What type of study is this?

September 10, 2025

DSM-5 Stimulant Use Disorder Severity, Stimulant Craving, and Other Clinical Characteristics Based on Stimulant Type (Cocaine, Methamphetamine, Nonmedical Prescription Stimulants, or Polystimulants)

Key Points

Past-year stimulant use disorder was most severe in users of crack cocaine, methamphetamine, or polystimulants.
Stimulant craving was most prevalent at 56.6% among polystimulant users, followed by methamphetamine and crack cocaine users.
Polystimulant use led to the highest rates of psychological distress and major depressive episodes.
Significantly lower odds of psychological distress and major depressive episodes were observed in non-crack cocaine users.

Abstract

Objectives: This study examined DSM-5 stimulant use disorder (StimUD) symptom severity, stimulant craving, and clinical characteristics associated with different stimulant types. Methods: Nationally representative cross-sectional data from the 2021–2022 National Survey on Drug Use and Health (N = 117,103) was analyzed to determine the past-year prevalence and adjusted odds of DSM-5 StimUD symptom severity, stimulant craving, psychological distress, suicidality, and major depressive episodes among individuals who used crack cocaine, methamphetamine, non-crack cocaine, nonmedical prescription stimulants (NPSU), or polystimulants (≥2 stimulants). Results: Past-year DSM-5 StimUD was most prevalent and severe among individuals who used crack cocaine, methamphetamine-only, or polystimulants, versus non-crack cocaine-only and NPSU-only. Stimulant craving was the most prevalent DSM-5 StimUD symptom, highest among those reporting polystimulant use (56.6%), followed by methamphetamine-only (51.2%), crack cocaine (48.0%), non-crack cocaine-only (18.6%), and NPSU-only (16.6%). Stimulant craving showed a dose-response association with more frequent use. Polystimulant use was associated with the highest rates of psychological distress, suicidal ideation, suicide attempt, and major depressive episodes. In controlled analyses, adjusted odds of impaired control, social impairment, risky use, pharmacologic indicators, and craving were greater among those using crack cocaine, methamphetamine-only, and polystimulants, relative to NPSU-only. Individuals reporting non-crack cocaine use-only had lower odds of psychological distress AOR = 0.63 (95% CI = 0.44–0.92) and major depressive episodes AOR = 0.61 (95% CI = 0.40–0.91) compared with NPSU-only. Conclusions: Individuals using different stimulant types differ in DSM-5 StimUD symptoms, craving, and other clinical characteristics, especially those engaged in crack cocaine, methamphetamine, and polystimulant use. Health care professionals should consider these differences when treating individuals who use stimulants.

Mark Helpful

Bookmark

Relay