The Health January/February 2024 | Page 18

Understanding and addressing the risks of stimulant use disorder

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18 The HEALTH | January-February . 2024

Beyond the high

Understanding and addressing the risks of stimulant use disorder

MINDTALK
BY DR ROZANIZAM ZAKARIA
AND DR HIJAZ RIDZWAN
Dr Rozanizam Zakaria is an Assistant Professor and Psychiatrist at the International Islamic University Malaysia ( IIUM ). He is pursuing his subspecialty training in child and adolescent psychiatry at Perth Children ’ s Hospital , Western Australia .
Dr Hijaz Ridzwan is an Assistant Professor and Psychiatrist at the International Islamic University Malaysia ( IIUM ). His special area of interest is addiction psychiatry .

STIMULANT drugs are a class of substances that increase alertness , attention , and energy . They primarily affect the central nervous system , leading to enhanced neural activity and increased levels of certain neurotransmitters in the brain .

Physiologically , stimulants can have various effects on the body , including increased heart rate , blood pressure , and elevated mood . Illicit stimulants are among the substances that are often abused for their euphoric effects . Common illicit stimulants include cocaine , a powerful stimulant derived from the coca plant , and methamphetamine , a synthetic stimulant that is chemically like amphetamine . They go by different street names such as ‘ ice ’, ‘ speed ,’ and ‘ coke .’
Stimulant drugs work by increasing the release or inhibiting the reuptake of certain neurotransmitters , such as dopamine and norepinephrine . While prescription stimulants , when used as directed by a healthcare professional , such as treatment of attention deficit and hyperactivity , can be safe and effective for treating specific medical conditions , the misuse or abuse of both prescription and illicit stimulants can lead to serious health consequences , including addiction , cardiovascular problems , and psychological issues .
The estimated global prevalence of cocaine use was 0 · 4 per cent and amphetamine use ( 0 · 7 per cent ), with dependence affecting 16 per cent of people who used cocaine and 11 per cent of those who used amphetamine . Stimulant use was associated with elevated mortality , increased incidence of HIV and hepatitis C infection , poor mental health , and increased risk of cardiovascular events .
HOW DOES ADDICTION OCCUR ?
Stimulant use can lead to addiction through a multifaceted process linking both physiological and psychological factors . Initially , the pleasurable effects of stimulants , such as heightened dopamine levels , reinforce the association between drug use and reward , motivating individuals to continue use . Tolerance development prompts increased drug intake to maintain looked-for effects , disrupting the brain ’ s neurotransmitter balance .
Cravings emerge , driving compulsive drugseeking behaviour , while loss of control over use and persistent negative consequences characterise the progression to addiction . Psychological dependence deepens as individuals feel they need the stimulant to cope with daily life . Without intervention , the cycle of relapse and remission will eventually lead to the chronic nature of addiction .
From the psychiatry perspective , problematic addiction to stimulants is classified as stimulant use disorder . The diagnostic criteria for stimulant use disorder are outlined in the Diagnostic and Statistical Manual of Mental Disorders , Fifth Edition ( DSM-5 ). Some common signs and symptoms of stimulant use disorder include : 1 . Taking stimulants in larger amounts or for longer periods than intended . 2 . Unsuccessful attempts to cut down or control stimulant use .
3 . Spending a significant amount of time obtaining , using , or recovering from the effects of stimulants . 4 . Craving or strong desire to use stimulants . 5 . Continued use despite knowing it contrib-
utes to physical or psychological problems . 6 . Neglecting responsibilities at work , school , or home due to stimulant use .
7 . Withdrawal symptoms when not using stimulants . Besides the primary effect of addiction , stimulant addiction also causes profound and disabling effects on mental health . Chronic stimulant use can elevate anxiety levels , induce depressive symptoms , trigger manic-like episodes , and contribute to cognitive impairment , disrupting memory and decision-making .
Psychotic symptoms , including paranoia and hallucinations , may arise , particularly with substances like methamphetamine . Mood swings , social isolation , and impaired judgment are common , impacting both interpersonal relationships and daily functioning .
Sleep disturbances , cravings , and obsessive thoughts further characterise the mental health consequences of stimulant addiction . Dual diagnoses with other mental health disorders often complicate the clinical picture .
MANAGEMENT OF STIMULANT U�E ����R�ER ��U��
The intricate nature of addiction encompasses physiological , psychological , and behavioural components . The alterations induced by stimulants on the brain ’ s reward pathways amplify treatment complexities , necessitating comprehensive and customised interventions .
At the forefront of treatment modalities for SUD are behavioural therapies . Studies have shown that individuals undergoing psychological interventions showcased reduced drug use , decreased injectable drug consumption and less high-risk practices .
Cognitive-behavioural therapy ( CBT ) is a type of psychotherapy that equips individuals with tools to identify and navigate triggers propelling drug use . CBT employs cognitive restructuring and skill development , empowering individuals to identify triggers and manage cravings effectively . CBT fosters significant reductions in stimulant use and enhances treatment retention .
Contingency Management ( CM ) is another
type of psychotherapy that rewards individuals with items like gift cards or vouchers when they achieve specific behaviours , like passing a drug test for stimulants .
Therapy alone is sometimes insufficient to fully address the issue of addiction . Even though there is limited evidence regarding the effectiveness of medicine in directly treating SUD , Medication-Assisted Treatment ( MAT ) is increasingly gaining traction . MAT integrates medications such as naltrexone with behavioural therapies .
This combination approach stabilises individuals by biologically reducing cravings withdrawal symptoms , as well as the pleasure associated with stimulant use , fostering a foundation for recovery . By harmonising both pharmacological and behavioural interventions , MAT enhances treatment retention rates and curtails illicit stimulant use .
Recovery from Substance Use Disorder ( SUD ) is supplemented by support from family as well as the community . Communities play an essential role in recovering addicts by offering tolerance and acceptance , cultivating an atmosphere conducive to recovery .
Familial relationships supply emotional sustenance , nurturing trust , fostering open communication , and establishing a supportive foundation vital for healing . Moreover , broader social networks , including friends and support groups , combat feelings of isolation by providing shared experiences and guidance .
It is also essential to address the pervasive stigma surrounding SUD , which often hampers individuals from seeking support within their communities due to misconceptions and judgment . Overcoming this stigma necessitates community education , advocacy , and fostering environments prioritising empathy over prejudice . By integrating efforts to combat stigma with robust community support , we can cultivate understanding , resilience , and holistic well-being , ensuring that no individual feels alienated but instead embraced by a supportive community .
On the prevention side , educating people , especially the younger generation , about the dangers of stimulants is crucial . Early intervention programmes , like checking for signs of drug use in schools , can help catch problems early on and lead to better recovery .
In conclusion , addressing stimulant addiction requires a holistic approach to treatment , prevention , and enhancing ongoing support . By using a comprehensive , multifaceted approach , raising awareness , and supporting those affected , we can work together to overcome challenges and promote health and well-being for everyone . - The HEALTH