10 Things to Know About Legal Stimulants

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Use of stimulants by humans goes back thousands of years.

Early records of stimulant use appear in pre-Columbian Meso- and South American civilizations such as the Mayans, Aztecs, Incans, and Olmecs. When European explorers arrived in the Caribbean, Central America, North America, and South America, they noted the use of products derived from chia, coca, and cacao in both religious rituals and in daily life. In religious rituals, priests and others ingested these chemicals to access altered states of consciousness and gain spiritual/religious experience or insight. In daily life, people used these chemicals to enhance mental alertness, heighten perception, and increase physical endurance, strength, and stamina.

Although we rarely use stimulants for religious or spiritual purposes in our culture, we do use legal stimulants in a wide variety of situations.

Legal Stimulants in the Modern World

In the 21st century, we use stimulants for various purposes. In most cases, we use legal stimulants for the same reason people in ancient civilizations used them: to stay awake, stay alert, and to help us complete or continue difficult physical tasks. Millions of people worldwide use stimulants in this way every day. From airline pilots to military officers to typical citizens, legal stimulants like caffeine, nicotine and others give people a boost of physical and mental energy that helps them accomplish the tasks associated with their occupations or daily activities.

The most common legal stimulants include:

  • Caffeine
  • Nicotine
  • Various herbal/plant-based stimulants

In the modern era, we use stimulants for medical purposes, as well. Healthcare providers often prescribe stimulants to treat attention-deficit/hyperactivity disorder (ADHD) in children, adolescents, and adults. These stimulant-based ADHD medications include, but are not limited to:

  • Dextroamphetamine (Dexedrine)
  • Dextroamphetamine/amphetamine combination (Adderall)
  • Methylphenidate (Ritalin)

In addition, healthcare providers prescribe prescription stimulant medication for weight loss. These include, but are not limited to, medications such as:

  • Lorcaserin (Belviq)
  • Phenterminetopiramate (Qsymia)
  • Semaglutide (Wegovy)
  • Setmelanotide (Imcivree)
  • Liraglutide (Saxenda)

Stimulants can be medically therapeutic and practically useful: that’s why most of us know what they are and why we use them. However, when people misuse stimulants, serious problems can follow. That’s what this article is about.

Legal Stimulants: What You Need to Know

We’ll start with a list of ten things we want everyone to know about legal stimulants, then we’ll expand on several items on the list.

10 Things to Know About Legal Stimulants

  1. Legal stimulants include common chemicals such as caffeine and nicotine. Less common legal stimulants include ephedra, ginseng, gingko, yerba mate, and others.
  2. Prescription stimulants are legal when used as directed. They’re most often prescribed to treat attention-deficit/hyperactivity disorder, ADHD, narcolepsy, and obesity.
  3. Prescription stimulants come in tablet, capsule, or liquid form, and are most often ingested orally.
  4. Misuse of a prescription stimulant – i.e., when used in a way other than directed by a physician, taken in a dose other than prescribed, and/or taken by a person other than the person with the prescription – is illegal.
  5. Stimulants increase the level and activity of dopamine and norepinephrine in the brain and body, two important chemicals related to reward, mood, memory, energy, attention, and alertness.
  6. Prescription stimulants – and non-prescription, legal stimulants – increase energy and improve attention and alertness when used as directed. They can also decrease appetite, which is why doctors prescribe some stimulants for weight loss.
  7. Misuse of stimulants – legal or illegal, prescription or illicit – can lead to psychosis, anger, and paranoia. In addition, misuse can damage the nervous system, the digestive system, and the cardiovascular system. In some cases, excess stimulant use/misuse can lead to a heart attack, seizures, and other physical problems.
  8. Misuse of stimulants can lead to disordered use of stimulants, called substance use disorder (SUD) or stimulant use disorder, a.k.a addiction. Stimulant addiction can develop from the misuse of legal, prescription stimulants.
  9. When a person who takes stimulants regularly – even prescriptions stimulants – withdrawal symptoms may develop. Stimulant withdrawal symptoms include fatigue, depression, and problems with sleep, among others.
  10. Evidence-based treatment for stimulant use disorder is available and easy to find. Integrated, individualized treatment programs can help people who engage in the misuse or disordered use of stimulants.

To learn about treatment for stimulant use disorder, click here.

What we’ll focus on now – since we specialize in substance use disorder (SUD)/addiction treatment – are the negative consequences of legal stimulant use. The negative consequences include physical, psychological, and emotional problems, up to and including stimulant disorder, a.k.a stimulant addiction.

What is Stimulant Use Disorder?

The American Psychological Association (APA), defines stimulant use disorder as ”…the disordered use of amphetamine-like substances.” The Diagnostic and Statistical Manual of Behavioral Disorders, Volume 5 (DSM-5) indicates diagnosis of a stimulant disorder requires the presence/occurrence of at least two of the following symptoms within a 12-month period:

  • Using or taking stimulants more often/for longer than intended
  • Inability to stop or control the use of stimulants
  • Spending significant amounts of time and energy excessive in activities related to stimulant use
  • Extreme cravings for and urges to use stimulants
  • Impaired ability to meet the obligations of home, school, or work due to stimulant use
  • Continued stimulant use when it causes personal, academic, or professional problems
  • Withdrawal from recreational, social, or work-related activities due to stimulant use
  • Using stimulants in physically hazardous situations
  • Continued stimulants despite knowledge continued use causes physical, emotional, and/or psychological problems
  • Developing tolerance to stimulants
  • Presence of withdrawal symptoms when stopping stimulant use

Those are the criteria clinicians use to diagnose stimulant use disorder. Remember: misuse of prescription stimulant is illegal, and carries a significant risk of addiction. Let’s take a look at the most recent data on the prevalence of stimulant use disorder.

Here’s the latest data from the 2021 National Survey on Drug Use and Health (2021 NSDUH). We’ll offer data on prescription stimulant use, misuse, initiation of misuse, and stimulant use disorder, broken down by totals and by age category.

Stimulant Use by Age Group

  • Any use of prescription stimulants
    • 12 + total: 5.9% (16 million)
    • 12-17: 7.0% (1.8 million)
    • 18-25: 10.0% (3.3 million)
    • 26+: 5.2% (11.4 million)
  • Misuse of prescription stimulants
    • 12 + total: 1.3% (3.7 million)
    • 12-17: 1.2% (304,000)
    • 18-25: 3.7% (1.2 million)
    • 26+: 1.0% (2.1 million)
  • Initiation of misuse of prescription stimulants
    • 12 + total: 0.3% (773,000)
    • 12-17: 0.6% (154,000)
    • 18-25: 0.9% (310,000)
    • 26+: 0.1% (309,000)
  • Prescription stimulant use disorder
    • 12 + total: 0.5% (1.5 million)
    • 12-17: 0.9% (245,000)
    • 18-25: 1.1% (379,000)
    • 26+: 0.4% (881,000)

Those figures are eye-opening. Millions of people in the U.S. misuse prescription stimulants each year, close to a million initiate the misuse of prescription stimulants each year, and over a million people in the U.S. meet clinical criteria for stimulant use disorder.

To put that data in context, here’s the latest prevalence data on overall SUD in the U.S.

SUD by Substance in 2021

  • Alcohol use disorder: 29.5 million
  • Illicit drug use disorder: 24.0 million
  • Marijuana use disorder: 16.3 million
  • Opioid use disorder: 5.6 million
  • Pain reliever use disorder: 5.0 million
  • Methamphetamine use disorder: 1.6 million
  • Stimulant use disorder: 1.5 million
  • Cocaine use disorder: 1.4 million
  • Heroin use disorder: 1.0 million

While stimulant use disorder is far less common than alcohol use disorder (AUD) or opioid use disorder (OUD), the problems associated with stimulant use, misuse, and disordered use are serious. We’ll discuss the consequences of long-term, chronic stimulant use, misuse, and disordered use below.

The Adverse Effects of Stimulant Use

The adverse effects of stimulant use are well-known and extensively documented. Please keep in mind that the stimulants we’re talking about in this article are all legal stimulants. That means anyone can access them either over the counter or with a prescription from a physician. We’ll reiterate two points until we’re sure they’re impossible to misunderstand: excess use of legal stimulants can lead to very serious health problems, including addiction, overdose, and organ failure that can, in some cases, lead to premature death.

Chronic, excess stimulant use can cause:

  • Increased heart rate
  • Irregular heartbeat
  • Vasoconstriction, i.e. narrowing of blood vessels, which leads to decreased blood flow to the body and brain
  • Heart failure
  • Seizures
  • Elevated body temperature, which can lead to hyperthermia
  • Increased blood sugar
  • Panic attacks
  • Hostility
  • Anger
  • Paranoia
  • Psychosis
  • Depression
  • Suicidal ideation
  • Nerve problems/nerve damage

Those consequences are the reason it’s critical for people with a prescription for a stimulant-type medication to follow doctor’s orders. A stimulant use disorder, like any substance use disorder, can be extremely dangerous, physically – as the list above shows – and it can also be extremely disruptive psychologically and emotionally. The symptoms of a stimulant use disorder can impair or prevent an individual’s ability to participate in the most basic activities of daily life, including work and school, and create problems in peer, romantic, and family relationships.

However, there is help: treatment for stimulant use disorder is widely available and accessible.

Treatment for Stimulant Use Disorder

The Substance Abuse and Mental Health Services Administration (SAMSHA) published a detailed treatment protocol for treating people with stimulant disorder called “Treatment of Stimulant use Disorders.” In the publication, expert in SUD review and assess the current best practices in treating people diagnosed with stimulant disorder.

After a thorough review of all the evidence available as of 2018, SAMHSA indicates the following therapeutic components are the most effective:

Motivational Interviewing (MI)

  • SAMHSA indicates the evidence for MI is strong.
  • MI is defined as “…a directive, client-centered counselling style for eliciting behavior change by helping clients explore and resolve ambivalence.”
  • MI involves helping a patient identify discrepancies between their overall goals and their current behavior
  • MI therapists help patients meet and overcome resistance to treatment, rather than confronting them about their resistance

Contingency Management (CM)

  • SAMHSA indicates the evidence for CM is strong.
  • CM incentivizes treatment adherence by reinforcing treatment-supporting behavior
  • Incentivized behaviors include attending treatment, passing drug tests, meeting the expectations defined by patient and therapist
  • Rewards for incentivized behavior may include: prizes, privileges (in the treatment context), and cash

Community Reinforcement Approach (CRA)

  • SAMHSA indicates the evidence for CRA is strong.
  • CRA involves identifying what makes stimulant use rewarding, and helps patients create a lifestyle where the absence of stimulant use is more rewarding than stimulant use
  • CRA includes multiple elements, such as relationship counseling, vocational support, and job skills training, as well as drug refusal skills and education on building a drug-free social network
  • Like CM, CRA often involves rewards for engage in incentivized behaviors such as abstinence and attending treatment sessions

Cognitive Behavioral Therapy (CBT)

  • SAMHSA indicates the evidence for CBT is strong.
  • CBT is a practical, goal-oriented, solution-focused type of psychotherapy
  • CBT therapists help patients understand the connection between thoughts, feelings, and behavior
  • Once a patient understands these connections, a CBT therapist helps patients replace patterns of thought and feeling that lead to unwanted behavior – i.e., stimulant use – with desired patterns of thought and behavior, i.e., those that promote and support recovery from stimulant use

These four approaches to the treatment of stimulant use disorder are most effective in the context of a holistic, integrated approach to treatment that includes – in addition to therapy like CBT – counseling, lifestyle changes, community/peer support, family therapy, and complementary therapies. Lifestyle changes typically include healthy eating, exercise, and sleep hygiene, while community and peer support often occurs in mutual self-help meetings such as Narcotics Anonymous (NA), SMART Recovery, or other 12-step type programs.

Treatment For Stimulant Disorder at Pinnacle Treatment Centers

At Pinnacle Treatment Centers, we offer a full continuum of compassionate care, including detoxification services, residential treatment programs, partial hospitalization programs, intensive outpatient programs, and outpatient programs. We welcome anyone who seeks support for substance use disorder. If you or someone you love has a problem with stimulant use that began with a legal, prescription stimulant and became unmanageable, we understand – and we can help. We’ll offer support and treatment at any level of care, in any way they will accept it. At Pinnacle, we live by this motto:

Any door is the right door.

That means we meet patients where they are and offer treatment they need at the level of care they’ll accept. Call us today or visit us online to learn more.

The materials provided on the Pinnacle Blog are for information and educational purposes only. No behavioral health or any other professional services are provided through the Blog and the information obtained through the Blog is not a substitute for consultation with a qualified health professional. If you are in need of medical or behavioral health treatment, please contact a qualified health professional directly, and if you are in need of emergency help, please go to your nearest emergency room or dial 911.