Stimulant

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Cocaine (also known as snow, blow, flake, and toot) is a naturally occurring alkaloid found in the leaves of the coca shrub, which is indigenous to the Andes Mountains in Peru and Bolivia.

Peruvian IndiansOpens in new window used to chew coca leaves mixed with lime. In 1886, cocaine was mixed with caffeine from African kola nuts to create Coca-Cola. In 1903, Coca-Cola removed the cocaine from the formula. In 1914, cocaine came under strict control in the United States with the Harrison Narcotics Act. Cocaine is typically taken through nasal inhalation (snorting), intravenous injection, or smoking (freebasing and crack).

Side effects may include heart attacks, respiratory failure, strokes, and seizures. Large amounts (or long-term use) can cause psychotic behavior, hallucinations, and bizarre or violent behavior (National Institute on Drug Abuse, 2008). Cocaine is highly addictive. Moderate cocaine use can result in withdrawal (marked by depression and intense cravings for the drug) on discontinuation of the drug.

AmphetaminesOpens in new window include methamphetamine (speed, crank, meth, ice), deztroamphetamine (e.g., diet pills such as Dexedrine), some attention-deficit hyperactivity disorder (ADHD) medications, and MDMA (Ecstasy). Adderall, a combination of dextroamphetamine and dextro/levo-amphetamine, is a medication used to treat ADHD and narcolepsy. Amphetamines have characteristics similar to cocaine in terms of physiological and psychological effects, side effects, addictive potential, and withdrawal. Amphetamines can be taken through snorting (nasally), smoking, injection, and anal insertion.

Stimulant diet pills (also referred to as anorectic medications) include benzphetamine (Didrex), diethylproprion (Tenuate, Tepanil), mazindol (Sanorex, Mazanor), phendimetrazone (Bontril, Prelu-27), phentermine (Lonamin, Fastin, Apidex), and fenfluramine and dexfenluramine (Fen-Phen, which was removed from U.S. market in the 1990s).

These medications can cause insomnia, irritability, hyperactivity, personality changes, and psychosis. Abrupt cessation can result in extreme fatigue and depression. It is dangerous to take these medications with other stimulants or with alcohol.

Methylphenidate (Ritalin, Concerta) is a stimulant medication used to treat ADHD, chronic fatigue syndrome, narcolepsy, and depression. Street names include kibbles and bits, vitamin R, kiddie cocaine, and study drugs.

Side effects may include insomnia, stomachache, diarrhea, headache, dry mouth, and appetite suppression, and psychosis. Methylphenidate should not be used in patients being treated with MAO inhibitors (a type of antidepressant) because of possible side effects on blood pressure. Methylphenidate has addiction and abuse potential. Minor stimulants—including caffeine, nicotine, guarana, and ephedra—are less potent central nervous system stimulants than the major stimulants (e.g., cocaine or amphetamines).

Other minor stimulants include theophylline (found in tea) and theobromine (found in cocoa beans). Caffeine is most potent in coffee and is also found in tea, cocoa, and kola nuts (used to make cola drinks).

Excessive caffeine intake can lead to a rapid heart rate, increased urination, nausea, vomiting, restlessness, anxiety, confusion, depression, tremors, or difficult sleeping. Caffeine use should be restricted or avoided in people with coronary heart disease or peptic ulcers, children, and women who are pregnant or nursing.

Caffeine may interact with other stimulant medications or substances that contain stimulants. While caffeine has little addictive potential, abrupt discontinuation of caffeine can result in headaches, drowsiness, irritability, nausea, vomiting, and fatigue.

• GuaranaOpens in new window, a plant with a high caffeine content, is often found in energy drinks.
• EphedraOpens in new window (from the plant Ephedra sinica) is found in some teas or herbs used to treat asthma and other breathing problems; it is also found in some herbal weight loss products.

Until 2004, many herbal weight loss and quick energy products combined caffeine or caffeine-containing herbs with ephedra. This combination may lead to dangerously increased heart rate and blood pressure and should be avoided by people with heart conditions, high blood pressure, diabetes, or thyroid disease.

Stimulants affect several neurotransmitters (chemical messengers in the brain) including epinephrine, norepinephrine, dopamine, and serotonin. Effects on epinephrine and norepinephrine can cause increased heart rate, blood pressure, respiration, and body temperature.

Stimulants may increase alertness (also causing insomnia or sleeping difficulties) and energy and decrease appetite. They can also cause euphoria or a sense of wellbeing.

One reason stimulants can be so addictive is that they flood the brain’s “reward” (limbic) system with the neurotransmitter dopamine (National Institute on Drug Abuse, 2007).

NicotineOpens in new window (found in tobacco) differs from other stimulants in that it acts as both a stimulant and a depressant. It produces a feeling of relaxation or satisfaction rather than the euphoria produced by major stimulants. Tolerance to nicotine develops rapidly, necessitating increased amounts of nicotine to produce similar pleasurable effects.

Nicotine is highly addictive; discontinuation causes withdrawal effects, including cravings, irritability, anxiety, depression, sleep disturbance, increased appetite, and restlessness. Tobacco may be ingested through smoking, chewing, or nasal inhalation (snuff).

Treatment for stimulant dependence may include some combination of inpatient or outpatient programs for the initial stages of treatment, cognitive-behavioral therapy, 12-step programs (such as Narcotics Anonymous), other psychotherapeutic approaches (such as motivational interviewing) and/or pharmacotherapy (medication).

Medications sometimes used to treat cocaine addiction include topiramite, modafanil, baclofen, and some antidepressant medications (National Institute on Drug Abuse, 2004).

Bupropion (the antidepressant medication Wellbutrin) is being explored as a component of treatment for methamphetamine dependence (National Institute on Drug Abuse, 2006).