ConditionMental health & sleep
Stimulant Use Disorder
Stimulant use disorder is a pattern of using stimulants, such as cocaine, methamphetamine, amphetamines or misused prescription ADHD medicines, that continues despite causing significant problems. Signs include cravings, using more than intended, failed attempts to cut down, and neglecting responsibilities. It raises the risk of heart attack, stroke, psychosis and overdose, especially now that many stimulants are contaminated with fentanyl. There is no approved medicine yet, but contingency management and cognitive behavioral therapy work, and recovery is common.
Also called: Stimulant addiction, cocaine use disorder, methamphetamine use disorder, amphetamine use disorder, stimulant dependence
At a glance
- What it is
- Problematic, compulsive use of stimulant drugs causing harm.
- Substances
- Cocaine, methamphetamine, amphetamines, and misused prescription stimulants.
- Signs
- Cravings, loss of control, tolerance, withdrawal crashes, neglecting life, using despite harm.
- Risks
- Heart attack, stroke, psychosis, infections, overdose (often with fentanyl).
- Treatment
- Contingency management, CBT, community reinforcement, peer support, treatment of co-occurring conditions.
When to get help
Call 911 or go to the ER
- Chest pain, a racing or irregular heartbeat, severe headache, seizure, or collapse after stimulant use
- Very high body temperature, extreme agitation, confusion or violent behavior
- Face droop, arm weakness or slurred speech (possible stroke)
- Slow or stopped breathing, blue lips or unresponsiveness: give naloxone if available (stimulants are often contaminated with fentanyl) and call 911
- Thoughts of suicide: call or text 988 (US), or call 911
See a doctor within a day or two
- Paranoia, hallucinations or hearing voices that do not settle
- Severe depression or exhaustion after stopping
- Fever, red or swollen injection sites
Book a routine appointment
- Wanting to cut down or stop but being unable to
- Using prescription stimulants in larger amounts or more often than prescribed
- Testing for HIV, hepatitis B and C, and STIs
How stimulants cause addiction
Stimulants increase dopamine, norepinephrine and serotonin in the brain, producing energy, alertness, confidence and euphoria. Cocaine blocks the reuptake of dopamine. Methamphetamine and amphetamines also force its release, causing a longer, stronger high. Repeated surges change the brain's reward and decision-making circuits, leading to cravings, tolerance and compulsive use. After a binge, a "crash" of exhaustion, low mood and cravings drives further use.
Diagnosis: DSM-5-TR criteria
Stimulant use disorder is diagnosed when at least 2 of the following occur within 12 months:
- using larger amounts or for longer than intended
- wanting or trying unsuccessfully to cut down
- spending a lot of time getting, using or recovering
- cravings
- failing to meet obligations at work, school or home
- continuing despite relationship problems caused by use
- giving up important activities
- using in physically dangerous situations
- continuing despite physical or psychological problems
- tolerance (needing more for the same effect)
- withdrawal (fatigue, sleepiness, increased appetite, low mood)
Severity: mild (2 to 3 criteria), moderate (4 to 5) or severe (6 or more). Tolerance and withdrawal do not count when stimulants are taken as prescribed under medical supervision.
Signs of stimulant misuse
- dilated pupils, fast heart rate, sweating
- talkativeness, restlessness, high energy, little sleep
- weight loss and poor appetite
- irritability, anxiety, paranoia
- nosebleeds and nasal damage (snorted cocaine)
- dental problems (methamphetamine)
- burns on lips or fingers (smoking), track marks (injecting)
- financial problems, secrecy, missing work or school
See methamphetamine abuse and cocaine abuse for drug-specific effects.
Health risks
| System | Possible harms |
|---|---|
| Heart and blood vessels | Heart attack, arrhythmias, cardiomyopathy, aortic dissection, high blood pressure |
| Brain | Stroke, seizures, cognitive problems |
| Mental health | Anxiety, depression, stimulant-induced psychosis, suicide risk |
| Infections | HIV, hepatitis B and C, skin and heart valve infections from injecting |
| Pregnancy | Placental abruption, preterm birth, low birth weight |
| Overdose | Hyperthermia, heart attack, stroke, seizures, and fatal opioid overdose from contaminated supply |
Overdose and fentanyl
Stimulant overdose deaths have risen sharply in the US, and many involve fentanyl mixed into cocaine or methamphetamine. People who use stimulants should carry naloxone, use fentanyl test strips where legal, avoid using alone, and start with small amounts.
Treatment
Behavioral treatments
- Contingency management (CM): rewards, such as vouchers or prizes, for drug-free urine tests. It is the most effective treatment for stimulant use disorder, reducing use and improving engagement.
- Cognitive behavioral therapy (CBT): identifying triggers, managing cravings, and building coping and refusal skills.
- Community reinforcement approach: making a non-drug life more rewarding through work, relationships and activities.
- Matrix Model: an intensive outpatient program combining these elements.
- Motivational interviewing to strengthen readiness for change.
- Mutual support groups: Cocaine Anonymous, Crystal Meth Anonymous, Narcotics Anonymous, SMART Recovery.
Medicines
No medicine is FDA-approved for stimulant use disorder. Specialists may consider:
- extended-release naltrexone with bupropion for methamphetamine use disorder
- other off-label options with limited evidence, such as topiramate or prescription psychostimulants under close specialist supervision
Treating co-occurring conditions
- depression, anxiety, PTSD and ADHD (with careful choice of ADHD treatment)
- other substance use, including alcohol and opioids
- infections, heart disease and dental problems
- housing, employment and legal support
Recovery
Recovery is possible, and many people reduce or stop stimulant use with sustained treatment. Relapse is common and is a signal to adjust treatment rather than a failure. Brain function and mood improve with time in recovery. In the US, the SAMHSA National Helpline (1-800-662-4357) offers free, confidential treatment referrals 24 hours a day.
Frequently asked questions
What is stimulant use disorder?
It is a medical condition in which a person keeps using stimulants such as cocaine, methamphetamine or misused prescription stimulants despite harm to their health, relationships or responsibilities. It is diagnosed using DSM-5-TR criteria.
What are the signs of stimulant use disorder?
Signs include intense cravings, using more than intended, failed attempts to stop, spending lots of time using or recovering, neglecting responsibilities, and continuing despite problems. Physical signs include weight loss, poor sleep, fast heartbeat and paranoia.
What is the best treatment for stimulant addiction?
Contingency management, which rewards drug-free tests, is the most effective treatment, especially combined with cognitive behavioral therapy and community support. There is no approved medicine, though some specialists use off-label options.
Can prescription ADHD medicine cause stimulant use disorder?
Taken as prescribed, ADHD stimulants rarely cause addiction and do not count toward the diagnosis. Misuse, such as taking higher doses, snorting or injecting, or using someone else's medicine, can lead to stimulant use disorder.
Why is naloxone recommended for people who use stimulants?
Many cocaine and methamphetamine supplies are contaminated with fentanyl, a powerful opioid. Naloxone reverses opioid overdose and can save a life. It does not reverse stimulant effects, but it is safe to give if you are unsure.
Sources
This guide was written from current patient and clinical guidance, including:
- American Psychiatric Association: DSM-5-TR criteria for stimulant use disorder
- Substance Abuse and Mental Health Services Administration (SAMHSA): Treatment of stimulant use disorders (Evidence-based resource guide)
- National Institute on Drug Abuse (NIDA): Cocaine and methamphetamine research reports
- American Society of Addiction Medicine and AAAP: Clinical practice guideline on the management of stimulant use disorder (2023)
- CDC: Stimulant overdose prevention