Stimulant Use Disorders

Stimulant use disorders are substance use disorders arising from problematic use of psychostimulants, principally cocaine and the amphetamine-type stimulants such as methamphetamine. DSM-5 groups these under a stimulant use disorder, diagnosed by the standard criteria, while ICD-11 distinguishes cocaine from other stimulants. Stimulants raise synaptic dopamine and are associated with intense craving and a withdrawal state dominated by negative mood rather than prominent physical signs.

Definition

A stimulant use disorder is a problematic pattern of psychostimulant use (such as cocaine or amphetamine-type stimulants) leading to clinically significant impairment or distress, diagnosed by the standard substance use disorder criteria and characterized by strong reinforcement and craving.

Scope

The entry covers how stimulant use disorders are classified, the dopaminergic pharmacology that underlies their reinforcing effects, and their epidemiologic significance. It is a reference and educational overview; it describes the disorders and their evidence base and does not provide diagnostic thresholds for individuals or any treatment guidance.

Core questions

• How are cocaine and amphetamine-type stimulant disorders classified?
• What pharmacological action underlies their reinforcing and addictive effects?
• What is their contribution to the global burden of substance-related harm?

Key concepts

• Cocaine
• Amphetamine-type stimulants
• Methamphetamine
• Dopamine reuptake inhibition and release
• Craving
• Stimulant withdrawal (negative affect)

Key theories

Dopaminergic reward dysregulation in stimulant addiction

A framework in which stimulants drive addiction by sharply elevating dopamine signaling in reward circuitry, with repeated use producing neuroadaptations in reward and stress systems that underlie craving and compulsive use.

Mechanisms

Stimulants increase synaptic dopamine — cocaine chiefly by blocking the dopamine transporter and amphetamines additionally by promoting dopamine release — producing strong, rapid reinforcement. Repeated use leads to neuroadaptations across reward and anti-reward circuitry that are associated with intense craving. Unlike alcohol or opioids, stimulant withdrawal is dominated by dysphoria, fatigue, and anhedonia rather than prominent autonomic physical signs, which shapes how the pharmacological criteria present in these disorders.

Clinical relevance

Stimulant use disorders contribute substantially to substance-related harm and are clinically distinctive in their craving-driven course; understanding their classification supports case identification and epidemiologic comparison. This entry is educational reference material and does not provide individual diagnostic cut-offs or any treatment guidance.

Epidemiology

Cocaine and amphetamine dependence together account for a meaningful share of the global burden of disease attributable to illicit drug use, with the predominant stimulant and the level of harm varying by region.

Evidence & guidelines

Stimulant use disorder is defined within DSM-5 (American Psychiatric Association, 2013), which combines cocaine and amphetamine-type stimulants under one disorder with a specifier, while ICD-11 separates cocaine from other stimulants. Degenhardt and Hall (2012) quantify the associated global burden.

History

Cocaine and amphetamine dependence were classified separately in earlier systems. DSM-5 (2013) introduced a combined stimulant use disorder with a specifier for the specific stimulant, reflecting their shared dopaminergic mechanism, whereas ICD-11 retained a distinction between cocaine and other stimulants.

Debates

Combining versus separating stimulant classes

DSM-5's decision to group cocaine and amphetamine-type stimulants under a single disorder contrasts with ICD-11's separation of cocaine from other stimulants, raising questions about whether their differing pharmacokinetics and clinical patterns warrant distinct diagnoses.

Key figures

• Nora Volkow
• George Koob
• Louisa Degenhardt
• Wayne Hall

Seminal works

• koob-2010
• degenhardt-2012
• apa-dsm5-2013

Frequently asked questions

Which substances are covered by stimulant use disorders?

They include cocaine and amphetamine-type stimulants such as amphetamine and methamphetamine; DSM-5 groups them under one stimulant use disorder with a specifier, while ICD-11 treats cocaine separately from other stimulants.

Why does stimulant withdrawal look different from alcohol or opioid withdrawal?

Stimulant withdrawal is dominated by low mood, fatigue, and loss of pleasure rather than the prominent physical and autonomic signs seen with alcohol or opioids, reflecting the disorders' basis in dopaminergic reward systems.