ADMISSION NO: 1610803021

COARSE CODE VPC4102

A. CENTRAL NERVOUS SYSTEM STIMULANT ARE ABUSIVE?

Three major types of CNS stimulant are currently abused in sport: amphetamine, cocaine and
caffeine. Each day drug type has its own characteristic mechanism of action on CNS neurons
and their associated receptors and nerve terminals. Amphetamine is widely abused in sports
requiring intense anaerobic exercise where it prolongs the tolerance to anaerobic metabolism.
It is addictive, and chronic abuse causes marked behavioral change and sometimes psychosis.
Major sports abusing amphetamine are cycling, American football, ice-hockey and baseball.
Cocaine increases tolerance to intense exercise, yet most of its chronic effects on energy
metabolism are negative. Its greatest effects seem to be as a central stimulant and the
enhancement of short-term anaerobic exercise. It is highly addictive and can cause cerebral
and cardiovascular fatalities. Caffeine enhances fatty acid metabolism leading to glucose
conservation, which appears to benefit long-distance endurance events such as skiing.
Caffeine is also addictive, and chronic abuse can lead to cardiac damage. Social abuse of
each of the three drugs is often difficult to distinguish from their abuse in sport.
B. HOW CAN WITHDRAWAL SYNDROME BE MANAGED?
Management of stimulant withdrawal Patients should drink at least 2-3 litres of water per day
during stimulant withdrawal. Multivitamin supplements containing B group vitamins and
vitamin C are recommended. Symptomatic medications should be offered as required for
aches, anxiety and other symptoms. Management of severe agitation A minority of patients
withdrawing from stimulants may become significantly distressed or agitated, presenting a
danger to themselves or others. In the first instance, attempt behavioural management
strategies. If this does not adequately calm the patient, it may be necessary to sedate him or
her using diazepam. Provide 10-20ng of diazepam every 30 minutes until the patient is
adequately sedated. No more than 120mg of diazepam should be given in a 24-hour period.
The patient should be observed during sedation and no more diazepam given if signs of
respiratory depression are observed. If agitation persists and the patient cannot be adequately
sedated with oral diazepam, transfer the patient to a hospital setting for psychiatric care.
Follow-up care Acute stimulant withdrawal is followed by a protracted withdrawal phase of
1-2 months duration, characterised by lethargy, anxiety, unstable emotions, erratic sleep
patterns and strong cravings for stimulant drugs. These symptoms may complicate the
patient's involvement in treatment and should be taken into account when planning treatment.
The preferred treatment for stimulant dependence is psychological therapy that focuses on
providing patients with skills to reduce the risk of relapse.