Episodic use tends to be separated by 2 or more days of non—use (e.g., intense use over a weekend or on one or more weekdays). "Binges" involve continuous high-dose use over hours or days and are often associated with physical dependence. Binges usually termi- nate only when stimulant supplies are depleted or exhaustion ensues. Chronic daily use may involve high or low doses, often with an increase in dose over time.
Stimulant smoking and intravenous use are associated with rapid progression to se- vere-level stimulant use disorder, often occurring over weeks to months. Intranasal use of cocaine and oral use of amphetamine-type stimulants result in more gradual progression occurring over months to years. With continuing use, there is a diminution of pleasurable effects due to tolerance and an increase in dysphoric effects.
Temperamental. Comorbid bipolar disorder, schizophrenia, antisocial personality disor- der, and other substance use disorders are risk factors for developing stimulant use disorder and for relapse to cocaine use in treatment samples. Also, impulsivity and similar personality traits may affect treatment outcomes. Childhood conduct disorder and adult antisocial per- sonality disorder are associated with the later development of stimulant—related disorders.
Environmental. Predictors of cocaine use among teenagers include prenatal cocaine ex- posure, postnatal cocaine use by parents, and exposure to community Violence during childhood. For youths, especially females, risk factors include living in an unstable home environment, having a psychiatric condition, and associating with dealers and users.
Stimulant use—attendant disorders affect all racial / ethnic, socioeconomic, age, and gender groups. Diagnostic issues may be related to societal consequences (e.g., arrest, school sus- pensions, employment suspension). Despite small variations, cocaine and other stimulant use disorder diagnostic criteria perform equally across gender and race/ethnicity groups.
Chronic use of cocaine impairs cardiac left ventricular function in African Americans.
Approximately 66% of individuals admitted for primary methamphetamine/amphet- amine-related disorders are non-Hispanic white, followed by 21% of Hispanic origin, 3%
Asian and Pacific Islander, and 3% non-Hispanic black.
Benzoylecgonine, a metabolite of cocaine, typically remains in the urine for 1—3 days after a single dose and may be present for 7—12 days in individuals using repeated high doses.
Mildly elevated liver function tests can be present in cocaine injectors or users with con- comitant alcohol use. There are no neurobiological markers of diagnostic utility. Discon- tinuation of chronic cocaine use may be associated with electroencephalographic changes, suggesting persistent abnormalities; alterations in secretion patterns of prolactin; and downregulation of dopamine receptors.
Short-half—life amphetamine-type stimulants (MDMA [3,4-methylenedioxy-N-methyl- amphetamine], methamphetamine) can be detected for 1—3 days, and possibly up to 4 days depending on dosage and metabolism. Hair samples can be used to detect presence of am- phetamine~type stimulants for up to 90 days. Other laboratory findings, as well as physical findings and other medical conditions (e.g., weight loss, malnutrition; poor hygiene), are similar for both cocaine and amphetamine-type stimulant use disorder.
Functional Consequences of Stimulant Use Disorder