564 Substance-Related and Addictive Disorders
Individuals with acute intoxication may pr esent with rambling speech, headache, tran-
sient ideas of reference, and tinnitus. There may be paranoid ideati on, auditory halluci-
nations in a clear sensorium, and tactile hallucinations, which the individual usually
recognizes as drug effects. Thre ats or acting out of aggressive  behavior may occur. Depres-
sion, suicidal ideation, irritability, anhedonia,  emotional lability, or disturbances in atten-
tion and concentration commonly occur during withdrawal. Mental disturbances associated
with cocaine use usually resolve hours to days  after cessation of use but can persist for
1 month. Physiological changes during stimulant withdrawal ar e opposite to those of the
intoxication phase, sometimes including bradycardia. Temporary depressive symptoms
may meet symptomatic and duration criteria for major depressive episode. Histories con-
sistent with repeated panic attacks, social an xiety disorder (social phobia)–like behavior,
and generalized anxiety–like syndromes are co mmon, as are eating disorders. One ex-
treme instance of stimulant toxicity is st imulant-induced psychotic disorder, a disorder
that resembles schizophrenia, with delusions and hallucinations. 
Individuals with stimulant use disorder of ten develop conditioned responses to drug-
related stimuli (e.g., craving on seeing an y white powderlike substance). These responses
contribute to relapse, are difficult to extinguish, and persist after detoxification.
Depressive symptoms with su icidal ideation or behavior  can occur and are generally
the most serious problems seen during stimulant withdrawal.
Prevalence 
Stimulant use disorder: amphetamine-type stimulants. Estimated 12-month prevalence