Coke, crack, meth, speed. Those are some shorthand terms for different types of stimulants that belong to a highly addictive class of drugs frequently used in the United States. Stimulants increase alertness, attention and energy while also elevating blood pressure, heart rate and breathing. While stimulants such as Adderall and Ritalin are legally prescribed for conditions such as attention deficit hyperactivity disorder (ADHD), recreational versions such as cocaine and methamphetamine are illegal. 

Excessive and non-medical use of those drugs can be dangerous, and sometimes deadly. Doctors and researchers at Yale Medicine are leading the field in developing behavioral therapies to help people with stimulant use disorder stop taking those drugs. From reward-based methods to internet-based approaches, Yale Medicine is creating and enhancing treatments for stimulant users and often offering clinical trials for participants.

Some of the most well-known stimulants are:

• Cocaine, an illegal drug made from the coca plant that’s often snorted or smoked.
• Methamphetamine, an illegal and particularly potent amphetamine drug.
• Prescription stimulants such as Adderall, Dexadrine, Ritalin and Concerta, which are used to treat attention deficit hyperactivity disorder.
• MDMA, commonly known as ecstasy or Molly, which has stimulant and hallucinogenic properties.

The most common risk factors for stimulant use disorder are:

• Gender. Men are more likely than women to use almost all illicit drugs. However, women have the same risk as men to develop a substance use disorder. 
• Psychiatric disorders. People with depression, attention deficit, and other psychiatric disorders are more likely to abuse drugs, including stimulants.
• Alcohol use. Alcohol shares a common metabolite that extends the “high” of stimulant use. 

Doctors use the American Psychiatric Association’s most recent criteria for substance use disorders to identify stimulant addiction. For someone to be considered addicted to stimulants, he or she must meet at least two of 11 criteria, which include an inability to reduce consumption, cravings to use a stimulant, continuing to use a stimulant despite it causing relationship problems, and needing to use increased amounts of a stimulant to achieve the desired effect.

Stimulants increase the amount of specific neurotransmitters in the brain, including dopamine, which leads to heightened alertness and feelings of euphoria. At the same time, stimulants elevate a user’s blood pressure, heart rate and breathing. Heavy use can cause irregular heartbeat, heart failure and seizures, and,  in some cases, death.

A user coming down from the high of a stimulant may experience restlessness, anxiety and insomnia.

Cocaine and methamphetamines are highly addictive, and withdrawal symptoms include strong cravings for the drug, mood swings, insomnia, hallucinations and headaches.

Effects of chronic stimulant use may include paranoia, anxiety, confusion and decreased sexual function, as well as potential damage to the respiratory, cardiovascular and central nervous systems. Chronic methamphetamine use has additional mental and physical side effects such as aggression, hallucinations, tooth decay, sores, weight loss and aging skin. 

As with some other illegal drugs, stimulant use can increase a person’s risk of suicide.

Behavioral therapy is the most effective treatment for stimulant use disorder. One such method, contingency management, gives patients tangible rewards for positive behaviors, aiding their efforts to stop using stimulants. Cognitive behavioral therapy, which helps to identify and modify damaging thinking and behavior, can also help people overcome their addiction. For early or less severe use disorder, motivational interviews can be effective: These help to turn ambivalence about quitting into motivation to quit and can help patients fight the urge to use stimulants.

While stimulant withdrawal is not typically medically dangerous, as with alcohol or heroin withdrawal, the resulting depression, especially in amphetamine withdrawal, may be quite severe. People going through treatment should be monitored for suicidal signs. Recovering users with other mental disorders are especially at risk.

There are no approved medications to treat stimulant dependence. Treatment is a process that requires long-term attentiveness. For all substance use disorders, detoxification by itself, without follow-up care, is a waste of time and money, says Yale Medicine psychiatrist Kathleen Carroll, PhD.

Yale Medicine clinicians offer a range of behavioral therapies, including a web-based Cognitive Behavioral Therapy (CBT) program for people with stimulant use disorder.

Yale Medicine psychiatrist Kathleen Carroll, PhD, and her team have shown through studies that people who use online CBT training together with regular treatment for drug and alcohol use reduce their use more than people in standard treatment alone.

Internet-based therapies are especially important for people in rural areas, who may not have access to evidence-based therapies that integrate the best research evidence with clinical expertise and patient values.