Trauma: Experiencing or witnessing traumatic events can predispose individuals to addictive disorders like stimulant use disorder.
• Prenatal Factors: Exposure to stimulants while in utero is a risk factor for future stimulant use disorder.
• High Stress: People who are chronically stressed may be more likely to use stimulants to increase their productivity and subsequently find that they are unable to stop.
• Previous or Co-Occurring Substance Use Disorder: Some individuals use substances to mitigate the effects of another substance, such as “downers” to mitigate the effects of “uppers.” This can exacerbate the addiction.
•  Co-Occurring Disorders: Co-occurring eating disorders, mood disorders, PTSD, ADHD, and schizophrenia may be risk factors in stimulant use and abuse. This issue may arise from efforts to “self-medicate.”

How Can Stimulant Use Disorder Impact Your Health?

Stimulants are powerful drugs that can have a variety of negative health effects, both physical and emotional. The severity and irreversibility of health concerns increase the longer the drug use continues. Even in mild cases, there is a risk of infection at the site of the drug use, tachycardia, respiratory discomfort, higher likelihood of health problems secondary to risk behaviors presented by drug-seeking or lowered inhibitions.

Negative effects of stimulant use disorder include:

• Nasal and lung damage
• Dental problems
• Gynecomastia (breast development) in males
• Sexual dysfunction
• Pre-term birth and other perinatal risk factors
• Nerve damage
• Peeling and scaly skin
• Scars
• Psychosis
• Suicide risk
• Risk of overdose and death

Stimulant Use and Co-Occurring Disorders

Some of the co-occurring disorders existing with stimulant use disorder include:

• Attention Deficit Hyperactivity Disorder (ADHD): People with ADHD are often prescribed stimulant medications that have the counter-intuitive effect of helping with focus. Some may begin to experiment with taking higher doses than prescribed and develop an addiction to the drug. Other people with undiagnosed ADHD may be predisposed to using stimulants to focus.
• Eating disorders: Someone with an eating disorder may be more likely to abuse stimulants due to the appetite-suppressing effects of stimulant drugs.
• Anxiety Disorders: Anxiety disorders often pre-date stimulant use disorder and may indicate the use of stimulants to attempt to control the effects of worry and rumination.
• Antisocial Personality Disorder: Individuals who suffer from antisocial personality disorder tend to ignore societal rules and expectations, and the use of stimulants falls into that category.
• PTSD: Post traumatic stress disorder may induce hypervigilance, anxiety, dissociation, and other uncomfortable emotional symptoms. Stimulant use may be an attempt to control those uncomfortable feelings
• Psychotic Disorders: Schizophrenia and other psychotic disorders have symptoms of cognitive disorganization, delusions, and hallucinations which may predispose individuals to make poor decisions regarding substance use with stimulants.

How Is Stimulant Use Disorder Diagnosed?

Stimulant use disorder is diagnosed by self-report of the user describing what drugs they are using, in what quantities, and how frequently. The focus will be on the most recent 12 months. They will be asked about attempts to stop and what happens when they reduce their use. They may be asked about other aspects of their medical and psychological history to determine co-occurring disorders and rule out other concerns. Diagnosis may be performed by a psychiatrist, psychologist or licensed drug and alcohol counselor.

Signs of a Stimulant Overdose

Long-term stimulant use often occurs in binge and withdrawal cycles. Unfortunately, periods of withdrawal will increase the sensitivity to the drug and subsequent doses may be more than the person’s system can tolerate. It can be difficult to predict how strong a substance is or how much it can be used safely. Because of this, it is possible to overdose the first time that you try a substance.

It is helpful to recognize signs of overdose and be prepared to intervene immediately. Time is critical in any overdose situation. Many times overdosing on stimulants may be complicated by the addition of other substances, including opioids. When responding to a suspected stimulant overdose, it is recommended also to administer naloxone (Narcan) to mitigate the effects of the opioids that are frequently used alongside stimulants.

Someone should seek immediate medical attention if they show signs of stimulant overdose, such as:

• Headache
• Dizziness
• Chest pain
• Heart palpitations
• Muscle cramping
• Seizures
• Tremors
• Fast or labored breathing
• Nausea or vomiting

Treatment for Stimulant Use Disorder

Treatment options for stimulant use disorder include outpatient and inpatient treatment options. Outpatient options may be offered in person or via telehealth and can vary in frequency, with “Intensive Outpatient” offering the most intense outpatient option. Inpatient options are recommended for severe stimulant use disorders. Groups may be offered in any of the settings as well as individual interventions.

It is common for individuals with severe stimulant use disorders to present repeatedly to the emergency room for increasingly serious mental health and physical disorders. Emergency Departments now frequently employ peer recovery specialists who may be better able to connect to those who are struggling with motivation to enter treatment.

Support Groups

Support groups and group therapy for stimulant use disorder are successful interventions for stimulant addiction. These groups are similar to groups like Alcoholics Anonymous but include peers who have suffered from similar addictions. Narcotics Anonymous is one such group. There are also support groups specifically designed to treat co-occurring disorders where participants also suffer from complex substance and behavioral health challenges. These groups offer support and accountability. Finding the right group therapy or support groups can be done through a recommendation from treatment facilities, hospitals, and county health departments, or through an online search. Often support groups have a screening process to help ensure that it is the right group for you.

Behavioral Therapies

Working with a licensed therapist adept at helping those with stimulant use disorder is a good approach. Some therapists are dually licensed in Substance Abuse Treatment and Mental Health Treatment. Some evidence-based treatment modalities are cognitive behavioral therapy and dialectical behavioral therapy. Cognitive behavioral therapy focuses on the ways that thoughts influence feelings and teaches coping skills. Dialectical behavioral therapy helps establish mindfulness skills, distress tolerance and improves people’s ability to handle complex emotions. Finding the right therapist can be done through referral from a hospital, primary care doctor, or treatment facility or often through online directories.

Inpatient or Outpatient Rehab

There are many rehab options for stimulant use disorder through public and private behavioral health clinics. Similar to rehab for other drug addictions, recommendations for settings and length of stay will vary based on the severity of the disorder and the length of treatment. The most intensive of inpatient rehabs may include stays of several weeks and sometimes step downs into sober housing options. Costs of treatment depend upon the setting and the participant’s insurance. Public health options for those insured through medical assistance may not have a cost for participation, while a private inpatient rehabilitative facility may cost $40-50,000 for a 12-week program. Inpatient vs. outpatient rehab recommendations are based on ASAM criteria which indicate the medical necessity criteria for each level of care.⁶

In My Experience

In my experience, stimulant use disorder experiences the same stigma as other addictions, which can hamper successful treatment. In addition, with stimulant use disorder specifically, the experience of depression and anhedonia suffered when withdrawing can make sufferers feel hopeless about seeking help. Like other addictions, the earlier compassionate care can be offered, the higher the likelihood of success. If you believe a loved one is suffering from stimulant addiction, you should be clear and upfront about your concerns and set expectations for what you will and will not be willing to tolerate in your relationship with them and offer hope that they can be helped. It also is helpful to have your own therapist for support.