Substance-Related and Addictive Disorders
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A problematic pattern of amphetamine-type substance, cocaine, or other stimulant use leading to clinically significant impairment or distress, evidenced by at least 2 of 11 criteria spanning impaired control, social impairment, risky use, and pharmacological indicators, within a 12-month period.
Stimulant Use Disorder covers amphetamine-type substances, cocaine, and other stimulants under one diagnostic category, following the same 11-criterion structure as other substance use disorders. What distinguishes it clinically is the pattern of use and its consequences -- craving, escalating tolerance, using in hazardous situations (e.g., driving), and continued use despite clear physical or psychological problems it's causing -- rather than any single symptom in isolation. Stimulant intoxication and withdrawal each have their own distinct symptom profiles that are clinically important to recognize separately from the use disorder itself.
Onset patterns vary by specific substance and route of use; prescription stimulant misuse (e.g., diverted ADHD medication) is a distinct and clinically important pathway, particularly in adolescents and young adults, alongside illicit stimulant use.
Can range from mild role impairment to severe, life-threatening presentations (cardiovascular complications, psychosis, significant weight loss, major occupational and relationship disruption); binge patterns of use are common and associated with particularly severe acute risk.
Stimulant intoxication can include euphoria, increased energy, and in severe cases paranoia or psychotic symptoms, cardiovascular strain, or aggression; withdrawal typically includes dysphoric mood, fatigue, increased appetite, and vivid, unpleasant dreams, often referred to as a "crash."
Access, legal status, and social framing of different stimulants (prescription medications versus illicit substances) vary and can affect help-seeking and stigma; clinicians should assess the actual pattern of use and its consequences rather than assuming risk level from the substance's legal category alone.
A common misconception is that prescription stimulant use for a legitimate, monitored medical condition (like ADHD, taken as prescribed) constitutes a use disorder simply because the medication is a stimulant. The diagnosis requires a problematic pattern of use meeting the 11 criteria -- appropriately prescribed and taken medication without misuse does not, on its own, meet criteria.
If stimulant medication is being taken exactly as prescribed for a legitimate medical indication without evidence of misuse, escalation, or impairment, criteria for a use disorder are not met. If psychosis or another induced symptom is the predominant clinical concern, consider a substance-induced disorder as the more specific diagnosis.
A young adult has escalated his cocaine use over the past eight months, needing increasingly larger amounts to achieve the desired effect, has used while driving on multiple occasions, continues using despite a recent cardiac scare his physician attributed to the drug, and has unsuccessfully tried to stop twice -- meeting criteria for a severe use disorder.
Know
Stimulant Use Disorder covers amphetamine-type substances, cocaine, and other stimulants under one 11-criterion structure -- appropriately prescribed medication taken as directed does not, by itself, meet criteria.
Notice
In a case, notice escalating use, use in hazardous situations, continued use despite known harm, and unsuccessful attempts to cut down -- not simply that a stimulant is involved.
Distinguish
Distinguish from appropriately prescribed and monitored stimulant medication use, and from stimulant-induced disorders where the induced symptom, not the use pattern, is the primary clinical focus.
Recognize
2+ of 11 criteria (spanning impaired control, social impairment, risky use, tolerance, withdrawal) within a 12-month period, reflecting a problematic pattern of stimulant use causing clinically significant impairment or distress; severity specified as mild (2-3), moderate (4-5), or severe (6+) criteria met.
Distinguish
Distinguish from appropriately prescribed and monitored stimulant medication use, and from stimulant-induced disorders where the induced symptom, not the use pattern, is the primary clinical focus.
Non-problematic use (e.g., appropriately prescribed and taken stimulant medication for ADHD without misuse) does not itself qualify, since criteria require a problematic pattern with impairment; the diagnosis is about the pattern of use and its consequences, not the substance category alone. Stimulant-induced psychotic disorder or stimulant-induced anxiety disorder are diagnosed separately when those induced symptoms are the predominant, clinically significant presentation.
Students sometimes assume cannabis has no withdrawal or addictive potential at all, treating it as categorically different from stimulant use disorder rather than structurally parallel with a different symptom/withdrawal profile.
The behavioral-versus-substance addiction parallel is a recurring point of confusion; students may underestimate how closely Gambling Disorder's criteria mirror a substance use disorder's criteria precisely because gambling has no ingested substance to point to.
Learners sometimes assume all substance use disorders share a similar presentation; opioid and stimulant use disorders instead present as near-opposite clinical pictures (sedated/constricted pupils versus activated/dilated pupils), which is itself a useful teaching contrast.
Because both are described as 'stimulants' colloquially, learners sometimes assume caffeine has a parallel use-disorder diagnosis; DSM-5-TR deliberately does not include one, reflecting caffeine's different risk profile from amphetamine-type stimulants and cocaine.
Reason
Apply
Recognize Insomnia Disorder as a distinct, primary sleep complaint with daytime impairment, distinguished from sleep disturbance secondary to Generalized Anxiety Disorder and from stimulant-related sleep disruption.
Retrieve
2 question(s) reference this disorder. Practice Stimulant Use Disorder →
Master