Stimulants: Caffeine, Cocaine, Amphetamine, and Other Stimulants

Abstract

The term stimulant refers to a diverse array of natural and synthetic compounds whose use results in varying degrees of euphoria, as well as heightened attention, wakefulness, and libido, in addition to sympathomimetic effects. Certain stimulants are FDA approved for various medical and psychiatric conditions and are therefore available via prescription. While some stimulants have relatively benign physiological profiles, such as caffeine, use of other stimulants such as amphetamines or cocaine can result in significant negative physiological and/or psychiatric consequences such as stroke or myocardial infarction, psychosis, and movement disorders, and also carry a high risk for physiological dependence and the development of use disorders (addiction). As a result of their non-medical and abuse potential, a robust illicit stimulant trade remains active worldwide. There are no pharmacotherapies that are FDA approved for the treatment of any stimulant use disorder, but several behavioral therapies, such as contingency management, have demonstrated promise. This chapter reviews the mechanisms of action of various stimulants, diagnostic features of different stimulant intoxication/withdrawal/use disorders, and evidence-based treatment modalities for these diagnostic entities. The stimulants of particular focus in this chapter will be caffeine, cocaine, as well as amphetamine and amphetamine-type (AAT) stimulants.