Stimulant abuse

DEFINITION: Stimulant abuse is diagnosed when the recreational use of stimulants negatively affects health, interferes with daily functioning, or results in physical dependency. Stimulants, substances that excite the central nervous system, include herbal mixtures, beverages, cigarettes, diet pills (Didrex, Bontril, Preludin, Fastin, Adipex P, and Meridia), legal prescriptions (Adderall and Dexedrine), and illicit drugs such as cocaine, ecstasy (MDMA), bath salts, and methamphetamine. Common street names include speed, ice, coke, bennies, snow, and uppers. Stimulant abuse is treatable but difficult to overcome.

Causes

Stimulants have been prescribed to treat a variety of medical conditions, including narcolepsy, attention deficit hyperactivity disorder, Parkinson’s disease, asthma, and obesity. Stimulants interfere with nerve cell communication by causing dopamine, a neurotransmitter responsible for the sensation of pleasure, to accumulate in the brain.

Stimulant use rapidly elevates dopamine levels, causing a surge of euphoria and energy that users desire. The continued use of stimulants can quickly lead to drug tolerance, physical and psychological dependency, and addiction.

Stimulant abuse is habit-forming, risky, and dangerous. Stimulants can be abused orally, crushed and snorted, heated and smoked, or dissolved and injected. Suddenly stopping stimulant use can lead to withdrawal, intense drug cravings, and possible relapse. Withdrawal symptoms may include fatigue, headaches, nausea, vomiting, intense hunger, mood swings, fear, shaking, irritability, anxiety, depression, aggression, violence, mental confusion, paranoia, psychosis, suicidal thoughts, and possible anhedonia, the inability to experience pleasure.

Risk Factors

The majority of stimulant users are adolescents and young adults between twelve and forty-four. Other risk factors may include a history of drug or alcohol abuse, family conflicts, mental illness, post-traumatic stress disorder, attention deficit hyperactive disorder, impulsive and aggressive behavior, depression, and childhood sexual abuse. Women and men are equally likely to abuse stimulants, but women are more likely to abuse prescriptions or cocaine, while men are more likely to use methamphetamine. Further research found individuals of minority groups and marginalized communities living with heart failure are more likely to be diagnosed with stimulant use disorder, as well as individuals receiving Medicaid.

Symptoms

Stimulant side effects vary in severity depending on the drug. The short-term effects associated with stimulant use may include euphoria, hyperactivity, alertness, abdominal cramps, nausea, vomiting, headache, decreased appetite, insomnia, dilated pupils, mood swings, dizziness, irritability, anxiety, depression, sweating, dry mouth, muscle spasms, irregular heartbeat, shortness of breath, increased heart and respiration rates, elevated blood pressure, and sudden death.

Long-term use of stimulants can be associated with compromised health, poor hygiene, dental problems, dermatitis, memory loss, anorexia, violent behavior, aggressiveness, hostility, depression, psychosis, delusions, paranoia, hallucinations, and suicidal thoughts. The most detrimental long-term effects of stimulant abuse are physical and psychological tolerance and addiction, which can occur quickly; users require increasingly large doses of the drug to achieve the original high. Serious medical complications associated with stimulant abuse can include stroke, heart failure, respiratory depression, organ toxicity, cerebral hemorrhaging, dangerously high body temperature (hyperthermia), seizures, convulsions, brain damage, coma, and death.

Screening and Diagnosis

A physician suspecting stimulant abuse should perform a physical examination and obtain a thorough medical history of illicit drug use, prescribed medications, and symptoms to determine the type of drug abused and any associated psychological complications. Diagnostic screenings may include urine, blood, and hair analysis, and an electrocardiogram to detect heart damage.

Treatment and Therapy

Stimulants can be highly addictive and difficult to overcome; treatment depends on the drug, length of use, and the severity of the symptoms. Physician-supervised stimulant abuse treatment programs may be inpatient, outpatient, or residential. Treatment programs typically begin with detoxification, slow tapering of drug use, and treatment of withdrawal symptoms.

No medications are available for the effective treatment of stimulant abuse, but some antidepressant medications can help with minimizing withdrawal symptoms and treating underlying issues, such as depression and anxiety. Behavioral therapies that encourage patients to modify thinking, expectations, and behaviors are effective treatment options for stimulant abuse.

Contingency management therapy enables patients to earn vouchers and rewards for drug-free behaviors and healthy living. Cognitive-behavioral therapies teach patients the skills to resist cravings, identify triggers and risky situations, effectively cope with stress, and avoid relapse. Other beneficial treatment options include mental health and substance abuse counseling, recovery support groups, and social services. Motivational interviewing and a community reinforcement approach have also proven effective for some individuals with an addiction to stimulants. Motivational interviewing is a client-centered counseling style that encourages self-confidence and client-led resolutions. Community reinforcement incorporates family and friends in the recovery process, which helps ensure a well-informed support system is waiting for the individual after treatment.

Prevention

The best preventive measure is to avoid stimulant use and better manage any underlying conditions associated with its use. Patients should be informed about the health hazards associated with stimulant abuse because many of the substances are highly addictive and habit-forming.

Bibliography

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