Abnormal Psychology

Substance Use Disorders 391

Stimulants

In 1960, when the Beatles fi rst started playing in Germany (before they became

famous in England), they worked at a club in Hamburg called Indra, where they

had to play for 8 hours nightly. As noted earlier, they got through their performances

by taking a legal stimulant (Preludin). Band members later reported that they did

not fully realize that they were ingesting a stimulant. A bouncer at the club simply

handed pills to the boys and suggested that they take them. The pills had their ef-

fect: The musicians played for hours and then stayed up for hours afterward, going

to other clubs (Spitz, 2005). And Preludin wasn’t the only stimulant that they took.

They drank coffee and tea, and all of them smoked cigarettes, as seen in the movie

A Hard Day’s Night. These stimulants are legal, but there are others that are illegal.

We’ll consider both types.

Stimulants are named for their effect on the central nervous system—they

stimulate it, causing increased activity and arousal. Stimulants include nicotine

and amphetamines (including Ritalin), which are restricted, as well as cocaine,

crack, and MDMA (Ecstasy, or “e”), which are illegal. At low doses, a stimu-

lant can make the user feel alert, less hungry, and more energetic, mentally and

physically.

People may use stimulants repeatedly in an effort to feel more energetic. How-

ever, there is a signifi cant cost to such repeated use: a high likelihood of dependence.

Stimulants also can cause a rapid or irregular pulse and heart failure.

What Are Stimulants?

In this section we fi rst consider the illegal drugs cocaine and crack, then consider

drugs that have both legal and illegal uses—amphetamines, methamphetamines,

Ritalin, and MDMA (“Ecstasy”)—and end with a common substance that many

people may not even realize is a stimulant—nicotine.

Cocaine and Crack

Derived from the coca leaf, cocaine was a popular medicine for various ailments

in 18th-century Europe and North America. Its use was declared illegal at the

beginning of the 20th century, after it became clear that the drug—and the

quest for it—were impairing people’s ability to function; it was being abused

and leading to dependence (Rebec, 2000). Cocaine that is obtained in the form

of a powder is typically inhaled, or “snorted”; as crack, a crystalline form, it

is smoked.

Cocaine acts as a local anesthetic. Thus, when snorted, it leaves the

user’s nose feeling numb; repeated snorting can lead to diminished sense of

smell and diffi culty swallowing (NIDA, 2007b). Although the fi rst few ex-

periences of cocaine use may provide a heightened sense of well-being that

can last for up to an hour, this positive state becomes increasingly harder to

attain as tolerance develops (NIDA, 2007b).

Higher doses of cocaine bring many negative effects: paranoia, to the

point of delusions; hallucinations, such as feeling insects crawling on the body

when there are none; compulsive, repetitive behaviors such as teeth grind-

ing; and increased heart rate and blood pressure with the accompanying

risk of heart attack and sudden death. The hallucinations occur because

cocaine causes sensory neurons to fi re spontaneously. Users also lose their

appetite, so those who are abusers or dependent on the drug may develop

malnutrition. Table 9.4 lists these and additional effects of cocaine abuse. It

is common for people with cocaine dependence to have alcohol dependence

as well (Brady et al., 1995; Carroll, Rounsaville, & Bryant, 1993; Regier

et al., 1990); when these two substances are used at the same time, the risk

of sudden death increases (NIDA, 2007b).

Long-term effects

of cocaine

Medical consequences

of cocaine abuse

Addiction

Irritability and mood

disturbances

Restlessness

Paranoia

Hallucinations

Cardiovascular effects

• disturbances in heart rhythm


• heart attacks
  Respiratory effects


• chest pain


• respiratory failure
  Neurological effects


• strokes


• seizures and headaches
  Gastrointestinal complications


• abdominal pain


• nausea

Source: NIDA, 2004, p. 5.

Table 9.4 • Effects of Cocaine Abuse