CNS Stimulants Through Kayla's Story

Описание: Ren and I presented on CNS stimulants and connected neurobiology to real-world clinical presentation through our case study, Kayla. We explained how stimulants such as Cocaine, Methamphetamine, and Adderall XR increase activity in the central nervous system by elevating dopamine, norepinephrine, and epinephrine levels. We broke down how amphetamines disrupt normal neurotransmitter storage and release—particularly through effects on VMAT2 and monoamine transporters—leading to dopamine flooding in the reward pathway.
Using Kayla’s case, we demonstrated how these neurochemical changes show up clinically. Initially, stimulant use increases focus, energy, and emotional regulation, but chronic use leads to dopamine depletion, depressive crashes, cravings, paranoia, hyperarousal, and significant withdrawal symptoms. We also discussed short- and long-term effects, including malnutrition, cardiovascular risk, psychosis, and executive functioning impairment. We highlighted the FDA black box warning associated with Adderall XR and the medical dangers of high-dose stimulant misuse.
Clinically, Kayla meets criteria for severe stimulant use disorder under the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Her screening results (KJ, DAST, DSM-5 criteria, and ASAM dimensions) indicate high biomedical risk, significant emotional complexity (CPTSD, anorexia, OCD), high relapse potential, and an unsupportive recovery environment.
We emphasized that there is currently no FDA-approved medication specifically for stimulant use disorder, though medications like Bupropion and Naltrexone may be used off-label to support mood and cravings. Treatment planning must be trauma-informed and integrative, addressing substance use, eating disorder symptoms, trauma, parenting motivation, and relapse prevention simultaneously.
We concluded by inviting discussion around how Kayla’s trauma and eating disorder impact treatment planning and what level of care would be most appropriate given her high ASAM risk and motivation to parent.