Amphetamine use disorder

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at August 2, 2016
StartDiseasesAmphetamine use disorder

Amphetamine use disorder is a condition in which a person is dependent on amphetamines such as crystal meth, speed, or diet pills. Amphetamines are highly addictive and difficult to quit. Those suffering from the disorder have great difficulty in curing themselves but with proper treatment and support, many are able to recover.

Contents

Definition & Facts 

Up to 56 million people in the world take amphetamines, the majority of them being male. Those suffering from amphetamine use disorder have built up a tolerance and go through drug withdrawals if they abstain from taking the drug. They are not only physically dependent on the drug but suffer many adverse effects upon their health and well-being as a result of their drug abuse.

In the Diagnostic and Statistical Manual of Mental Disorders, amphetamine use disorder combines two previously separated classifications: amphetamine dependence and amphetamine abuse. Cocaine and amphetamines have very similar effects and symptoms. Sometimes they are grouped together and referred to as stimulant-use disorder though cocaine also has its own classification in the DSM as cocaine use disorder which collates cocaine dependence and cocaine abuse.

Amphetamines are extremely dangerous even for those who do not go on to develop an addiction. Use can cause sudden death, even among those taking the drugs for the first time. Amphetamines users are susceptible to seizure, stroke, or heart attack.

People who develop amphetamine use disorder can often end up with other conditions such as HIV, dangerous weight loss, and cardiovascular disease. Those with amphetamine use disorder tend to suffer from more severe mental disorders and health problems than those who abuse cocaine.

The most commonly abused amphetamine is crystal meth. It can be snorted, smoked, swallowed or taken intravenously. Users generally abuse amphetamines a few times per day. 

Symptoms & Complaints

Amphetamine use disorder has a slew of symptoms which generally involve severe and harmful medical, psychological and social consequences of their use as well as physical dependence on the drug resulting in withdrawal symptoms. Tolerance forms among those who are physically dependent, necessitating an increase in the quantity of drugs in order to achieve the same effect or high.

Users tend to be moody. Either they are very happy, excited and hyperactive or they are irritable and easy to anger. They may have no insight or perspective on how they are behaving. Amphetamine users can develop stimulant psychosis in which they are suspicious and experience hallucinations or delusions such as hearing voices, having false beliefs or seeing things that are not there.

As a result of amphetamines' negative effects on the structure of the brain, amphetamine use disorder can result in severe neurological problems including cognitive impairment. Such chronic abusers will think and move slowly, their problem-solving skills are poor, and they get lost often. Many users also fixate on routines and repetitive movements.

Socially, amphetamine abusers have a very difficult time with school and work. Often, they are withdrawn and prefer to be alone. Many users report a lack of emotion, even in situations that normally elicit a strong emotional reaction. They have little energy, feel very depressed and no longer take pleasure in things they once found enjoyable.

When intoxicated, amphetamine abusers can be very aggressive and violent. They can partake in impulsive, risky, abusive, or neglectful behavior. Many users get involved in criminal activities such as prostitution, theft, and more.

Causes

Amphetamine use disorder can result from repeated use of amphetamines such as methamphetamine, and people start taking amphetamines for varying reasons. Some take them to experience euphoria and pleasure. Amphetamines can boost mood and energy levels significantly.

Some people use them to give them a productive edge at school or in the workplace. Others take amphetamines as a way of self-medicating; if they suffer from depression, they may try to cure themselves with illegal drugs.

Adderall® is a type of legal amphetamine that is commonly prescribed to treat attention deficit hyperactivity disorder and narcolepsy and which can be addictive. Finally, there is some evidence that many with this disorder are genetically predisposed to having it.

Diagnosis & Tests

Determining whether someone suffers from this disorder requires the help of a physician or addiction specialist trained in psychiatric diagnosis. Self-diagnosis is often misinformed or inaccurate due to patients generally lacking perspective on their own condition. Psychiatric assessments are required to establish a pattern of behavior.

Tests that are often employed include clinical urine tests. Amphetamines remain in the urine for up to four days. Hair samples could also be taken, as evidence of use remains in the follicles for three months. These tests simply establish the patient's use of amphetamines rather than the disorder itself.

The examiner will look for signs that the patient's use of amphetamines has become persistent and that it is causing great difficulties at work, school, or home. The examiner might look for physical signs like issues with the nasal septum caused by snorting. Those who smoke generally develop a cough and can end up with bronchitis.

Amphetamine users who shoot drugs will likely have needle puncture marks on their arms. Malnutrition and poor hygiene are also common indicators of those with amphetamine use disorder.

Treatment & Therapy

Those who have taken amphetamines and are having a negative physical reaction or overdose (amphetamine toxicity) should be hospitalized. Activated charcoal as well as sedatives and muscle relaxants may be administered to alleviate the effects. It may be necessary to remove the patient from any selective serotonin reuptake inhibitors (SSRI's) in order to prevent or stop serotonin syndrome.

Treatment of amphetamine use disorder involves multiple approaches though is unfortunately understudied. Medications like fluoxetine can help reduce cravings while imipramine, an antidepressant may also help those with this disorder partake successfully in behavioral therapy. The FDA has not approved any medications for treatment of amphetamine use disorder, however.

Psychotherapy or talk therapy is a standard form of treatment for disorders involving the addiction to stimulants. Cognitive behavioral therapy is a type of talk therapy that is used to treat amphetamine use disorder. Contingency management is considered a useful component of treatment that monitors behavior and offers rewards for abstinence. For example, users undergoing treatment will receive positive reinforcement upon completion of a clean urine test.

Support groups and twelve-step programs like Crystal Meth Anonymous and Narcotics Anonymous may offer social support, positive reinforcement, and a sense of accountability among recovering users. Keeping in touch with others who have stayed clean and devoting oneself to work or hobbies that give a feeling of deep purpose to one's life may help an individual with amphetamine use disorder stave off relapse.

Prevention & Prophylaxis

Experts say that the best method of prevention is education. Many who are taught at a young age about the negative effects of amphetamines are better prepared to avoid them.