Stimulant use disorder

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Stimulant use disorder
Specialty Psychiatry, clinical psychology

Stimulant use disorder is a type of substance use disorder where the use of stimulants caused clinically significant impairment or distress. It is defined in the DSM-5 as "the continued use of amphetamine-type substances, cocaine, or other stimulants leading to clinically significant impairment or distress, from mild to severe". [1] These psychoactive drugs, known as stimulants, are among the most widely used drugs in the world today, although not all stimulants can induce addiction. As of 1993, Approximately 200 million Americans have used some type of stimulant in the past year alone. [2] [ page needed ]

Contents

Definition

A psychoactive drug, such as a stimulant, is a chemical or substance that affects one's behavior, mind, and body. A stimulant can be smoked, injected, snorted, taken in pill form, chewed, and even ingested in the form of a drink. Synthetic stimulants are becoming increasingly popular as users attempt to alter the chemicals in drugs to create different reactions, and ultimately steer clear of jail time, legal penalties, and detection in drug screening efforts. [3]

If a substance is used over a long period of time and the user becomes dependent upon it, a substance use disorder may develop. Substance use may lead to substance dependence and with time, addiction. Both mental and physiological dependence requires the development of tolerance leading to withdrawal symptoms. Stimulants come in a very large variety of subtypes and among the most common are caffeine, nicotine, cocaine, methamphetamine, amphetamines, amphetamine congeners, electronic cigarettes, diet pills, plant stimulants, energy drinks, and the ever-evolving designer stimulants such as bath salts. Caffeine and nicotine are the most popular stimulants used today, with roughly 400 million cups of coffee consumed daily [4] and 36.5 million current cigarette smokers, [5] according to a 2015 study conducted by the Centers for Disease Control and Prevention. [6] Nicotine, however, is treated separately psychiatrically under tobacco use disorder. Conversely, caffeine misuse does not qualify as an addictive disorder; thus it can not be diagnosed as a stimulant use disorder or any other substance use disorder. [7] Certain isolated conditions related to caffeine are recognized in the DSM-5’s "substance-related" [8] section, however: caffeine intoxication, caffeine withdrawal and other caffeine-induced disorders (e.g., Anxiety and Sleep Disorders). [9]

Signs and symptoms

Short-term effects

Even in low doses, stimulants cause a decrease in appetite, an increase in physical activity and alertness, convulsions, an elevated body temperature, increased respiration, irregular heartbeat, and increased blood pressure; [10] some of which can cause sudden death depending upon the medical history of the user, even among first-time users.

Long-term effects

The long-term use of stimulants can ultimately cause very serious medical issues, including addiction. Stimulant addiction, similar to other kinds of addiction, involves neurobiological changes that cause sensitization of the reward system to the stimulus in question (stimulants, in this case). People who use stimulants for a prolonged period frequently experience physiological changes that can be detrimental to their quality of life and require long-term treatment. [10]

Symptoms of the disorder

The symptoms of stimulant use disorder include failure to control usage and frequency of use, an intense craving for the drug, increased use over time to obtain the same effects, known as a developed tolerance, and continued use despite negative repercussions and interference in one's everyday life and functioning. [10] Furthermore, a disorder is noted when withdrawal symptoms occur because of a decrease in the drug amount and frequency, as well as stopping the use of the drug entirely. These withdrawal symptoms can last for days, weeks, months, and on rare occasions, years, depending on the frequency and dosages used by the individual. These symptoms include, but are not limited to, increased appetite, decreased energy, depression, loss of motivation and interest in once pleasurable activities, anxiety, insomnia, agitation, and an intense craving for the drug. Unless intensive medical and psychological treatment is sought after, there is a very high likelihood of relapse among the user. [11]

Epidemiology

The use of stimulants in humans causes rapid weight loss, cardiovascular effects such as an increase in heart rate, respiration, and blood pressure, emotional or mental side effects such as paranoia, anxiety, and aggression, as well as a change in the survival pathway known as the reward/reinforcement pathway in our brain. An increase in energy, a reduced appetite, increased alertness and a boost in confidence are all additional side effects of stimulant use when introduced to the body. [12]

Medical

Currently, stimulants are used medically to treat certain types of asthma, the common cold, depression, obesity, and a wide variety of physical pain and ailments. Most commonly, stimulants such as Adderall, Ritalin, and Vyvanse (lisdexamfetamine) are prescribed for both children and adults diagnosed with attention deficit hyperactivity disorder (ADHD). [13]

Recreational

Recreationally speaking, stimulants are used to change one's state of mind and users report feeling a "rush" as the central nervous system is flooded with dopamine and epinephrine, and norepinephrine. This rush is caused by the sudden change in both the electrical and chemical activity in the brain. This alteration occurs when a stimulant is introduced, as it causes a manipulation in the natural energy chemicals which are forced out and released into the body when they are not needed. In terms of recreational use, it is common for the user to smoke, inject, snort, and ingest stimulants, all of which create different effects on the body. [14]

History

Certain types of stimulants are found in plants and grow naturally. The tobacco plant, the cocoa shrub, yohimbe, the betel nut, and the ephedra bush are just a few of the naturally occurring stimulants. Other forms of stimulants are man-made, with no naturally occurring plant base, and are instead created using synthetic chemicals. Often, this involves using prescription or over-the-counter pharmaceutical products as precursor materials. [15]

Stimulants were first introduced to the medical community with the isolation of cocaine from the coca leaf in 1855, which is not only a stimulant but also a topical anesthetic.

In 1879, Vassili von Anrep of the University of Würzburg conducted an experiment in which he applied cocaine to one side of a frog's limbs before attempting an invasive medical procedure. Cocaine proved to be extremely effective as both an anesthetic and pain reducer. [16]

In World War II, soldiers were medicated using a type of stimulant called amphetamines to keep both pilots and soldiers alert, full of energy, and ready to fight. Amphetamines were given in pill form to American soldiers, as well as to Japanese and German military members. [17] It is estimated that German soldiers ingested roughly 35 million doses of Pervitin through the course of the war. Pervitin is a brand-name for methamphetamine, a drug that belongs to the stimulant class of drugs. The use of methamphetamine was an attempt by the Nazi leadership to create "super soldiers" who felt no pain and operated with extreme energy and unwavering confidence. The United States, for comparison, had dispensed roughly 200 million Benzedrine tablets. A mixture of amphetamine salts, these pills were favored for their ability to increase wakefulness and energy levels while simultaneously suppressing appetite. [18]

The United States, around the year 1960, saw large increases in amphetamines sold as diet pills, with pharmaceutical companies recognizing the appetite-suppressing and energy-boosting effects stimulants could provide. It was estimated that worldwide sales of diet pills containing stimulants rocketed to over 10 billion tablets sold and that between 6% and 8% of the U.S. population were prescribed these types of medications to aid in weight loss. Within a decade, the Comprehensive Drug Abuse Prevention and Control Act of 1970 was passed, the purpose of which was to make it more difficult for individuals to obtain these drugs, with or without a prescription. The rationale for the act was the dangerous and life-threatening side effects of such drugs, which became better understood during the 1960s. [19]

See also

Related Research Articles

<span class="mw-page-title-main">Amphetamine</span> Central nervous system stimulant

Amphetamine is a central nervous system (CNS) stimulant that is used in the treatment of attention deficit hyperactivity disorder (ADHD), narcolepsy, and obesity. Amphetamine was discovered as a chemical in 1887 by Lazăr Edeleanu, and then as a drug in the late 1920s. It exists as two enantiomers: levoamphetamine and dextroamphetamine. Amphetamine properly refers to a specific chemical, the racemic free base, which is equal parts of the two enantiomers in their pure amine forms. The term is frequently used informally to refer to any combination of the enantiomers, or to either of them alone. Historically, it has been used to treat nasal congestion and depression. Amphetamine is also used as an athletic performance enhancer and cognitive enhancer, and recreationally as an aphrodisiac and euphoriant. It is a prescription drug in many countries, and unauthorized possession and distribution of amphetamine are often tightly controlled due to the significant health risks associated with recreational use.

<span class="mw-page-title-main">Recreational drug use</span> Use of drugs with the primary intention to alter the state of consciousness

Recreational drug use is the use of one or more psychoactive drugs to induce an altered state of consciousness, either for pleasure or for some other casual purpose or pastime. When a psychoactive drug enters the user's body, it induces an intoxicating effect. Recreational drugs are commonly divided into three categories: depressants, stimulants, and hallucinogens.

<span class="mw-page-title-main">Psychopharmacology</span> Study of the effects of psychoactive drugs

Psychopharmacology is the scientific study of the effects drugs have on mood, sensation, thinking, behavior, judgment and evaluation, and memory. It is distinguished from neuropsychopharmacology, which emphasizes the correlation between drug-induced changes in the functioning of cells in the nervous system and changes in consciousness and behavior.

<span class="mw-page-title-main">Stimulant</span> Drug that increases activity of central nervous system

Stimulants are a class of drugs that increase the activity of the brain and the spinal cord. They are used for various purposes, such as enhancing alertness, attention, motivation, cognition, mood, and physical performance. Some of the most common stimulants are caffeine, nicotine, amphetamines, cocaine, and modafinil.

<span class="mw-page-title-main">Club drug</span> Category of recreational drugs

Club drugs, also called rave drugs or party drugs, are a loosely defined category of recreational drugs which are associated with discothèques in the 1970s and nightclubs, dance clubs, electronic dance music (EDM) parties, and raves in the 1980s to today. Unlike many other categories, such as opiates and benzodiazepines, which are established according to pharmaceutical or chemical properties, club drugs are a "category of convenience", in which drugs are included due to the locations they are consumed and/or where the user goes while under the influence of the drugs. Club drugs are generally used by adolescents and young adults.

<span class="mw-page-title-main">Dextroamphetamine</span> CNS stimulant and isomer of amphetamine

Dextroamphetamine is a potent central nervous system (CNS) stimulant and enantiomer of amphetamine that is prescribed for the treatment of attention deficit hyperactivity disorder (ADHD) and narcolepsy. It is also used as an athletic performance and cognitive enhancer, and recreationally as an aphrodisiac and euphoriant.

Stimulant psychosis is a mental disorder characterized by psychotic symptoms. It involves and typically occurs following an overdose or several day 'binge' on psychostimulants; however, one study reported occurrences at regularly prescribed doses in approximately 0.1% of individuals within the first several weeks after starting amphetamine or methylphenidate therapy. Methamphetamine psychosis, or long-term effects of stimulant use in the brain, depend upon genetics and may persist for some time.

<span class="mw-page-title-main">Adderall</span> Drug mixture used mainly to treat ADHD and narcolepsy

Adderall and Mydayis are trade names for a combination drug called mixed amphetamine salts containing four salts of amphetamine. The mixture is composed of equal parts racemic amphetamine and dextroamphetamine, which produces a (3:1) ratio between dextroamphetamine and levoamphetamine, the two enantiomers of amphetamine. Both enantiomers are stimulants, but differ enough to give Adderall an effects profile distinct from those of racemic amphetamine or dextroamphetamine, which are marketed as Evekeo and Dexedrine/Zenzedi, respectively. Adderall is used in the treatment of attention deficit hyperactivity disorder (ADHD) and narcolepsy. It is also used illicitly as an athletic performance enhancer, cognitive enhancer, appetite suppressant, and recreationally as a euphoriant. It is a central nervous system (CNS) stimulant of the phenethylamine class.

Drugs and prostitution have been documented to have a direct correlation.

<span class="mw-page-title-main">Polysubstance use</span> Use of multiple psychoactive substances

Polysubstance use or poly drug use refers to the use of combined psychoactive substances. Polysubstance use may be used for entheogenic, recreational, or off-label indications, with both legal and illegal substances. In many cases one drug is used as a base or primary drug, with additional drugs to leaven or compensate for the side effects, or tolerance, of the primary drug and make the experience more enjoyable with drug synergy effects, or to supplement for primary drug when supply is low.

Cocaine dependence is a neurological disorder that is characterized by withdrawal symptoms upon cessation from cocaine use. It also often coincides with cocaine addiction which is a biopsychosocial disorder characterized by persistent use of cocaine and/or crack despite substantial harm and adverse consequences. The Diagnostic and Statistical Manual of Mental Disorders, classifies problematic cocaine use as a "Stimulant use disorder". The International Classification of Diseases, includes "Cocaine dependence" as a classification (diagnosis) under "Disorders due to use of cocaine".

Behavioral addiction, process addiction, or non-substance-related disorder is a form of addiction that involves a compulsion to engage in a rewarding non-substance-related behavior – sometimes called a natural reward – despite any negative consequences to the person's physical, mental, social or financial well-being. In the brain's reward system, a gene transcription factor known as ΔFosB has been identified as a necessary common factor involved in both behavioral and drug addictions, which are associated with the same set of neural adaptations.

<span class="mw-page-title-main">Psychoactive drug</span> Chemical substance that alters nervous system function

A psychoactive drug, psychopharmaceutical, psychoactive agent, or psychotropic drug is a chemical substance that changes the function of the nervous system and results in alterations of perception, mood, cognition, and behavior. These substances may be used medically, recreationally, for spiritual reasons, or for research. Some categories of psychoactive drugs may be prescribed by physicians and other healthcare practitioners because of their therapeutic value.

<span class="mw-page-title-main">Darryl S. Inaba</span> President of CNS Productions, Inc.

Darryl S. Inaba, PharmD., was born June 16, 1946, in Denver, Colorado. He is the remaining owner and President of CNS Productions, Inc. in Medford, OR. He is an associate professor of Pharmacology at the UCSF Medical Center in San Francisco, California, and the Director of Clinical and Behavioral Health Services at ARC in Medford, Oregon. He is also special consultant and instructor for the University of Utah School of Alcoholism and Other Drug Dependencies, as well as the Director of Education and Research at CNS Productions. Dr. Inaba is also on the editorial board of the Journal of Psychoactive Drugs, which has been published since 1967.

<span class="mw-page-title-main">William Edgar Cohen</span> American film director

William Edgar Cohen was the president of CNS Productions, Inc. and co-author of Uppers, Downers, All Arounders, a textbook on the neurochemistry and neuropharmacology of psychoactive drugs. Additionally, he wrote and directed over two hundred teaching films and documentaries. Cohen was born in Washington, D.C., and raised in New York City.

CNS Productions is a publisher of educational materials — primarily textbooks and instructional DVDs — dealing with psychoactive drugs and addiction. It was formed in 1983 by Paul Steinbroner, with long-time collaborator William E. Cohen who had an extensive background in medical film production. CNS Productions has produced and distributed over fifty separate titles on issues related to the neurobehavioral effects of psychoactive drugs.

<span class="mw-page-title-main">Paul Steinbroner</span> American film director

Paul J. Steinbroner was born March 18, 1949, in Los Angeles. In 1983, he founded CNS Productions, a publishing and distribution company specializing in topics related to addiction, neuropharmacology, and brain chemistry. He is the publisher of Uppers, Downers, All Arounders, a textbook on the neurochemistry and neuropharmacology of psychoactive drugs. Having previously produced informational and scientific documentaries, Steinbroner formed TouchPoint Productions to create a series of documentaries on transformational healing. Collectively known as Called From Darkness, the five part series examines willingness and spiritual awakening from five different cultural perspectives. In 2023, Paul was awarded the Michael Ford Journalism Award from the National Association of Addiction Treatment Providers for his contribution of over 50 films and publications related to addiction and treatment.

<span class="mw-page-title-main">Use of drugs in warfare</span>

Use of mind-altering substances in warfare has included drugs used for both relaxation and stimulation. Historically, drug use was often sanctioned and encouraged by militaries through including alcohol and tobacco in troop rations. Stimulants like cocaine and amphetamines were widely used in both World Wars to increase alertness and suppress appetite. Drug use can negatively affect combat readiness and reduce the performance of troops. Drug use also poses additional expenses to the health care systems of militaries.

<span class="mw-page-title-main">Prescription drug addiction</span> Medical condition

Prescription drug addiction is the chronic, repeated use of a prescription drug in ways other than prescribed for, including using someone else’s prescription. A prescription drug is a pharmaceutical drug that may not be dispensed without a legal medical prescription. Drugs in this category are supervised due to their potential for misuse and substance use disorder. The classes of medications most commonly abused are opioids, central nervous system (CNS) depressants and central nervous stimulants. In particular, prescription opioid is most commonly abused in the form of prescription analgesics.

References

  1. ↑ American Psychiatric Association. "Substance-Related and Addictive Disorders". In American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. doi:10.1176/appi.books.9780890425596.dsm16. 20 Feb 2017.
  2. ↑ Inaba, Darryl, William E. Cohen, and Michael E. Holstein. Uppers, Downers, All Arounders: Physical and Mental Effects of Psychoactive Drugs. Ashland, OR: CNS Productions, 1993. Print.
  3. ↑ American Psychiatric Association. "Substance-Related and Addictive Disorders". In American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. doi:10.1176/appi.books.9780890425596.dsm16. 20 Feb 2017.
  4. ↑ "Find Out How Obsessed Americans Are WIth Drinking Coffee". HuffPost. 2011-11-02. Retrieved 2023-04-24.
  5. ↑ "Burden of Tobacco Use in the U.S." Centers for Disease Control and Prevention. 2022-08-08. Retrieved 2023-04-24.
  6. ↑ Centers for Disease Control and Prevention. “Burden of Tobacco Use in the U.S.: Current Cigarette Smoking Among Aged 18 Years and Older.” 2017. Tips from Former Smokers™. 20 Feb 2017. https://www.cdc.gov/tobacco/campaign/tips/resources/data/cigarette-smoking-in-united-states.html
  7. ↑ "American Psychiatric Association Substance-Related and Addictive Disorders" (PDF). www.psychiatry.org. 2013. Retrieved 2020-07-08.
  8. ↑ "Substance-Related and Addictive Disorders", Diagnostic and Statistical Manual of Mental Disorders, DSM Library, American Psychiatric Association, 2013-05-22, doi:10.1176/appi.books.9780890425596.dsm16, ISBN   978-0-89042-555-8 , retrieved 2020-07-08
  9. ↑ Addicott, Merideth A. (September 2014). "Caffeine Use Disorder: A Review of the Evidence and Future Implications". Current Addiction Reports. 1 (3): 186–192. doi:10.1007/s40429-014-0024-9. ISSN   2196-2952. PMC   4115451 . PMID   25089257.
  10. 1 2 3 "What are the immediate (short-term) effects of methamphetamine misuse?". National Institute on Drug Abuse. Retrieved 2023-04-24.
  11. ↑ Inaba, Darryl, William E. Cohen, and Michael E. Holstein. Uppers, Downers, All Arounders: Physical and Mental Effects of Psychoactive Drugs. Ashland, OR: CNS Productions, 1993. Print.
  12. ↑ Yentis SM, Vlassakov KV (1999). "Vassili Von Anrep: Forgotten Pioneer of Regional Anesthesia". Anesthesiology. 90 (3): 890–5. doi:10.1097/00000542-199903000-00033. PMID   10078692.
  13. ↑ "Prescription Stimulants DrugFacts". National Institute on Drug Abuse. 2018-06-06. Retrieved 2023-04-24.
  14. ↑ Yentis SM, Vlassakov KV (1999). "Vassili Von Anrep: Forgotten Pioneer of Regional Anesthesia". Anesthesiology. 90 (3): 890–5. doi:10.1097/00000542-199903000-00033. PMID   10078692.
  15. ↑ Inaba, Darryl, William E. Cohen, and Michael E. Holstein. Uppers, Downers, All Arounders: Physical and Mental Effects of Psychoactive Drugs. Ashland, OR: CNS Productions, 1993. Print.
  16. ↑ Yentis SM, Vlassakov KV (1999). "Vassili Von Anrep: Forgotten Pioneer of Regional Anesthesia". Anesthesiology. 90 (3): 890–5. doi:10.1097/00000542-199903000-00033. PMID   10078692.
  17. ↑ Inaba, Darryl, William E. Cohen, and Michael E. Holstein. Uppers, Downers, All Arounders: Physical and Mental Effects of Psychoactive Drugs. Ashland, OR: CNS Productions, 1993. Print.
  18. ↑ Inaba, Darryl, William E. Cohen, and Michael E. Holstein. Uppers, Downers, All Arounders: Physical and Mental Effects of Psychoactive Drugs. Ashland, OR: CNS Productions, 1993. Print.
  19. ↑ Inaba, Darryl, William E. Cohen, and Michael E. Holstein. Uppers, Downers, All Arounders: Physical and Mental Effects of Psychoactive Drugs. Ashland, OR: CNS Productions, 1993. Print.
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