Sage Prairie

Stimulant Use Disorder

Stimulant Use Methamphetamine/ Amphetamine or Cocaine Use

What is considered Stimulant Use Disorder?

Individuals with stimulant use disorder are those who compulsively self-administer stimulant substances without medical purposes. In general, stimulants are prescribed to treat attention-deficit/
hyperactivity disorder, narcolepsy, and other diagnosed conditions, however sometimes individuals with stimulant use disorder will over use or take these medications outside of medical purposes. Disordered use includes patterns of stimulant administration which are either episodic to daily use. With ongoing use, there is a decrease in the pleasurable effects of the drug, this is due to tolerance; which also produces an increase in the dysphoric effects (examples would include depression or anger). Stimulant use disorder, can be diagnosed as severe, moderate or mild. Usually individuals develop significant consequences as a result of their use.

Symptoms of stimulant use disorder can include (these develop whether the individual recently used
or not, depending on the severity of the use):
• Abnormally fast or slow heartbeat
• Dilation of the pupils
• Elevated or lowered blood pressure
• Sweating or chills
• Nausea or vomiting
• Weight loss
• Muscle weakness
• Euphoria
• Hypervigilance
• Anger
• Interpersonal sensitivity
• Auditory hallucinations
• Paranoid thoughts
• Repetitive movement

A diagnosis of Stimulant Use Disorder is made when a person who regularly uses amphetamine, cocaine, or other stimulants and has experienced at least two of the following signs and symptoms within the past 12-month period:
• Taking the stimulant in larger dosages and/or for a longer period of time than intended
• Desiring to reduce stimulant use, and/or making failed efforts to do so
• Spending a large amount of time procuring, using, or recovering from the effects of the stimulant
• Experiencing a strong desire or urge to use the stimulant
• Demonstrating the inability to maintain obligations for one’s job, school, or home life
• Continuing to use the stimulant in the face of social/interpersonal problems that result from, or are made worse by, the use of the stimulant
• Prioritizing stimulant use to such an extent that social, occupational, and recreational activities are either given up or are reduced drastically
• Repeatedly using the stimulant in situations in which it is physically hazardous
• Continuing to use the stimulant even when the individual knows that it is causing or exacerbating physical and psychological problems
• Tolerance, where intoxication requires considerably greater amounts of the stimulant.
• Withdrawal, as shown by one of the following:
• Fatigue, unpleasant dreams, insomnia or hypersomnia, increased appetite, abnormally slow heartbeat.
• Symptoms of withdrawal diminish as a result of the use of the stimulant (or similar substances)

Some of these symptoms will develop within a few hours to several days after stimulant use has stopped. Craving the drug and an inability to feel pleasure may also be present for a longer length of time after the individual has stopped use. The tolerance and withdrawal criteria are not considered to be met if the stimulant is used only under appropriate medical supervision.

• Access to and availability of stimulants
• Previous exposure to substance use (e.g., having friends or family who use substances)
• Current or past substance use disorder
• Family history of substance use disorder
• Having mental health conditions such as depression or post-traumatic stress disorder
• History of trauma during childhood
• History of exposure to amphetamines as a child or adolescent

According to the National Institutes of Health, there are significant problems associated with stimulant use. These include:
• Physical effects of stimulants (which will vary by the type of stimulant taken, route of administration, dose, purity of the substance, the individual’s pattern of use, and other substances the individual may be using) including permanent brain changes.
• Medical complications such as are cardiovascular conditions, respiratory problems, cerebrovascular events, muscular and renal dysfunction, gastrointestinal problems, infections including HIV/AIDS, and hepatitis C.
• Psychological complications of stimulant use disorders include psychosis, depression, hyper-vigilance, and anxiety.
• If an individual also suffers from a co-occurring condition, stimulant use can exacerbate their symptoms and make recovery from all co-occurring conditions more difficult.

Contrary to belief, and different from other drugs of abuse, stimulants can cause significant effects in the brain, these include:

  • • Dopamine depletion (causes slower motor function, difficulty recalling memories, depression and fatigue)
  • • Damage to neuron receptors (difficulty fighting infection, decreased myelin on neurons, which allows the nervous system to react properly, difficulty with planning, limited ability to think abstractly and poor judgement in decision making). 
  • • Less gray matter, particularly in women (decreased in cognition, memory loss, mood swings, difficulty learning new things, increased cravings, decrease in self-control)
  • • Mental and psychological effects resulting in co-occurring conditions, and decreased pleasure in activities.
  • • Depression, anxiety, fatigue, aggression, irritability, and lowered impulse control. 
  • • Schizophrenia-like symptoms, including paranoia or hallucinations while using stimulants or upon stopping stimulant use.

Sage Prairies’ approach to stimulant use disorder is evidence-based, integrated, and individualized. Our specialists and partners utilize a range of interventions with demonstrated efficacy for helping individuals meet their recovery goals. Care is often integrated with patients’ other needs to improve treatment outcomes, reduce costs, and promote better physical and mental health. 

Sage Prairie has recognized, that most individuals who experience disordered use of stimulants do not seek medical treatment or professional services. Of those that do seek help to recovery, the most common type of interventions available are behavioral interventions, peer support and peer-based groups. 

Among the behavioral interventions that are evidence based, contingency management (CM), various forms of motivational enhancement therapies and cognitive-behavioral therapy (CBT).

Cognitive-Behavioral Therapy (CBT)
This form of therapy is based on the principle that one’s thoughts, feelings, and behaviors can all influence one another. The goal is to help patients reduce or stop alcohol use by adjusting patterns of thinking and feeling that can lead to consumption of alcohol. 

Motivational Interviewing
This therapy helps people identify and accept ambivalent feelings about drinking with the goal of strengthening a commitment to their recovery goals. 

Contingency Management
This is an intervention with the aim to change specific behaviors that are closely related to substance use by providing positive reinforcement procedures, or rewards. Evidence shows that behaviors that are rewarded are likely to increase. Examples of Contingency Management at Sage Prairie include, rewarding patients for progress by having decreased restrictions and they are given rewards when
peers recognize positive behavior.

Family Counseling
For people with alcohol use disorder and their families, this form of therapy helps all involved to identify and face consequences of alcohol use in order to support reduction in or abstinence from alcohol consumption.

  • Sage Prairie also provides medication management, which can be useful when individuals suffer from the manifestations of use, with the primary goal is to stabilize individual physically, psychologically and behaviorally, with the ultimate goal is to maintain long-term and stable remission of symptoms. 

If an individual has great difficulty stopping use, or they suffer withdrawal symptoms, Sage Prairie partners with detox of withdrawal management programs to initiate treatment. Withdrawal management or detox is best when it takes place under medical supervision, it is termed “medically managed withdrawal.” While under medical supervision, depending on the severity and route of use. 

Medical management includes: treating dehydration, restoring electrolyte balance, reduction of body temperature, and using medications to prevent acute coronary syndrome. Sometimes antipsychotics are needed to reduce severe agitation.

After a period of physical and psychiatric stabilization, treatment with medication will normalize some of the changes in brain functioning, decreasing impulsivity and craving for the drug, allowing individuals to decrease or stop drug use and to benefit from psychosocial treatments. Management of co-occurring disorders significantly increases an individual’s ability to engage in recovery activities.

These include 12-step groups, SMART recovery, Al-Anon Family groups, All Recovery groups, and others. Sage Prairie also has developed a partnership with local Recovery Community Organizations to offer other peer services. These programs are designed to offer participants active help and support for one another in their recovery.

Sage Prairie has partnered with Recovery Properties to offer patient housing. In the housing, there are only current and former Sage Prairie patients. This helps patients to develop a community, which is supportive of recovery. 

Financial Assistance
A major barrier to recovery can be access to care. Sage Prairie has partnered with navigators to assist individuals to fund treatment and access other financial services available through Federal, State and local programs and scholarships. 

Physical Health
Patients are given a healthy meal each treatment day. Patients living in housing are offered a free
local gym membership to improve their physical health.

Amphetamine salts were being used by the mid-1930s for treatment of sleep disorders, depression and weight loss. During World War II, amphetamines were being tested in military medical research. The research concluded that amphetamines were habit forming and had “minimal effects on judgement.” By 1942 the military was routinely using amphetamines as a cancer treatment, treatment for
injuries by field medics, German soldiers used amphetamines as an “alertness aid” preparation to carry out suicide mission, and soon was a normal in battle tool. With increased research, and knowing the risks associated with amphetamines, American soldiers were urged to use amphetamines by superiors despite knowing the concerns. It helped soldiers to sleep while under artillery fire, and
shelter in inclement conditions, keeping them awake, alert and ready to fight during battle. Soldiers also had decreased fear or anxiety and felt confident and purposeful. Military psychiatrists rationalized prescribing amphetamine, to help soldiers. Soon amphetamines were being used for their mood-altering effects, to keep people in combat longer, and a tool against “combat fatigue,” now
known as PTSD. 

Due to exposure during WWII, after it was over, civilian use skyrocketed stateside. Women used them to suppress appetite, weight loss and as a treatment for depression. Soon, amphetamines were incorporated into different forms of diet pills which were prescribed to anyone at walk-in clinics, which also gave kickbacks to the prescribing doctor. Doctors would prescribe stimulants combined with
other medications to counteract the side effects of the stimulants. The diet pill companies marketed directly to doctors to combine the medications. Amphetamine was combined with drugs like barbiturates at high doses that were untested. The FDA had difficulty regulating the clinics because of the logistical challenge of taking down the thousands of clinics in the United States by the 1960s. 

By the 1960’s the dangers (dependence, elevated blood pressure, and stimulant-induced psychosis) were increasingly known; still amphetamine pills was encouraged by a culture that recommended them for a variety of physical and mental ills. One of those consequences was increased recreational use. 

By 1970, 5 percent of Americans—at least 9.7 million—used prescription amphetamines, and another 3.2 million were addicted. After the deaths of several young women, and a series of congressional hearings by 1970, with the passage of the Controlled Substances Act, amphetamine became a Scheduled drug, with a high potential for abuse, with use potentially leading to severe psychological or physical dependence.