Stimulant Drugs Overview

What Is a Stimulant?

Stimulants are a class of drugs that have an exciting effect on the central nervous system. These drugs can create feelings of increased energy or elation, which is why they are often abused for performance enhancement or recreation. Though the short-term effects on the brain can be desirable, stimulants can have dangerous long-term effects.

Stimulants may be legal and available without a prescription, like caffeine and nicotine; legal and prescribed by a doctor, like Adderall; or illegal, like cocaine and meth. All of these stimulants are commonly abused in different ways. Prescribed stimulants are typically taken orally, but when used illicitly, stimulants may be snorted, smoked, or injected.

Are Prescription ADHD Drugs Stimulants?

Medications commonly used to treat attention deficit hyperactivity disorder (ADHD) in adults and children are stimulants. When taken as prescribed, they can be an effective treatment as they help increase focus. However, when taken without underlying medical need, the drugs have just as high potential for abuse as illicit stimulants like cocaine.

What are common prescription stimulants?

  • Dextroamphetamine (Dexedrine®): Dextroamphetamine is prescribed to treat ADHD and narcolepsy.
  • Dextroamphetamine/amphetamine combination product (Adderall®): Sold commercially as Adderall, this combination of dextroamphetamine and amphetamine is commonly abused by young adults.
  • Methylphenidate (Ritalin®, Concerta®): Ritalin and Concerta are used to treat attention deficit disorders and narcolepsy and can be prescribed in immediate-release and extended-release variants, leading to different effects.

Effects of Stimulants on The Brain

The primary effects of stimulants are to increase alertness, focus, and energy. Due in part to the increase of dopamine in the brain, stimulants may also produce other related effects such as:

  • Reduced social inhibition
  • Feelings of euphoria
  • Talkativeness
  • Mood swings
  • Nervousness
  • Paranoia
  • Feelings of grandiosity and power
  • Panic attacks
  • Agitation
  • Hostility
  • Delusions or hallucinations

Stimulant use often leads to unpleasant temporary effects when the drug wears off known as the “come down” period. During this period, the brain experiences a drastic reduction in the pleasure-inducing neurotransmitter dopamine. As a result, users may experience:

  • Restlessness and agitation
  • Short-temperedness
  • Anxiety
  • Problems sleeping
  • Paranoia
  • Irritability
  • Confusion

Side Effects of Stimulants

Stimulant use, particularly when it’s prolonged and excessive, may cause various side effects including:

  • Headaches
  • Insomnia
  • Nausea and vomiting
  • Dry mouth
  • Decreased appetite and weight loss
  • Stomach pain
  • Muscle tightness or twitching
  • Increased body temperature
  • Increased heart rate
  • Increased respiratory rate
  • Elevated blood pressure
  • Dizziness
  • Diarrhea
  • Constipation
  • Sex drive changes
  • Cardiovascular failure

Commonly used stimulants

Amphetamines

Amphetamines may be prescribed for attention disorders or may be produced illegally for recreational or performance enhancing use. They may take the form of pills, crystals, or powder and are known by the street name “speed.”

Betel nut

Betel nut is the seed of the areca palm fruit, which can be used fresh, dried, baked or cured to produce its stimulant effects. It is commonly used in Asia and the Asia Pacific region where it is sometimes part of religious and cultural practices.

Caffeine

Caffeine is a widely available stimulant that can be found in many plants including those used to make coffee, tea, chocolate, and energy drinks. Though it is commonly used, prolonged and heavy use can lead to anxiety, headaches, and sleep problems among other effects.

Cocaine

Cocaine is a powerful stimulant derived from the leaves of the coca plant. It is commonly known as coke, crack, or blow and can be snorted, injected, or smoked as is common with crack cocaine. Cocaine has no legal medical use and has a high potential for addiction.

Crystal methamphetamine

Crystal methamphetamine is an illegally produced form of amphetamine that is more addictive and has more dangerous side effects. The drug, which may be smoked or injected, is commonly referred to as “ice” due to its rocky clear appearance.

Khat

Originating in parts of the Middle East and Eastern Africa, khat is a stimulant that is used both medicinally and recreationally. The leaves of the khat plant are typically chewed to obtain the stimulant effects.

Mephedrone

Mephedrone is classed as one of several New Psychoactive Substances (NPS), which are designed to mimic the effects of illicit drugs using new chemicals to substitute for those that are banned. The stimulant is available as a powder, crystals, or pills.

Nicotine

Nicotine is the main psychoactive component in tobacco products. In addition to common side effects of stimulant use, because it is often smoked, nicotine use is associated with serious detrimental health effects like cancer and respiratory illness.

Synthetic cathinones

Synthetic cathinones are typically powders or crystals derived from the khat plant that are designed to produce stimulant effects. Bath salts are an increasingly popular type of synthetic cathinone stimulants which can cause serious side effects.

Stimulant Withdrawal Symptoms

Stimulant withdrawal may cause severely distressing side effects due to the chemical changes that occur in the brain during and after stimulant use. When stimulant use is discontinued, withdrawal symptoms may include:

  • Tiredness or fatigue
  • Irritability and mood swings
  • Depression
  • Anxiety
  • Increased appetite
  • Insomnia
  • Vivid and distressing dreams
  • Body aches
  • Drug cravings

Signs of Stimulant Overdose

Stimulant overdose is possible, particularly when they are mixed with other substances. Though illicit stimulants like cocaine or meth may be considered more dangerous, prescription and over-the-counter stimulants have the potential for overdose if used improperly. Signs of stimulant overdose include:

  • Fever
  • Increased or irregular heart rate
  • Increased respiratory rate
  • Muscle pains or weakness
  • Increased sweating
  • Headache
  • Nausea or vomiting
  • Diarrhea
  • Uncontrollable body movements
  • Seizure
  • Coma
  • Panic and agitation
  • Confusion
  • Dark urine
  • Aggressiveness

Diagnosing Stimulant Abuse and Addiction

Stimulant abuse that is prolonged and compulsive may be diagnosed as Stimulant Use Disorder (SUD) according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Diagnosis involves the identification of problematic psychological symptoms lasting for at least two months. Some of these symptoms include:

  • Taking stimulants in larger doses or at a higher frequency
  • Persistent desire to stop or failed attempts to stop using stimulants
  • Intense cravings and urges to use
  • Stimulant use that results in neglect of social or occupational responsibilities
  • Tolerance of the drug, requiring more of it to achieve the same effect
  • Withdrawal when stimulant use is discontinued

Treating diagnosed SUD may require medically supervised detox in order to safely eliminate the substances from the body.

Psychotherapies for stimulant addiction

Treatment for stimulant addiction and abuse generally involves regular therapy sessions to address issues that may be related to or underlying the substance use. Commonly used psychotherapies include:

Cognitive-behavioral therapy (CBT)

Cognitive-behavioral therapy is designed to identify problematic patterns of thinking and behaving that exacerbate substance use. During CBT, individuals learn to identify and avoid triggers as well as learning adaptive behaviors in order to avoid long-term consequences of addiction.

Contingency Management

Based on a series of incentives, contingency management is a therapy that rewards periods of abstinence from drug use and other positive behaviors. In doing so, it provides positive reinforcement and long-term motivation to remain drug-free.

Matrix Model

This integrative approach to stimulant addiction treatment combines components from many different kinds of therapy in order to achieve long-term success. Through individual and group therapy sessions, individuals learn relapse prevention techniques, self-esteem building, and drug addiction education. The Matrix model can be incorporated into inpatient or outpatient treatment programs, offering several hours of addiction treatment per day.

Common Stimulant Addiction Treatment Options

The first step in stimulant addiction treatment is typically detox. Only after the stimulants and any other substances have been removed from the user’s system, can long-term addiction treatment begin. Many treatment options are available depending on individual need and severity of addiction.

In severe cases or cases of multi-substance abuse, residential inpatient treatment may be most effective at treating stimulant addiction. During residential inpatient treatment, individuals have access to round-the-clock care and therapeutic support in order to overcome the pitfalls of recovery. Treatment may range from 30 to 90 days and may be followed by an intensive outpatient program that allows individuals to continue receiving intensive care while living at home

Intensive outpatient treatment may also be helpful for those with less severe addictions who would benefit from attending therapy sessions and group meetings multiple times a week with the goal of long-term sobriety.