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How Do Stimulants Produce Euphoria?

Stimulants change the way the brain works by changing the way nerve cells communicate. Nerve cells, called neurons, send messages to each other by releasing chemicals called neurotransmitters. Neurotransmitters work by attaching to key sites on neurons called receptors. Learn more about how neurotransmitters work in the section “How Does Your Brain Communicate?”
(http://www.teens.drugabuse.gov/facts/
facts_brain1.php#brain_communicate).

There are many neurotransmitters, but dopamine is one that is directly affected by most stimulants. Dopamine makes people feel good when they do something they enjoy, like eating a piece of chocolate cake or riding a roller coaster. Stimulants cause a buildup of dopamine in the brain, which can make people who abuse stimulants feel intense pleasure and increased energy. They can also make people feel anxious and paranoid. And with repeated use, stimulants can disrupt the functioning of the brain’s dopamine system, dampening users’ ability to feel any pleasure at all. Users may try to compensate by taking more and more of the drug to experience the same pleasure.

What Are the Short-Term Effects?

In the short term, stimulants can produce feelings of tremendous joy, increased wakefulness, and decreased appetite. Users can become more talkative, energetic, or anxious and irritable. Other short-term effects of stimulants can include increased body temperature, heart rate, and blood pressure; dilated pupils; nausea; blurred vision; muscle spasms; and confusion.

Stimulants can also cause the body’s blood vessels to narrow, constricting the flow of blood, which forces the heart to work harder to pump blood through the body. The heart may work so hard that it temporarily loses its natural rhythm. This is called fibrillation and can be very dangerous because it stops the flow of blood through the body.

What Are the Long-Term Effects?

As with many other drugs of abuse, repeated stimulant abuse can cause addiction. That means that someone repeatedly seeks out and uses the drug despite its harmful effects. Repeated drug use changes the brain in ways that contribute to the drug craving and continued drug seeking and use that characterizes addiction. Other effects of long-term stimulant abuse can include paranoia, aggressiveness, extreme anorexia, thinking problems, visual and auditory hallucinations, delusions, and severe dental problems.

Repeated use of cocaine can lead to tolerance of its euphoric effects, causing the user to take higher doses or to use the drug more frequently (e.g., binge use) to get the same effects. Such use can lead to bizarre, erratic behavior. Some cocaine users experience panic attacks or episodes of full-blown paranoid psychosis, in which the individual loses touch with reality and hears sounds that aren’t there (auditory hallucinations). Different ways of using cocaine can produce different adverse effects. For example, regularly snorting cocaine can lead to hoarseness, loss of the sense of smell, nosebleeds, and a chronically runny nose. Cocaine taken orally can cause reduced blood flow, leading to bowel problems.

Repeated use of methamphetamine can cause violent behavior, mood disturbances, and psychosis, which can include paranoia, auditory hallucinations, and delusions (e.g., the sensation of insects creeping on the skin, called “formication”). The paranoia can result in homicidal and suicidal thoughts. Methamphetamine can increase a person’s sex drive and is linked to risky sexual behaviors and the transmission of infectious diseases, such as HIV. However, research also indicates that long-term methamphetamine use may be associated with decreased sexual function, at least in men.

Can These Drugs Be Lethal?

Yes, in rare instances, sudden death can occur on the first use of cocaine or unexpectedly thereafter. And, like most drugs, stimulants can be lethal when taken in large doses or mixed with other substances. Stimulant overdoses can lead to heart problems, strokes, hyperthermia (elevated body temperature), and convulsions, which if not treated immediately can result in death. Abuse of both cocaine and alcohol compounds the danger, increasing the risk of overdose.

What Are the Differences Between Cocaine and Methamphetamine?

They act in different ways to increase dopamine in the brain. Cocaine works by blocking the dopamine transporter; that is, it doesn’t allow dopamine to be recycled back into the neuron after it has done its work. Methamphetamine interferes with this recycling process as well, but it also causes too much dopamine to be released. Another difference is that cocaine disappears from the brain quickly, while methamphetamine has a much longer duration of action. The longer presence in the brain ultimately makes methamphetamine more harmful to brain cells.

If a Pregnant Woman Uses Stimulants, Will the Baby Be Hurt?

In the United States between 2006 and 2007, 22.6 percent (or 20,000) of teens ages 15 to 17 used an illicit drug during their pregnancy. Scientists have found that exposure to cocaine during fetal development may lead to subtle but significant deficits later in life, including problems with attention and information processing—abilities that are important for success in school. Research is also underway on the effects of methamphetamine use during pregnancy. So far, the data suggest that it may affect fetal growth and contribute to poor quality of movement in infants.

Research in this area is particularly difficult to interpret because it is often hard to single out a drug’s specific effects among the multiple factors that can all interact to affect maternal, fetal, and child outcomes. These factors include exposure to all drugs of abuse, including nicotine and alcohol; extent of prenatal care; possible neglect or abuse of the child; exposure to violence in the environment; socioeconomic conditions; maternal nutrition; other health conditions; and exposure to sexually transmitted diseases.

What Treatments Are Available for Stimulant Abuse?

Several behavioral therapies are effective in treating addiction to stimulants. These approaches are designed to help the person think differently, change their expectations and behaviors, and increase their skills in coping with various stresses in life. One form that is showing positive results in people addicted to either cocaine or methamphetamine is called contingency management, or motivational incentives (MI). These programs reward patients who refrain from using drugs by offering vouchers or prizes. MI may be particularly useful for helping patients to initially stop taking the drug and for helping them to stay in treatment.

Currently, there are no medications approved by the U.S. Food and Drug Administration to treat people who are addicted to stimulants, although that is an active area of research for NIDA.

What Should I Do if Someone I Know Is Abusing a Stimulant?

When someone has a drug problem, it's not always easy to know what to do. If someone you know is using stimulants, encourage him or her to talk to a parent, school guidance counselor, or other trusted adult. There are also anonymous resources, such as the National Suicide Prevention Lifeline (1-800-273-TALK) and the Treatment Referral Helpline (1-800-662-HELP).

The National Suicide Prevention Lifeline (1-800-273-TALK) is a crisis hotline that can help with a lot of issues, not just suicide. For example, anyone who feels sad, hopeless, or suicidal; family and friends who are concerned about a loved one; or anyone interested in mental health treatment referrals can call this Lifeline. Callers are connected with a professional nearby who will talk with them about what they’re feeling or concerns for other family and friends.

In addition, the Treatment Referral Helpline (1-800-662-HELP)—offered by the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment—refers callers to treatment facilities, support groups, and other local organizations that can provide help for their specific need. You can also locate treatment centers in your state by going to www.findtreatment.samhsa.gov.

Resource Materials

1.	National Institute on Drug Abuse. Mind Over Matter: Stimulants (http://teens.drugabuse.gov/mom/mom_stim1.php): NIH Pub. No. 03-3857. Bethesda, MD. NIDA, NIH, DHHS. Printed 1997. Reprinted 1998, 2000, 2003. Retrieved June 2009.
2.	National Institute on Drug Abuse. NIDA Research Report: Cocaine: Abuse and Addiction (http://www.drugabuse.gov/ResearchReports/Cocaine/Cocaine.html): NIH Pub. No. 99-4342. Bethesda, MD. NIDA, NIH, DHHS. Revised May 2009. Retrieved June 2009.
3.	National Institute on Drug Abuse. NIDA Research Report: Methamphetamine: Abuse and Addiction (http://www.drugabuse.gov/ResearchReports/methamph/ methamph.html): NIH Pub. No. 02-4210. Bethesda, MD. NIDA, NIH, DHHS. Printed April 1998. Reprinted January 2002. Revised September 2006. Retrieved June 2009.
4.	National Institute on Drug Abuse. NIDA NIDA InfoFacts: Stimulant ADHD Medications - Methylphenidate and Amphetamines (http://www.drugabuse.gov/Infofacts/ritalin.html): Bethesda, MD. NIDA, NIH, DHHS. Revised June 2009. Retrieved June 2009.
5.	National Institute on Drug Abuse. Commonly Abused Drugs (http://www.drugabuse.gov/DrugsofAbuse.html): Bethesda, MD. NIDA, NIH, DHHS. Revised December 2004. Retrieved June 2009.
6.	Office of National Drug Control Policy. Street Terms: Drugs and the Drug Trade (http://www.whitehousedrugpolicy.gov/streetterms/default.asp): Retrieved June 2009.
7.	National Institute on Drug Abuse. Monitoring the Future. National Results on Adolescent Drug Use. Overview of Key Findings 2008. (http://www.drugabuse.gov/drugpages/MTF.HTML): Bethesda, MD. NIDA, NIH, DHHS. May 2007. Retrieved June 2009.
8.	National Institute on Drug Abuse. NIDA Research Report: Prescription Drugs: Abuse and Addiction (http://www.drugabuse.gov/ResearchReports/Prescription/ Prescription.html): NIH Pub. No. 01-4881. Bethesda, MD. NIDA, NIH, DHHS. Printed 2001. Revised 2005. Retrieved June 2009.
9.	National Institute on Drug Abuse. Mind Over Matter: Methamphetamine (http://www.teens.drugabuse.gov/mom/mom_meth1.php): NIH Pub. No.03-4394. Bethesda, MD. NIDA, NIH, DHHS. Printed 1997. Reprinted 1998, 2000, 2003. Retrieved June 2009.
10.	National Institute on Drug Abuse (1998). NIDA InfoFacts: Crack and Cocaine (http://www.nida.nih.gov/Infofacts/cocaine.html): Bethesda, MD. NIDA, NIH, DHHS. Revised June 2009. Retrieved June 2009.

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