Stimulant Use Disorder is a new diagnosis included in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, DSM-5. Stimulant Use Disorder captures a range of problems associated with the use of a wide variety of stimulant drugs, including meth, cocaine and amphetamines, but not including caffeine or nicotine. In the previous edition of the manual, known as DSM-IV-TR, problems with these drugs were reflected in the diagnoses of Stimulant Abuse and Stimulant Dependence.
Now the diagnoses have been combined, with either a mild, moderate or severe diagnosis of Stimulant Use Disorder being given, depending on how many symptoms the person has. There is now no difference in diagnosis or severity simply because the person has the physical aspects of dependence, even though previously the physical symptoms of tolerance and withdrawal were considered to be central to substance related problems.
Symptoms of Stimulant Use Disorder
The diagnosis of Stimulant Use Disorder can be given to someone who has a pattern of problematic use of amphetamine, cocaine, or other stimulants except caffeine or nicotine, leading to at least two of the following problems within a 12 month period:
- Taking more stimulants than intended.
- Unsuccessful in trying to cut down or control use of stimulants, despite wanting to do so.
- Spending excessive amounts of time to activities surrounding stimulant use.
- Urges and cravings for stimulants.
- Failing in the obligations of home, school or work.
- Carrying on taking stimulants, even though it has lead to relationship or social problems.
- Giving up or reducing important recreational, social, or work related activities because of using stimulants.
- Using stimulants in a physically hazardous way.
- Continuing to use stimulants even while knowing that it is causing or worsening a physical or psychological problem.
- Tolerance to stimulants.
- Withdrawal from stimulants if you don't take them.
What if I am Prescribed Stimulant Drugs?
Although medication addiction can happen, if you are on prescribed stimulant drugs, such as ritalin or other medications for treating ADHD, or medications for narcolepsy, then developing tolerance and withdrawal are not considered part of Stimulant Use Disorder, as long as you are taking medication as prescribed. On the other hand, if you are taking more of the medication than prescribed, or feeling you want to, you may be at risk for developing a Stimulant Use Disorder.
The best course of action if you start experiencing cravings for stimulants beyond the prescribed amount is to discuss the situation honestly with your doctor. If it appears you are vulnerable to developing medication addiction, it may make more sense to seek out other non-medication treatments, such as neurotherapy, which is an effective non-medication approach to treating ADHD.
What if I Need Stimulants to Cope With Shift Work?
While many people who develop Stimulant Use Disorder take the drugs for recreational reasons, or as an unhealthy, pro-ana method for weight loss, some people use stimulants to cope with working long or unsocial hours. Although drugs are not being used for pleasure in this context, it is still possible to develop Stimulant Use Disorder, and to become addicted.
Staying awake at night, or for longer than usual, conflicts with your body's natural rhythms, and some people are more able to adapt to this than others. Lifestyle changes, such as always setting your alarm for the same time each day, including days off, getting up rather than lying in, and always going to bed at the same time can help. Exposing your eyes to sunlight as early as possible in the daytime and exercising during the day can aso help. But if you make these changes and are still struggling to stay awake without drugs, it might be advisable to think about a change of job or even career. Stimulant Use Disorder is not only unpleasant, but can lead to serious work problems in the future, so it is better to make a change before the problem develops than to lose your job later.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, fifth edition. DSM-5. American Psychiatric Association, 2013.