• Let’s list the most frequently heard of stimulants
    • Cocaine
      • PET images showing brain metabolism in drug addicts vs controls
    • Amphetamine
      • Evekeo is 50% dextroamphetamine and 50% levoamphetamine
      • Adderall is 75% dextroamphetamine, and 25% levoamphetamine
        • Adderall XR releases half of its contents immediately, and half after four hours
        • Image result for adderall addiction effects
      • Zenzedi is instant-release dextroampehtamine
      • Dexedrine is dextroamphetamine
        • Deexedrine ER releases more slowly
      • Vyvanse is delayed-released dextroampehtamine
    • Methamphetamine
      • Almost never a reason to prescribe
      • Maximum dosage is 25 mg by mouth per day
        • This is counter to very pure 100’s and 1000’s of milligrams of street meth used at once
        • And by much more potent routes
          • Nasally, injected, or smoked
      • Image result for meth addiction effects
    • Methylphenidate
      • Ritalin is instant release methylphenidate
      • Concerta is delayed-release methylphenidate
    • Dextromethylphenidate
      • This is called Focalin
    • Technically, for obesity
      • Fastin is phentermine
      • Tenuate is diethylpropion
      • Image result for phentermine addiction effects

Stimulants, when abused, very directly target the pleasure center of the brain, the meoslimbic system.

Stimulant abuse is notorious for causing a particular rapid and significant decline in quality of life. Whereas alcoholism can take years, or even decades, to take hold, stimulant addiction is much more rapid.

If abused once, with enough to abuse more so in hand, it is terribly difficult to resist.

This goes with the fact that people recover 98% of the damage they caused themselves after six months of abstinence from abusing every other drug. With stimulants, this can take twice as long.

Here we see how amphetamine leads to the release of a lot of dopamine, the neurotransmitter that is involved in pleasure, novelty, and reward. It also does the name with norepinephrine, epinpehrine, and (to a much lesser extent) serotonin.

Thus, amphetamine works on the monoamine chemical class. These neurotransmitters are thought to be behind depression and other psychiatric disorders. Yet, amphetamine is too primitive to trick the brain into producing a sustained antidepressant effect.

When taken in reasonable doses for those whom actually gain therapeutic value from them, stimulants mostly work on the mesocortical region, which involves being able to think more clearly.

As with most other potentially abusable drugs, the majority of stimulant users do so according to the orders of their doctor. This isn’t technically abuse. But, given how freely that high doses of stimulants are prescribed in the United States, it’s reasonable to say that a large proportion of people whom are on stimulants medications, but just take it as prescribed, are still abusing their brain, and still activating the mesolimbic addiction pathway. A significant portion of America’s stimulant abuse begins with shiny pharmaceutical factories.

Over ten years ago, in 2003, the amount of legal amphetamine produced in the United States, reached the same level of amphetamine that was illegally produced during 1969, during the so-called “speed epidemic”.

And today, it’s much more.

Particularly in the United States, for college students, and those with demanding jobs, casual stimulant abuse is a huge issue, with perhaps the greatest irony being that medical students are particularly likely to abuse stimulants. That said, they are Schedule II substances. This means that one 5 mg pill, if not personally prescribed, can have one charged with a felony, regardless of its intended use.

Image result for stimulant use

Here are a few reasons that perpetuate the overuse and abuse of stimulants in America, versus in Europe

  1. Unlike in European countries, stimulants like Ritalin (methylphenidate) and  Adderall (mixed amphetamine salts) are prescribed way too frequently
  2. Generally, instead of being created illegally and being sold by a hard criminal, they are neatly made in massive quantities by coporations, and handed over in a neat pill bottle and/or by the hand of an intellectual. Even when one’s name isn’t on the bottle, the standardized pill appears much more safe than strange powder. When given to a friend, no one suspects danger, because that friend is an academic and/or has a good job, and was implicitly assured by the doctor that the pills are safe
  3. This lack of restraint communicates to the user, their friends, and society, that these drugs are not dangerous
  4. There is more significant pressure to get good grades and be accepted to an Ivy League school, or otherwise perform well in society

The biggest reason, however, is not because they are too easy to get from doctors. It’s not their clean look that implies total safety, or the unrealistic societal pressure to achieve. But these factors play into the mix. It’s because of another, more timeless, American value: instant gratification. Stimulants appear to resolve many problems during the “honeymoon” period of use, including issues such as…

  • Anxiety
  • Depression
  • Poor work ethic
  • Difficulty socializing

This essay on amphetamine drugs focuses on amphetamine itself (essentially, Adderall), but goes over several aspects related to the drug and its relatives. Roughly, pages four to six covers how it works, and how that figures into its addictive potential.

A stimulant addict may leave various signs:

  • Frequently increasing their amount of use
  • Withdrawal signs when use is reduced or stopped
    • Sleep disturbances
    • Anxiety
    • Depression
    • Trembling
    • Touch-sensitivity
  • Reduced appetite
    • Similarly, gaunt frame
  • Inability to sleep a healthy amount, though tired
  • Great difficulty in reducing or stopping use
    • Going to great lengths to secure the substance
  • Feeling the need for stimulants to carry out daily activities
    • Needing it simply to function normally

Here are short-term (acute), and long-term (chronic), health issues that go along with stimulant abuse.

Organ System/Organ Acute Complications Chronic Complications
CNS Hallucinations, especially tactile; dyskinesia; seizures Psychotic symptoms; cerebrovascular disease/stroke; movement disorders, eg, dystonic reactions, akathisia, choreoathetosis, tardive dyskinesia
Cardiovascular System Tachycardia, hypertension, myocardial infarction, arrhythmias Myocarditis, cardiomyopathy, myocardial fibrosis, myocardial infarction
Pulmonary System Cough, shortness of breath, wheezing, pulmonary edema, hemorrhage, pneumothorax Interstitial pneumonitis, bronchiolitis obliterans
Renal System Renal ischemia, renal failure
Gastrointestinal System Reduced gastric motility Gastric ulceration and perforation, intestinal infarction, ischemic colitis
Liver Viral hepatitis secondary to contaminated syringe use
Endocrine System Reduced prolactin; increased epinephrine, CRH, ACTH, cortisol, and LH Increased, normal, or decreased prolactin; normal testosterone, cortisol, LH, and thyroid hormones
Musculoskeletal System Movement disorders (see CNS) Rhabdomyolysis
Head and Neck Rhinitis Rhinitis, perforated nasal septum, nasal and gingival ulceration, sinusitis, dental decay and periodontal disease, xerostomia, corneal ulcers
Immune System Vasculitis syndromes
Sexual Function Erectile dysfunction, irregular menses
Reproductive System Vaginal bleeding, abruption placenta, premature rupture of membranes FDA category C, placenta previa, low birth weight
General/Other Dehydration Weight loss, nutritional deficits

Abbreviations: ACTH, adrenocorticotropic hormone; CRH, corticotropin-releasing hormone; FDA, Food and Drug Administration; LH, luteinizing hormone.

As for the process of progressive stimulant addiction, SpunkySkunk374 best described it. These are the eight progressive stages of amphetamine (or stimulants in general) use:

Note: The Cause of transitioning to further stages (past the first 2) is usually caused by factors such as Lack of sleep, Malnutrtion, Sedentary Lifestyle, or simply because the dose is too large.

Stage 1 of Amphetamine Use – During this stage, amphetamine will be at its hedonic peak; the pleasure of taking amphetamine will not get any higher from this point on. The most notable feelings are a “lovey” feeling, powerful euphoria, increased motivation, deep philosophical thinking, strong feelings of “lust”, etc.

Length of phase: 1-3 days with binge usage; 5-10 days with daily usage; About 5-15 uses total if used sparingly with at least several days in between doses.

Characteristic Effects of this Stage:
– Powerful euphoria
– Empathy and socialability
– Overwhelming amount of increased motivation

Stage 2 of Amphetamine Use – During this stage, the “lovey” and empathetic feelings of amphetamine quickly fade, although the “pleasurable” feelings of euphoria and increased motivation are still present. The decrease in empathetic feelings is likely responsible from a depletion of serotonergic vesicles. Most users note that it is impossible to transition back to “Stage 1” at this point, no matter how long of a break a person takes from amphetamine. This suggests that a permanent tolerance develops for the empathetic effects of the drug – whether this occurs from a psychological acclimation to the effects, or from physiological reasons, I don’t know. This is the stage which doctors aim for when prescribing amphetamine for medicinal use with ADD and ADHD. This stage can be prolonged for quite some time (and if the dose is low enough, some medical professionals say that this phase can be prolonged indefinitely) this is assuming of course that the user continuously maintains an adequate amount of high quality sleep (7+ hours a night), proper nutrition, and a non-sedentary lifestyle.

Length of Stage: 1-7 days with binge usage (note that binge usage is defined by immediately taking another dose once the effects of one dose wear off or begin to wear off, interrupting sleep in the process). 2 Weeks to 6+ Months if used daily (and maintaining a healthy lifestyle). Indefinitely if used sparingly (with 3-5+ days in between uses).

Characteristic Effects of this Stage:
– Increased Motivation
– Slight Euphoria

Stage 3 of Amphetamine Use, the “Tool” phase – At this point, most if not all empathetic effects of usage have diminished. This point is characterized by the fact that amphetamine becomes the sole motivator for tasks, hence the nickname “The Tool Phase” because amphetamine is now used as a Tool for accomplishment. The negative physiological effects (the “body load”) become more prominent.

Length of Stage: At this point, it is hard to define the length it will take to transition from one stage to the next. Some users will find that if they take breaks from their usage or just lower their dose, they can go backwards to earlier stages. Some binge users may even rapidly progress through the stages, possibly even skipping to the final ones or developing psychosis.

Characteristic Effects of this stage:
– Period of ‘positive effects’ and period of ‘negative effects’ from taking a dose begin to merge. (usually, if negative effects are present they only follow after the positive effects wear off)
– The user needs amphetamine to stay at/above a baseline level of motivation, and when amphetamine is not in effect the user is below a baseline level of motivation.
-In order for a task to be done efficiently, the user finds that they need to be on amphetamine.
– The level of euphoria decreases to a point where it is no more significant than the level of euphoria which most people get from daily life without amphetamine.

Stage 4 of Amphetamine Use, “The Decline” – The efficiency of amphetamine as a “Tool” begins to drop significantly, and this stage is characterized by the “comedown” (the period of negative effects after the drug begins to wear off) becoming much stronger. The “comedown” may even begin to merge in with the period of positive effects. At this point, the body load may begin to become painful.

Characteristic Effects of this Stage:
– Painful body load (Muscle Pain, High Blood Pressure, Inadequate Circulation, Dehydration, Malnutrition, deterioration of the skin and other tissues, etc).
– Depression
– Severe Anxiety

Stage 5 of Amphetamine Use, The Procrastination – This Stage may or may not be experienced by amphetamine users. In this stage, the positive effects of amphetamine are almost absent if not completely gone, and the “coming up” of a dose of amphetamine is subsequently followed by an immediate barrage of negative effects (both physiological and psychological). The reason this phase is called “The Procrastination” is because the user forgets how unbearable the negative sensations are (due to amphetamine compromising the brain’s ability to efficiently make memories, especially goal-orientated memories); by the next day, even though the user may have told himself to not take amphetamine, he takes amphetamine again anyways (due to the brain not being able to make a goal-orientated memory, the brain was unable to produce counter-motivation to stop the user from taking more amphetamine the next day). This might possibly be the most psychologically painful and strenuous phase for the amphetamine user, since he is unable to figure out why he keeps taking amphetamine even though he clearly knows it only causes him pain.

Characteristic Effects:
– Repeatedly taking amphetamine despite knowledge that it no longer gives the desired effects, and only causes negative effects.

Stage 6 of Amphetamine Use, Irritability and Pessimism – This phase is characterized by extreme irritability. The user begins forgetting the drug is responsible for his negative feelings, and begins to blame things in the environment around them instead. The user begins to think that other people are responsible for how poorly he/she feels. The user might show hostility, or social withdrawal. The user also begins to develop an extremely pessimistic attitude towards life.

Characteristic Effects of this Stage:
– Acute Depression
– Severe Anxiety
– Irritability, even when the drug is out of the user’s system
– Psychosis
– Inability to Sleep
– Severe Restlessness
– lack of willpower
– Inability to find “the right choice of words”
– Obsessive Thinking

Stage 7 of Amphetamine use, Nihilism and Dissociation – During this phase, incidences of psychosis begin to emerge (if they haven’t already) even if the drug user has been maintaining an adequate amount of sleep. The user usually becomes nihilistic, thinking that nothing in life matters or has meaning. Some users may even become solipsistic, which means they think that they are the only things which are real in the world. Solipsism is often accompanied by paranoia, or thinking that others only have the intention of harming the solipsistic individual. If the user had obtained any philosophical or meta-cognitive methods of thinking during the earlier stages of amphetamine use, those same meta-cognitive methods begin to eat away at the person’s psyche. They feel as if they are helpless to do anything besides sit back and watch their mind become unraveled. Even if the user realizes that his irritable attitude towards other people isn’t how he truly feels, he is unable to manage his irritability (most likely due to a complete diminish of serotonin, as well as the brain’s ability to make memories being compromised). The individual’s ego may begin to deconstruct itself, and the user may have a feeling that they completely lack any willpower to do anything. This stage is also accompanied by a large amount of confusion.

Characteristic Effects of this stage:
– Confusion
– Paranoia
– Unbearable Depression and Anxiety
– Delusions
– Increased Incidences of Psychosis
– Increasingly Painful Body Load
– Lack of willpower
– Cognition become confusing and incoherent. Users often claim things like their mind is “too loud”, “jumping to false conclusions”, or “doesn’t make sense” and the user feels helpless to control this.
– Panic Attacks become very prominent
– Feelings of Deja Vu
– If weight loss was experienced in beginning stages, it may come to a hault or even reverse into weight gain
– Inability to experience pleasure
– Akathisia
– Feelings that an individual no longer has “free will”
– Difficult to form coherent sentences and speak properly. Similar to “Clanging” or “Word Salad” experienced in schizophrenics.

Stage 7b “Letting Go / Giving Up” – This stage is not always experienced, but in some instances after the user has experienced an excruciating and unbearable amount of anxiety and mental stress, he may experience a period of “Letting Go” in which the brain gives up on constructing/maintaining its deluded psychological structures. The negative effects of the drug temporarily fade, and the user has a “moment of peace”. This temporary phase usually only lasts several hours (if not less) before the user returns to phase 7. Since the brain during this phase has completely abandoned any attempts to make goal orientated behavior, the user may find it difficult (or simply not want to) to take care of themselves. However, during this phase, the user will find that they will actually be able to get to sleep, and they should take advantage of this temporary somnia to get sleep. I do not know what neurological mechanisms are responsible for this phase; it is almost as if it is the brain’s last resort – to enter a careless and stress-less stupor. Perhaps the brain releases endorphins in response to the unbearable anxiety?

Characteristic Effects:
– Stupor
– Irresponsiveness
– Carelessness
– Ironically, if effects of “word salad” or “clanging” were experienced in stage 7, they are no longer as present in stage 7b.

Stage 8, “The Stupor”, Brain Damage – In this stage, amphetamine no longer gives effects, and the brain’s desire for taking amphetamine (even if taking it has become a habit) begins to drop. As long as amphetamine use continues, the user makes no progress towards recovery of any sort. The individual is unresponsive and disconnected. Amphetamine has a tendency to make the user put too much effort into anything/everything, and this gives the brain not a single moment of psychological “rest” (where the individual doesn’t think deeply). However, during this phase, it is quite the opposite – the individual’s mind is in a prolonged state of resting and won’t even follow through with the very act of thinking if the thought takes too much effort to think. During this phase, the user may have a steep decline in intelligence.

Characteristic Effects:
– Prolonged episodes of stupor and carelessness
– Lethargy
– Diminished Intelligence and mental efficiency
– Irreversible Psychological Damage
– Possible brain damage
– The individual may develop a “permanent stuttering” which persists even after amphetamine has long since been ceased.
– In a similar way that the stuttering develops, an individual may develop a possible permanent difficulty talking, using correct grammar and sentence structure, or expressing thoughts to others. In severe cases, this may even resemble a schizophrenic’s clanging or word salad.
– Essentially, the mind at this point is irreversibly compromised. The user’s personality might have changed permanently. The individual may be much more easily irritated for the rest of his/her life. Cognitive functioning will never work the same as it used to. Although the user may make improvements and greatly recover, it will almost always seem like something “isn’t right” in the mind, or that something is “missing”. Individuals will still be able to lead fulfilling lives, and some may make amazing recoveries where they feel normal again like they did before they ever began using. Unfortunately, in severe cases, the individual may never be the same again.

Quite the interesting description! There are permanent effects from stimulant abuse, such as the 15% of people who don’t fully recover from stimulant psychosis. But these above stages detail how one can completely destroy themself from stimulant abuse. People end up in sensory deprivation rooms in mental health hospitals for severely, permanently damaged people because of stimulant addiction.

And yet, stimulants are very important psychiatric medications because they work more than any other class of medication for attention deficit hyperactivity disorder, which disorder rose by 3.2% between 2007 and 2011, among similar statistics of rising ADHD and stimulant use.

Currently, there are no FDA-approved medications to treat stimulant addiction. No substance, even off-label, has been deemed significantly effective. But there are a few medications that may help somewhat.

  • Gabapentin
  • Various antidepressants
  • Modafinil (a mild stimulant itself)
  • Baclofen
  • Wellbutrin
  • Hydroxizine
  • Noampramin
  • Antabuse
  • Topomax
  • (Rarely, and risky) various stimulants
    • Dexedrine
    • Adderall
    • Vyvanse
    • Studies have found this “stimulant replacement therapy” to be not significantly medicinal.
      • This is opposed to opiate replacement therapy, discussed at the end of the Opioid Addiction section

Sources: Ithaca Alcohol and Drug Council, Ben Komor, Dr. Beenard Member, Angela Mcenerney, On Speed: The Many Lives of Amphetamine, https://www.semel.ucla.edu, Stimulant Abuse: Pharmacology, Cocaine, Methamphetamine, Treatment, Attempts at PHarmacotherapy, https://www.recoveryconnection.com/substance-abuse, https://longevity.media/dancing-with-death-frightening-and-freaky-facts-about-crystal-meth-addiction, http://adderalladdictionsupport.com/adderall-side-effects/, https://www.stanforddaily.com/a-look-at-stimulants-and-study-drugs-on-campus/