CHAPTER 8
Use and Misuse of Central Nervous System Stimulants
LEARNING OBJECTIVES
After studying this chapter, students should be able to:
•
8.1: Understand the current medical use of stimulants
•
8.3: Comprehend the current misuse of stimulants, including the methods
of use and the effects
•
8.5: Understand the DSM criteria for stimulant-related disorders
CHAPTER OUTLINE
CNS Stimulants as Used in Medical Practice
The Amphetamine-Like Drugs
The Amphetamine Compounds
Subjective Experience of Amphetamine Use in Medical Practice
Challenges to the Use of CNS Stimulants to Treat Identified Disorders
CNS Stimulant Misuse
Scope of the Problem
Methods of CNS Stimulant Misuse and Their Effects
CNS Stimulant Misuse and the Diagnostic and Statistical Manual of Mental Disorders (5th
Edition)
CHAPTER OVERVIEW
The main purpose of this chapter is to review the history of the central nervous system (CNS)
stimulants and how they are used both by physicians and by those who misuse substances.
Thus, this chapter is split into two sections: In the first section, the medical use of these
compounds, their subjective effects, complications induced by their medicinal use, and the
challenges to their continued use will be reviewed. The second section is devoted to the misuse
of CNS stimulants, the incentives for their use, and the consequences of their misuse.
DISCUSSION QUESTONS
Break-Out Discussion #1:
Ephedrine as a legal drug: Because of a historical accident, ephedrine was introduced in an era
between the Pure Food and Drug Act of 1906, which required that manufacturers only identify
the ingredients of a compound that was sold as a medicine, and the Food, Drug, and Cosmetic
Act of 1938. This second law, passed in response to a disaster in which a toxin accidentally
The Durham-Humphrey Amendment to the Food, Drug, and Cosmetic Act of 1938 was passed in
1952. This amendment defined a pharmaceutical as a compound that required a physician’s
prescription before it could be dispensed through a licensed pharmacy. Ephedrine was defined
as an over-the-counter agent for the treatment of such conditions as nasal congestion. The CNS
stimulatory effects of ephedrine, especially when this compound was abused by long-distance
truck drivers, or students attempting to “cram” for final examinations, were quietly ignored
Questions
1. If the efforts to control methamphetamine production have failed, should the restrictions on
access to ephedrine or pseudoephedrine be lifted? Why or why not?
2. How do you think the production of methamphetamine could be stopped or reduced? Have
the efforts you think of been tried in some way in the past? How effective were they?
Break-Out Discussion #2:
Attention deficit hyperactivity disorder (ADHD): ADHD has certainly been a subject of much
controversy over the years. This condition was once thought to be a result of “toxic
motherhood” at least by mental health clinicians who leaned toward the psychoanalytic
Questions have been raised about whether ADHD is an actual disease or an excuse for parents
and teachers to avoid dealing with a troublesome child’s behavior (Whitaker, 2010). This
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23
As ludicrous as this might sound at first, the majority of cases in which ADHD is diagnosed are
based on teacher complaints, and the children only rarely demonstrate the undesirable
behaviors in a physician’s office (Whitaker, 2010).
It is important to remember that psychiatric medications are a form of chemotherapy, although
in this case the “disease” is not a form of cancer or cardiac dysfunction but a perceived
neuro/psycho/behavioral/interpersonal problem. Pharmaceuticals used to treat a disease
It has been argued that parents seek to have their children diagnosed with ADHD so that they
have a convenient excuse for the child’s misbehavior, their own lack of parenting skills, and as
justification to use the “chemical straight jacket” of psychiatric medications (Rasmussen, 2008;
Questions
1. Do you know someone who has been diagnosed with ADHD? On what was the diagnosis
based?
2. What reasons might a teacher have for reporting that a student seems to have ADHD? What
about a parent? Do you think such a diagnosis can benefit a child?
3. As demonstrated above, CNS stimulants have both legal and illegal uses. What should the
factors be in deciding whether a drug should be available legally?
References
KEY CONCEPTS AND TERMS
Norepinephrine: One of the catecholamine family of neurotransmitters. In the central nervous
system, norepinephrine serves a stimulatory function
Anorexic: Causing a state of anorexia
Reticular activating system (RAS): A small region of the brain, possibly only 100 neurons in size,
which is responsible for the individual’s ability to focus attention on the task at hand.
Blood-brain barrier: A structural component of blood vessels in the brain that blocks the
passage of many toxins, bacteria, and other substances that might cause harm to the brain
Monoamine oxidase inhibitor (MAO inhibitors, or MAOIs): Any of a number of compounds that
will block the actions of the enzyme monoamine oxidase
Tourette’s syndrome: A movement disorder in which the person will engage in repetitive,
stereotypical movements, and often engage in repetitive vocalizations
Reuptake pump: Molecular structure located in the walls of a neuron that absorb molecules of a
specific neurotransmitter after its release into the synapse for recycling by the neuron
Narcolepsy: Neurological condition in which the patient will experience sudden attacks of sleep
Pituitary gland: Structure in the brain that has been called the “master gland” in the body. It
activates a number of other glands through the release of hormones through the blood, thus
controlling growth, to cite one example
Stimulant: A term associated with many substances, including cocaine, that stimulate the
individual in some way
“Pusher”: One who sells illicit drugs
“Speed run”: When an individual injects more amphetamine every few minutes because of
tolerance to the effects of the amphetamine being misused
Statistically significant: A statistical determination that indicates the results of a research study
were not due to chance
Serotonin syndrome: A potentially life-threatening drug-induced neurological condition. In spite
of the best medical care, up to 11% of patients who develop this condition will fail to survive.
Formication: The sensation of having unseen bugs crawling on or just under the skin. This
sensation is often induced by large doses of some chemicals, such as the amphetamines or
cocaine
“Ice”: A form of methamphetamine prepared for smoking, concentrated into a crystal that
resembles a chip of ice or a piece of clear rock candy
Filler(s): When drugs are prepared for oral administration, pharmaceutical companies will mix
the active agent with compounds designed to give the pill or capsule shape and form. These
LO/STANDARDS CORRELATION CHART
A-head
LO
Standard—CACREP
CNS Stimulants as Used in
Medical Practice
8.1:
Understand
the current
medical use
of stimulants
3d: theories and etiology of addictions
and addictive behaviors
3e: biological, neurological, and
physiological factors that affect human
development, functioning, and behavior
CNS Stimulants as Used in
Medical Practice
8.2:
Understand
the
pharmacology
and
subjective
3d: theories and etiology of addictions
and addictive behaviors
3e: biological, neurological, and
physiological factors that affect human
development, functioning, and behavior
effects of
stimulants
CNS Stimulant Misuse
8.3:
Comprehend
the current
misuse of
stimulants,
including the
methods of
use and the
effects
3d: theories and etiology of addictions
and addictive behaviors
3e: biological, neurological, and
physiological factors that affect human
development, functioning, and behavior
CNS Stimulant Misuse
8.4: Describe
the
consequences
of
amphetamine
misuse
3d: theories and etiology of addictions
and addictive behaviors
3e: biological, neurological, and
physiological factors that affect human
development, functioning, and behavior
CNS Stimulant Misuse and
the Diagnostic and
Statistical Manual of
Mental Disorders, 5th
Edition
8.5: Understand the
DSM criteria for
stimulant-related
disorders
3d: theories and etiology of addictions
and addictive behaviors
3e: biological, neurological, and
physiological factors that affect human
development, functioning, and behavior