The stimulant class of drugs includes both illicit and legal drugs. However, all are central nervous system (CNS) stimulants, which means that they increase brain activity. Stimulant abuse carries an inherent risk for psychosis, a state that may include agitation, hallucinations, paranoia, and delusions.2 This article highlights the properties of stimulants, their symptoms and risks, and the treatments available for those struggling with addiction.
Commonly abused stimulants include methamphetamine, cocaine, methylphenidate, and amphetamines.3,5 Physicians prescribe stimulants, such as Adderall, Concerta, and Ritalin, for attention-deficit hyperactivity disorder (ADHD), narcolepsy, and more rarely for depression that hasn’t responded to conventional interventions.4 These medications help boost focus, calmness, and overall learning and thinking abilities for people with ADHD.5 However, people without ADHD often abuse prescription stimulants for their desired effects of wakefulness, attention, and euphoria.
A popular stimulant of abuse is cocaine, which is largely illicitly produced from the South American coca plant and induces intense feelings of pleasure, and increased energy, confidence, and sex drive.3 Similarly, methamphetamine, which appears in both pill or powder form, also produces similar effects, but with a significantly longer half-life (meaning a longer, sustained high).3 Though prescription methamphetamine (e.g., Desoxyn) exists for a limited number of medical indications, crystal methamphetamine, or crystal meth, predominates the illicit market, and often resembles rocks or pieces of glass.3
Due to their desirable effects and unpleasant withdrawal symptoms when use is reduced or stopped, stimulants can quickly lead to compulsive use or addiction. Currently, the DEA classifies many stimulants as Schedule II controlled substances, meaning that, while they might have acceptable medical use, they also present with a high potential for abuse.6
Stimulant abuse is extremely prevalent due to their desired effects, such as feelings of well-being, increased focus and concentration, suppressed appetite, and overall wakefulness. Some statistical examples of the alarmingly prevalent issue of stimulant abuse are as follows:1,3,7
Research suggests a strong relationship between amphetamine misuse and the development of acute psychosis. While exact statistics on prevalence vary, between 8-46% of people abusing amphetamines report drug-induced psychosis.8
A study of people with pre-existing psychosis or psychotic features, regardless of their mental state at time of experimentation, revealed that large enough doses of stimulants can result in a brief exacerbation of psychosis ratings.9 Chronic, high-dose “binging” can especially exacerbate psychotic symptoms.
Signs and symptoms of substance-induced psychosis can include:2,8,10
Stimulant-induced psychosis can be extremely dangerous and detrimental to both the user and the people around the user. Because someone in a psychotic state often acts illogically and irrationally, an elevated risk of violence, self-harm, and suicide exists. When people develop full-blown psychosis due to stimulant abuse, they may need to be hospitalized in the emergency room or in a psychiatric hospital for monitoring and stabilization.
Some people in psychosis will need emergent psychiatric hospitalization to receive necessary medical stabilization.2 This is especially true if the user becomes violent or presents as a danger to themselves or others. While antipsychotic medications, such as olanzapine and haloperidol, can provide immediate relief for psychotic symptoms, no evidence exists to demonstrate whether they can prevent a relapse of psychotic symptoms.2
In acute psychosis, the user’s vital signs will be closely observed, as stimulants can rapidly increase heart rate, blood pressure, and body temperature.8 Furthermore, because stimulant overdose can occur, the user may present at risk for cardiac arrhythmia, seizures, and stroke.10 Due to the potentially fatal risks of acute stimulant intoxication and psychosis, 24-hour care may be indicated in order to provide the person with adequate supervision and treatment.
Once medically stabilized, the user may be assessed for stimulant addiction and receive appropriate referrals for substance abuse treatment and care. At this time, receiving treatment is critical, as stimulant withdrawal can induce violence and suicidal thoughts. Symptoms of psychosis can persist within the initial few weeks of abstinence.10
Other concerning stimulant withdrawal symptoms may include:10
Often, a combination of both behavioral and pharmacological approaches can help people struggling with addiction. Today, there are several options available for securing appropriate treatment for stimulant use disorder:11
Twelve-step groups, which are often used as an adjunct to formal addiction treatment, provide guidance and support for anyone who wishes to stop using stimulants. Meetings are free and widely accessible throughout the United States. Today, there are many branches of 12-step groups for stimulant or polydrug users, including Narcotics Anonymous (NA), Crystal Meth Anonymous (CMA), and Cocaine Anonymous (CA).
In treatment settings, clients often receive group and individual therapy.11 Both can be highly effective in providing a safe place to explore thoughts and feelings and receive helpful and constructive feedback. Types of therapy include:11
Within the initial stages of treatment, the drug user will collaborate on an appropriate treatment plan for maintaining abstinence and changing their overall attitude and lifestyle surrounding drug use. Aftercare treatment should focus on preventing relapse, managing negative emotions, and implementing positive coping skills for stress management.11