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STIMULANT USE DISORDERS

Stimulant Use Disorder:DSM-5 Criteria & Treatment in KY

Learn about stimulant use disorder including cocaine, meth, and prescription stimulant addiction. DSM-5 criteria, symptoms, and treatment at CommonHealth Recovery KY.

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Stimulant Use Disorder: Diagnosis, DSM-5 Criteria, and Treatment in Kentucky

Understanding Stimulant Use Disorders

How Stimulants Work

DSM-5 Diagnostic Criteria for Stimulant Use Disorder

Signs and Symptoms of Stimulant Use Disorder

Health Risks and Complications of Stimulant Use

Special Considerations

Evidence-Based Treatment for Stimulant Use Disorder

Comprehensive Treatment at CommonHealth Recovery

Recovery and Relapse Prevention

Getting Help at CommonHealth Recovery

Frequently Asked Questions

Related Programs and Resources

Stimulant Use Disorder: Diagnosis, DSM-5 Criteria, and Treatment in Kentucky

Stimulant use disorder is a substance use disorder characterized by the problematic use of stimulant drugs—including cocaine, methamphetamine, prescription stimulants like Adderall, and other substances that increase alertness, energy, and activity. Despite significant negative consequences, individuals with stimulant use disorder experience compulsive drug-seeking behavior and difficulty controlling their use.

At CommonHealth Recovery in Frankfort, Kentucky, we provide comprehensive evidence-based treatment for stimulant use disorder, including individual and group counseling, behavioral therapies, case management, and integrated mental health care to address both the addiction and underlying conditions.

Understanding Stimulant Use Disorders

Stimulants are a class of drugs that increase activity in the central nervous system (CNS), producing heightened alertness, energy, attention, elevated mood, and increased heart rate and blood pressure. While some stimulants have legitimate medical uses (such as treating ADHD or narcolepsy), their potential for misuse and addiction is significant.

Categories of Stimulant Drugs

Illicit Stimulants:

Cocaine:

  • Powder cocaine (cocaine hydrochloride) – typically snorted or dissolved and injected
  • Crack cocaine (freebase cocaine) – smokable form, produces intense, rapid high
  • Derived from coca plant leaves
  • Schedule II controlled substance

Methamphetamine (Meth):

  • Crystal meth – crystalline form, highly addictive
  • Street names: ice, crystal, glass, crank, speed
  • Can be smoked, snorted, injected, or taken orally
  • Schedule II controlled substance (pharmaceutical form: Desoxyn)

Prescription Stimulants (When Misused):

Amphetamines:

  • Adderall (amphetamine/dextroamphetamine) – prescribed for ADHD and narcolepsy
  • Dexedrine (dextroamphetamine)
  • Vyvanse (lisdexamfetamine)

Methylphenidate:

  • Ritalin, Concerta (methylphenidate) – prescribed for ADHD

Other Stimulants:

  • MDMA (Ecstasy, Molly) – synthetic stimulant with hallucinogenic properties
  • Synthetic cathinones (Bath salts) – designer stimulants, highly dangerous
  • Khat – plant-based stimulant containing cathinone

How Stimulants Work

Stimulants primarily affect three neurotransmitters in the brain:

Dopamine: Controls the brain’s reward and pleasure centers, reinforcing behaviors

Norepinephrine: Increases alertness, attention, blood pressure, heart rate, and breathing rate

Serotonin: Affects mood, appetite, and sleep (particularly with MDMA)

Stimulants increase the levels of these neurotransmitters in the brain by:

  • Increasing their release
  • Blocking their reuptake (preventing them from being reabsorbed)
  • Inhibiting enzymes that break them down

This flood of neurotransmitters produces the characteristic effects of stimulants: euphoria, increased energy, enhanced focus, confidence, and reduced appetite. However, repeated use leads to tolerance, dependence, and ultimately addiction.

DSM-5 Diagnostic Criteria for Stimulant Use Disorder

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) provides specific criteria for diagnosing stimulant use disorder. The diagnosis is made when an individual exhibits at least two of the following eleven criteria within a 12-month period:

Impaired Control

  1. Taking larger amounts or over a longer period than intended: Using stimulants in greater quantities or for a longer duration than originally planned
  2. Persistent desire or unsuccessful efforts to cut down: Wanting to reduce or stop use but being unable to do so despite repeated attempts
  3. Spending significant time obtaining, using, or recovering: A great deal of time is spent in activities necessary to obtain stimulants, use them, or recover from their effects
  4. Cravings: Experiencing strong desires or urges to use stimulants

Social Impairment

  1. Failure to fulfill major role obligations: Recurrent use resulting in failure to fulfill obligations at work, school, or home (such as repeated absences, poor performance, neglect of responsibilities)
  2. Continued use despite social or interpersonal problems: Continued use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by stimulant effects (such as arguments, relationship conflicts)
  3. Reduction of important activities: Important social, occupational, or recreational activities are given up or reduced because of stimulant use

Risky Use

  1. Recurrent use in hazardous situations: Recurrent use in situations where it is physically hazardous (such as driving while impaired, engaging in risky sexual behavior)
  2. Continued use despite physical or psychological problems: Continued use despite knowledge of having a persistent or recurrent physical or psychological problem likely caused or exacerbated by stimulants (such as cardiovascular problems, depression, anxiety, paranoia)

Pharmacological Criteria

  1. Tolerance: Defined by either:
    • A need for markedly increased amounts of stimulants to achieve intoxication or desired effect
    • A markedly diminished effect with continued use of the same amount
  2. Withdrawal: Manifested by either:
    • The characteristic withdrawal syndrome for stimulants (dysphoric mood, fatigue, vivid unpleasant dreams, insomnia or hypersomnia, increased appetite, psychomotor retardation or agitation)
    • Taking stimulants (or closely related substances) to relieve or avoid withdrawal symptoms

Severity Specifiers

The severity of stimulant use disorder is determined by the number of criteria met:

  • Mild: 2-3 criteria
  • Moderate: 4-5 criteria
  • Severe: 6 or more criteria

Note: The DSM-5 specifies whether the stimulant use disorder involves cocaine, amphetamine-type substances, or other stimulants.

Signs and Symptoms of Stimulant Use Disorder

Behavioral and Social Warning Signs

  • Using stimulants compulsively despite negative consequences
  • Spending significant time and money obtaining drugs
  • Neglecting work, school, or family responsibilities
  • Social withdrawal or exclusively associating with others who use stimulants
  • Engaging in risky behaviors (unsafe sex, driving while impaired, criminal activity)
  • Legal problems (possession charges, theft to support use)
  • Financial difficulties due to spending on drugs
  • Lying or being secretive about drug use
  • Doctor shopping for prescription stimulants
  • Crushing and snorting prescription pills
  • Loss of interest in previously enjoyed activities

Physical Signs

During Intoxication:

  • Dilated pupils
  • Increased energy and alertness
  • Rapid speech and racing thoughts
  • Decreased appetite and weight loss
  • Increased heart rate and blood pressure
  • Elevated body temperature
  • Restlessness and fidgeting
  • Jaw clenching and teeth grinding (especially with MDMA)
  • Insomnia
  • Hypersexuality

Signs of Chronic Use:

  • Significant weight loss and malnutrition
  • Dental problems (“meth mouth” with methamphetamine)
  • Skin picking and sores (especially with methamphetamine)
  • Premature aging
  • Nasal damage (if snorting)
  • Track marks (if injecting)
  • Burn marks on lips or fingers (if smoking)
  • Tolerance (needing more to achieve same effect)
  • Cardiovascular problems

Psychological Symptoms

  • Euphoria followed by depression (“crash”)
  • Anxiety and panic attacks
  • Paranoia and suspiciousness
  • Hallucinations (especially with chronic use)
  • Aggressive or violent behavior
  • Impaired judgment and impulsivity
  • Psychosis (with prolonged high-dose use)
  • Severe mood swings
  • Irritability and agitation
  • Suicidal thoughts (especially during withdrawal)

Withdrawal Symptoms

Stimulant withdrawal, sometimes called the “crash,” is characterized by:

  • Severe depression and anhedonia (inability to feel pleasure)
  • Extreme fatigue and lethargy
  • Increased appetite
  • Intense cravings for stimulants
  • Vivid, unpleasant dreams and nightmares
  • Insomnia or hypersomnia (sleeping excessively)
  • Psychomotor retardation or agitation
  • Anxiety and irritability
  • Difficulty concentrating
  • Suicidal ideation (in severe cases)

Timeline:

  • Initial crash: Hours to days after last use – extreme fatigue, depression, hunger
  • Acute withdrawal: 1-2 weeks – mood disturbances, sleep problems, cravings
  • Protracted withdrawal: Weeks to months – anhedonia, low energy, intermittent cravings

While stimulant withdrawal is not medically dangerous like alcohol or benzodiazepine withdrawal, it can be intensely uncomfortable and the severe depression can pose suicide risk. Medical and psychological support during withdrawal is important for safety and success.

Health Risks and Complications of Stimulant Use

Cardiovascular Effects

Stimulants place significant strain on the cardiovascular system:

  • Increased heart rate and blood pressure
  • Arrhythmias (irregular heartbeat)
  • Heart attack (myocardial infarction), even in young people
  • Stroke (both ischemic and hemorrhagic)
  • Cardiomyopathy (weakened heart muscle)
  • Aortic dissection (tearing of the heart’s major artery)
  • Sudden cardiac death

These risks are present even with single-use events, particularly with cocaine and methamphetamine.

Neurological Effects

  • Seizures
  • Stroke
  • Intracerebral hemorrhage (bleeding in the brain)
  • Cognitive impairment (memory problems, impaired executive function)
  • Neurotoxicity (particularly with methamphetamine – damage to dopamine and serotonin neurons)
  • Movement disorders (with chronic use)
  • Persistent psychosis (in susceptible individuals)

Psychiatric Complications

  • Stimulant-induced psychosis (paranoia, hallucinations, delusions)
  • Severe depression and anxiety
  • Panic disorder
  • Increased suicide risk
  • Aggressive and violent behavior
  • Worsening of pre-existing mental health conditions

Physical Health Complications

Respiratory:

  • Damage to nasal passages and septum (snorting cocaine)
  • Lung damage (smoking crack or meth)
  • Respiratory failure

Dental:

  • “Meth mouth” – severe tooth decay and gum disease (with methamphetamine)

Dermatological:

  • Skin picking and sores
  • Infections
  • Premature aging

Infectious Diseases:

  • HIV, hepatitis B and C (from needle sharing)
  • Bacterial infections (endocarditis, abscesses)

Gastrointestinal:

  • Reduced blood flow to intestines (mesenteric ischemia)
  • Bowel infarction

Reproductive:

  • Sexual dysfunction
  • Pregnancy complications
  • Neonatal abstinence syndrome in babies

Overdose

Stimulant overdose is a medical emergency that can be fatal.

Signs of stimulant overdose:

  • Extremely elevated heart rate and blood pressure
  • Chest pain
  • Severe agitation or panic
  • Seizures
  • Hyperthermia (dangerously high body temperature)
  • Stroke symptoms (confusion, slurred speech, weakness)
  • Heart attack symptoms (chest pain, shortness of breath)
  • Psychosis or severe paranoia
  • Loss of consciousness

If overdose is suspected, call 911 immediately. There is no reversal medication like naloxone for stimulant overdose – emergency medical treatment is essential.

Special Considerations

Prescription Stimulant Misuse

Prescription stimulant misuse (such as Adderall, Ritalin, Vyvanse) is particularly common among:

  • College students (using for academic performance)
  • Young professionals (using for work productivity)
  • Individuals with ADHD who escalate beyond prescribed doses
  • People seeking weight loss

While these medications are beneficial when used as prescribed for ADHD, misuse carries similar risks to illicit stimulants and can lead to addiction.

Polysubstance Use

Many individuals with stimulant use disorder also use other substances:

  • Alcohol or benzodiazepines to “come down” from stimulants
  • Opioids used in combination (dangerous combination)
  • Marijuana used concurrently
  • Multiple stimulants (cocaine and methamphetamine together)

Polysubstance use significantly increases health risks and complicates treatment.

Co-Occurring Mental Health Disorders

Stimulant use disorder frequently co-occurs with:

  • ADHD – individuals prescribed stimulants who develop dependence, or those self-medicating undiagnosed ADHD
  • Depression – using stimulants to self-medicate low mood
  • Anxiety disorders
  • Bipolar disorder – stimulants can trigger manic episodes
  • Antisocial personality disorder
  • Other substance use disorders

Integrated treatment addressing both stimulant use disorder and co-occurring conditions simultaneously produces the best outcomes.

Evidence-Based Treatment for Stimulant Use Disorder

Currently, there are no FDA-approved medications specifically for treating stimulant use disorder (unlike opioid use disorder, where medications like buprenorphine are available). However, comprehensive behavioral treatment combined with support services is highly effective.

Behavioral Therapies

Cognitive Behavioral Therapy (CBT):

CBT is one of the most effective treatments for stimulant use disorder. It helps individuals:

  • Identify and change thought patterns related to drug use
  • Develop coping strategies for cravings and triggers
  • Learn to recognize and avoid high-risk situations
  • Build problem-solving and decision-making skills
  • Address underlying issues contributing to use
  • Develop relapse prevention strategies

Contingency Management (CM):

CM, also called motivational incentives, uses positive reinforcement to encourage abstinence:

  • Providing tangible rewards (vouchers, prizes) for negative drug tests
  • Rewarding treatment attendance and engagement
  • Incrementally increasing rewards for sustained abstinence
  • Highly effective for stimulant use disorder

Research shows contingency management significantly improves treatment retention and abstinence rates for cocaine and methamphetamine use disorders.

The Matrix Model:

Developed specifically for stimulant use disorder, this intensive 16-week outpatient program combines:

  • Individual counseling
  • Group therapy
  • Family education
  • Drug testing
  • 12-step support
  • Relapse prevention education

The Matrix Model has strong evidence for effectiveness with methamphetamine and cocaine use disorders.

Motivational Interviewing (MI):

MI helps strengthen personal motivation and commitment to change by:

  • Exploring ambivalence about stopping stimulant use
  • Building intrinsic motivation
  • Enhancing confidence in ability to change
  • Supporting self-efficacy

Community Reinforcement Approach (CRA):

CRA helps individuals build a rewarding life without stimulants by:

  • Improving relationships and social support
  • Developing job or educational skills
  • Finding alternative reinforcing activities
  • Involving family in treatment
  • Teaching communication and problem-solving skills

Medication-Assisted Treatment Research

While no FDA-approved medications currently exist specifically for stimulant use disorder, ongoing research is exploring several possibilities:

Medications Being Studied:

  • Bupropion (antidepressant) – may reduce cravings
  • Naltrexone – may reduce reinforcing effects
  • Modafinil – may help with withdrawal and cravings
  • Topiramate (anticonvulsant) – shows some promise
  • Combination approaches – using multiple medications

Medications to Treat Co-Occurring Conditions:

While not targeting the stimulant use itself, treating co-occurring conditions is important:

  • Antidepressants (SSRIs, SNRIs) for depression and anxiety
  • Mood stabilizers for bipolar disorder
  • Antipsychotics (low dose) for persistent psychosis
  • Sleep aids (non-addictive) for insomnia during early recovery
  • ADHD medications (carefully prescribed and monitored in recovery)

At CommonHealth Recovery, we provide psychiatric care to address co-occurring conditions as part of comprehensive treatment.

Comprehensive Treatment at CommonHealth Recovery

Intensive Outpatient Program (IOP):

  • Group therapy 3-4 days per week
  • Evidence-based behavioral therapies (CBT, motivational interviewing)
  • Individual counseling
  • Drug screening to monitor progress
  • Case management
  • Family education and involvement
  • Flexible day or evening scheduling

Standard Outpatient Treatment:

  • Weekly or bi-weekly individual counseling
  • Group therapy sessions
  • Evidence-based approaches
  • Ongoing psychiatric care when needed
  • Case management as needed

Integrated Mental Health Care:

We treat co-occurring mental health conditions alongside stimulant use disorder:

  • Comprehensive psychiatric evaluation
  • Medication management when appropriate
  • Trauma-informed care for those with PTSD
  • Treatment for depression, anxiety, bipolar disorder
  • ADHD assessment and appropriate treatment

Case Management and Support Services:

  • Transportation assistance
  • Housing support and referrals
  • Employment and vocational services
  • Legal advocacy when needed
  • Insurance navigation
  • Connection to community resources
  • Peer support linkages

Family Involvement:

When appropriate, we involve family members through:

  • Family education about stimulant use disorder
  • Family therapy sessions
  • Communication skills training
  • Support for family members

Recovery and Relapse Prevention

Recovery from stimulant use disorder involves:

Early Recovery (First 3 Months):

  • Managing withdrawal symptoms (particularly anhedonia and depression)
  • Building new coping strategies
  • Avoiding triggers and high-risk situations
  • Establishing structure and routine
  • Addressing physical and mental health
  • Building support network

Mid Recovery (3-12 Months):

  • Strengthening relapse prevention skills
  • Rebuilding relationships
  • Pursuing education or employment
  • Engaging in healthy activities and hobbies
  • Continued therapy and support
  • Brain healing (dopamine system recovery takes time)

Long-Term Recovery (1+ Years):

  • Sustained abstinence
  • Meaningful life without stimulants
  • Strong support system
  • Healthy coping mechanisms
  • Purpose and fulfillment
  • Continued vigilance for triggers

Understanding Relapse:

Relapse is common with stimulant use disorder but doesn’t mean failure:

  • View relapse as a learning opportunity
  • Identify what led to the relapse
  • Adjust treatment plan accordingly
  • Re-engage immediately with treatment and support
  • Don’t give up – recovery is still achievable

Keys to Preventing Relapse:

  • Identifying and avoiding triggers
  • Managing stress effectively
  • Treating co-occurring mental health conditions
  • Building a strong support network
  • Maintaining involvement in treatment/support groups
  • Developing healthy lifestyle (sleep, exercise, nutrition)
  • Finding meaning and purpose
  • Having an emergency plan

Getting Help at CommonHealth Recovery

If you or someone you love is struggling with stimulant use disorder, help is available at CommonHealth Recovery in Frankfort, Kentucky.

We serve residents throughout Central Kentucky, including Lexington, Louisville, Georgetown, Versailles, Shelbyville, and surrounding communities.

Why Choose CommonHealth Recovery

  • Evidence-Based Treatment: CBT, contingency management, motivational interviewing
  • Experienced Team: Specialists in stimulant use disorder treatment
  • Integrated Mental Health Care: Treatment for co-occurring conditions
  • Flexible Outpatient Programs: IOP and standard OP
  • Case Management: Practical support for recovery
  • Insurance Accepted: Medicaid, Medicare, commercial plans
  • Compassionate Care: Non-judgmental, supportive environment

How to Get Started

Call (502) 661-1444 to speak with our admissions team about treatment options for stimulant use disorder.

We provide confidential assessments and will work with you to develop a personalized treatment plan.

Frequently Asked Questions

Stimulant use disorder is a substance use disorder involving problematic use of stimulant drugs (cocaine, methamphetamine, prescription stimulants like Adderall) characterized by compulsive use despite harmful consequences. It’s diagnosed when an individual meets at least two of eleven specific DSM-5 criteria within a 12-month period, including loss of control, continued use despite problems, and pharmacological signs like tolerance and withdrawal.

Currently, there are no FDA-approved medications specifically for treating stimulant use disorder. However, behavioral therapies like CBT and contingency management are highly effective. Medications may be used to treat co-occurring conditions like depression or ADHD. Research is ongoing to develop medication-assisted treatments for stimulant use disorder.

Acute stimulant withdrawal typically lasts 1-2 weeks, with initial “crash” symptoms (extreme fatigue, depression, hunger) in the first few days. However, some symptoms like anhedonia (inability to feel pleasure), low energy, and intermittent cravings can persist for weeks to months. The brain’s dopamine system takes time to recover from chronic stimulant use.

Stimulant withdrawal itself is not medically dangerous like alcohol or benzodiazepine withdrawal. However, the severe depression during withdrawal can pose suicide risk, and medical/psychological support is important. Additionally, returning to use after a period of abstinence increases overdose risk due to decreased tolerance.

Cocaine and crack are the same drug (cocaine) in different forms. Powder cocaine (cocaine hydrochloride) is typically snorted or dissolved and injected. Crack cocaine is the freebase form that can be smoked, producing a more intense, rapid high. Both are highly addictive and carry similar long-term health risks.

When used as prescribed under medical supervision, ADHD medications like Adderall have relatively low addiction risk. However, misuse (taking higher doses, using in ways not prescribed, or using without a prescription) can lead to dependence and addiction. People with histories of substance use disorders may be at higher risk and should discuss alternatives with their healthcare provider.

Methamphetamine is particularly neurotoxic, causing more severe damage to dopamine and serotonin neurons than other stimulants. It also tends to be more addictive due to its potency and the intensity of the high. Methamphetamine use is associated with more severe physical effects (dental problems, skin sores, rapid aging) and psychiatric symptoms (psychosis, paranoia).

Yes, most insurance plans cover treatment for stimulant use disorder. The Mental Health Parity and Addiction Equity Act requires insurance companies to cover substance use disorder treatment at levels comparable to other medical conditions. CommonHealth Recovery accepts Medicaid, Medicare, and most commercial insurance plans.

Start Your Recovery Journey Today

Recovery from stimulant use disorder is possible with evidence-based treatment and support. Don’t wait another day.

Call CommonHealth Recovery at (502) 661-1444 to begin treatment.

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References

  1. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Arlington, VA: American Psychiatric Publishing.
  2. National Institute on Drug Abuse (NIDA). (2021). Cocaine DrugFacts. Retrieved from https://nida.nih.gov/publications/drugfacts/cocaine
  3. National Institute on Drug Abuse (NIDA). (2021). Methamphetamine DrugFacts. Retrieved from https://nida.nih.gov/publications/drugfacts/methamphetamine
  4. Substance Abuse and Mental Health Services Administration (SAMHSA). (2020). Treatment for Stimulant Use Disorders. Treatment Improvement Protocol (TIP) Series 33.
  5. Roll, J. M., et al. (2006). Contingency management for the treatment of methamphetamine use disorders. American Journal of Psychiatry, 163(11), 1993-1999.
  6. Rawson, R. A., et al. (1995). A multi-site comparison of psychosocial approaches for the treatment of methamphetamine dependence. Addiction, 99(6), 708-717.
  7. Dutra, L., et al. (2008). A meta-analytic review of psychosocial interventions for substance use disorders. American Journal of Psychiatry, 165(2), 179-187.
  8. Volkow, N. D., et al. (2001). Loss of dopamine transporters in methamphetamine abusers recovers with protracted abstinence. Journal of Neuroscience, 21(23), 9414-9418.
  9. Karila, L., et al. (2012). Pharmacological approaches to methamphetamine dependence: a focused review. British Journal of Clinical Pharmacology, 74(4), 664-673.
  10. Lee, N. K., & Rawson, R. A. (2008). A systematic review of cognitive and behavioural therapies for methamphetamine dependence. Drug and Alcohol Review, 27(3), 309-317.

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