Stimulant Use Disorder

Aka: Stimulant Use Disorder, Stimulant Abuse, Stimulant-Related Disorder, Stimulant Use, Stimulant Dependence

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II. Epidemiology

  1. Up to 80% of Stimulant Abuse patients obtain medications from family or friends
    1. Up to 20% abuse their own medications
  2. Polysubstance abuse with stimulants is common (e.g. Opioids, Benzodiazepines)

III. Causes: Stimulants

  1. See Stimulant Medication
    1. Prescribed for Attention Deficit Disorder
    2. Abused via higher oral dose, or via snorting or injecting the oral medication
    3. Lower risk of abuse with long acting agents (e.g. Methylphenidate ER) or Lisdexamfetamine (Vyvanse)
  2. Illicit agents
    1. Cocaine
    2. Amphetamine
    3. Methamphetamine
    4. Bath Salts
    5. MDMA

IV. Labs

  1. See Urine Drug Screen

V. Diagnosis: Stimulant Intoxication (DSM-5)

  1. Recent use of Amphetamine-like substance, Cocaine or other stimulant agent
  2. Problem behavioral or pyschological symptoms during or shortly after Stimulant Use (examples follow)
    1. Euphoria or blunted affect
    2. Sociability changes
    3. Hypervigilance
    4. Interpersonal sensitivity
    5. Anxiety, tension or anger
    6. Stereotyped behaviors
    7. Impaired judgement
  3. Physical findings that develop during or shortly after Stimulant Use (>=2 of the following)
    1. Tachycardia or Bradycardia
    2. Pupilary dilation
    3. Hypertensive or hypotensive
    4. Chills or sweats
    5. Nausea or Vomiting
    6. Weight loss
    7. Psychomotor change
    8. Muscular weakness
    9. Respiratory depression
    10. Chest Pain
    11. Cardiac Arrhythmias
    12. Confusion
    13. Seizures
    14. Involuntary Muscle movements
    15. Coma
  4. Findings not attributable to other medical or psychological condition (including other substance Intoxication)
  5. Modifiers
    1. Specific intoxicant (e.g. Cocaine, Methamphetamine, bath salts)
    2. Perceptual disturbance
      1. Hallucinations with intact reality testing OR
      2. Auditory, visual or Tactile Hallucinations without Delirium
  6. References
    1. (2013) DSM-5, APA

VI. Diagnosis: Stimulant Withdrawal (DSM-5)

  1. Dysphoric mood AND
  2. Two or more of the following symptoms developing withing hours to days of stimulant cessation
    1. Fatigue
    2. Vivid or unpleasant dreams
    3. Sleep problems (Insomnia or Hypersomnia)
    4. Increased appetite
    5. Psychomotor retardation or Agitation
  3. References
    1. (2013) DSM-5, APA

VII. Diagnosis: Stimulant Use Disorder (DSM-5)

  1. Pattern of Amphetamine-like substance, Cocaine or other stimulant AND
  2. Use leads to Clinically SignificantImpairment or distress AND
  3. At least 2 of the following criteria within 12 months
    1. Stimulant take in larger amounts or over a longer period than intended
    2. Persistent desire or unsuccessful efforts to cut down or control Stimulant Use
    3. Significant amount of time spent trying to obtain, use or recover from the stimulant
    4. Craving or strong desire or urge to use the stimulant
    5. Recurrent Stimulant Use resulting in failure to fulfill major role obligations at work, school or home
    6. Use continues despite persistent or recurrent stimulant exacerbated social or interpersonal problems
    7. Important social, occupational or recreational activities are abandoned or reduced due to Stimulant Use
    8. Recurrent Stimulant Use in physically hazardous situations
    9. Use continues despite persistent or recurrent stimulant-related physical or psychological problems
    10. Tolerance not due to prescribed Stimulant Medication (e.g. Attention Deficit Disorder or Narcolepsy)
      1. Marked increase in stimulant amounts needed to reach Intoxication or desired effect OR
      2. Markedly diminished effect with continued use of the same stimulant amount
    11. Withdrawal not due to prescribed Stimulant Medication (e.g. Attention Deficit Disorder or Narcolepsy)
      1. Characteristic stimulant withdrawal symptoms (see above) OR
      2. Stimulant or similar agent is taken to relieve or avoid withdrawal symptoms
  4. Modifiers
    1. Early remission
      1. Following full criteria for Stimulant Use Disorder, no criteria are met for 3-12 months
      2. Exception: Craving or strong desire or urge for use of stimulant may still be present
    2. Late remission
      1. Following full criteria for Stimulant Use Disorder, no criteria are met for >12 months
      2. Exception: Craving or strong desire or urge for use of stimulant may still be present
    3. Controlled environment
      1. Patient is in a controlled environment where stimulant access is restricted
  5. References
    1. (2013) DSM-5, APA

VIII. References

  1. (2023) Presc Lett 30(8): 45-6
  2. Klega (2018) Am Fam Physician 98(2): 85-92 [PubMed]

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