Stimulants are a group of drugs designed to increase alertness, amplify physical and mental energy, and improve attention, according to the National Institute on Drug Abuse (NIDA). As these drugs stimulate the brain, they also stimulate the body; heart rate, blood pressure, and respiration all increase. This class of drugs can be found both illicitly, on the black market, and for prescription use. There are also some stimulants that are technically legal, although they can be dangerous. According to the Centers for Disease Control and Prevention (CDC), stimulant drugs, especially cocaine and methamphetamine, are often found in overdoses.
Types of Stimulant Drugs
Most stimulant drugs fall into the amphetamine class, which includes drugs with chemical bases amphetamine, dextroamphetamine, and methamphetamine. MDMA, ecstasy, crystal meth, and Adderall are the most famous drugs from this class. These drugs typically have psychoactive as well as stimulating effects on the brain.
Popular prescription forms of stimulant drugs, which is often abused by students in high school and college, are drugs with the base chemical methylphenidate. Prescription brands of this drug include Ritalin and Concerta, which are prescribed to treat attention deficit hyperactivity disorder.
Cocaine is another famous stimulant drug. It can be found in purer powdered form, which is typically snorted, and as crack cocaine, which is most commonly smoked. Cocaine is technically a Schedule II substance, like prescription opioid painkillers because it has very localized numbing effects that is used in near, nose, and throat surgeries. Crack cocaine, however, is completely illegal, with no medical uses, and its use was an epidemic in the 1980s and 1990s.
Synthetic cathinones, which are modeled after cocaine, are growing in popularity in the US because they are cheap, and many of them are sold legally. Because they are produced in a laboratory, manufacturers can alter the chemical structure of these drugs to bypass regulations around intoxicating substances. Bath salts are the most famous of the synthetic cathinones; while these have been made illegal in recent years, variants on bath salts are, unfortunately, still available. Because they are produced without any regulation, the drugs are difficult to dose properly and have unpredictable effects on the brain.
Caffeine and nicotine are legalized stimulant drugs. Nicotine has properties that cause both stimulation and relaxation, which makes it highly addictive while caffeine has a mild stimulating effect which, although addictive, is not considered dangerous because it is very difficult to overdose on it.
How Do Stimulants Affect the Brain and Body?
All stimulants affect the central nervous system by changing the balance of neurotransmitters called monoamines, primarily dopamine. Some stimulants also affect the release, and prevent reabsorption, of norepinephrine or serotonin. However, the main mood-altering, energy-improving, and blood vessel-constricting effects come mainly from dopamine flooding the brain.
Mental and Psychological Effects
When a stimulant drug is abused, it releases a large amount of dopamine into the brain and prevents the reabsorption of the neurotransmitter. This floods synapses, causing greater and faster communication between neurons. While very small, therapeutic doses of stimulants like Ritalin can improve attention or reduce depression in some individuals, stimulant abuse typically causes euphoria, increased physical energy, and greater physical stimulation, such as sexual interest. In nonmedical doses, stimulants can be highly addictive because of the intense pleasure associated with dopamine release.
Psychological side effects from nonmedical doses are also common. For drugs like cocaine and crystal meth, this often leads to binges to avoid feeling depressed or exhausted; once a person goes on a stimulant binge, they may not sleep for several days. For people struggling with meth addiction, this is a common side effect called tweaking. However, people struggling with abuse of other stimulants may go on a similar binge cycle.
Those who are at a greater risk for schizophrenia, bipolar disorder, or similar psychological disorders may experience a psychotic break. This means that the stimulant drug could trigger hallucinations, paranoia, or mania associated with a psychosis.
General physical side effects from stimulant abuse include:
- Chest pain
- Heart palpitations
- Increased body temperature
- Headache from constricted blood vessels
- Teeth grinding, which may cause tooth or jaw damage
- Shaking or tremors
- Flushed skin
- Abdominal cramps
Stimulants mainly damage the cardiovascular system. They speed up heartbeat and amp up blood pressure, which can increase the risk of a heart attack, stroke, or pulmonary embolism. However, consistent stimulant abuse can also prematurely age the heart, according to a recent Australian study published in Heart Asia. The research team used arterial stiffness as a measure of aging in the cardiovascular system; those who abused amphetamines had prematurely stiff heart muscles.
When stimulants are consumed orally, the drugs can cause damage to the digestive system; ulcers and bowel decay can develop. As stimulants typically suppress appetite, the person may suffer malnutrition. Smoking and snorting stimulants also damages the lungs, increasing the risk of infections like pneumonia and tuberculosis as well as the risk of lung cancer.
Dehydration is a common side effect from stimulants, especially MDMA and synthetic cathinones. Dehydration may cause the breakdown of skeletal muscles in a process called rhabdomyolysis, which floods the kidneys with toxins and causes them to shut down.
Cocaine and other snorted drugs can damage the lining inside the nose, the back of the throat, the upper palate, and the upper respiratory system. A perforated septum – the thin lining between nostrils inside the nose – is a common symptom of powdered cocaine abuse. If the abuse continues for years, the structure of the nose may collapse, and perforations could occur in the palate (between the nose and mouth).
Meth can change how saliva is produced in the mouth; that, and the craving for sugar which leads to increased consumption of sodas and candy, causes damage called meth mouth, when the teeth become very rotten and may fall out.
People experiencing hallucinations because of stimulants like bath salts, meth, or crack may pick at their skin, or even develop formication, a hallucination that there are insects crawling on them. This excessive scratching or picking damages the skin, leading to open sores that can become infected.
MDMA, ecstasy, and Molly increase internal body temperature to potentially dangerous levels – sometimes, as high as 108 degrees Fahrenheit (fever temperatures leading to hospitalization occur around 104-106 degrees Fahrenheit). High body temperature called hyperthermia rapidly damages the liver and kidneys. It can also damage the brain.
Identifying Stimulant Abuse
A person struggling with addiction to a stimulant drug may appear highly energized or very excited followed by extremely fatigue a few hours later. They may begin to suffer from anxiety or depression. They may shake or develop tremors; their teeth may change color; their skin could develop acne or sores; they may cough if they smoke stimulants; they may struggle with infections that never seem to clear up, like lung infections; they may hallucinate or become paranoid; or they may even disappear for several days.
A doctor may spot physical changes like hypertension, dilated pupils, malnutrition or weight loss, lung and nasal problems, dysphoria, convulsions, or other signs of stimulant abuse.
Additionally, other signs that a person is struggling with drug abuse, such as stimulant addiction, include:
- Compulsively taking drugs even when trying to stop
- Experiencing withdrawal symptoms when not taking drugs
- Worrying about where the next dose will come from
- Lying about substance abuse
- Hiding evidence of substance abuse
- Stealing prescriptions, money, or valuables to get more drugs
- Choosing to take the drug over going to work, school, or social engagements
- Spending too much money on the drug
Getting Treatment to Overcome Stimulant Abuse
If a person struggles with stimulant addiction, it is important to get medical help detoxing from these substances and to find a high-quality rehabilitation program that specializes in treating stimulant abuse. The body and brain have likely become dependent on the presence of stimulants to regulate neurotransmitters, especially dopamine, so withdrawing from these drugs will require medical oversight. Withdrawing from most stimulants is not life-threatening, but it can be uncomfortable enough that an unsupervised person may relapse into substance abuse, which increases the risk of overdose.
Depression is the primary symptom of stimulant withdrawal. If the mental health condition is caused by withdrawal, and not an underlying psychological condition that led to stimulant abuse (co-occurring disorder), then it will clear up after a week or two. If the individual struggled with depression before self-medicating with stimulants, treating this mental health condition along with the addiction will be important.
While substances like alcohol and opioids have medications that can ease withdrawal symptoms, stimulants do not have equivalent medication management. An overseeing doctor may instead recommend over-the-counter painkillers like aspirin or acetaminophen to manage any pain or anti-nausea drugs to manage nausea.
Needs after Detoxing from Stimulants
If the person has suffered a psychotic break after taking stimulants, the co-occurring mental health condition – schizophrenia, psychosis, or bipolar disorder, most commonly – will need to be treated alongside the addiction. These conditions will likely require both psychotherapy and medication to balance brain chemistry. Rehabilitation programs are becoming increasingly aware of co-occurring disorders, so there may be special programs available that offer therapy and medication for both stimulant addiction and a co-occurring mental condition like psychosis.
About 20-25 percent of people struggling with stimulant abuse have a cyclical mood disorder like bipolar disorder; most have lifetime depression; and many have borderline personality disorder, post-traumatic stress disorder (PTSD), antisocial personality disorder, or untreated ADHD, which led to self-medicating with stimulants. People who struggle with co-occurring disorders are more likely to benefit from inpatient or residential long-term treatment; this way, they can get group and individual therapy to treat addiction and therapy to treat their mental health condition.
Underlying health conditions, like heart damage or lung problems, which were caused by stimulant abuse should be treated by a doctor. This will likely involve long-term management and lifestyle changes.
Those who struggle with stimulant abuse but do not have a co-occurring mental health condition, and who have a supportive home life, may benefit more from outpatient treatment. They will still be required to attend group and individual therapy for several hours per week after detox. Part of assessment after supervised detox should include a plan for how often the individual should attend therapy sessions. The individual may attend as few as 10 hours of treatment per week or as much as 20-30 hours of treatment per week with intensive outpatient treatment.
The Matrix Model of therapy in rehabilitation programs works best with people who have struggled with stimulant abuse. The therapist is a combination of coach and teacher, offering positive reinforcement for good changes in behavior and increasing awareness of negative impacts of some behaviors. The therapist gives specific suggestions and recommends changes to help their client learn better behaviors.
To successfully complete rehabilitation, taking a leave of absence from work or school will be important. The Family and Medical Leave Act (FMLA) means that employers may not discriminate against employees who must take time off to care for themselves; however, without a source of income, paying for treatment may appear daunting. Friends and family can be asked for financial contributions, and insurance, if available, is likely to cover at least some of the first month of treatment. Additionally, many rehabilitation programs offer payment plans. Social workers or case managers may be able to help individuals find government assistance and scholarships too.