Stimulants are a class of drugs that have the effect of increasing energy, alertness, and euphoria in the mind and body, increasing metabolism and physical activity, and masking the depressant effects of substances like alcohol.
Some stimulants, such as Adderall and Ritalin, have established medical use and are prescribed to treat the symptoms of Attention-deficit/ hyperactivity disorder (ADHD). Unfortunately, their addictive qualities, (Adderall, in particular), frequently lead to abuse and addiction.
Other stimulants, like cocaine and methamphetamine, have an extremely limited medical use and are used on a tightly restricted basis due to their highly addictive nature and serious health risks. And in the case of concentrated, illicit versions of certain stimulants, such as crack cocaine or Crystal Meth, there are no known medical uses and are abused purely for recreation.
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As of 2014, approximately 1.5 million Americans were dependent on cocaine, which was responsible for roughly 6,000 overdose deaths that year, while 570,000 were using meth and 4,000 fatally overdosing on it. According to SAMHSA’s 2015 National Survey on Drug Use and Health, 2.5 million adults aged 18 to 25 reported misuse of prescription stimulants like Adderall.
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How Stimulants Affect the Brain
The classification of “stimulant” covers a fairly broad range of substances that can produce different effects for wildly different lengths of time. However, they all work in the brain in very similar ways, namely, by entering the brain and central nervous system and increasing the levels of a neurotransmitter called dopamine.
Dopamine’s job within the brain is to control what is commonly referred to as the “pleasure centers,” regulating the feelings of motivation, reward, movement, the speed the body reacts to external stimuli, and, yes, pleasure.
Normally, your brain will release a certain amount of dopamine as a chemical response and then, when the feelings that it produces are no longer needed, reabsorb them in a process called “reuptake,” that is meant to regulate how much of a given neurotransmitter remains in the brain and central nervous system.
Stimulants are what’s known as “reuptake inhibitors” and work by flooding the brain and central nervous system with increased levels of dopamine as well as blocking reuptake, so the dopamine stays in the synapses longer and also builds up way past what would be considered “normal.”
This increase in the amount of dopamine and length of time it stays in the synapses are what causes the intense increase in feelings of alertness, energy, and euphoria. However, there are some differences between stimulants in how this is achieved.
Cocaine, for example, does not actually increase the amount of dopamine being released but blocks the process of reuptake so that the amount produced naturally by the brain builds up. It also provides a very brief high. Crack, which is concentrated cocaine, works the same way but provides an even shorter, more powerful high.
Methamphetamine, on the other hand, increases the amount of dopamine being released as well as inhibiting reuptake, creating a longer-lasting high that is also, due to the much higher amount of dopamine, more intense.
Similarly, the ADHD medication Adderall, which is typically seen as stronger and more stimulating than Ritalin, increases dopamine and blocks its reuptake, while Ritalin only works as a reuptake inhibitor.
Along with the increased feelings of energy, pleasure, alertness, and focus, regular misuse and abuse of stimulants can also have side effects like:
- Suicide ideation
- Increased risk of seizures
- Rapid weight loss
- Unstable moods
- Permanent brain damage
- Extreme depression (during the “crash” period after the high)
In order to halt these effects and prevent the onset of irreversible damage, it is recommended that anyone suffering from a dependency on stimulants detox as soon as possible, preferably in a safe and controlled environment of a professional medical detox center.
Types of Stimulants
Cocaine is one of the most well-known drugs in the world. It is highly addictive, and it is made from the coca plant that originates in the regions of Colombia, Peru, and Bolivia. Cocaine typically comes in white powder, although there is another drug, which is known as crack that comes in a crystallized rock.
Cocaine and crack can be used in several different ways, but the most common route of administration is to snort the powder. The most common method for crack is to smoke it.
Symptoms of cocaine use include:
- Dilated pupils
- Runny nose
- Weight loss
- Nose bleeds
The age in which cocaine is used seems to be getting lower. A survey released by the National Institute on Drug Abuse (NIDA) shows that 1.4 percent of 8th graders had tried cocaine. It was compared to results of 12th graders that showed 3.7 percent of them had experimented with the substance.
Childhood use of substances can lead to adult use. Adolescents who experiment with drugs are more likely to develop a substance use disorder than those who start as adults. A little more than 16 percent of surveyed adults 26 or older had used cocaine in their lifetime.
Methamphetamine is incredibly potent and addictive. It is commonly referred to as meth and can be found in a powder or crystal form. Meth can be smoked, injected, or snorted. Once the initial rush passes from using the drug, it is met with feelings of anger and agitation, which is known as the crash. Some severe medical issues can arise from using meth, that includes:
- High body temperature that can cause fainting
- Severe itching
- Dry mouth resulting in broken teeth, 'meth mouth'
- Cognitive problems
Methamphetamine use can easily lead to an overdose, which can cause death. In addition to its adverse effects, it can generate severe withdrawal symptoms. Someone looking to stop using meth must look into professional treatment.
Illegal drugs are not the only stimulant drugs to be aware of. Prescription amphetamines have become prevalent drugs of abuse. These drugs include Adderall, Ritalin, and Concerta. They are prescribed by doctors to treat attention-deficit hyperactivity disorder, but they can make their way onto college campuses very easily.
College students abuse the drugs to cram as much information for exams or finals. Twenty percent of high school students admitted to taking a prescription stimulant without a valid prescription in 2009, according to the U.S. Centers for Disease Control and Prevention (CDC).
What You Can Expect from Stimulant Withdrawal
When someone becomes addicted to stimulants, this means they have built up a tolerance that requires more frequent use in increasingly large doses to achieve the same effects as before.
It also means that their brain will have, depending on the stimulant and the severity of abuse, either been making much less dopamine or stopped producing it entirely, depending on the dopamine provided by the stimulant to keep functioning.
Once someone stops taking stimulants, their dopamine levels bottom out and crash as the brain struggles to deal with this sudden loss, which is what creates stimulant withdrawal symptoms.
Something to keep in mind during stimulant detox is that stimulant withdrawal differs from that of many other substances due to the fact that the majority of the stimulant withdrawal symptoms are psychological, and typically do not include nausea, vomiting, or other flu-like symptoms.
While some of these symptoms will vary based on the specific stimulant that someone has been abusing, the list of common withdrawal symptoms that can be expected during a stimulant detox includes:
- Panic attacks
- Irritability and mood swings
- Extreme fatigue
- Increased appetite (appetite suppression is a common stimulant side-effect)
- Difficulty concentrating
- Drug cravings
- Severe depression
- Vivid nightmares or sleep disturbances
- Impaired memory
- Suicidal thoughts or behavior
Stimulant Withdrawal Timeline
For those wondering how long their stimulant withdrawal will last, there is no simple and straightforward answer. There is a common stimulant withdrawal timeline that will match up with many people’s stimulant detox. In the case of determining a stimulant withdrawal timeline from person to person, everyone is going to be somewhat different based on factors unique to them, such as:
- How long someone has been abusing this stimulant
- How much of the stimulant they had been taking
- How they had been taking it
- If they have a history of previous addictions
- If they had been abusing stimulants with alcohol or other drugs
- Whether or not they are detoxing on a tapering schedule
- If they have mental health issues or other co-occurring disorders
- The state of the overall current health
The length of a stimulant withdrawal timeline also depends on which specific stimulant someone has been abusing.
For example, since cocaine has a very short high and therefore is in the body for significantly less time than meth or Adderall, someone who has been abusing cocaine will begin to feel symptoms and enter the withdrawal phase much faster than those stimulants that remain in the body longer.
Also, if someone was specifically abusing a prescription ADHD stimulant, then their withdrawal timeline will also depend on whether they were using an extended-release version, which can often remain in the body for as long as 24 hours. It could take days for the withdrawal symptoms to appear and greatly lengthening their stimulant withdrawal timeline.
Keeping those distinctions in mind, the general stimulant withdrawal timeline can be broken down as follows:
1 to 3 Days: This is what’s known as the “crash phase,” when the drug exits the body and the early withdrawal symptoms; usually depression, fatigue, and increased appetite begin to appear and, for some stimulants, reach their peak intensity
If someone has been using cocaine, they can expect to experience symptoms in just a couple hours after their last dose, and a crash phase that can last up to several days. Crack peaks even faster, and so withdrawal symptoms can start in as little as one hour after their last dose, and definitely no longer than 12 hours. The crash phase for crack is about 24 hours in length.
Adderall and Ritalin have about the same half-life and, excluding the extended-release version, can typically take between 12 hours and a few days for early symptoms to appear. Methamphetamine’s crash period follows the same timeline as well.
4 to 10 Days: This is where the stimulant withdrawal timelines begin to differ significantly. For drugs like Adderall and Ritalin, this is when all the withdrawal symptoms will be present and at their peak intensity, subsiding over the course of the week.
Meth withdrawal symptoms will also be at their worst during this period and can take as long as 10 days to begin to lessen and become more manageable.
For cocaine and crack, the worst of the symptoms will have passed, although drug cravings will be at their strongest, almost all-consuming, with symptoms of irritability, lack of focus, restlessness hitting their peaks. Unfortunately, this craving period can last, depending on the severity of the addiction, anywhere from one week to more than two months.
2 to 3 Weeks: With the previously-mentioned exception of crack and cocaine, at this point, the majority of stimulant withdrawal symptoms will have run their course and will be either greatly diminished or completely gone, barring certain symptoms like depression and insomnia, which are likely to linger. Also, those withdrawing from methamphetamine will still likely be experiencing strong cravings.
Beyond: For crack and cocaine, the final phase of the withdrawal timeline can last as long as six months, with the majority of the symptoms disappearing. Cravings, however, will still be present, though much weaker and for shorter periods of time.
What are the Treatment Steps?
While stimulant withdrawal may not be as severe as the process of detoxing from other substances such as benzodiazepines, because some of the symptoms, particularly the psychological ones, can be so intense and often unpredictable, detoxing at a professional medical detox center is the recommended first step of stimulant withdrawal treatment.
Being treated for stimulant withdrawal at a detox center as opposed to at home ensures your safety with around the clock medical supervision, which can often be the difference between life and death. This is critical, especially when experiencing symptoms such as depression, insomnia, and suicidal behavior in combination.
Another important thing to keep in mind is that heavily abusing certain stimulants can cause more life-threatening symptoms, such as seizures during Adderall withdrawal or Crystal Meth, which can often cause delusions and psychosis. No one should, for their own safety, attempt to manage these symptoms on their own.
Detoxing at a professional facility takes these dangers out of the equation while also removing the risk of relapse and providing the individual undergoing stimulant detox with medication to help ease withdrawal symptoms and remove any unnecessary discomfort.
It also means that you can be put on a tapering schedule by a doctor who is well-experienced in detox treatment, slowly diminishing the use of whichever stimulant someone has become dependent on until it is safe for them to stop using it entirely without the risk of triggering a seizure or other serious health problems.
Once past the withdrawal phase and a successful detox, the next treatment step, if someone wants to maintain their sobriety, needs to be enrolling in an addiction rehabilitation treatment program.
Detox alone is not recovery, but by flushing the body of whichever stimulant they were abusing, detox makes it possible for someone to focus on their recovery without the haze of drugs or the discomfort of withdrawal.
If someone wants to lower the chances of relapsing, they need to gain a proper understanding of the issues behind their addiction and how best to manage their addictive behaviors with more positive and useful coping mechanisms that don’t involve using.
In a typical recovery treatment program, the person undergoing treatment will work collaboratively to create a treatment plan that will be most effective for them, picking from a wide range of different treatment programs, but generally involving counseling, support groups, educational workshops, and different types of individual therapies.
If You’re Suffering from Stimulant Addiction, We Can Help
If you or someone that you care about is currently suffering from a dependence on stimulants, whether it’s cocaine, Adderall, or methamphetamines, The Palm Beach Institute is here to provide all of the resources, care, and support needed to get on the road to long-lasting sobriety.
National Institute on Drug Abuse. (n.d.). How is methamphetamine different from other stimulants, such as cocaine? from https://www.drugabuse.gov/publications/research-reports/methamphetamine/how-methamphetamine-different-other-stimulants-such-cocaine
Press Release. (2010, June 03). from https://www.cdc.gov/media/pressrel/2010/r100603.htm
Methamphetamine. (2018, December 21). from https://medlineplus.gov/methamphetamine.html
National Institute on Drug Abuse. (n.d.). Cocaine. from https://www.drugabuse.gov/drugs-abuse/cocaine