Stimulants: Caffeine, Cocaine, Amphetamine, and Other Stimulants

Abstract

High-Yield Review Points • Caffeine's psychostimulatory effects are generally less than that of classical psychostimulants, and its effects are the result of A 1 and A 2A adenosine receptor antagonism. • The DSM-5 allows for formal diagnoses of Stimulant Intoxication, Stimulant Withdrawal, Other Stimulant-Induced Disorder, Unspecified Stimulant-Related Disorder, and Stimulant Use Disorder (addiction) with the categories of stimulants being amphetamine-type substances, cocaine, and other or unspecified stimulants (e.g., khât, cathinone derivatives). The DSM-5 also allows for Caffeine-Induced Disorders (e.g., anxiety and panic) as well as a characteristic Caffeine Withdrawal Syndrome. • Cocaine is a potent reuptake blocker of catecholamines, while amphet-amine and most amphetamine-type stimulants both block reuptake and function as transporter substrates that cause a greater release of intracel-lular catecholamines. • There are no FDA-approved pharmacotherapies for cocaine use disorder and for amphetamine and amphetamine-type stimulant use disorders, despite trials of many potential different pharmacotherapies for this purpose. • Psychosocial and behavioral therapies remain the mainstay of treatment for cocaine use disorder and for amphetamine and amphetamine-type stimulant use disorders, with cognitive behavioral therapies and contingency management approaches having demonstrated efficacy. 186