Stimulant Withdrawal

To obtain a diagnosis of stimulant withdrawal, an individual must have recently stopped or significantly reduced the use of a stimulant substance after prolonged use. In addition, they must experience dysphoric mood and at least two of the following symptoms within a few hours or days of cessation:

• Sleep problems such as insomnia or hypersomnia
• Fatigue
• Increased appetite
• Vivid and unpleasant dreams
• Anxiety
• Slowed speech 
• Slowed movement
• Memory impairment
• Hallucinations³
• Body aches
• Paranoia
• Loss of interest in daily activities or interests
• Bradycardia (slowed heart rate)

These withdrawal symptoms must cause disruption or distress that impairs function in daily life, such as at home, work, or social relationships.

Symptoms of stimulant withdrawal often follow the following timeline: 

• First, immediately after cessation of a stimulant, the individual may experience an intense craving for the substance, as well as depression, agitation, or anxiety. 
• In the following few hours, specific symptoms may begin, such as hallucinations, panic, and paranoia. The individual may have difficulty sleeping. Physical symptoms may be strongest in the first week after cessation. 
• After the first week, physical symptoms may subside, but psychological cravings may grow stronger. Severe fatigue and depression may be present. 
• Days 11 through 17 may see a lessening of most symptoms, but insomnia and depression may continue. Mood swings can still be common at this time, and lack of sleep may cause hypersomnia (excessive sleeping, even during daytime hours)
• Day 18 and beyond often bring an improvement, with any remaining symptoms being mild as they continue to fade. Cravings and depression may persist, however, and may last for several weeks or months. 

Substance withdrawal is caused by the cessation or reduced use of stimulant substances after a period of prolonged or heavy use. The type and severity of symptoms can depend on several factors, including genetics, type of substance, how often it was used, and for how long it was used. 

Risk factors

Risk factors for stimulant use can include the following:

• Growing up in an unstable home or experiencing childhood trauma like physical, mental, or sexual abuse
• Having a parent who used cocaine during pregnancy
• Having other mental health conditions, such as depression, bipolar disorder, and other substance use disorders⁴
• Being a shift-worker, which can create a situation in which individuals use stimulants to stay awake

Treatment for stimulant withdrawal often involves medical supervision for managing symptoms, as they can be difficult to face without support. Medical care may be found in a hospital or inpatient medical detox clinic. Once the initial severe symptoms taper off, the individual may be referred to other treatments, such as therapy or short or long-term medication. 

Medication

There is no FDA-approved pharmacological treatment for stimulant use, but several types of medications may be used in the initial phases of detox to manage unpleasant symptoms. These medications may include the following: 

• Anti-anxiety medications may be used in the initial stages of withdrawal
• Antipsychotics may be used in the acute stage to help individuals manage any psychotic symptoms
• After the initial stages of detox, a medical professional may recommend antidepressants or other medications alongside therapy to manage depressive symptoms such as mood swings and problems with sleep
• Pain medications for headaches caused by withdrawal
• Sleep medications to treat any sleep disturbances caused by withdrawal

Consult a medical doctor before starting, changing, or stopping a medication for any condition. The information in this article is not a replacement for medical advice or diagnosis. 

Other treatment options

For any substance use disorder, community support groups may be a part of recovery. For someone who has recently gone through stimulant withdrawal, this type of group may be recommended by healthcare professionals. For example, 12-step and other programs encourage members to gather with others in recovery and engage in social activities to help them create new and healthier habits. 

Self-care

A mental health professional working with someone experiencing stimulant withdrawal may recommend several healthy lifestyle habits to aid in recovery, such as the following: 

• Maintain an active social life with people who are supporting your recovery.
• Avoid situations and people that you associate with using substances.
• Eat nutritious, well-balanced meals.
• Get moderate exercise on most days of the week.
• Engage in relaxation exercises like deep breathing, meditation, or visualization.

For those who have experienced stimulant withdrawal and are seeking to stop the use of these substances, therapy may be one of the most effective ways to support recovery. A licensed therapist can facilitate building healthy patterns of thought and behavior that help the individual avoid use. They may also work with the client to address any co-occurring mental health conditions and offer stress management techniques. 

In some areas, it may be difficult to find specialized therapy. In addition, even if that specialization is available, there may not be a significant diversity of therapists. With online therapy platforms like BetterHelp, you can fill out an online questionnaire and get matched with a therapist you can meet with via phone, video, or live chat. 

Below are other resources you can visit to find out more about stimulant withdrawal, stimulant use, and treatment available for these conditions:

• The Substance Abuse and Mental Health Services Administration (SAMHSA)
• The National Institute on Drug Abuse (NIDA)
• The US Dept of Veteran Affairs, SUD Program Locator
• Parents of Addicted Loved Ones (PAL)

For those struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

For those experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7.

A systematic review from 2020 found that the most effective, evidence-based form of treatment for stimulant use disorder continues to be contingency management (CM). Researchers add that the use of psychostimulants to aid in the treatment of stimulant-use disorder shows early promise, but more research could be necessary to determine clinical utility. 

A 2021 clinical study to assess the efficacy of naltrexone plus bupropion to treat methamphetamine use disorder saw a higher response in those who received treatment over a 12-week period than those using placebo, but the numbers were not clinically significant in this particular study. 

Below are several statistics on stimulant withdrawal:

• The estimated prevalence of cocaine use in the United States is 0.3% in adults.
• For amphetamine-type substances (prescription or illegal versions), the estimated prevalence of use in the United States is 0.2% in adults.
• Use of prescription medications that are not prescribed to the individual who uses them (taking someone else’s prescribed meds) occurs at a prevalence of around 9% in children and 5% to 35% in college-aged individuals in the United States.
• Use of intravenous stimulants is significantly more common in men than in women, with a 3:1 ratio.
• Studies have found that internet-based therapy for people with substance use disorders may sometimes be more effective than in-person modalities and has been associated with more cost-effectiveness and convenience.