Learning Objectives
By the end of this section, you will be able to:
- Identify stimulants that can be misused
- Describe the symptoms of stimulant use disorder
- Outline the role of the nurse in treating stimulant use disorder
Amphetamine-type substances, cocaine, and crack are stimulants; they cause the release of dopamine in the brain and are highly addictive because the flood of dopamine in the brain’s reward circuit strongly reinforces drug-taking behaviors. With continued drug use, the reward circuit adapts and becomes less sensitive to the drug. As a result, people take stronger and more frequent doses in an attempt to feel the same high and to obtain relief from withdrawal symptoms. Because the high from stimulants starts and fades quickly, people often take repeated doses in a form of binging, often giving up food and sleep while continuing to take the drug every few hours for several days. Both the use and withdrawal from amphetamines can cause psychosis with symptoms of hallucinations and paranoia (NIDA & National Institutes of Health, 2019).
Stimulants That Can Be Misused
Legal stimulants are most commonly prescribed to address attention-deficit hyperactivity disorder (ADHD) and include the medications Ritalin and Adderall, among others (NIDA, 2020a). These medications enhance cognition and focus in clients with ADHD. When used by a person who does not have ADHD, these substances can become addictive and cause a dangerous rise in body temperature, irregular heartbeat, anger, psychosis, and paranoia. It is estimated that 1.5 million people, aged twelve or older, misused prescription stimulants in 2021 (NIDA, 2020a). Also frequently misused, and often more easily accessible, are over-the-counter cold/allergy medications containing pseudoephedrine, a stimulant.
Illegal stimulants, on the other hand, such as cocaine and methamphetamine, are highly addictive substances that cause a sense of euphoria and increased energy. When used in combination with alcohol, the person has a higher risk of cardiac toxicity.
Life-Stage Context
Nonmedical Prescription Stimulant (NMPS) Use among College Students
Increased academic performance is the number one reason for college students obtaining and misusing prescription stimulants, such as Adderall and Ritalin. Fairman et al. (2020) report that 45.7 percent of 219 students responding used a NMPS without their own prescription and without a diagnosis for attention-deficit disorder. Most users wanted to improve concentration for studying and thereby improve academics. Students who have lower grade point averages are more likely to use NMPS. Rates of use in the United States are higher than in any other part of the world. Health concerns for this practice include adverse reactions, risk for dependence, and polydrug use (using more than one drug at a time).
(Fairman et al., 2020)
Amphetamines
Amphetamines are prescription stimulant drugs and many are classified as Schedule II controlled substances due to the potential for misuse. Amphetamines were first used in the 1930s in an inhaler called Benzedrine (Department of Justice/Drug Enforcement Administration, 2022) after which prescriptions for the pill form of amphetamines became available to treat narcolepsy and ADHD. Today, these drugs have a high rate of misuse and have street names, such as crank, speed, and ice. Ice is the crystallized form of methamphetamine that is used for smoking. The effect is like cocaine but is slower and lasts longer in the body. Side effects include insomnia, loss of appetite, increased heart rate and blood pressure, and feeling exhausted (Department of Justice/Drug Enforcement Administration, 2022).
Methamphetamines
Methamphetamines are illegal stimulant drugs with no recognized medical use. Methamphetamines are unregulated and addictive and are classified as Schedule II drugs. Approximately two million Americans use methamphetamine in any given year, according to SAMHSA (2023b). The National Institute on Drug Abuse data reveals that overdose death rates involving methamphetamine quadrupled from 2011 to 2017 (NIDA & National Institutes of Health, 2019). Methamphetamine comes in many forms and can be ingested by smoking, swallowing a pill, snorting, or injecting a powder that has been dissolved in water or alcohol. Methamphetamine can be easily made in small, clandestine laboratories with relatively inexpensive over-the-counter ingredients, such as pseudoephedrine, a common ingredient in cold medications. To curb this illegal production, federal law requires pharmacies take steps to limit sales and obtain photo identification from purchasers. Methamphetamine production also involves a number of other very dangerous chemicals. Toxic effects from these chemicals can remain in the environment long after the lab has been shut down, causing a wide range of health problems for people living in the area. These chemicals can also result in deadly lab explosions and house fires (NIDA & National Institutes of Health, 2019).
Long-term use of methamphetamine has many negative consequences, including extreme weight loss, severe dental problems, intense itching leading to skin sores from scratching, involuntary movements (dyskinesia), anxiety, memory loss, and violent behavior (NIDA & National Institutes of Health, 2019).
Cocaine
Cocaine is another powerfully addictive stimulant drug. The drug is made from the leaves of the coca plant native to South America. Estimates indicate that 4.8 million people aged twelve or older used cocaine in 2021 (SAMHSA, 2022c). Those who have used the drug may snort cocaine powder through the nose, rub it into their gums, or dissolve the powder and inject it into the bloodstream. Cocaine processed to make a rock crystal is called “crack.” People heat the crystal (making crackling sounds) to produce vapors that they inhale into their lungs (American Psychiatric Association, 2013; Boyer & Hernon, 2019). In the short-term, cocaine use can result in increased blood pressure, restlessness, and irritability. In the long-term, severe medical complications of cocaine use include heart attacks and seizures (NIDA & National Institutes of Health, 2019).
MDMA
A synthetic, psychoactive drug, MDMA, is more commonly known by the names Molly or Ecstasy (NIDA, 2020b). It is like amphetamine and the hallucinogen mescaline in that it makes its users feel like they have more energy, pleasure, and a distorted sense of time (NIDA, 2020b). MDMA affects three chemicals in the brain—dopamine, norepinephrine, and serotonin—by increasing their activity. People using MDMA commonly take it in pill or capsule form or by snorting it. The pleasurable effects usually last three to six hours. Because this drug lowers inhibitions, people may engage in risky behaviors, such as unsafe sex, thus increasing their chances of contracting a sexually transmitted infection or becoming pregnant. Other side effects are chills, nausea, teeth clenching, and extremely high body temperature that can cause kidney, liver, or heart failure, and ultimately lead to death (NIDA, 2020b).
Symptoms of Stimulant Use Disorder
Stimulant intoxication causes problematic behavioral or psychological changes, such as euphoria or blunted affect; changes in sociability; hypervigilance; interpersonal sensitivity; anxiety, tension, or anger; and impaired judgment. Other symptoms of stimulant intoxication include tachycardia, hypertension, pupillary dilation, elevated or decreased blood pressure, perspiration or chills, nausea or vomiting, weight loss, psychomotor agitation or retardation, muscular weakness, respiratory depression, chest pain or cardiac dysrhythmias, confusion, seizures, coma, psychosis/hallucinations, dyskinesia (involuntary, erratic, writhing movements of the face, arms, legs, or trunk) and dystonia (involuntary muscle contractions that result in slow repetitive movements) (American Psychiatric Association, 2013; Boyer & Hernon, 2019).
Approaches to Treating Stimulant Use Disorder
Treatment begins with detoxing from the stimulant, which is when the client stops taking the stimulant and allows all traces to leave their body. During withdrawal, the client may experience muscle tension, headaches, stomach cramps, increased appetite, insomnia, depression, and slower thinking (Cleveland Clinic, 2019). These withdrawal symptoms can begin within a few hours of the most recent use and last for up to seven days. The next part of treatment is for the client to participate in therapy, which can be in group format, individual counseling, or attend a twelve-step program. The support offered through these treatment options can increase the chances of the client maintaining sobriety.
Planning Nursing Care for a Client in Stimulant Withdrawal/Detoxification
The nurse initially assesses the client for withdrawal symptoms. Nurses commonly use the Clinical Institute Narcotic Assessment (CINA) or Clinical Opiate Withdrawal Scale (COWS) to determine the level of discomfort the client is experiencing. The higher the score, the higher the level of symptoms that need to be managed by medication administration. Although there is no medication specifically for treating stimulant withdrawal, there are medications that can be used to treat individual symptoms (Cleveland Clinic, 2019). As the client’s symptoms decrease, the nurse should invite the client to attend group sessions to learn more about positive coping methods. Discharge planning can include obtaining a bed in a residential recovery facility or the use of outpatient sobriety programs, such as Narcotic Anonymous, Cocaine Anonymous, or looking at a list of treatment options located on the SAMHSA website.
Collaborative Care for Clients in Stimulant Use Recovery
It is important for health-care systems to work together to assess and provide treatment to individuals who are experiencing all substance use disorders. There have been improvements to access to care brought about by the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 and the Affordable Care Act, which work together to require that substance use disorder treatment be covered by insurance (U.S. Department of Health and Human Services, Office of the Surgeon General, 2016). Implementing screening of all clients at each appointment is one of the first steps of early intervention. If a provider identifies a substance use disorder, they can initiate treatment within the primary care office or refer to more intense treatment for detox and recovery. Nurses, and other health-care professionals who complete client screenings, should receive training. According to the U.S. Department of Health and Human Services, Office of the Surgeon General (2016), each dollar that is spent on treatment saves four dollars in related health-care costs.
Collaborative care achieves the best results in client recovery. It is important that all the members of the interprofessional team work together to recognize possible substance use disorders in their clients, determining the best treatment options for each individual and recognizing signs of relapse (Jahan & Burgess, 2023).