Stimulant Addiction Explained
Every day, millions of people rely on stimulants to help them manage and treat conditions as wide-ranging as obesity, narcolepsy, ADHD, asthma and many more – while literally hundreds of millions of us consume the world’s most popular stimulant caffeine at least once a day.
Stimulants comprise of some of the most problematic substances of abuse on earth, and stimulant addiction is a devastating condition affecting every part of the world, including the UK.
About Stimulant Abuse and Addiction
Addiction develops when repeated exposure to a rewarding stimulus leads to the reward centres of the brain adjusting to the repeated stimulus, producing greater quantities of neurotransmitters such as dopamine (responsible for reward-motivated behaviours).
Stimulants tend to significantly increase the production of dopamine which explains in part why stimulants are habit forming. An individual may continue to take stimulants in an attempt to repeat or sustain the enjoyable feelings associated with the drug – and in order to drive off the negative sensations and emotions which result from cessation. The compulsion to repeat the consumption of stimulants – despite being aware of the negative consequences of doing so – constitutes a stimulant addiction.
Physical dependence occurs when the body and brain become reliant on the presence of stimulants to function normally. In the case of stimulants, psychological dependence can occur as a direct response to neurotransmitter imbalance. If stimulants are suddenly withdrawn from the system, the brain can enter a state of abnormal functioning by which a range of potentially distressing symptoms may arise from the depletion of dopamine and other neurotransmitters.
Common Types of Stimulants
The term “stimulant” is used to describe a wide range of different substances, ranging across numerous classes of drugs with significant variations in effect, structure, legal status and risk potential.
The phrase “diet pills” refers to any various medications provided in tablet form for the reduction or control of weight and as a component of the treatment of obesity. These medications work in a number of different ways, and not all diet pills are stimulants; however, one of the primary strategies used to promote weight loss is the suppression of the appetite, and a number of substances in the amphetamine and substituted amphetamine classes are included in certain diet medications for their appetite-suppressant properties.
Diet pills came to prominence in the first half of the 20th century, especially following the arrival on the scene of amphetamines (first marketed as Benzedrine) in the 1930s. Over the following decades stimulant diet pills grew increasingly popular in the west, but their obvious disadvantages and dangers saw them subject to increased government regulation and removal from sale.
Nevertheless, diet pills of various kinds remain popular today albeit not commonly prescribed due to their abuse potential.
Anabolic steroids – more formally known as anabolic-androgenic steroids (AAS) – are a group of substances including natural androgens (hormones which govern the development and maintenance of male characteristics in humans and other vertebrates) such as testosterone, and synthetic androgens related to and similar in effect to testosterone. Anabolic steroids increase the amount of protein found in cells, and are used medically to promote muscle growth and appetite; in the treatment of wasting conditions such as AIDS and cancer; and to induce puberty in males.
Anabolic steroids are also used as performance-enhancing drugs, especially amongst athletes and bodybuilders to increase muscle density and/or increase strength.
Steroids are typically taken orally or via intravenous or intramuscular injection. The use of anabolic steroids is associated with a significant number and variety of health risks (some very serious, and potentially deadly) including cardiovascular disease, cancer, growth defects, feminisation or masculinisation, kidney and/or damage, and an array of psychological issues.
The effects on body shape and image often associated with steroid use can be a powerful factor in the development of psychological addiction, while individuals using anabolic steroids may also develop tolerance and dependence, with numerous symptoms manifesting upon cessation of use.
Ritalin & Concerta
Ritalin and Concerta – two of several trade names for the stimulant medication methylphenidate – are used in the treatment of attention deficit hyperactivity disorder (ADHD), narcolepsy, and sometimes to address cases of bipolar disorder and major depressive disorder which have previously been resistant to treatment. Concerta is a longer-lasting, slow-release version of methylphenidate, with one Concerta tablet typically being taken once per day. Ritalin however, is a rapid release form of methylphenidate which typically lasts for a period of 2-4 hours and requires multiple doses for daily therapeutic cover.
Methylphenidate works by inhibiting the reuptake of norepinephrine and dopamine in the brain and central nervous system (CNS), which along with having stimulant effects can produce euphoria in users. As a result, methylphenidate is sometimes used and abused recreationally in schools and universities as a ‘study drug’.
Although Ritalin and Concerta are relatively well-known and popular medications, methylphenidate has pronounced addiction and dependence liabilities (similar to those of amphetamine), which are increased at higher doses (such as those typically consumed during recreational use). A range of adverse effects are associated with methylphenidate consumption, including loss of appetite, nausea, anxiety, insomnia, abdominal pain, agitation, irritability, palpitations, dizziness, changes in blood pressure, changes in heart rate, blurred vision, chest pains and psychosis.
Taking methylphenidate also poses a risk of overdose, with symptoms including vomiting, tremors, agitation, muscle twitches, confusion, hallucinations, hyperthermia, sweating, headache, hypertension, cardiac arrhythmia, hyperpyrexia, convulsions, paranoia, rapid muscle breakdown, circulatory collapse and coma, potentially resulting in death.
Dexedrine is one of several brand names for dextroamphetamine, a powerful CNS stimulant used in the treatment of ADHD and narcolepsy, as a performance enhancer, and recreationally for its euphoriant and aphrodisiac properties. Dexedrine has also been used by various military bodies for its ability to stave off sleep and to enhance cognitive functioning.
Dextroamphetamine is a member of the amphetamine class of drugs. Dextroamphetamine works by inhibiting the function of the dopamine, norepinephrine and serotonin transporters, and by increasing the quantity of these chemicals released in the brain and central nervous system.
Dextroamphetamine is very psychologically addictive, and some physical symptoms have also been associated with its withdrawal. As well as dependence and addiction, side effects of dextroamphetamine use and abuse can include cardiovascular effects (including hypotension and hypertension), tachycardia, abdominal pain, sexual dysfunction, constipation, diarrhoea, nausea, blurred vision, nosebleeds, grinding of teeth, mood swings, depression, insomnia restlessness, anxiety and psychosis.
Certain medications used in the treatment of depression are known to have stimulant properties, in particular some belonging to the norepinephrine reuptake inhibitor (NRI’s) group which share some properties with stimulants such as cocaine.
Serotonin and norepinephrine reuptake inhibitors (SNRI’s) such as Venlafaxine are also known to produce stimulant affects, but neither NRI’s nor SNRI’s belong to any class of stimulants.
Adderall increases the activity of dopamine and norepinephrine in the brain, and induces the release of other neurotransmitters including serotonin and histamine. This gives rise to Adderall’s stimulant effects, but can also produce euphoria and cognitive-enhancing effects, which make it attractive to recreational drug users and also as a “study aid” in academic or professional environments.
The side effects of Adderall consumption can be dangerous, including cardiovascular and respiratory problems, and overdose can lead to potentially fatal symptoms including convulsions and coma. Prolonged Adderall consumption, especially at dosages appropriate for recreational use, can lead to tolerance, addiction and dependence.
Probably the most notoriously common illicit stimulant, cocaine is derived from the leaves of the cocoa plant, originally grown in South America but now cultivated in various other parts of the world. Cocaine – typically found in the form of a white powder, but also available in a smokable “rock” form known as crack cocaine, are commonly used and abused recreationally due to its euphoric and invigorating properties. Cocaine is the second most abused substance in the UK, and carries significant penalties for supple and distribution.
Cocaine is extremely psychologically addictive, with most withdrawal symptoms being psychological in nature. Some physical symptoms have also been observed in cocaine withdrawal.
Cocaine’s reputation as a “high status” drug has contributed to its comparatively high price, making cocaine addiction an extremely expensive condition often resulting in financial ruin.
Cocaine use poses a number of significant risks to physical and mental health. Users can suffer from accelerated heart rate, hyperthermia, arrhythmia, delusions, hallucinations, tremors, anxiety, paranoia, and possibly convulsions and death.
Long-term use can lead to damage to cardiovascular and respiratory systems, stroke, tissue damage (especially in the nose as a result of snorting) and an array of autoimmune disorders. Cocaine abuse is also linked to neurological damage potentially resulting in permanent cognitive impairment.
Methamphetamine (commonly known as “crystal meth” or simply “meth”) is an extremely potent central nervous system stimulant belonging to the substituted phenethylamine and substituted amphetamine classes of drugs. Methamphetamine works by activating trace amine-associated receptor 1 (TAAR1) in the brain and CNS, which inhibits or reverses the direction of dopamine, norepinephrine and serotonin transporters, leading to a greater quantity and persistence of those chemicals in the system.
Methamphetamine is sometimes used medically to treat ADHD or obesity in tablet form but is more commonly used recreationally, typically in the crystalline form known as crystal meth. Crystal meth can produce an intense and comparatively long-lasting euphoric and aphrodisiac “high”, as well as elevating mood, increasing invigoration, alertness and appetite suppressant. However, methamphetamine use and abuse is associated with numerous negative and potentially dangerous side effects including the manifestation of psychosis and other mental health disorders, seizures, cardiovascular and respiratory problems, stroke, heart attack and neurological damage.
Methamphetamine is not considered to be physically addictive but is strongly psychologically addictive, with users frequently driven to take more of the drug once its effects wear. This is to dispel the various negative sensations and emotions associated with a meth “crash”.
Some methamphetamine users engage in binges of the drug which may last several days, especially in environments such as raves and sex parties in which methamphetamine consumption is used for its aphrodisiac, energising and orgasm-delaying properties.
The Psychology of Stimulant Addiction
Stimulants of any kind, have the ability to make users feel good, and their euphoric and cognitive enhancing properties can be extremely enjoyable, whilst warding off negative or unpleasant emotions. The pursuit of these pleasurable experiences can drive many people into patterns of repeated stimulant consumption, and contribute to the development of addiction and dependence.
People using stimulants for purposes other than pure pleasure are also at risk of developing addiction, as the effects of stimulant consumption are not defined by its purpose. Any individuals taking stimulants over time, including those using them for medical purposes or as performance enhancers, are in danger of becoming addicted to them. This is due partly to the additive nature of the substance itself, and also because their intended effects can be attractive.
Stimulant addicts frequently become defensive and even aggressive if confronted, and may withdraw from the company of those not engaging in stimulant consumption or those who question their use of stimulants. This social withdrawal can lead to isolation or to the formation of peer groups within which stimulant use and abuse is commonplace. This makes it increasingly difficult for the addict to get different perspectives on their situation which might otherwise encourage a diminution or cessation of problematic stimulant consumption.
Risk Factors and Causes of Stimulant Addiction
Although addiction is a well-studied and comparatively well understood phenomenon, it is not yet perfectly established why some people develop addictions to stimulants while others do not. Every instance of addiction is unique, just as every addict is, and the precise events and influences which lead someone into addiction will differ from one case to the next.
However, various factors have been identified which are known to increase the likelihood that someone will develop an addiction to stimulants, including:
- a family history of addiction
- a family history of mental health problems
- personal experience of substance abuse, especially problematic stimulant use
- suffering from mental health issues, especially behavioural disorders for which stimulants may typically be prescribed
- experience of childhood abuse
- exposure to trauma or other challenging life events
- easy access to stimulants
- low self-esteem
- associating with a peer group within which stimulant abuse is commonplace
- participation in competitive sport
- engaging in weight training or bodybuilding, especially in competitive environments
- participating in sex parties
- engaging in sex work
- working in professions where long hours and/or stressful working conditions are commonplace
- a pattern of risk-taking or thrill-seeking behaviour
- social isolation
The Stages of Stimulant Addiction
Because every instance of addiction is unique, and the properties of different stimulants can vary so significantly, it is impossible to draw up a universally applicable “roadmap” to stimulant addiction. However, roughly speaking it is possible to describe four main stages of stimulant addiction.
- Initial exposure: first contact (which may be medical or recreational) with stimulants and the experience of their effects, and the fostering of the desire to recreate those effects.
- Familiarisation: repeatedly consuming stimulants and becoming familiar with their effects, as well as associated factors such as stimulant terminology, where and how to obtain stimulants etc.
- Habituation: coming to incorporate stimulant consumption into daily life, and increasingly focusing on procuring and consuming stimulants, potentially at the expense of other activities and aspects of life.
- Addiction: having stimulant consumption take the central role in one’s life, possibly at great cost to health, life circumstances and relationships; potentially developing a stimulant dependence with withdrawal symptoms manifesting upon cessation of use; being unable to stop taking stimulants.
The Addiction Potential of Different Stimulants
Different stimulants have different abuse potentials and addiction rates.
Generally, most stimulants are not considered especially physically addictive – that is, any dependence associated with their use is typically psychological rather than physical in nature – and therefore exactly how addictive one stimulant may be compared with another depends upon the impact and production of dopamine. For example, methamphetamine can produce dopamine levels up to 40 times higher than those which may occur naturally in the system of a user, making it much more psychologically addictive than a substance with a much lower capacity to produce dopamine.
However, the addiction potential of a given stimulant may also be related to other factors. For example, someone taking steroids or amphetamines for performance-enhancing purposes or in the pursuit of an ideal body shape (for instance, in bodybuilding or weight loss) might become increasingly addicted to the positive feelings resulting from improved performance or self-image.
Such users may come to identify such positive feelings with the stimulant in question, and their addictive behaviour may therefore incorporate consuming stimulants even if they do not necessarily consider the direct effects of stimulant consumption to be particularly pleasurable.
This effect can also be felt by users taking stimulants for genuine medical purposes, such as ADHD, who take stimulants to counteract some of the problematic symptoms of the condition.
In such circumstances stopping stimulant medication may result in ADHD symptoms returning, thus compelling the ADHD sufferer to seek remedies in the form of stimulants. This scenario is still a form of dependency.
Therefore, the likelihood that someone will become addicted to a given stimulant is not simply a function of the properties of that stimulant itself in isolation, and is therefore challenging to compare individual stimulants’ addictive properties. Moreover, while the legal status of certain drugs may be used as an indication of how problematic their use and abuse may be, legislation is determined by numerous factors other than addiction potential. Just because a drug is legal does not automatically imply that it is significantly less addictive than an illegal substance.
While it is true that highly illegal substances such as cocaine and methamphetamine are generally considered among the most addictive stimulants, many other stimulants including legal substances are also habit-forming. If you have any questions about the addictive nature of stimulant medication prescribed to you, speak with your doctor as soon as possible.
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Co-Occurring Disorders: Mental Health Issues & Stimulants Addiction
Substance abuse disorders frequently occur alongside other mental health issues (a condition known as dual diagnosis) partly because many people suffering from poor mental health engage in substance abuse as a means of escapism or self-medication, and partly because substance abuse itself can cause numerous mental health problems.
In the case of stimulants in particular, dual diagnosis is an especially common condition because stimulants can be prescribed to treat certain mental health issues, greatly increasingly the likelihood that the individuals in question will engage in their abuse and go on to develop stimulant addiction.
Dual diagnosis can greatly complicate addiction treatment in numerous ways, partly because both disorders need to be treated simultaneously if one is not to impact negatively upon the treatment of the other. As a result, specialist care is typically required in cases of dual diagnosis.
Mood Disorders Associated with Stimulants
As well as conditions which may be treated with stimulants, a number of mood disorders and other psychiatric phenomena are associated with stimulant abuse and addiction. Mood swings, paranoia, aggression (potentially resulting in violence), psychosis, depression, anxiety and increased suicidal and homicidal ideation have each been identified in many long-term stimulant users, while stimulant withdrawal can also cause the manifestation of negative symptoms.
Detox and Withdrawal from Stimulants
Stimulant detoxification (detox) is considered an indispensable aspect of all addiction treatment, as it addresses the immediate challenges associated with dependence whilst cleansing the addict’s system of stimulants. Many treatment facilities, including residential rehabilitation (rehab), require a period of detox prior to the treatment phases involving psychotherapy.
Detox typically brings on a period of withdrawal. In the case of stimulant withdrawal, the symptoms are not usually physically life-threatening but are primarily psychological in nature. However, these symptoms can be extremely distressing and may result in suicidal ideology. As a result, some rehabs may provide detox medication to alleviate some of the more serious psychological withdrawal symptoms
If you are suffering from an addiction to stimulants, we recommend you speak with your GP and/or an addiction specialist about your condition and the various treatment options which may be available to you.
Medication for Stimulant Addiction
There is no “magic bullet” pharmaceutical cure for stimulant addiction; though some substances (including the antidepressant bupropion) have been trialled with some reduction in usage. Research into other drugs is ongoing, and treatment for stimulant addiction still rests upon therapy.
Some medications may be used to decrease the severity of various symptoms of withdrawal. For example, antipsychotic drugs can be used to counter the emergence of stimulant psychosis or other psychotic symptoms; antidepressants are commonly prescribed to treat depression emerging during withdrawal; and anxiolytic (“calming”) drugs may also be given in cases of anxiety.
Some addicts develop a condition known as post-acute, or protracted, withdrawal syndrome (PAWS) in which symptoms of withdrawal – especially depression and other mood disorders – may persist for months or even years. In cases of PAWS, medication may be prescribed on a long-term basis to counter distressing or debilitating symptoms.
Inpatient vs Outpatient Rehabilitation for Stimulant Abuse
Rehab facilities may offer treatment on either an inpatient or an outpatient basis, each with its own advantages and disadvantages.
Inpatient rehab typically involves staying in residential facilities for a period of 30 to 90 days. Treatment usually consists of a detox phase – which will be monitored by a medical professional to ensure the safety of the addict – followed by a therapy phase. Other core elements include dietary and fitness planning. Rehab facilities are secure, pleasant, calm and confidential environments in which addicts are able to focus wholly upon healing and recovery. Therapy allows the addict to achieve greater understanding of the problematic thought processes and behaviours which have resulted in the development of addiction – as well as psychological defence mechanisms against relapse.
Outpatient treatment for stimulant addiction typically sees clients attending a facility for regular therapy sessions and assessments, and if required for the provision of medication; detox and withdrawal will need to be monitored very frequently (and many facilities will require at least an initial inpatient stay during the detox/withdrawal phase for the safety of the client). Other aspects of treatment, including fitness and diet, will need to be managed by the client independently. Outpatient treatment may also include regular phone or email consultations and clients are encouraged to come into the facility if they feel in danger of relapsing or if they require urgent attention.
Outpatient treatment may be especially appropriate for addicts who do not feel comfortable taking the time out of their daily lives, and away from obligations such as work or family commitments, which an inpatient stay would entail. However, because inpatient treatment does not take an addict out of their daily environment in which substance abuse and addiction have developed – in particular, contact with drug dealers and other sources of stimulants, and any of various triggers which may typically have driven further instances of stimulant abuse – the risk of relapse (with potentially very serious consequences for health, especially following any period of detox during which tolerance may have declined) is immeasurably greater than would be the case in the controlled, substance-free settings of inpatient rehab.
Whether a client enrols in inpatient treatment or takes an outpatient option, quality treatment facilities will offer up to a year’s free aftercare after the conclusion of a treatment programme. Recovery is not complete when treatment concludes, but is rather a long-term (sometimes lifelong) process with plenty of potential pitfalls along the way, and aftercare (often including a commitment to engage in ongoing counselling, and attendance at support groups such as Narcotics Anonymous) is considered an essential follow-up to treatment, providing recovering addicts with the best possible foundation for ongoing abstinence and sobriety.
Getting Help for Stimulants Addiction
Any addiction is a serious condition with potentially vast ramifications for the addict’s health and life circumstances. Stimulant addiction is no different; indeed, an addiction to stimulants poses very substantial health risks and claims thousands of lives each year worldwide, as a result of overdose, long-term health complications, accidents, and violence associated with the consumption of stimulants and/or their supply.
If you suffer from a stimulant addiction, the longer you labour under its burden the greater the likelihood that you will experience permanent damage, or even die as a result of your stimulant abuse. Therefore, the sooner you can get help for your condition the sooner you will be able to embark upon your recovery – and the greater the chance that you will be able to return to a healthy and happy life with no permanently debilitating effects.
If you are a stimulant addict and want to get help, contact your GP and/or an addiction specialist to talk about your condition and find out about what treatment options might be available to you. Don’t waste any more time: make that call today and take your first step on the road back to a life free of stimulant abuse.
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