Stimulant Use Disorder

A Guide for Patients, Families and Friends

Publication Date: November 8, 2023
Last Updated: May 29, 2024

INTRODUCTION

INTRODUCTION

Addiction is a chronic illness that affects millions of people, as well as their families and communities. Across the United States overdose deaths involving stimulant use have been increasing since 2012. There are now three-times more deaths involving cocaine and twelve-times more deaths involving methamphetamine and similar drugs compared to a decade ago. Stimulants also cause serious long-term health problems including heart problems, mental health problems, and dental problems. Stimulant drugs may also contain fentanyl, which increases overdose risks. In addition, some people inject stimulants which can spread diseases such as HIV and hepatitis.

Drug Overdose Deaths Involving Stimulants

SOURCE: National Center for Health Statistics, National Vital Statistics System, mortality data file.
Like diabetes or heart disease, there is no cure for stimulant use disorder. But it can be managed. People with addiction can and do recover.

CONTINGENCY MANAGEMENT (CM)

CM is an evidence-based treatment in which patients get small rewards to encourage positive behaviors. Cash, vouchers, or prizes are given for treatment participation or progress.
Safe and effective treatments for stimulant use disorder are available. Treatment by trained clinicians can lead to a healthier way of life free from the symptoms of stimulant use disorder. This healthier way of life is referred to as recovery. CM is the most effective treatment for stimulant use disorder. CM may be combined with counseling and other support. It may also be combined with medications.

This document provides information about stimulant use disorder treatment for patients, families, and friends. It was developed by the American Society of Addiction Medicine (ASAM) and American Academy of Addiction Psychiatry (AAAP), the leading medical societies for addiction treatment. Learn more about ASAM at www.ASAM.org and AAAP at www.AAAP.org

DEFINITION OF ADDICTION*

Addiction is a treatable, chronic medical disease in which a person compulsively seeks and uses substances like drugs or alcohol, or engages in other behaviors (such as gambling) despite the harms that it causes to their health and/or their life. It is a brain disease because addiction changes how the brain works. Addiction impacts areas of the brain that control motivation, impulse control, reaction to stress, memory, and decision-making. These changes may last a long time, even after the person stops using substances. Without treatment and recovery support, addiction may keep getting worse.
*Modified from ASAM Definition of Addiction
https://www.asam.org/Quality-Science/definition-of-addiction

ASSESSMENT

ASSESSMENT

Seeking help is the first important step to recovery. The next step in the process is to meet with a clinician. A clinician is a health professional such as a physician, psychiatrist, psychologist, social worker, or nurse. During this first appointment, the clinician will determine if the patient has a stimulant use disorder and complete an assessment. The goal of the assessment is to understand the severity of the patient’s illness and their treatment needs. This helps the clinician and patient develop a treatment plan.

Getting Started

  • The clinician will ask questions to understand all the factors that contribute to the patient’s addiction. The more that is known, the better treatment can be planned with the patient. The patient will likely be asked about:
    • Current drug and alcohol use
    • Withdrawal symptoms
    • History of substance use
    • Family history of addiction and mental health problems
    • Mental health concerns
    • Physical health concerns
    • Support systems
    • Available safe, stable housing
    • Motivation for change
  • The next step is a complete physical examination to check the patient’s overall health. This includes screening for other common physical and mental health conditions. You may be asked to take a drug test as part of the physical examination.

TREATMENT OPTIONS: FOUR BROAD LEVELS OF CARE

TREATMENT OPTIONS: FOUR BROAD LEVELS OF CARE

There are many different treatment options depending on the severity of the illness and other factors.

Four Broad Levels Of Care

It’s important to discuss the different treatment options with your clinician to determine which is best for you.

CONTINUING CARE

Addiction is a chronic illness. Patients benefit from long-term care which often begins with more intensive treatment. Patients transition to less intensive care and recovery support over time. When the patient has achieved stable recovery, they should check in with their clinician once every few months to monitor their recovery and re-start care if needed.

TREATMENT OVERVIEW

TREATMENT OVERVIEW

Behavioral Treatment

  • Contingency Management (CM): CM is the most effective treatment currently available to treat stimulant use disorder. CM is an evidence-based treatment in which patients get small rewards to encourage positive behaviors. Cash, vouchers, or prizes are given for treatment participation or progress. CM can be combined with other behavioral treatments including individual counseling, group counseling, cognitive behavioral therapy (CBT), the community reinforcement approach (CRA), and the Matrix Model.
  • Cognitive Behavioral Therapy (CBT): During CBT trained clinicians help the patient to change negative thought patterns. Patients develop skills to change unwanted behavior patterns and cope with threats to recovery. CBT can be provided in individual or group therapy.
  • Community Reinforcement Approach (CRA): During CRA, clinicians work closely with patients to build a new way of living without substance use that is more rewarding than their life with substance use. CRA helps patients discover a healthier way of living that brings them enjoyment.
  • Matrix Model: The Matrix Model of addiction treatment provides individual counseling, CBT, family education, and social support groups. Patients are encouraged to participate for 16 weeks of intensive treatment.

Behavioral Treatment Modalities

Behavioral treatments can be provided both individually (working one-on-one with a trained clinician) and in groups (where one clinician works with multiple patients at once). Additionally, some behavioral treatments can be provided through your computer or phone. Many clinicians offer telehealth services, including virtual counseling or therapy. CBT may also be available through computer or mobile phone based-applications.

MEDICATIONS

MEDICATIONS

There are no medications that have been approved by the Food and Drug Administration (FDA) to treat stimulant use disorder. However, some medications that have been approved to treat other conditions may be helpful for some patients with stimulant use disorder. Some of these medications also help treat other substance use disorders or mental health conditions. Some medications can help with cocaine use disorder. Other medications can help with use of methamphetamine and similar drugs.

Medications That May Help Treat Stimulant Use Disorder Include:

  • Bupropion: Bupropion is FDA-approved for the treatment of major depressive disorder, seasonal affective disorder, and smoking cessation. It can help some patients reduce or stop their use of cocaine, methamphetamine, and similar drugs.
  • Bupropion plus naltrexone: Naltrexone is FDA-approved for the treatment of opioid use disorder. Combining bupropion with naltrexone can help some patients reduce their use of methamphetamine and similar drugs more than bupropion alone.
  • Topiramate: Topiramate is a medication that is FDA-approved for the treatment of epilepsy and migraine. It can help patients reduce their use of cocaine, methamphetamine, and similar drugs. This medication may also help a patient reduce their alcohol use.
  • Mirtazapine: Mirtazapine is FDA-approved for the treatment of major depressive disorder and can help reduce the use of methamphetamine and similar drugs.

STIMULANT MEDICATIONS

The medications in red are stimulant medications. These medications have higher risks for patients with stimulant use disorder than non-stimulant medications. They should only be prescribed by a specialist such as an addiction medicine or addiction psychiatry doctor. Prescribing stimulant medication for patients with stimulant use disorder is complex. For many patients with stimulant use disorder the risks of these medications outweigh the benefits. If these medications are prescribed, your doctor will closely monitor your progress. They will check to see if you are taking the medication as prescribed. They will also use drug testing to see what other substances you may be taking. They will review how the medication may be helping or harming you. They will stop the medication if it is harming you more than it is helping.
  • Modafinil: Modafinil is FDA-approved for the treatment of narcolepsy, obstructive sleep apnea, and shift work-related sleep disorder. It can help patients reduce cocaine use. This medication is less effective if the patient has an alcohol use disorder.
  • Extended-release mixed amphetamine salts plus topiramate: Extended-release mixed amphetamine salts (such as Adderall and Mydayis) are FDA-approved for the treatment of Attention Deficit Hyperactivity Disorder (ADHD). This medication, combined with topiramate, may help reduce cocaine craving.
  • Extended-release Methylphenidate: Methylphenidate is FDA-approved for the treatment of ADHD. This medication may help a patient reduce their use of methamphetamine and similar drugs.

MENTAL HEALTH CONDITIONS

MENTAL HEALTH CONDITIONS

Some patients with stimulant use disorder may have other substance use disorders or mental health conditions. For example, patients may have depression, anxiety disorders, post-traumatic stress disorder (PTSD), or ADHD. These conditions should be treated at the same time as the stimulant use disorder. The clinician will consider all of these conditions when recommending a treatment program for the patient. Some patients may be recommended care in a program that provides treatment for both substance use disorder and mental health disorders.

STIMULANT INTOXICATION AND WITHDRAWAL

STIMULANT INTOXICATION AND WITHDRAWAL

Intoxication

  • Severe stimulant intoxication and overdose (where a patient experiences agitation, anger, aggressiveness, mood swings, anxiety, paranoia, hallucinations, and/or loss of consciousness following stimulant use) can be life-threatening. If the patient is experiencing significant symptoms when intoxicated, a medical professional will determine if the patient needs care in a hospital.

Withdrawal

  • Stimulant withdrawal symptoms can include depression, anxiety, sleep problems, and concentration problems. For some patients these symptoms can last for several weeks. Patients who are experiencing withdrawal symptoms should have a medical exam. The doctor may prescribe medication to help manage the symptoms.

POPULATION CONSIDERATIONS

POPULATION CONSIDERATIONS

Adolescents and Young Adults

The treatment of adolescents and young adults with stimulant use disorder is similar to treatment for adults. However, the clinician may focus more on the following items:
  • Where and why the patient typically uses drugs
  • Risks the adolescent or young adult takes while using stimulants
  • Mental health disorders
  • Collateral information from important people in the patient’s life
  • Stage of development
Family involvement: Family therapy may be recommended to help support both the young person and their parents or caregivers and improve family functioning.

Building Trust

Trust between the patient and the clinician is important. Confidentiality can help maintain trust. States have different laws on confidentiality and when information can or must be shared with parents or others. States laws also differ on whether an adolescent can consent to treatment. In some states, parent or guardian consent is required for treating adolescent patients. The clinician should clearly explain the laws that apply to the adolescent.

These same medications listed elsewhere in this document for the treatment of adults with stimulant use disorder are not FDA-approved and have not been extensively studied in adolescents but may be considered by the doctor on a case-by-case basis, balancing risks and benefits.

Pregnant and Postpartum Patients

Stimulant use can pose significant risk during pregnancy. It can lead to pregnancy complications as well as miscarriage, premature delivery, fetal growth restriction, maternal death, and fetal death.
  • Treatment for stimulant use disorder should be initiated as early in the pregnancy as possible.
  • It is important for the pregnant patient to get regular prenatal care.
  • Contingency management (CM, described earlier) may be used to encourage prenatal care as well as stimulant use disorder treatment.
  • Clinicians treating the stimulant use disorder and clinicians providing prenatal care should work together.
  • Clinicians should ask for patient consent before drug testing and explain the potential consequences of a positive drug test during pregnancy.
  • Patients may need extra support for their stimulant use disorder after the birth of the baby.
  • Breastmilk can contain high levels of stimulants. People who are currently using stimulants should not breastfeed.

Lesbian, Gay, Bisexual, Transgender, and Questioning (LGBTQ+)

Individuals who identify as LGBTQ+ have a high risk of developing a substance use disorder. They are also more likely to have mental health concerns. Some addiction treatment programs offer services designed for LGBTQ+ patients. Some patients may be more comfortable engaging in treatment with others who are LGBTQ+. The clinician should consider the patient’s unique experiences and needs when recommending a treatment program.

The American Society of Addiction Medicine represents leading addiction care providers dedicated to ensuring individuals suffering from addiction can access high quality care and enter into long term recovery.

The American Academy of Addiction Psychiatry is a national professional society that focuses on the education, training, and delivery of evidence-based prevention, treatment, and recovery approaches, particularly for people with substance use disorders and co-occurring psychiatric disorders.

For an online version of this patient guide and additional treatment and support resources visit: www.asam.org/guidelines

Disclaimer

© 2024 American Society of Addiction Medicine (ASAM.org) and American Academy of Addiction Psychiatry (AAAP.org). All rights reserved.