Stimulant Addiction: Signs, Effects, and Treatment

What Are Stimulants?

Stimulants are a class of psychoactive drugs that increase activity in the brain. Stimulants include prescription medications like Adderall (mixed amphetamine salts) and Ritalin (methylphenidate), and illicit substances like methamphetamine and cocaine.^1,2

The legal status for stimulants varies depending on the substance; however, several stimulant drugs fall under Schedule II, including Ritalin, Adderall, Dexedrine, cocaine, and meth. Schedule II substances have a high potential for misuse, which can lead to physiological dependence.⁴

Dependence is not the same as addiction, rather it means that the body has adapted to the presence of a drug, and if a person stops taking the drug or significantly reduces their usual dose, they will likely experience unpleasant withdrawal symptoms.⁵

How Do Stimulants Work?

Stimulants work by increasing the activity of the brain, mainly by augmenting norepinephrine (a neurotransmitter that influences arousal, attention, mood, learning, memory, and stress response) and dopamine (a neurotransmitter that influences the reinforcement of behavior).^1,2,3,6

Increased dopamine activates feel-good chemicals in the reward center of the brain, triggering the desire for more and creating a “rush” of euphoria.⁷

Increased norepinephrine results in a rise in blood pressure, breathing, and heart rate, all of which create an experience of increased alertness and attention.⁷

Stimulants with Potential for Addiction

The following are examples of stimulants with the potential for addiction. All stimulants produce a similar range of effects; however, the intensity and duration of those effects depend on the potency, dose, route of administration, and duration of use.

Prescription Amphetamines (Adderall, Dexedrine) and Methylphenidate (Ritalin, Concerta)

First-line medication for treating ADHD includes prescription amphetamines like Adderall and Dexedrine, and prescription methylphenidate, like Ritalin and Concerta. Both amphetamines and methylphenidate have similar mechanisms of action, and both are potentially reinforcing due to their effects on dopamine availability, with amphetamines relatively more reinforcing, likely in a dose-dependent manner.^8,9

All ADHD stimulant medications have the potential for diversion and misuse; however, it is important to note that studies have consistently shown that taking ADHD medication is not associated with an increased rate of substance misuse.

Methamphetamine and Crystal Meth

Methamphetamine can be used to treat ADHD (Desoxyn), but is also sold illicitly on the street as a powder, pill, and “crystal meth,” which looks like fragments of glass or shiny white-blue rocks.¹⁰ It can be swallowed but is typically snorted, smoked, or injected, which can lead to a more intense rush or “high.”¹¹

Cocaine

Cocaine is a highly addictive stimulant that is commonly found as a powdered white substance derived from the leaves of the coca plant. It’s also processed into a freebase, rock-like substance, known as crack cocaine.¹²

Khat and Synthetic Cathinones (“Bath Salts”)

Synthetic cathinones are manmade substances similar to a natural substance found in the khat plant, native to East Africa and southern Arabia. Khat is illegal in the U.S. and has mild stimulant effects.¹³

Many of the synthetic cathinones are also illegal, but new formulations are created regularly in efforts to skirt law enforcement. They are commonly marketed as “bath salts” (but also as other seemingly benign products like plant food, jewelry cleaner, or phone screen cleaner). They can be much stronger and, in some cases, more dangerous, than more expensive drugs they are designed to mimic, which include the street drugs cocaine and methamphetamine.¹³

Effects of Stimulants

All stimulants produce a similar range of psychological, behavioral, and physiological effects. In general, short-term effects of stimulants can include:^1,7,10

• Increased energy.
• Increased alertness.
• Increased heart rate.
• Increase in body temperature.
• Feelings of euphoria, particularly at higher doses.

At high doses, prescription stimulants can cause adverse effects, particularly on the cardiovascular system, including irregular heartbeat, dangerously high body temperature, seizures, and heart failure.⁷

People who use stimulants by means of injection increase their chances of contracting infectious diseases like hepatitis and human immunodeficiency virus (HIV).^7,10

Stimulant Addiction

Stimulant use disorder is defined in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), as a “pattern of an amphetamine-type substance, cocaine, or another stimulant use leading to clinically significant impairment or distress.”³

Signs of Stimulant Addiction

A stimulant use disorder is diagnosable only by a medical professional and must meet specific criteria as outlined in the DSM-5. However, knowing the criteria may help you identify when it’s time to get help for stimulant misuse. The criteria for stimulant use disorder are:³

• Taking the stimulant in higher quantities or more frequent doses than originally intended.
• Being unable to cut down on stimulant use, even if you want to.
• Spending a lot of time obtaining, using, and recovering from the effects of stimulants.
• Craving or strongly desiring more of a stimulant.
• Being unable to fulfill your responsibilities at work, home, or school due to stimulant misuse.
• Continuing to use stimulants even though you experience difficulties in your social life or relationships because of your stimulant misuse.
• Giving up activities you once enjoyed due to stimulant use.
• Using stimulants in situations where it’s physically dangerous to do so (like driving or operating machinery).
• Continuing to use stimulants even though you’ve developed a physical or psychological condition that you know is probably due to stimulant use.
• Experiencing tolerance, which is the need for increased amounts of a stimulant to achieve desired effects or feeling fewer effects when using the same amount of a stimulant.
• Developing withdrawal symptoms when you try to stop using stimulants or taking stimulants to relieve withdrawal symptoms.

Stimulant Withdrawal Symptoms

Stimulant withdrawal symptoms can begin to develop within hours or days after a person stops using them.⁵ The symptoms can occur after short-term binges or following long-term stimulant use.⁵ Withdrawal symptoms and their severity will depend on the stimulant taken, the dose, frequency, whether other substances are also regularly used, and various individual factors, such as a person’s biological or genetic makeup.

Common stimulant withdrawal symptoms include:⁵

• Chills.
• Hunger.
• Fatigue.
• Intense craving.
• Impaired memory.
• Weight gain.
• Dehydration.
• Loss of interest or pleasure (i.e., anhedonia).
• Anxiety.
• A state of unease or dissatisfaction in life (i.e., dysphoria).
• Intense drug-related dreams.

Dysphoria, intense agitation and anxiety, and anhedonia can be quite severe during stimulant withdrawal, putting a person at higher risk of engaging in self-harm, including a heightened risk of suicide.⁵ It’s beneficial for people likely to experience severe depression to receive support and supervision during stimulant withdrawal, which can help mitigate risks through doctor or detox provider consultation during acute withdrawal.⁵

Stimulant Addiction Treatment

A combination of psychosocial treatment and behavioral therapy has been found to be the most effective at treating stimulant use disorders.⁵

Evidence-based practices like cognitive-behavioral therapy (CBT), motivational interviewing (MI), and contingency management (CM) are commonly used and have shown positive results in stimulant addiction treatment, with CM having the most significant evidence of effectiveness.⁵

While treatment medications have been developed to assist in the withdrawal from other substances like alcohol and opioids, there are currently no Food and Drug Administration (FDA)-approved medications specifically indicated to treat stimulant addiction.⁵

Treatment Settings for Stimulant Addiction

Treatment settings can include varying levels of care, including:

• Inpatient treatment. Inpatient treatment requires a person to live at the facility for the duration of treatment, which can range from a few weeks to several months depending on their needs. Typically, inpatient care is best for those with more severe addictions and who need more structured support and services.⁵
• Outpatient treatment allows a person to continue living at home while attending treatment at a local facility. There are varying levels of outpatient care that require a person to be in treatment for a set number of hours per week based on a person’s needs, including intensive outpatient programs and high intensity outpatient programs like PHPs.⁵

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