A Complex Case of Stimulants and Related Pathologies

  • Sarah Penfold
  • Jennifer L. Pikard
  • M. Nadeem Mazhar


The use of stimulants to treat disorders such as attention deficit hyperactivity disorder (ADHD) has become commonplace, though it continues to represent a clinical complexity due to the prevalence of stimulant use disorder. Here, we present a brief review of the literature centered on a case involving both disorders and their associations. We provide a discussion of the relevant neurophysiology as well as various pharmacological agents which can be used to treat or manage symptoms.


Stimulant use disorder ADHD Cocaine Methylphenidate Modafinil 


  1. 1.
    Favrod-Coune T, Broers B. The health effect of psychostimulants: a literature review. Pharmaceuticals. 2010;3(7):2333–61.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Washington, DC: American Psychiatric Association; 2000.Google Scholar
  3. 3.
    Substance Abuse and Mental Health Services Administration. Results from the 2008 National Survey on Drug Use and Health: National Findings (Office of Applied Studies, NSDUH Series H-36, HHS Publication No. SMA 09–4434). Rockville: 2009.Google Scholar
  4. 4.
    Ciccarone D. Stimulant abuse: pharmacology, cocaine, methamphetamine, treatment, attempts at pharmacotherapy. Prim Care. 2011;38(1):41–58.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Taylor SB, Lewis CR, Olive MF. The neurocircuitry of illicit psychostimulant addiction: acute and chronic effects in humans. Subst Abuse Rehabil. 2013;4:29–43.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Gay GR. Clinical management of acute and chronic cocaine poisoning. Ann Emerg Med. 1982;11(10):562–72.CrossRefPubMedGoogle Scholar
  7. 7.
    McGregor C, Srisurapanont M, Jittiwutikarn J, Laobhripatr S, Wongtan T, White JM. The nature, time course and severity of methamphetamine withdrawal. Addiction. 2005;100(9):1320–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Anthony JC, Warner LA, Kessler RC. Comparative epidemiology of dependence on tobacco, alcohol, controlled substances, and inhalants: basic findings from the National Comorbidity Survey. Exp Clin Psychopharmacol. 1994;2(3):244.CrossRefGoogle Scholar
  9. 9.
    Flaum M, Schultz SK. When does amphetamine-induced psychosis become schizophrenia? Focus. 2003;1(2):205–10.CrossRefGoogle Scholar
  10. 10.
    Fasano A, Barra A, Nicosia P, Rinaldi F, Bria P, Bentivoglio AR, Tonioni F. Cocaine addiction: from habits to stereotypical-repetitive behaviors and punding. Drug Alcohol Depend. 2008;96(1):178–82.CrossRefPubMedGoogle Scholar
  11. 11.
    Phupong V, Darojn D. Amphetamine abuse in pregnancy: the impact on obstetric outcome. Arch Gynecol Obstet. 2007;276(2):167–70.CrossRefPubMedGoogle Scholar
  12. 12.
    Curtis EK. Meth mouth: a review of methamphetamine abuse and its oral manifestations. Gen Dent. 2005;54(2):125–9.Google Scholar
  13. 13.
    Molitor F, Truax SR, Ruiz JD, Sun RK. Association of methamphetamine use during sex with risky sexual behaviors and HIV infection among non-injection drug users. West J Med. 1998;168(2):93.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Pérez-Mañá C, Castells X, Torrens M, Capellà D, Farre M. Efficacy of psychostimulant drugs for amphetamine abuse or dependence. Cochrane Database Syst Rev. 2013;2(9):CD009695.Google Scholar
  15. 15.
    Biederman J, Monuteaux MC, Spencer T, Wilens TE, MacPherson HA, Faraone SV. Stimulant therapy and risk for subsequent substance use disorders in male adults with ADHD: a naturalistic controlled 10-year follow-up study. Am J Psychiatr. 2008;165(5):597–603.CrossRefPubMedGoogle Scholar
  16. 16.
    Kollins SH. ADHD, substance use disorders, and psychostimulant treatment current literature and treatment guidelines. J Atten Disord. 2008;12(2):115–25.CrossRefPubMedGoogle Scholar
  17. 17.
    Katusic SK, Barbaresi WJ, Colligan RC, Weaver AL, Leibson CL, Jacobsen SJ. Psychostimulant treatment and risk for substance abuse among young adults with a history of attention-deficit/hyperactivity disorder: a population-based, birth cohort study. J Child Adolesc Psychopharmacol. 2005;15(5):764–76.CrossRefPubMedGoogle Scholar
  18. 18.
    McGough JJ, Smalley SL, McCracken JT, Yang M, Del'Homme M, Lynn DE, Loo S. Psychiatric comorbidity in adult attention deficit hyperactivity disorder: findings from multiplex families. Am J Psychiatr. 2005;162(9):1621–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Kessler RC, Adler L, Barkley R, Biederman J, Conners CK, Demler O, Faraone SV, Greenhill LL, Howes MJ, Secnik K, Spencer T. The prevalence and correlates of adult ADHD in the United States: results from the national comorbidity survey replication. Am J Psychiatr. 2006;163(4):716–23.CrossRefPubMedGoogle Scholar
  20. 20.
    Park TM, Haning WF. Stimulant use disorders. Child Adolesc Psychiatr Clin N Am. 2016;25(3):461–71.CrossRefPubMedGoogle Scholar
  21. 21.
    Lee NK, Lee NK, Rawson RA, Lee NK, Rawson RA. A systematic review of cognitive and behavioural therapies for methamphetamine dependence. Drug Alcohol Rev. 2008;27(3):309–17.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Polcin DL, Bond J, Korcha R, Nayak MB, Galloway GP, Evans K. Randomized trial of intensive motivational interviewing for methamphetamine dependence. J Addict Dis. 2014;33(3):253–65.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Harstad E, Levy S. Attention-deficit/hyperactivity disorder and substance abuse. Pediatrics. 2014;134(1):e293–301.CrossRefPubMedGoogle Scholar
  24. 24.
    American Society of Addiction Medicine [Internet]. What is the ASAM Criteria. [cited 2016 Aug 15]. Available from:
  25. 25.
    Wilens TE, Adler LA, Adams J, Sgambati S, Rotrosen J, Sawtelle R, Utzinger L, Fusillo S. Misuse and diversion of stimulants prescribed for ADHD: a systematic review of the literature. J Am Acad Child Adolesc Psychiatry. 2008;47(1):21–31.CrossRefPubMedGoogle Scholar
  26. 26.
    Download Guidelines – CADDRA – Canadian ADHD Resource Alliance [Internet]. 2016 [cited 18 September 2016]. Available from:
  27. 27.
    Wilens TE, Morrison NR. The intersection of attention-deficit/hyperactivity disorder and substance abuse. Curr Opin Psychiatry. 2011;24(4):280–5.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Prescribing Drugs|Policy|Policies & Publications|​College of Physicians and Surgeons of Ontario [Internet]. 2016 [cited 1 September 2016]. Available from:

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Sarah Penfold
    • 1
  • Jennifer L. Pikard
    • 1
  • M. Nadeem Mazhar
    • 1
  1. 1.Department of PsychiatryQueen’s UniversityKingstonCanada

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