Addiction Counselor's Guide to the Neuroscience of Stimulants
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The 2024 update on the pharmacology of stimulants, hosted by Dr. Donnelly Snipes, is part of an addiction counselor training series aimed at mental health counselors and social workers. It reviews neurotransmitters impacted by substance use, exploring mechanisms of action, symptoms, and side effects. Dopamine plays a crucial role in addiction, regulating movement, motivation, attention, and mood. Low dopamine levels can lead to depression and low energy, and antipsychotics that lower dopamine may cause individuals to use nicotine and caffeine to compensate. Dopamine is also involved in movement and reward pathways, and is secreted during the fight or flight response. Noradrenaline, part of the sympathetic nervous system, affects arousal, concentration, and memory, and stimulants trigger the stress response, increasing adrenaline levels. Serotonin, linked to depression and anxiety, regulates various bodily functions including muscle control, blood pressure, and pain, and affects sexual behavior, temperature, and hormone secretion. Neurotransmitter dysfunction can result from imbalances, nutrient deficiencies, and over-responsive receptors, leading to mood symptoms and heightened sensitivity. Misusing stimulants can cause nervous system dysregulation, and the HPA axis can develop tolerance, leading to increased substance use. Tolerance occurs when receptors stop reacting to stimuli, and cross-tolerance can develop with similar drugs. Physiological dependence means the body relies on the drug, and withdrawal symptoms occur when stopping use. Older adults have difficulty clearing substances due to slower metabolism by cytochrome P450 enzymes, and drugs like caffeine and diphenhydramine compete for these enzymes. Schedule 1 drugs have no medical use and high abuse potential, while Schedule 2-5 drugs have varying levels of medical use and abuse risk. Stimulants like cocaine, ecstasy, MDMA, bath salts, and ADHD medications are used recreationally and to prevent fatigue and suppress appetite. Stimulants trigger the HPA axis, releasing stress hormones and increasing dopamine levels by binding to presynaptic membranes. They prevent dopamine breakdown, increasing synaptic dopamine, and tolerance develops with repeated use. Combining stimulants with other drugs amplifies effects. Signs of intoxication include euphoria, energy, confidence, and alertness, while physical signs include itching, dilated pupils, and high blood pressure. Abusing stimulants can cause severe side effects like hypertensive crisis, sleep disruption, and mood issues. Withdrawal symptoms include depression, anxiety, irritability, and drug cravings, with symptoms peaking around one week. Long-term use can cause dental issues, reduced immunity, and increased inflammation. Detoxing from stimulants strains the heart and kidneys, increasing stroke risk and causing confusion and sexual dysfunction. Educating clients on the sensitivity to stimulants from herbs and medications is crucial, and cytochrome P450 enzymes help break down stimulants. Older pharmacology videos are being updated, and various substance-related videos are available on YouTube.
The 2024 update on the pharmacology of stimulants, hosted by Dr. Donnelly Snipes, is part of an addi