Specialty Psychiatry ICD-9-CM 303-305, 292.0 | ICD-10 F15.9 MeSH D019966, D013375 | |
Stimulant use disorder is a type of substance use disorder, also known as a drug use disorder. It is defined in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (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. These psychoactive drugs, known as stimulants, are the most widely used drugs in the world today. Approximately 200 million Americans have used some type of a stimulant in the past year alone, and a total of 1 billion individuals have smoked a cigarette.
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Definition
A psychoactive drug, such as a stimulant, is a chemical or substance that effects 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.
If a substance is used over a long period of time and the user becomes dependent upon it, a substance abuse issue begins to appear. Substance abuse 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 and an astounding 36.5 million current cigarette smokers, according to a 2015 study conducted by the Centers for Disease Control.
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 have been created using synthetic chemicals in a lab, or refined from other preexisting drugs on the market today.
Historically speaking, stimulants such as cocaine were first introduced to the medical community and used topically as anesthetics during surgery after an experiment proved its effectiveness 1879, by a scientist named Vassili von Anrep, of the University of Würzburg. He conducted an experiment in which he used cocaine on one side of a frog’s limbs before attempting an invasive medical procedure, which proved to be extremely effective as both an anesthetic and pain reducer.
In World War II, soldiers were medicated using a type of stimulant called and amphetamine to keep both pilots and soldiers alert, full of energy and ready to fight. The soldiers were given this drug in pill form to both the American soldiers, Japanese and German military members. It is estimated that Germany soldiers ingested roughly 35 million doses of Pervitin® which is a methamphetamine that belongs to the stimulant class of drugs that is also an opiate pain killer. This was an attempt by the German military leaders to create “super soldiers” who felt no pain, had extreme energy and confidence. The United States alone had dispensed roughly 200 million Benzedrine® tablets, which were used primarily for their ability to increase wakefulness, energy levels and its appetite suppressant properties.
The United States, in the year 1960, had an increase in amphetamine-based diet pills as pharmaceutical companies began recognizing the appetite suppressant and energy boosting effects stimulants have on the body. It was estimated that Worldwide sales of diet pills containing stimulants rocketed to over 10 billion weight-loss tablets sold, and 6% to 8% of the U.S. population were prescribed this type of medication to aid in weight loss. Soon after, the Comprehensive Drug Abuse Prevention and Control Act of 1970 was created which made it increasingly hard for individuals to obtain the drug, even with a prescription, as the dangerous and lie-threatening side effects became well known and understood.
Usage
The use of stimulants in humans causes rapid weight loss, cardiovascular effects such as an increase in heart rate, respirations 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.
Medicinal
Currently, stimulants are used medicinally 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® and Ritalin® are prescribed for both children and adults diagnosed with ADHD. Additionally, stimulant medications are available such as Rexulti® which are given to individuals diagnosed with narcolepsy.
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 (6). 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 in the body.
Short Term Effects
Even in small doses, stimulants cause a decrease in appetite, an increase in physical activity and alertness, convulsions, an elevated body temperature, increased respiration, irregular heart beat and increased blood pressure; 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 abuse of stimulants ultimately causes very serious medical issues, including but not limited to, addiction. Addiction, which is a disease that causes high rates of relapse, can be defined as a chronic disease that is characterized as a compulsive drug seeking behavior in which the user will stop at nothing to obtain the drug. Long time users of stimulants have noted changes in the body such as brain function, chemistry and molecular or cellular adaptations.
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 a continued use despite negative repercussions and interference in one’s everyday life and functioning. 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.