Stimulant use disorder

A psychoactive drug, such as a stimulant, is a chemical or substance that affects 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.[3]

If a substance is used over a long period of time and the user becomes dependent upon it, a substance use disorder may develop. Substance use 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[4] and 36.5 million current cigarette smokers,[5] according to a 2015 study conducted by the Centers for Disease Control and Prevention.[6] Nicotine, however, is treated separately psychiatrically under tobacco use disorder. Conversely, caffeine misuse does not qualify as an addictive disorder; thus it can not be diagnosed as a stimulant use disorder or any other substance use disorder.[7] Certain isolated conditions related to caffeine are recognized in the DSM-5’s "substance-related"[8] section, however: caffeine intoxication, caffeine withdrawal and other caffeine-induced disorders (e.g., Anxiety and Sleep Disorders).[9]

The use of stimulants in humans causes rapid weight loss, cardiovascular effects such as an increase in heart rate, respiration, 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.[14]

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 are instead created using synthetic chemicals. Often, this involves using prescription or over-the-counter pharmaceutical products as precursor materials.[17]

Stimulants were first introduced to the medical community with the isolation of cocaine from the coca leaf in 1855, which is not only a stimulant but also a topical anesthetic.

In 1879, Vassili von Anrep of the University of Würzburg conducted an experiment in which he applied cocaine to one side of a frog’s limbs before attempting an invasive medical procedure. Cocaine proved to be extremely effective as both an anesthetic and pain reducer.[18]

In World War II, soldiers were medicated using a type of stimulant called amphetamines to keep both pilots and soldiers alert, full of energy, and ready to fight. Amphetamines were given in pill form to American soldiers, as well as to Japanese and German military members.[19] It is estimated that German soldiers ingested roughly 35 million doses of Pervitin® through the course of the war. Pervitin® is a brand-name for methamphetamine, a drug that belongs to the stimulant class of drugs. The use of methamphetamine was an attempt by the Nazi leadership to create "super soldiers" who felt no pain and operated with extreme energy and unwavering confidence. The United States, for comparison, had dispensed roughly 200 million Benzedrine® tablets. A mixture of amphetamine salts, these pills were favored for their ability to increase wakefulness and energy levels while simultaneously suppressing appetite.[20]

The United States, around the year 1960, saw large increases in amphetamines sold as diet pills, with pharmaceutical companies recognizing the appetite-suppressing and energy-boosting effects stimulants could provide. It was estimated that worldwide sales of diet pills containing stimulants rocketed to over 10 billion tablets sold and that between 6% and 8% of the U.S. population were prescribed these types of medications to aid in weight loss. Within a decade, the Comprehensive Drug Abuse Prevention and Control Act of 1970 was passed, the purpose of which was to make it more difficult for individuals to obtain these drugs, with or without a prescription. The rationale for the act was the dangerous and life-threatening side effects of such drugs, which became better understood during the 1960s.[21]

• Nicotine dependence
• Amphetamine dependence
• Cocaine dependence
• Substance use disorder