Stimulant Use Disorder

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Stimulant Use Disorder

Stimulant use disorder is a misuse of stimulant substances. Stimulants are classified as cocaine, methamphetamine, and amphetamines. They are used to increase attention, energy, and alertness, as well as having a wide range of effects on the body. Some individuals begin stimulant use to control weight or to improve performance in work, school or athletics. In 2014, an estimated 913,000 people ages 12 and older had a stimulant use disorder because of cocaine use, and an estimated 476,000 people had a stimulant use disorder as a result of using other stimulants besides methamphetamines (SAMHSA, 2015). Stimulant dependence causes withdrawal symptoms, which makes it difficult to stop taking them, consequently developing an addiction. Stimulant use disorders occur throughout all levels of society and are more common among individuals ages 12-25 years compared with individuals 26 years and older.

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Stimulant Use Disorder Defined

Stimulant use disorder includes signs and symptoms that reflect compulsive, prolonged self-administration of stimulant substances that are used for no legitimate medical purpose. Although stimulant usually are prescribed to treat attention deficit/hyperactivity disorder, depression, narcolepsy, and obesity, a patient may continue to take these drugs despite the development of serious related problems. Patterns of stimulant administration include episodic or daily (or almost daily) use. With continuing use, there is a decrease in pleasure effects due to tolerance and an increase in dysphoric effects. Stimulant use disorder, with severity specified as mild, moderate, or severe, depending on the number of diagnostic criteria that have been met. While it can range from mild to severe, even a mild disorder can escalate and lead to serious problems, so early treatment is important.

Different Types of Stimulant Use Disorders:

There are not separate types of stimulant use disorders, but there are levels of severity. These levels are based on which criteria is met, which is listed under symptoms. This is also broken down into amphetamine-type substance, cocaine and other or unspecified stimulants.

Mild: Presence of 2-3 symptoms.

Moderate: Presence of 4-5 symptoms.

Severe: Presence of 6 or more symptoms.

Stimulant Use Disorder Causes:

There can be several causes to stimulant use disorder. Various factors like genetic, psychological, social and environmental factors can all impact how taking stimulant affects your body and behavior. For certain people taking stimulant has a different and stronger impact that can lead to stimulant use disorder that it may not have on others. 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.

Stimulant Use Disorder Symptoms:

To be diagnosed with an stimulant use related disorder, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the following criteria must be met:

A pattern of amphetamine-type substance, cocaine, or other stimulant use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period.

    1. The stimulant is often 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 stimulant.
    5. Recurrent stimulant use, resulting in a failure 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 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. Continued stimulant use 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 stimulant to achieve intoxication or desired effect.
      • A markedly diminished effect with continued use of the same amount of 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.

Symptoms of stimulant use disorder 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
    • Euphoria
    •  Hypervigilance
    •  Anger
    •  Interpersonal sensitivity
    •  Auditory hallucinations
    •  Paranoid thoughts
    •  Repetitive movement

If you are taking a stimulant solely under appropriate medical supervision, an individual does not meet this criteria. Stimulant withdrawal causes brief, but severe, episodes of depression that can lead to suicide attempts and completed suicide. Accidental stimulant overdose is common, and should not be mistaken for a suicide attempt. Stimulant use disorder can include periods of stimulant intoxication and symptoms of withdrawal.

Stimulant Intoxication:

To be diagnosed with stimulant intoxication, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the following criteria must be met:

A. Recent use of an amphetamine-type substance, cocaine, or other stimulant.

B.Clinically significant problematic behavioral or psychological changes (e.g., euphoria or affective blunting; changes in sociability; hypervigilance; interpersonal sensitivity; anxiety, tension, or anger; stereotyped behaviors; impaired judgment) that developed during, or shortly after, stimulant use.

C. Two (or more) of the following signs or symptoms developing during, or shortly after, stimulant use:

      1. Tachycardia or bradycardia.
      2. Pupillary dilation.
      3. Elevated or lowered blood pressure.
      4. Perspiration or chills.
      5. Nausea or vomiting.
      6. Evidence of weight loss.
      7. Psychomotor agitation or retardation.
      8. Muscular weakness, respiratory depression, chest pain, or cardiac arrhythmias.
      9. Confusion, seizures, dyskinesias, dystopias, or coma.

D. The signs or symptoms are not attributable to another medical conditioning and are not better explained by another mental disorder, including intoxication with another substance.

Stimulant withdrawal:

To be diagnosed with stimulant withdrawal, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the following criteria must be met:
Presence of either of the following:
A. Cessation of (or reduction in) prolonged amphetamine- type substance, cocaine, or other stimulant use.

B. Dysphoric mood and two (or more) of the following physiological changes, developing within a few hours to several days after Criterion A.

      1. Fatigue.
      2. Vivid, unpleasant dreams.
      3. Insomnia or hypersomnia.
      4. Increased appetite.
      5. Psychomotor retardation or agitation.

C. The signs of symptoms in Criterion B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance.

How to Approach a Loved One:

There is not a perfect way to approach a loved one that you assume or know is struggling with a stimulant use disorder. Many people with stimulant use disorder hesitate to get treatment because they don't recognize they have a problem, so approaching them to tell them that they do have a problem can be difficult. An intervention from loved ones can help some people recognize and accept that they need professional help. If you're concerned about someone who may have an stimulant use disorder, ask a professional experienced in drug addiction treatment for advice on how to approach that person. You can not force someone to seek professional care, but you can always offer your support and encouragement. Even though you may not be able to prevent your loved one from developing an stimulant use disorder, you can still talk with them about treatment options.

Types of Opioid Use Disorder Treatment:

There are effective treatments for stimulant use disorder. The first step in treatment is being able to recognize that you have have an stimulant use problem, which can be difficult for most individuals. Many individuals reach this realization at very low point brought upon by stimulant use disorder. Even with treatment, there is a probability that you may return to stimulant use. This is more like occur if you spend time with people who drink stimulant or you're in environments where stimulant use is common. A key part of recovery for stimulant use disorder is continued support.

Aftercare programs and/or support groups help people recovering from stimulant use disorder to stop using stimulant, manage relapses and cope with necessary lifestyle changes. If you feel that you'll start to use stimulants again, contact your mental health professional or sponsor right away to prevent a relapse. Lifestyle changes are also crucial in recovering from stimulant use disorder. Ensuring that your family and friends are aware that you are recovering from stimulant use disorder and develop a support system of friends and family who can support your recovery, not impair your recovery. If you have people in your life that continue to take stimulants that do not support your recovery, they may impact your course of treatment and recovery. Finally, continuing to engage in other healthy habits is necessary for treatment. This can include managing stress in a healthy way, good sleep habits, maintaining a schedule, or regular physical activity can make it easier for you to recover from stimulant use disorder.

Detox and withdrawal

The first step in treatment is enrolling in a program to begin detoxification or detox. This process is medically managed, which generally takes two to seven days. You may need to take sedating medications to prevent withdrawal symptoms. Detox is usually done at an inpatient treatment center or a hospital.

Psychotherapy

Psychotherapy, also known as talk therapy or psychological counseling is used to identify the patterns of behaviors, thoughts, triggers, etc. that may impact individuals with stimulant use disorder. In therapy, individuals learn skills and establishing treatment plans that usually involve drug treatment specialists. It may include goal setting, behavior change techniques, use of self-help manuals, counseling and follow-up care at a treatment center. In therapy or counseling, it may help individuals better understand their problem with stimulant s and support recovery from the psychological aspects of stimulant use. Stimulant use disorder commonly occurs along with other mental health disorders, like depression and anxiety, which can be discussed in therapy.

Family therapy: This form of therapy can provide the individual with support, as well as the family in regards to how the stimulant use behaviors affect the family unit. It can provide the family with skills on how to resolve issues that arise and communicate with each other in a healthy manner. Family therapy also provides the individual with support needed for their recovery.

Self- Help Groups

There are various self-help groups that are options for individuals to attend, such as Narcotics Anonymous. Some people find that talking with others who have an stimulant use problem may be a helpful part of treatment. Through self-help groups, individuals find a forum of peer support, gaining strength as they share their feelings, and experiences with others who are facing the same obstacles as themselves. Self- help groups can also be helpful because you can have a sponsor that will assist in your continued recovery.

Medications

There are no pharmaceutical drugs formulated for treating stimulant use disorder. There are certain drugs that may potentially reduce cravings and lead to a successful recovery; prozac and naltrexone. Although Prozac is prescribed for mood disorders like depression and obsessive compulsive disorder, is has shown some limited potential in reducing cravings. Naltrexone is commonly used for the treatment of opioid and alcohol dependencies, but has also showed potential in treating prescription stimulant dependence.

Residential treatment programs

For serious stimulant use disorder, enrolling in a residential treatment facility may be necessary. Most residential treatment programs include individual and group therapy, support groups, educational lectures, family involvement and activity therapy. These programs will include the collaborative efforts of a team, which typically include licensed drug counselors, social workers, nurses, doctors and others with expertise and experience in treating stimulant use disorder.

Other practices

While medication, psychotherapy, residential programs and other treatment options are necessary in treatment, research has found that other forms of treatment can also helpful. Partaking in practices like meditation, yoga, your religious beliefs, etc., help individuals gain greater insight into their spiritual side and this is a key element in recovery.

Differences Between Common Disorders:

There are other possible causes of that resemble stimulant use disorder but would not meet criteria for this disorder. These are common disorders but the differences between them and stimulant use disorder.

  • Primary mental disorders - Stimulant-induced disorders may resemble primary mental disorders, like major depressive disorder. Mental disturbances resulting from effects of stimulants should be distinguished from generalized anxiety disorder, panic disorder, depressive bipolar disorder and symptoms of schizophrenia.
  • Phencyclidine intoxication-Intoxication with phencyclidine (also known as PCP or angel dust) or synthetic “designer drugs” such as mephedrone (also known as bath salts) may cause a similar clinical picture and can only distinguished from stimulant intoxication by the presence of cocaine or amphetamine- type substance metabolites in a urine plasma sample.
  • Stimulant intoxication and withdrawal- Stimulant intoxication and withdrawal are distinguished from the other stimulant-induced disorders (e.g., anxiety disorder, with honest during intoxication) because the symptoms in the latter disorders predominate the clinical presentation and are severe enough to warrant independent clinical attention.

Resources:

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders.

(5th ed.) Arlington, VA: American Psychiatric Association.

Stimulant-Related Disorders. (n.d.). Retrieved from:
https://www.psychologytoday.com/us/conditions/stimulant-related-disorders

Stimulant Treatment and Rehab. (n.d.). Retrieved from:
https://www.addictioncenter.com/stimulants/treatment/

Substance Use Disorders. (2015). Retrieved from:
https://www.samhsa.gov/disorders/substance-use

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