//Amphetamine Addiction, Withdrawal and Treatment
Amphetamine Addiction, Withdrawal and Treatment 2018-09-17T18:29:48+00:00

Amphetamine Addiction, Withdrawal and Treatment

Amphetamine Addiction

Amphetamine is a strong stimulant drug used in the treatment of attention deficit hyperactivity disorder (ADHD), narcolepsy, and obesity.  While lifestyle changes are the preferred course of action to address all three conditions, there are a number of amphetamine and substituted amphetamine drugs used as front-line treatments for these conditions.  

The drugs include:

ADHD

  • Brand Name: Adderall, Adderall XR, Adzenys ER, Adzenys XR-ODT, Aptensio XR, Concerta, Cotempla XR-ODT, Daytrana, Desoxyn, Dexedrine, Dextrostat, Dyanavel XR, Evekeo, Focalin, Focalin XR, Liquadd, Metadate CD, Metadate ER, Methylin, Methylin ER, Mydayis, ProCentra, QuilliChew ER, Quillivant XR, Ritalin, Ritalin LA, Ritalin-SR,  Strattera, Vyvanse, Zenzedi
  • Generics: amphetamine, atomoxetine, dexmethylphenidate, dextroamphetamine, lisdexamfetamine, methamphetamine, methylphenidate

Narcolepsy

  • Brand Name: Adderall, Adderall XR, Concerta, Dexedrine, Dextrostat, Evekeo, Methylin, Methylin ER, Nuvigil, ProCentra, Provigil, Ritalin, Ritalin-SR, Zenzedi    
  • Generics: amphetamine, armodafinil, desvenlafaxine, dextroamphetamine, modafinil, methylphenidate

Obesity

  • Brand Name: Adipex-P, Adipost, Atti-Plex P, Bontril, Desoxyn, Didrex, Evekeo, Fastin, Ionamin, Lomaira, Melfiat, Obezine, Oby-Cap, Phendiet, Phentercot, Phentride, Prelu-2, Qsymia, Recede, Regimex, Suprenza, T-Diet, Tenuate, Tepanil, Zantryl
  • Generics: amphetamine, benzphetamine, desvenlafaxine, methamphetamine, methylphenidate, phentermine, phendimetrazine, diethylpropion, sibutramine

Chemically, amphetamine is the racemic free base form of levoamphetamine and dextroamphetamine.  Colloquially, it refers to many combinations of “substituted amphetamine” drugs with similar chemical structure and effects as amphetamine, including many of those listed above; ephedrine and pseudoephedrine (commonly found in nasal decongestants); bupropion (a commonly-used antidepressant and smoking cessation drug); and several other pharmaceuticals and so-called “club drugs,” such as MDMA (ecstacy) and synthetic cathinones (bath salts).  Many over-the-counter (OTC) and prescription drugs classified as substituted amphetamine can lead to a false positive for amphetamine during drug testing.

All are considered psychotropic stimulants and impact the central nervous system, specifically in terms of dopamine and norepinephrine release and reuptake. All are considered highly addictive and subject to recreational abuse and misuse.  Amphetamine can be taken orally, crushed and snorted or rubbed on the gums, smoked, injected, or chewed.  The method of ingestion depends on the reason for abuse. Those abusing the drug as a study enhancer (cognitive function), for improved athletic performance (vasoconstriction), or for weight loss (appetite suppression) typically take the drug orally.  Those using it recreationally for the euphoric effects may smoke or inject the drug for a rapid “high.”    

The color and format of these drugs vary widely by manufacturer, whether brand name, generic, prescription, or illicit.  Prescription amphetamine comes in capsule or tablet form, while illicit variations can also be found in powder, paste, crystal, or liquid form. Street names also vary by formulation, though purity and the exact contents are often unknown.  Common street names for amphetamine are Addies, Bennies, Black Beauties, crosses, hearts, goey, LA Turnaround, speed, truck drivers, uppers, JIF, MPH, R-ball, Skippy, the Smart Drug, the Study Drug, kiddie speed, vitamin R, eye-openers, wake-ups, whiz, pep pills, lid openers, louee, and Dexies, among others.   

Amphetamine has been used since the 1930s for its stimulating mental and cardiovascular effects. It has been used to treat conditions such as asthma and to enhance performance for military pilots. It gained popularity with women in the 1970s as an effective tool for weight management.  Abuse of amphetamine and amphetamine-type stimulants has been on the rise since the 1990s due to the sharp increase in prescription use for the treatment of ADHD, making these drugs widely available and easily accessible.

Signs & Symptoms of Abusing Amphetamines

The largest population of users and abusers of amphetamine are teenagers and college students. These drugs are widely used by students for the enhanced cognitive effects that aid in studying, test taking, and academic activities, but are also used by student athletes for enhanced endurance and decreased fatigue. Prescription amphetamine is most commonly used for this purpose, and is generally acquired directly from someone with a prescription as opposed to other illicit means. However, because prescription amphetamine is often acquired from friends, relatives, and acquaintances, there is also an increased likelihood of improper dosing in those with a legitimate medical need for the drug.  

Signs that someone is using amphetamine includes:

  • Alertness
  • Extreme focus
  • Loss of appetite
  • Weight loss
  • Nervousness
  • Dizziness
  • Insomnia
  • Dry mouth
  • Elevated blood sugar
  • Elevated body temperature
  • Compulsive behavior

These symptoms also apply to non-prescription amphetamine-like substances, but abusers of those substances are more likely to experience impaired motor skills such as slurred speech and coordination issues.   

When abusing amphetamine and substituted amphetamine for the euphoric and aphrodisiac effects, it is often in conjunction with other drugs.  While amphetamine use is dangerous when not done under a physician’s care, it is extremely dangerous when used in recreational settings to get “high.” Amphetamine decreases the effects of depressants such as alcohol or Xanax, sedatives, or sleeping pills, which increases the risk of overdose.        

Signs of overdose include:

  • Panic
  • Aggression
  • Tremors or muscle spasms
  • Rapid breathing and heart rate
  • Dizziness or fainting
  • Seizure
  • Hyperthermia
  • Psychosis
  • Heart attack

Overdosing on amphetamine is a medical emergency, and professional treatment should be sought immediately to prevent death and reduce the risk of permanent damage to organs and tissue.  The risk of overdose and the health consequences that follow depend on the specific drug and how it was used.

Using any amphetamine or amphetamine-type drugs in conjunction with alcohol significantly increases the risk of alcohol poisoning and organ damage.  It can also pose dangerous health risks when taken in conjunction with other common medications such as blood thinners, acid reflux medications, monoamine oxidase inhibitors (MAOIs), and medications that treat migraines, seizures, and depression. Long-term use can also result in malnutrition due to the appetite suppressing side effects of the drug.

Other potential health effects from amphetamine use include an increased risk for sexually transmitted infections (STIs), HIV/AIDS, hepatitis B and C, and other infectious diseases, predominantly from sharing needles or engaging in risky sexual behavior.  

Amphetamine Withdrawal & Detox

As with other stimulants, amphetamine is subject to progressive tolerance, which means users need higher doses more often to achieve the same euphoric effects.  Subsequently, the amount and frequency of dosing impacts the severity and duration of withdrawal. Typically, amphetamine withdrawal begins as the euphoric effects fade, and is removed from the system within 24 hours.  However, the physical and emotional effects can last much longer, and the likelihood of relapse is significant without proper treatment early in the process.   

Common symptoms of amphetamine and substituted amphetamine withdrawal include:

  • Depression
  • Anxiety
  • Disrupted sleep patterns

While these are the most common symptoms, other long-term effects of abusing the drug can include damage to the heart, kidneys, and muscle tissue. In many cases, these effects are permanent.  

Unfortunately, prolonged or excessive use of amphetamine can also damage the dopamine system in the brain, leading to potentially irreversible brain damage.  The likelihood of such complications increases with prescription amphetamine use beyond the therapeutic dose, or use of non-FDA regulated, amphetamine-like substances such as MDMA and synthetic cathinones, as well as abuse of over-the-counter products containing pseudoephedrine. As a result, amphetamine or stimulant psychosis is common with prolonged abuse, and can mimic schizophrenia.       

Symptoms of psychosis may include:

  • Suicidal thoughts
  • Violent actions
  • Hallucinations
  • Delusions
  • Catatonic or non-responsive state
  • Poor hygiene
  • Self-mutilation

The likelihood of recovery from psychosis increases with abstinence, but can potentially take years, and may never result in a full recovery.    

Treatment for Amphetamine Dependence

There are currently no medications approved by the FDA for treatment of amphetamine dependence, though certain types of medication may be used in conjunction with behavioral therapy to aid recovery.  Drugs such as antidepressants may be used to diminish symptoms of withdrawal, like depression and anxiety, while other medications may be needed to address organ or cardiovascular damage or malnutrition.

The recovery program will typically focus on one of four approaches: cognitive behavioral therapy (CBT), contingency management interventions/motivational incentives, 12-step facilitation therapy, or the Matrix Model.

Cognitive behavioral therapy focuses on teaching the user coping strategies and methods for self-awareness and self-control.  It also helps the user analyze positive and negative consequences for their behavior, and teaches skills that help in avoiding relapse.

Contingency management interventions/motivational incentives make use of the user’s predisposition to addictive behavior by offering tangible rewards for continuing to participate in a treatment program and staying clean. Incentives involve a system that provides vouchers for goods or services in exchange for each clean urine sample, and prize incentives that provide cash for those reaching larger recovery milestones. This method is particularly effective for those who have previously relapsed.

12-step facilitation therapy is a group technique that focuses on affiliation to help the user abstain.  The primary focus of 12-step programs is abstinence, surrendering to a higher power, and actively participating in meetings and other group activities to help prevent relapse.  

The Matrix Model incorporates components of these and other behavioral therapies to educate, coach, and mentor participants.  This approach is thought to be the most effective, as it provides one-on-one support while the user is most vulnerable to relapse, and educates them on group programs and how to prevent relapse as they continue in recovery.

Classic conditioning is a factor in abuse of amphetamine and other stimulants, making it important to disrupt the user’s routine regardless of the chosen treatment program.  For this reason, inpatient programs can sometimes be helpful in aiding recovery and avoiding relapse.    

Parents electing to use amphetamine therapy to support treatment of a child with ADHD, or adults using it for ADHD, narcolepsy, or weight loss, should not use medication alone.  It should always be used in conjunction with behavioral therapy and making the appropriate lifestyle changes to mitigate the risk of dependence. By eating an appropriate diet, incorporating regular exercise, and participating in therapeutic programs to help address contributing environmental factors, the required dosage of amphetamine and duration of use can be limited.    

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