Stimulant Withdrawal: Symptoms of Dependence

Stimulants include a wide range of substances, from a daily cup of coffee to prescription medications (e.g., dextroamphetamine) to illicit street drugs (e.g., cocaine). Across the board, stimulants are powerful drugs that can lead a person to become tolerant to them, physically dependent on them, and even addicted and unable to stop using them without substance abuse treatment help.

If you or someone you love is battling an addiction to stimulants, read on to learn about the withdrawal process. It is important to understand what you’ll go through when you decide to quit in order to prepare yourself for the process.

Understanding Stimulant Dependence

The abuse of stimulants is increasing worldwide, with approximately 37 million people using amphetamine-derived stimulants—MDMA, amphetamine (illicit and prescription), and methamphetamine—and some studies estimating as many as 40% of college students misusing prescription stimulants like Ritalin and Adderall.^1,2

In fact, among college students, stimulants are the second most commonly abused type of illicit drug, just behind marijuana.³

Many stimulants are classified as Schedule II drugs.*³ This means that while they do provide some medicinal benefits, they carry a high risk for abuse and significant physiological or psychological dependence. Abusing stimulants means using them inappropriately (outside the prescription guidelines) or recreationally to get high.

Stimulant abuse can take a number of forms such as taking higher doses than prescribed, crushing and snorting pills, mixing them with drugs and alcohol, using drugs for reasons other than prescribed (for partying instead of to treat ADHD), and injecting them.

Common prescription stimulants that are abused for their energizing and/or euphoric effects include:⁴

• Adderall.
• Dexedrine.
• Ritalin.
• Concerta.

Among illicit stimulants, cocaine and amphetamines (including meth) are the most commonly abused. In animal studies, researchers found that these stimulants are so addictive that animals will continue taking them—even if it kills them.⁵

So how do they work? When you take a stimulant, it sets in motion chemical processes in the brain, including the release of an abnormally large amount of a certain neurotransmitter, dopamine. This neurotransmitter is associated with feelings of pleasure as well as:⁶

• Satisfaction.
• Reward.
• Euphoria.
• Motivation.
• Movement.
• Cognition.

If you repeatedly misuse stimulants, you may eventually become tolerant to their effects, finding that you no longer get high with the amounts you used to take. This may lead you to increase your usual dose and/or take them more often. With these repeated and increasing doses, you may come to rely physically on these drugs.

This is known as physiological dependence, which is a condition common to people who are addicted to drugs. Once you are physically dependent on a drug, your body will need some time to readjust, and you may experience a number of less-than-optimal physical and psychological effects should you attempt to quit or decrease your use. This process is called withdrawal.

Physiological dependence is the reason that many people must begin their addiction treatment with a period of detox to manage withdrawal symptoms.

* MDMA falls under Schedule I; however, it is a somewhat atypical stimulant. It is what’s known as a substituted or methylated amphetamine; it is a synthetic drug that produces both stimulant and hallucinogenic effects.

Signs and Symptoms of Withdrawal

The abuse of stimulants typically involves a binge pattern followed by withdrawal and intense cravings.⁵ According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), stimulant withdrawal produces dysphoric mood along with 2 or more of the following symptoms:⁷

• Fatigue.
• Psychomotor retardation or agitation.
• Unpleasant dreams.
• Inability to sleep or sleeping excessively.
• Increase in appetite.

In addition, you might experience withdrawal-related depression and accompanying suicidal ideation.⁷ This can be severe and may require management by medical professionals in a detox facility equipped to manage the full spectrum of withdrawal symptoms.

Other signs and symptoms that you might experience while withdrawing from stimulants include:⁶

• Dehydration.
• Weight loss.
• Chills.
• Cravings.
• Anxiety.
• Irritability.
• Impaired memory.
• Dulled senses.
• Loss of interest in fun activities (anhedonia).
• Lack of interest in social interactions.

How Long Does Stimulant Withdrawal Last?

The effects of stimulant withdrawal vary largely from person to person and from drug to drug. The precise withdrawal timeline is influenced by pharmacokinetic factors, such as the half-life of the substance abused, but also by how long you abused the substance. For example, meth has a longer half-life than cocaine, and withdrawal may be longer if you are detoxing off of meth compared to cocaine.⁷

In general, the course of stimulant withdrawal may follow this general timeline:⁶

• Early crash phase: After you stop using stimulants, especially after using them in a binge fashion, your body will experience a crash. This may manifest with feelings of anxiety, sadness, agitation, and extreme cravings. After the initial crash, you may begin feeling mental and physical exhaustion. Depressive symptoms may begin to emerge during this time. Your thoughts may feel scattered and you might experience a “tweaking” period due to lack of sleep. If you are tweaking you may have rapid eye movements, jerky movements, extreme irritability, paranoia, and delusions.
• Middle crash phase: This phase typically lasts for 24 to 36 hours after the initial crash, and you will experience an intense desire for sleep. However, in spite of your fatigue, you may have trouble sleeping and may be extremely low on energy, both physically and mentally. Many users desperate to get some sleep may unwisely turn to alcohol, benzodiazepines, and opioids to try and get some rest, which can have dangerous and unintended consequences.
• Late crash phase: This period is characterized by excessive sleepiness during the day and long periods of nighttime sleep. When you do wake up, you might be very hungry.
• Protracted withdrawal: After early withdrawal phase described above, you may continue to experience some of the symptoms of acute withdrawal (i.e., depression, loss of energy, and decrease in interest in activities or your environment). These symptoms can intensify in the 12-96 hours after the initial crash, and they may also emerge and reemerge over a period of weeks.

With a period of detox and continued abstinence from stimulants, symptoms will alleviate and cravings should begin to lessen in intensity.

Potential Risks of Stimulant Withdrawal

Across the board, withdrawal is a difficult process to manage. Stimulant withdrawal is unlike opioid or alcohol withdrawal in that it is not life-threatening or intensely physically uncomfortable. However, you may experience very extreme mood changes, negative thoughts, and depression—which could culminate in suicidal ideas or attempts. In particular, if you are detoxing off of amphetamines, you should be monitored closely for signs of depression or suicidal ideation, so that clinicians can intervene and treat the issues appropriately.⁵

The exact stimulant you were taking impacts your withdrawal experience because certain stimulants may be associated with longer-lasting syndromes when their use is slowed or stopped. And, if you have preexisting mental health problems such as clinical depression, you may become even more depressed during the withdrawal period.

As such, it can be challenging and risky to withdraw alone in your normal environment. Seeking professional detox help can ensure your safety and your emotional and mental health during this potentially turbulent time.

Other risks during withdrawal include:⁶

• Cocaine dreams: There are reports of individuals experiencing “cocaine dreams” during early withdrawal and as late as 8 or 9 months after stopping their use of stimulants. Cocaine dreams are typically experienced by injection cocaine users, crack cocaine users, and meth users. They are usually characterized by an intense feeling that you are actually using stimulants and feeling their high. It is not unusual for people to sweat and experience other symptoms of intoxication during these dreams. These dreams can produce intense cravings to use stimulants, increasing vulnerability to relapse.
• Self-harm: Depression and withdrawal-related dysphoria can be severe among stimulant abusers. The risk of suicide may be high during the withdrawal period. Individuals already suffering from low mood due to withdrawal may also begin reflecting on how their stimulant use damaged relationships, finances, and other aspects of their life. This may increase their depression and could further increase suicide risk.
• Self-medicating: Stimulant abusers may frequently self-medicate with alcohol, benzodiazepines, and opioids. This can make withdrawal more complicated, as it may be influenced by several substances rather than just one. Given the risks associated with these drugs and their withdrawal symptoms, it is important to seek medical attention to ensure a safe detox from all substances to which you’ve developed dependence.

 Detox for Stimulant Withdrawal

If you are struggling to quit, you might begin treatment with a period of supervised detox. Depending on your needs, you might choose to detox in an inpatient facility. An inpatient facility avails a more hands-on approach, with around-the-clock supervision, progress monitoring, and access to medical care, if needed. If your stimulant dependence is relatively severe or you struggle with co-occurring mental health issues, this might be the best option for you. Inpatient facilities often cost more, but it will be worth it when you consider that being in an environment where you are closely monitored may improve your treatment outcomes.

There are different types of inpatient detox:

• Medical detox facilities will have doctors and nurses equipped to provide medical care and prescribe medications to ease your symptoms.
• Social (or non-medical) detox offers a supportive and substance-free inpatient environment, but no medications will be offered. Should an emergency arise, however, staff will initiate your transfer to an appropriate facility.

You may also detox from stimulants on an outpatient basis with the help of a doctor. If you experience any complications or issues, you can talk to your counselor or doctor during your visits. This option is less-hands on but may fit in well with your lifestyle if you have to take care of other things outside of treatment, such as school, childcare, work, or other obligations.

It is important to get help for withdrawal, especially if you have a preexisting mental health condition. Most people are curious about whether or not you can stop using stimulants cold turkey. The answer is yes, but in light of the risks involved (severe depression, suicidal thoughts, mood changes), it is best if you detox under medical supervision.⁵ It is important to get help for withdrawal, especially if you have a preexisting mental health condition. If you’re using other drugs like alcohol, opioids, or benzodiazepines to try to self-medicate from withdrawal symptoms, you absolutely must get help in a medical detox environment. These drugs can be dangerous and you may experience symptoms of withdrawal from them at the same time.⁶

Professional detox and rehab provide an entryway into substance abuse treatment with specialized support to help you clear your body and mind and learn how to change your lifestyle.

Therapy and counseling that takes place in rehab or outpatient treatment will also help to educate you on why you became addicted to stimulants in the first place. Arming yourself with knowledge and support will help you feel ready to conquer and build a new life once you are clean.

It’s never too late to enter treatment for a substance abuse disorder. If stimulants have taken over your life, you have a number of resources at your fingertips to help you get back in control of your life. Call us to learn more.

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