● Stimulant use continues despite persistent or recurrent inter- personal problems. ● Important social, occupational, or recreational activities are given up or reduced due to stimulant use. ● Recurrent stimulant use occurs in situations when physically hazardous. ● Stimulant use is continued despite the knowledge of hav- ing physical or psychological problems that may have been caused or exacerbated by the stimulant. ● Tolerance develops: ○ A need for increased amounts of the stimulant to achieve intoxication. ○ Diminished effect with continued use of the same amount of the stimulant. ● Withdrawal occurs: ○ Characteristic withdrawal syndrome for stimulant. ○ The stimulant is taken to relieve or avoid the withdrawal. (APA, 2013) Stimulant intoxication As in other situations, behavioral and psychological changes oc- cur in stimulant intoxication. Auditory hallucinations or paranoid ideations may be prominent (APA, 2013). Signs and symptoms of intoxication develop during or shortly after use, including: ● Tachycardia or bradycardia. ● Pupillary dilation. ● Elevated or lowered blood pressure. ● Perspiration or chills. ● Nausea or vomiting. ● Evidence of weight loss. ● Psychomotor agitation or retardation. ● Muscular weakness, respiratory depression, chest pain, or car- diac arrhythmias. ● Confusion, seizures, dyskinesias, dystonias, or coma. Stimulant intoxication is not a criterion for substance use disorder (APA, 2013). A specific antidote does not exist; therefore, activat - ed charcoal is warranted in this situation. Otherwise, supportive treatment is prescribed in the case of an overdose. Stimulant withdrawal The essential feature of stimulant withdrawal is characterized by the development of dysphoria along with: ● Fatigue.
limited medical use but is widely used as an illicit drug through inhalation (snorting) and other routes. When snorted, the onset of action is within 5 minutes and typically peaks within 30 minutes. The half-life of cocaine is 30-90 minutes, and it can be absorbed across any mucosal surface, including respiratory, gastrointestinal, and genitourinary tracts (Holstege et al., 2021). The drug has numerous adverse health effects on all organ sys- tems (Holstege et al., 2021). Cocaine increases dopamine in the brain, reinforcing drug-taking behaviors that are desensitized over time. Individuals with cocaine use present with many different symptoms. Physical effects of cocaine include constricted blood vessels, dilated pupils, increased body temperature, tachycardia, tremors, or restlessness (NIDA, 2020). Methamphetamine is a highly addictive psychostimulant chemi- cally related to amphetamine. In the central nervous system, am- phetamines block presynaptic reuptake of catecholamines, such as dopamine and norepinephrine, causing hyperstimulation at selected postsynaptic neurons (Richards, 2023). Other non-cate- cholaminergic central and nervous pathways are hyperstimulated. CNS dopaminergic alterations cause changes in mood, excitation, motor and sensory movements, and appetite. Serotonin contrib- utes to mood changes and psychotic and aggressive behavior (Richards, 2023). This drug is inexpensive and readily synthesized from cheap chemicals, such as pseudoephedrine, anhydrous am- monia, red phosphorus, and hydrochloric acid (Richards, 2023) Snorting or smoking methamphetamine causes excessive tooth and gum disease (meth mouth); snorting methamphetamine causes anosmia and deviated septum; smoking this drug causes lung and airway damage (SAMSHA, 2020). MDMA is commonly known as ecstasy ( E or X ) and is derived from methamphetamine. MDMA is an indirect sympathomimetic that stimulates the release and inhibits the reuptake of epinephrine, norepinephrine, and dopamine. MDMA can cause tachycardia, elevated blood pressure, mydriasis, increased energy, anorexia, and increased concentration (Preda, 2018). Adverse effects can include nausea, diaphoresis, anorexia, tremors myoclonus, tics, paresthesia nystagmus, hyperreflexia, hypertension, urinary reten - tion, and ataxia (Preda, 2018). Individuals exposed to these stimulants can develop stimulant use disorder within one week (APA, 2013). Individuals demonstrating a problematic pattern of substance use that leads to significant impairment as manifested by two or more of the following over a 12-month period meet the criteria: ● The stimulant is taken in larger amounts than intended. ● There is a persistent desire or unsuccessful efforts to cut down or control stimulant. ● A great deal of time is spent in activities to obtain the stimu- lant. ● Craving is an urge to use the stimulant. ● Recurrent stimulant use results in a failure to fulfill work and home obligations.
● Vivid or unpleasant dreams. ● Insomnia or hypersomnia. ● Increased appetite. ● Psychomotor retardation or agitation.
Bradycardia is often present and can be a measure of withdrawal (APA, 2013). Additionally, anhedonia and drug craving can also be present. Withdrawal lasts up to 1-3 weeks. Pharmacotherapeutics utilized in withdrawal include trazodone, benzodiazepines, and neuroleptics as part of a comprehensive treatment plan (Preda, 2018).
HALLUCINOGEN RELATED DISORDERS
● Peyote (mescaline) is a small, spineless cactus with mescaline as its main ingredient (NIDA, 2019). ● DMT (N,N-dimethyltryptamine) is a powerful chemical found in plants in the Amazon. Ayahuasca is a tea from these plants, called hoasca , aya , and yagé (NIDA, 2019). ● 251-NBOMe is a synthetic hallucinogen similar to LSD and MDMA but much more potent. Classic hallucinogens temporarily disrupt communication through the brain and spinal cord (NIDA, 2019). Additionally, some inter- fere with serotonin, which regulates mood, sensory perception, sleep, hunger, body temperature, sexual behavior, and intestinal muscle control (NIDA, 2019). These hallucinogens cause individu- als to see images, hear sounds, and feel sensations that seem real, which generally begin within 20-90 minutes and can last from 15 minutes to 12 hours. These are commonly referred to as a trip by the individual. The short-term effects can range from tachy- cardia and nausea to seeing intense colors and changes in the
A long history of using hallucinogenic plants exists among humans for ceremonial and religious purposes. It is difficult to define psy - choactive drugs that are so diverse in chemical structures. Halluci- nogens are a group of drugs that alter an individual’s awareness of surroundings, emotions, and thoughts. Despite their name, hallu- cinogens do not consistently cause hallucinations (Forrest, 2020). These are divided into two categories, including classic hallucino- gens and dissociative drugs. Classic hallucinogens Common classic hallucinogens include the following: ● D-lysergic acid diethylamide (LSD) is one of the most potent mind-altering chemicals. Theis clear or white odorless sub- stance is derived from a fungus that grows on rye or grains (NIDA, 2019). ● Psilocybin originates from mushrooms in tropical and sub- tropical regions of South America, Mexico, and the United States (NIDA, 2019).
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