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Stimulant use disorder matters because intoxication and the subsequent crash feel like opposite states, and recognising both phases helps explain a patient's presentation at different points. It is diagnosed as a problematic pattern of stimulant use, such as cocaine or amfetamines, causing impairment, with toleranceNeeding a larger dose of a drug over time to get the same effect.Read more →, craving, and continued use despite harm. For example, imagine a patient brought to the emergency department agitated, sweating, with dilated pupils, hours after using cocaine, then seen days later exhausted, low in mood, and sleeping far more than usual. In practice, both presentations can come from the same patient's stimulant use, just at different phases.

Intoxication produces euphoria, dilated pupils, increased energy, and at high doses or with heavy use, paranoid psychosis and formication (a sensation of insects crawling on or under the skin). The crash, or withdrawal, that follows is markedly different: dysphoria (low, unpleasant mood), hypersomnia (excessive sleepiness), increased appetite, and intense craving. Take a patient who reports vivid insects crawling under her skin during heavy cocaine use, then two days later cannot get out of bed and sleeps sixteen hours a day. In practice, that dramatic mood and energy shift from intoxication to crash is characteristic of stimulant use disorder.

• A man with cocaine-associated chest pain is treated in the emergency department. Which drug class is generally avoided?
• Which treatment has the strongest evidence for reducing cocaine use in dependence?
• A long-term intranasal cocaine user is examined. Which physical finding is most characteristic?

• Opioid intoxication, sedation and pinpoint pupils, unlike stimulant intoxication's agitation and dilated pupils.
• Stimulant crash, dysphoria and hypersomnia resolving over days, whereas a primary depressive episode persists for weeks and is not tied to recent stimulant use.
• Stimulant-induced psychosis, paranoid and linked to heavy recent use with formication, rather than the more gradual onset typical of primary schizophreniaA long-term mental illness involving episodes of psychosis such as hallucinations and delusions.Read more →.
• Alcohol intoxication, sedation and disinhibition, unlike the euphoria and dilated pupils of stimulant intoxication.

• Antipsychotics treat stimulant-induced psychosis rather than dependence itself.
• Disulfiram is licensed for alcohol dependence rather than for cocaine.
• Benzodiazepines are first-line here, since reducing sympathetic drive treats the underlying problem.
• Nitrates relieve coronary spasm and are recommended in this setting.
• Aspirin is given as for other acute coronary presentations.

• Extract the defining phenomenology, duration, severity and functional-impact clues.
• Match the pattern to the most specific diagnostic or assessment construct.
• Actively test the closest look-alike against the missing or contradictory clue.
• Choose the precise term rather than a broader category that is merely compatible.