Why All Stimulant Drugs Are Damaging to Recreational Users: an Empirical Overview and Psychobiological Explanation

Aims: Stimulant drugs such as nicotine and Ecstasy/3, 4-methylenedioxymethamphetamine (MDMA) are taken for positive reasons, yet their regular use leads to deficits rather than gains. This article outlines the psychobiological rationale for this paradox.

Methods: The empirical literature on nicotine, cocaine, amphetamine, Ecstasy/MDMA, and mephedrone are reviewed. A theoretical explanation for why they are problematic to humans is then described.

Results: The acute effects of central nervous system (CNS) stimulants are typically positive, with greater alertness and emotional intensity. However, in the post-drug recovery period, the opposite feelings develop, with lethargy and low moods. All recreational stimulants cause mood fluctuation, although it is most pronounced in drugs with rapid onset and comedown (e.g. nicotine and cocaine), explaining why they are the most addictive. Parallel fluctuations occur across many psychological and neurocognitive functions, with users suffering various off-drug deficits. CNS stimulants also affect the hypothalamic-pituitary-adrenal axis, impairing sleep, disrupting homeostasis, and exacerbating psychiatric distress. Neuroimaging studies reveal altered brain activity patterns in regular users. These problems are related to lifetime usage but commence in novice users.

Conclusions: Repetitive CNS stimulation is potentially damaging to the organism, both acutely and chronically. The review describes the various psychobiological systems through which recreational stimulant drugs impair human well-being.