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
|