Stimulant Drugs

Also called psychostimulants, drugs that produce increased levels of mental and physical energy and alertness and an elevated mood by stimulating the central nervous system.

Stimulants are used for the treatment of certain psychiatric conditions and also used (and abused) for recreational purposes, enhanced levels of energy, and weight loss. They may be prescription or over-the-counter medications, illegal street drugs, or ingredients in commonly ingested substances, such as the caffeine in coffee or the nicotine in cigarettes. Whatever their form, stimulants increase respiration, heart rate, and blood pressure, and their abuse can cause adverse physical effects and endanger a person's health and even his or her life. An overdose of stimulants can result in chest pains, convulsions, paralysis, coma, and death.

Caffeine and nicotine

The most commonly used stimulant (and the most widely consumed drug) in the United States is caffeine. Found in coffee, tea, soft drinks, chocolate, and drugs, including pain relievers, diet pills, and cold and allergy medications, caffeine belongs to a family of drugs called methylxanthines. It works by disrupting the action of a neurotransmitter called adenosine. Since caffeine is usually consumed in food, it normally enters the body through the gastrointestinal system, passing from the intestines into the blood, which circulates it through the body. It reaches its maximum effect within 30-60 seconds from the time it is consumed, although it remains in the body for several hours. Caffeine is addictive. People who consume it regularly develop a tolerance for it, meaning that they need to ingest progressively greater amounts to continue getting the same effect. (Thus, diet pills containing caffeine lose their effectiveness after a few days, when a tolerance is established.) Caffeine causes physical dependence, producing withdrawal symptoms including anxiety, headaches, and fatigue when its use is discontinued. People who stop using caffeine also experience a craving for it, which is a sign of psychological dependence. It is generally agreed that daily caffeine consumption equal to the amount contained in one cup of coffee or soft drink (under 240 milligrams) is probably harmless, but that consumption over 600 milligrams (the amount in four cups of coffee) can cause anxiety, sleep and digestive disorders, a rapid heartbeat, and other health problems. The National College Athletic Association has limited the amount of caffeine that its players can consume.

Besides caffeine, the other stimulant widely ingested is the nicotine consumed in smoking. Both caffeine and nicotine are classified as secondary stimulants because, unlike drugs such as amphetamines and cocaine, they affect the sympathetic nervous system more than the central nervous system. Also unlike stimulants that are abused for recreational purposes, caffeine and nicotine produce only an increased energy level but not a feeling of intoxication. Nicotine acts mostly as a stimulant in new users, but long-term users claim that it relaxes them. Teenage smoking has been rising steadily throughout the 1990s. A 1995 survey of high school students by the Centers for Disease Control and Prevention found that on average 34.8% of teenagers smoke. Like users of other addictive substances, teen smokers start out thinking they will be able to control their use of cigarettes, but two-thirds of young people who smoke have tried to quit and failed. Nicotine withdrawal symptoms include anxiety, irritability, insomnia, depression, headaches, mood swings, difficulty concentrating, and changes in appetite.

Stimulants used for therapeutic purposes

Stimulant drugs have long been used to treat psychological disorders. In the past, psychiatrists used certain stimulants as antidepressants, but today this practice is confined primarily to seriously depressed patients who have failed to respond to either psychotherapy or to the wide range of other antidepressants that are currently available (and that, unlike stimulants, are not addictive). Today the primary therapeutic use of stimulants is for the treatment of attention deficit/hyperactivity disorder (ADHD) in children, and the most widely used drug is Ritalin (methylphenidate). Ritalin works by facilitating the release of the neurotransmitter norepinephrine, which improves alertness, attention span, and the ability to focus. Although it is generally considered safe and effective for the treatment of ADHD, there is still controversy surrounding the frequency with which this medication—whose use by children doubled between 1988 and 1994—is prescribed. Side effects include insomnia, appetite loss, and stomach pains. Ritalin may also produce withdrawal symptoms, including headache, irritability, nausea, and abnormal chewing movements and movements of the tongue. Other stimulants used for ADHD (usually when Ritalin doesn't work or produces too many negative side effects) are Dexedrine and Cyclert (pemoline), a stimulant similar to Ritalin. Ritalin and other stimulants have also been prescribed to prevent daytime sleep episodes in persons suffering from severe narcolepsy.

Abuse of illegal stimulants

The primary illegal stimulants used for recreational purposes are amphetamines and cocaine. Street names for various types of amphetamines include speed, uppers, dexies, bennies, ice, L.A. ice, Ecstasy, and crank. Amphetamines produce an effect similar to that of the hormone adrenaline, making its users feel awake, alert, and energetic. Drugs of this type were abused by young people as early as the 1930s, when it was popular to tear the medicated strip out of Benzedrine nasal inhalers and ingest them directly or in coffee. By the 1950s and 1960s amphetamines were widely used by people who needed to keep themselves awake through the night, such as truck drivers and night musicians, or by athletes for extra energy. Many young people used them to stay awake when they needed to cram for tests or complete school assignments. It is estimated that up to half the amphetamines sold by drug companies in the 1960s were sold illegally. After the government imposed controls on the manufacture of these drugs, they began to be produced illegally in home laboratories. Not only are these preparations vulnerable to contamination, they are often diluted by manufacturers and dealers. Many supposed amphetamines sold on the street contain mostly caffeine and other drugs, with a very small percentage of amphetamine or even none at all.

The use of amphetamines declined in the 1980s as cocaine became the drug of choice. However, in the 1990s methamphetamine (traditionally known as speed) has become newly popular, especially among middle-class suburban teenagers, in a crystalline form—known as ice, L.A. ice, or crank—that can either be smoked or snorted like cocaine. Smoking methamphetamine first became fashionable in Hawaii. Use of the drug then became widespread in California, and now it is increasing in other parts of the country. A 1994 survey conducted at the University of Michigan found that more high school seniors had used methamphetamine than cocaine. In 1993 alone, the number of emergency room admissions related to the use of this drug increased by 61%. Crank is much cheaper to produce than cocaine, so its manufacturers realize a larger profit (a pound can be produced for $700 and sold for as much as $225,000). Users like it because it reaches the brain almost immediately, and its effects last longer than those of cocaine. It produces feelings of alertness, euphoria, and increased energy. Like other amphetamines, crank also decreases appetite and promotes weight loss, making it attractive to young women, who represent 50% of the teenage market for the drug.

People taking methamphetamine, which remains in the body for as long as four days, quickly establish a tolerance for the drug and require ever greater amounts to experience the same effect. Users can become addicted within four to six months. Side effects of the drug include a dry mouth, sweating, diarrhea, insomnia, anxiety, and blurred vision. Severe reactions can include hallucinations (called "tweaking"), paranoia, and speech disorders, all of which may persist for up to two days after use of the drug. In addition to physical addiction, amphetamines produce a psychological dependency on the euphoric effects produced by these drugs, especially since when they wear off they are followed by a "crash" that produces a depression so severe it can lead to suicide.

A related stimulant, which is derived from methamphetamine, is MDMA, also known as Ecstasy. MDMA combines the characteristics of a stimulant and a psychedelic drug, producing hallucinations and enhanced feelings of sociability and closeness to others. It is less addictive than amphetamines but more dangerous. Persons have died from taking this drug; some had preexisting heart conditions, but others had no known medical problems. MDMA causes brain damage, and its use can lead to the development of panic disorder.

Cocaine is a stimulant made from the leaves of the coca plant. Its street names include coke, snow, toot, blow, stardust, nose candy, and flake. When the pure drug was first extracted from the leaves in the 19th century, its harmful effects—including addiction—weren't known, and early in the 20th century it was legally sold in medicines and soft drinks, including Coca-Cola, which originally contained small amounts of the substance (from which its name is derived). Cocaine use has been illegal since 1914. Until the 1970s it was not widely used, except among some members of the arts community. At first cocaine was largely used in a diluted powder form that was inhaled. Eventually, more potent smokable forms were developed, first "freebase" then "crack," which has been widely used since the 1980s. In 1988, the National Household Survey on Drug Abuse reported that 1 in 10 Americans had used cocaine. Of young adults between the ages of 18 and 25, one in four reported having used cocaine at some point. Cocaine also became visible as a substance abused by celebrities, including actor John Belushi (who died of a cocaine-heroin overdose), comedian Richard Pryor (who was badly burned freebasing cocaine), and Washington, D.C. mayor Marion Barry, who was forced to resign from office but was later reelected. In 1991, a government study found that 15% of high school seniors and 21% of college students had tried cocaine, and cocaine use by teenagers continued to increase significantly through the 1990s.

Cocaine produces a physical addiction by affecting the brain's chemistry and a psychological addiction because users become dependent on the confident, euphoric feeling it creates to help them cope with the stresses of daily life. Possible negative reactions to large doses of cocaine use include hallucinations, paranoia, aggressive behavior, and even psychotic "breaks" with reality. Cocaine can cause heart problems, seizures, strokes, and comas. Reactions to withdrawal from the drug are so severe that most users are unable to quit without professional help. Withdrawal symptoms, which may last for weeks, include muscle pains and spasms, shaking, fatigue, and reduced mental function. Both inpatient and outpatient programs are available to treat persons for cocaine addiction.