Stimulant Abuse: Signs, Effects, and Treatment Options

What Is a Stimulant?

Stimulants increase central nervous system activity through their interaction with various neurotransmitter systems—including norepinephrine and dopamine. This can ultimately lead to an increase in attention, alertness, and energy, among other effects. That said, misuse of certain stimulants can generate a host of adverse effects such as psychosis, paranoia, and anger, and may increase the risk of overdose toxicity and severe physiological outcomes such as heart attack, seizure, and stroke.²

Available in various forms such as pills/capsules, injectable liquids, and powder, stimulants can be taken orally as well as smoked, injected, and snorted. Aside from their intended therapeutic effects, stimulants are sometimes misused to enhance self-esteem, reduce appetite, produce a sense of exhilaration, extend wakefulness, improve physical and mental performance, increase activity, and get high.¹

Results from the 2020 National Survey on Drug Use and Health shed some light on stimulant misuse in the United States. According to the data:³

• 758,000 people aged 12 and older had a prescription stimulant use disorder in 2020.
• 7% of the U.S. population (10.3 million people) misused any type of central nervous system stimulant in the past year.
• Of the aforementioned 10.3 million, roughly 33.3% used cocaine only, 33.3% misused prescription stimulants only, and 1 in 7 used methamphetamine.

Prescription stimulants fall under Schedule II of the Controlled Substance Act as they have medical utility, despite their high potential for dependence and abuse.⁴ Meanwhile, illegal stimulants that serve no medical purpose fall under Schedule I.¹

Types of Stimulants

Stimulants comprise a broad category of legal and illicitly used substances. Keep in mind, however, that even legally prescribed stimulants, including prescription amphetamines, can be illicitly diverted and misused for nonmedical purposes. But to give you a broad overview of stimulant types, here’s a quick breakdown of both common prescription stimulants and those often illicitly used.

Prescription stimulants can also be misused. In fact, studies indicate that 45.2% of young adults who used prescription stimulants misused them in 2019.⁵

Stimulant misuse occurs when:²

• The drug is taken only for its effects and to get high as opposed to for its intended medical purpose.
• The substance is taken in ways that are not prescribed (e.g., in higher or more frequent doses or in other unintended methods or routes of use, such as crushing and snorting pills).
• The medication used was prescribed for someone else.

How Do Stimulants Work?

To generate their stimulating effects, stimulant drugs impact the central nervous system (CNS) through their influence on several neurotransmitters in the brain, specifically dopamine, norepinephrine, and serotonin.⁶ To break it down a bit further, stimulants increase the activity norepinephrine and dopamine. Norepinephrine is involved with CNS-regulated physiological functions such as heart rate, blood pressure, and breathing. Meanwhile, dopamine influences the reinforcement of rewarding behaviors.²

Due to the way they impact the brain and body, stimulants have an inherent potential for misuse. Even when not prescribed for such uses, people may misuse stimulants to reverse feelings of physical and mental fatigue, reduce appetite for weight loss, increase mental alertness, and produce feelings of exhilaration or a “high.”²

These effects are highly desirable for many people, and certain routes of administration—such as injecting, smoking, or snorting stimulants—may be attempted to further intensify these effects. Additionally, regardless of their route of use, stimulants are often taken in large quantities, a behavior known as binging, to achieve a “high” or “rush.”¹

Common Stimulant Effects

Stimulant effects vary depending on factors such as the route of administration, potency, dosage, combination of substances used, and level of prior use.⁵

Some of the sought-after or desirable effects of stimulants include:¹

• Sense of exhilaration.
• Enhanced self-esteem.
• Improved mental and physical performance.
• Increased physical activity.
• Appetite reduction.
• Extended wakefulness.

However, adverse effects can also occur, especially if you misuse/abuse stimulants by taking them in large quantities or, in the case of prescription stimulants, taking them more often than therapeutically needed.¹

Serious adverse effects of stimulant misuse can include:⁷

• Dangerously elevated body temperature (i.e., hyperthermia).
• Increased cardiovascular risks from persistently accelerated heart rate, vasoconstriction, and increased blood pressure.
• Panic attacks.
• Hostility.
• Paranoia.
• Psychosis.
• Violent behavior.
• Seizures.

What is polysubstance use?

Polysubstance use is when two or more drugs are used within a short period of time. This type of drug mixing can lead to potentially more dangerous intoxicating effects, even if one or more of the substances are prescription medications.⁸

Mixing various stimulants can dangerously elevate blood pressure and heart rate levels and can increase the risk of heart attack, stroke, and brain injury. Pairing stimulants with benzodiazepines or opioids may mask the effects of one or both drugs, potentially leading to unpredictable results, increased use, and ultimately overdose.⁸ Additionally, mixing stimulants with heavy alcohol consumption increases the risk of violent behavior and heart damage.⁹

Are Stimulants Addictive?

Regardless of their legal status, some stimulants can lead to addiction, or what is diagnosed by treatment professionals as a stimulant use disorder. Continued stimulant misuse may result in a stimulant use disorder, which can develop after as little as one week of use (although this speed of onset is rare).¹⁰

Signs of Stimulant Addiction

Formal diagnosis of a stimulant use disorder can only be made by a healthcare professional.¹⁰ However, it’s helpful to understand the criteria used for diagnosis.

According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a person has a stimulant use disorder when use leads to significant impairment, as manifested by exhibiting at least two of the following criteria within a 12-month period:¹⁰

• Use of the drug in larger doses or for a longer period than had been intended.
• A persistent desire to use or repeated unsuccessful attempts to decrease or cease use.
• Spending an inordinate amount of time attempting to procure the drug, use it, or get over its effects.
• Cravings, urges, or a desire to use.
• Recurrent use resulting in failure to fulfill obligations at school, home, or work.
• Continued use despite negative effects on social life and interpersonal relationships.
• Reduced recreational, work, or social activities reduced or abandoned.
• Repeated use in environments or situations where it could cause physical harm.
• Ongoing use even with the knowledge that physical and/or psychological problems. are likely to have either been caused or worsened by use.
• Tolerance. (This criterion doesn’t count toward diagnosis if a prescription stimulant such as Adderall is being used as prescribed.)
• Withdrawal. (This criterion doesn’t count toward diagnosis if a prescription stimulant such as Adderall is being used as prescribed.)

Stimulant Addiction Treatment

If you or a loved one is misusing stimulants or other drugs, treatment is available in various formats and with the use of myriad therapies.

Along with symptoms such as fatigue, anxiety, paranoia, drug cravings, and more, withdrawal can include temporary yet severe depression.^10,11 There are currently no FDA-approved medications for the treatment of stimulant withdrawal. However, patients may benefit from being monitored during withdrawal to potentially treat depression and suicidal ideation.¹¹

Common treatment environments include:

• Outpatient treatment, which may include regularly scheduled group and/or individual counseling and may be used independently or as an initial or follow-up complement to inpatient treatment.¹²
• Inpatient treatment comprises 24/7 care within a hospital or residential setting, each of which offers a unique mix of therapeutic approaches to help patients lead a drug-free lifestyle after treatment.¹²

According to Treatment of Stimulant Use Disorders, a guide compiled by the Substance Abuse and Mental Health Services Administration, the following therapies can be helpful in treating stimulant use disorders.⁷

• Cognitive behavioral therapy. This goal-oriented treatment helps patients understand their problems, challenges, and experiences to help change their behavior and thinking.
• Contingency management. A type of behavioral therapy, contingency management reinforces desired behaviors via incentives such as privileges, cash, or prizes.
• Community reinforcement. Often involving relationship counseling, job skills training, and vocational guidance, community reinforcement is often used alongside contingency management. The therapy helps to identify behaviors that reinforce stimulant use and attempts to make a substance-free lifestyle more rewarding.
• Motivational interviewing. This client-centered counselling helps people overcome ambivalent feelings and insecurities in order to become more engaged with treatment efforts and more motivated to reduce or stop stimulant use.

If you or a loved one are ready to take the first step toward recovery, American Addiction Centers (AAC) can help. For those with health insurance, the process starts with a quick call to discuss your benefits and what services they cover. However, if you don’t have insurance, many treatment centers will work with you to identify grants and scholarships, or they may use an income-based sliding fee scale.

AAC can connect you with an admissions navigator that will answer your questions, verify your insurance and help you start treatment today.