Stimulant use disorder: cocaine and amphetamine addiction, risks and help in the UK

Stimulants are drugs that speed up the brain and body. The most common in the UK are cocaine, including crack, and amphetamines such as speed. Stimulant use disorder is the clinical term for when use becomes harmful and difficult to control, with cravings, tolerance and continued use despite damage to health, work or relationships.

FRANK says cocaine is very addictive because regular use changes the way the brain releases dopamine, a chemical that makes you feel happy. It adds that cocaine is mostly known for causing psychological dependence, and that people can continue to use it just to overcome the negative after effects of using, which can lead to a binge pattern. For speed, FRANK says that if you take a lot on a regular basis you can build up a tolerance so that you need higher doses to get the same buzz or feel normal, and regular users may use more to avoid unpleasant withdrawals.

FRANK says cocaine can make you feel happy, excited, wide awake and confident, but also anxious, panicky and paranoid, and can make your heart beat faster, raise your body temperature and stop you feeling hungry. The initial high, it says, lasts around 20 to 30 minutes, with smoked crack shorter, and some people feel down, anxious and paranoid the next day or longer.

For speed, FRANK describes feeling alert, energised and wide awake, but also agitated and panicked, with effects lasting about 3 to 6 hours and a comedown that can last for days, when people often say they feel exhausted and sad.

FRANK says cocaine is risky for anyone with high blood pressure or a heart condition, but that even healthy young people can have a fit, heart attack or stroke. Overdose risk increases when cocaine is mixed with other drugs or alcohol. Snorting damages the cartilage in the nose, smoking crack can cause breathing problems and chest pains, and injecting can damage veins and cause ulcers and gangrene, with a risk of spreading HIV and hepatitis through shared equipment. FRANK also says taking cocaine in pregnancy can damage the baby and cause miscarriage, premature labour and low birth weight.

On mental health, FRANK says regular cocaine use can make people feel depressed, run-down, anxious and paranoid, and can bring previous mental health problems to the surface. Regular use of speed can lead to problems with learning and concentration, as well as anxiety, depression, irritability, aggression, paranoia and acute psychotic episodes in which a person sees or hears things that are not there. Using several stimulants at the same time puts the heart under a lot of stress.

• Chest pain, a racing or irregular heartbeat, severe headache or collapse need emergency help.

• Seeing or hearing things that are not there, or intense paranoia, needs urgent assessment.

• Low mood or suicidal thoughts during a comedown should be taken seriously.

• Injecting carries extra risks of infection, vein damage and overdose.

FRANK says frequent users find they begin to crave more of the drug, which can become an expensive habit to keep up. For speed it describes needing higher doses to get the same buzz or to feel normal, using to avoid unpleasant withdrawals, difficulty relaxing or sleeping and no appetite, and for cocaine using again to overcome the negative after effects. If you are not sure whether your use is a problem, a GP or drug service can talk through your pattern of use.

The NHS says a GP may be a good place to start and will usually refer you to your local drug service, or you can approach your local drug treatment service yourself. FRANK can help you find support near you. Charities and the NHS provide most drug treatment, and there are also private organisations that you pay for. At your first appointment staff ask about your drug use, work, family and housing, may ask for a urine or saliva sample, and agree a treatment plan with you, and you are given a keyworker.

The NHS lists talking therapies such as CBT, self-help groups such as UKNA (Narcotics Anonymous) and SMART Recovery, harm reduction including testing and treatment for hepatitis or HIV, and treatment at home or, for intensive treatment, in hospital or a residential rehabilitation service.

The NHS describes substitute medicines such as methadone and buprenorphine for dependence on heroin or another opioid, but its drug treatment page does not describe an equivalent substitute for cocaine or amphetamine. For stimulants, the treatments it lists are therefore talking therapies such as CBT, self-help groups, harm reduction and, where needed, intensive or residential treatment, planned with your keyworker.

FRANK notes that people can feel down, anxious or paranoid after cocaine and that a speed comedown can last several days, so low mood and mental health deserve attention during treatment. Tell your keyworker or GP if you have symptoms of depression, anxiety or psychosis.

Call 999 if someone has chest pain, collapses, has a fit, is extremely agitated or confused, or has overdosed after taking stimulants. FRANK says to tell the ambulance crew everything you know, as it could save their life. For mental health crises such as suicidal thoughts, call NHS 111 and choose the mental health option, or go to A&E.

Most drug treatment in the UK is provided by the NHS and charities and is free to use. Private drug and alcohol treatment is available if you want to pay. Whichever you choose, ask what the programme involves, who will monitor your physical and mental health and how it will link with your GP.