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STIMULANT USE DISORDER
 


Prediction: Episodic/Chronic For Years

      Occupational-Economic:
  • Works poorly with others
  • Impaired cognitive functioning
  • Irrationality (eccentricity, delusions, hallucinations)
      Social:
  • Negative emotion (depression, suicidal behavior)
  • Antagonism (hostility)
  • Disinhibition (irresponsibility, impulsivity, dangerous risk taking)
  • Detachment (suspiciousness, social withdrawal)
  • Marital/child abuse/neglect; theft, prostitution or drug-dealing; legal problems
      Medical:
  • Denial of addiction; HIV (if using needles); weight loss & malnutrition; seizures; heart attack, stroke, sudden death


Explanation Of Symbols


(Personal Note: One of my patients suddenly died after playing hours of tennis on ecstasy on a hot summer's day.)

SYNOPSIS

Dependence Syndrome Due To Amphetamines F15 - ICD10 Description, World Health Organization
Repeated amphetamine use that typically includes a strong desire to take the drug, difficulties in controlling its use, persisting in its use despite harmful consequences, a higher priority given to drug use than to other activities and obligations, increased tolerance, and a physical withdrawal state.
Stimulant Use Disorder - Diagnostic Criteria, American Psychiatric Association

An individual diagnosed with stimulant use disorder needs to meet all of the following criteria:

  • A problematic pattern of amphetamine-type substance, cocaine, or other stimulant use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:

    • The stimulant is often taken in larger amounts or over a longer period than was intended.

    • There is a persistent desire or unsuccessful efforts to cut down or control stimulant use.

    • A great deal of time is spent in activities necessary to obtain the stimulant, use the stimulant, or recover from its effects.

    • Craving, or a strong desire or urge to use the stimulant.

    • Recurrent stimulant use resulting in a failure to fulfill major role obligations at work, school, or home.

    • Continued stimulant use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the stimulant.

    • Important social, occupational, or recreational activities are given up or reduced because of stimulant use.

    • Recurrent stimulant use in situations in which it is physically hazardous.

    • Stimulant use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the stimulant.

    • Tolerance, as defined by either of the following:

      • A need for markedly increased amounts of the stimulant to achieve intoxication or desired effect.

      • A markedly diminished effect with continued use of the same amount of the stimulant.

        Note: This criterion is not considered to be met for those taking stimulant medications solely under appropriate medical supervision, such as medications for attention-deficit/hyperactivity disorder or narcolepsy.

    • Withdrawal, as manifested by either of the following:

      • The characteristic withdrawal syndrome for the stimulant:

        • Cessation of (or reduction in) prolonged amphetamine-type substance, cocaine, or other stimulant use.

        • Dysphoric mood and two (or more) of the following physiological changes, developing within a few hours to several days after the cessation of (or reduction in) stimulant use:

          • Fatigue.

          • Vivid, unpleasant dreams.

          • Insomnia or hypersomnia.

          • Increased appetite.

          • Psychomotor retardation or agitation.

      • The stimulant (or closely related substance) is taken to relieve or avoid withdrawal symptoms.

        Note: This criterion is not considered to be met for those taking stimulant medications solely under appropriate medical supervision, such as medications for attention-deficit/hyperactivity disorder or narcolepsy.

    • Specify if:

      • In early remission: After full criteria for stimulant use disorder were previously met, none of the criteria for stimulant use disorder have been met for at least 3 months but for less than 12 months (with the exception that the criterion, "Craving, or a strong desire or urge to use the stimulant," may be met).

      • In sustained remission: After full criteria for stimulant use disorder were previously met, none of the criteria for stimulant use disorder have been met at any time during a period of 12 months or longer (with the exception that the criterion, "Craving, or a strong desire or urge to use the stimulant," may be met).

    • Specify if:

      • In a controlled environment: This additional specifier is used if the individual is in an environment where access to stimulants is restricted.

Stimulant use disorder is compulsive use of an amphetamine-type substance, cocaine, or other stimulant (e.g., MDMA or ecstasy), leading to clinically significant impairment or distress. These stimulants can be taken by oral and IV routes, nasal snorting, and smoking. Intoxication or overdose causes individuals to go for long periods without food or sleep, followed by exhaustion and fatigue, giving way to long periods of sleep and periods of extreme hunger. Intoxication can cause death, even in first time users. Chronic abuse leads to legal problems; depression; social and occupational failure. High-dose use causes psychotic episodes. Men have a higher prevalence of abuse than women. Peak risk of use is during ages 18 to 25.

Effective Therapies

Acute toxicity is treated by giving activated charcoal within 1 hour of oral ingestion (but this is ineffective if the substance was snorted or smoked).

Ineffective therapies

Apart from treatment for acute toxicity, there is no effective psychosocial or pharmacological treatment for stimulant use disorder that has been proven effective in replicated, randomized, placebo-controlled clinical trials. Thus there are no FDA-approved pharmacotherapies for stmulant use disorder. Some argue that illegal stimulant use should be decriminalized, and that stimulant addiction should be treated "like any other medical disorder". They forget that there is no treatment for stimulant use disorder that has been proven effective.

It is possible to stop using stimulants. To do this you must: (1) totally divorce yourself from drug-using or drug-supplying people, (2) not use alcohol or any other illegal drug, (3) be socially active and help others, (4) talk to other people who have successfully stayed off drugs, (5) devote yourself to important activities that give meaning and purpose to life (e.g., family, friends, sports, work, helping others, church etc.). Therapists know that these 5 steps work, but our therapies often are ineffective in motivating patients to complete these essential steps to recovery.

Should Illicit Drugs Be Legalized?

Some people argue that illicit drugs should be legalized to decrease the crime associated with these drugs. Historically, tobacco and alcohol were once illegal drugs. Tobacco smoking is now the leading cause of death in America, and alcoholism is the third leading cause of death. Thus legalizing illicit drugs does not make them any less medically and socially harmful. In fact the opposite is true; legalizing illicit drugs increases their use and the harm they cause. The Government of Finland is passing legislation that will gradually ban all tobacco use by 2040.

Top 20 Most Harmful Drugs In Britain In 2008

Professor David Nutt published in the Lancet the following rating of Britain's most dangerous drugs. They are listed in descending order from the most harmful.

1. Heroin

Class A drug. Originally used as a painkiller and derived from the opium poppy. There were 897 deaths recorded from heroin and morphine use in 2008 in England and Wales, according to the Office of National Statistics (ONS). There were around 13,000 seizures, amounting to 1.6m tonnes of heroin.

2. Cocaine

Class A. Stimulant produced from the South American coca leaf. Accounted for 235 deaths -- a sharp rise on the previous year's fatalities. Nearly 25,000 seizures were made, amounting to 2.9 tonnes of the drug.

3. Barbituates

Class B. Synthetic sedatives used for anaesthetic purposes. Blamed for 13 deaths.

4. Street methadone

Class A. A synthetic opioid, commonly used as a substitute for treating heroin patients. Accounted for 378 deaths and there were more than 1,000 seizures of the drug.

5. Alcohol

Subject to increasing concern from the medical profession about its damage to health. According to the ONS, there were 8,724 alcohol deaths in the UK in 2007. Other sources claim the true figure is far higher.

6. Ketamine

Class C. A hallucinogenic dance drug for clubbers. There were 23 ketamine-related deaths in the UK between 1993 and 2006. Last year there were 1,266 seizures.

7. Benzodiazepines

Class C. A hypnotic relaxant used to treat anxiety and insomnia. Includes drugs such as diazepam, temazepam and nitrazepam. Caused 230 deaths and 1.8m doses were confiscated in more than 4,000 seizure operations.

8. Amphetamine

Class B. A psychostimulant that combats fatigue and suppresses hunger. Associated with 99 deaths, although this tally includes some ecstasy deaths. Nearly 8,000 seizures, adding up to almost three tonnes of confiscated amphetamines.

9. Tobacco

A stimulant that is highly addictive due to its nicotine content. More than 100,000 people a year die from smoking and tobacco-related diseases, including cancer, respiratory diseases and heart disease.

10. Buprenorphine

An opiate used for pain control, and sometimes as a substitute to wean addicts off heroin. Said to have caused 43 deaths in the UK between 1980 and 2002.

11. Cannabis

Class B. A psychoactive drug recently appearing in stronger forms such as "skunk". [Since this video was made; there is now conclusive proof that cannabis causes a 6.7 fold increase in the risk of developing schizophrenia.] Caused 19 deaths and there were 186,000 seizures, netting 65 tonnes of the drug and 640,000 cannabis plants.

12. Solvents

Fumes inhaled to produce a sense of intoxication. Usually abused by teenagers. Derived from commonly available products such as glue and aerosol sprays. Causes around 50 deaths a year.

13. 4-MTA

Class A. Originally designed for laboratory research. Releases serotonin in the body. Only four deaths reported in the UK between 1997 and 2004.

14. LSD

Class A. Hallucinogenic drug originally synthesised by a German chemist in 1938. Very few deaths recorded.

15. Methylphenidate

Class B drug. Brand name of Ritalin. A psychostimulant sometimes used in the treatment of attention deficit disorders.

16. Anabolic steroids

Class C. Used to develop muscles, notably in competitive sports. Also alleged to induce aggression. Have been blamed for causing deaths among bodybuilders. More than 800 seizures.

17. GHB

Class C drug. A clear liquid dance drug said to induce euphoria, also described as a date rape drug. Can trigger comas and suppress breathing. Caused 20 deaths and 47 seizures were recorded.

18. Ecstasy

Class A. Psychoactive dance drug. Caused 44 deaths, with around 5,000 seizures made.

19. Alykl nitrites

Known as "poppers". Inhaled for their role as a muscle relaxant and supposed sexual stimulant. Reduce blood pressure, which can cause fainting and in some cases death.

20. Khat

A psychoactive plant, the leaves of which are chewed in east Africa and Yemen. Also known as qat. Produces mild psychological dependence. Its derivatives, cathinone and cathine, are Class C drugs in the UK.

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