From the Guidelines
Treatment of stimulant use disorder should prioritize contingency management, a behavioral form of incentivized treatment, as the most efficacious form of treatment, as recommended by recent clinical guidelines 1. The primary treatment approach for stimulant use disorder involves a comprehensive combination of behavioral therapies and supportive care, given the lack of FDA-approved medications specifically for this condition.
- Cognitive-behavioral therapy (CBT) and motivational interviewing are also essential components of treatment, typically delivered in individual or group settings over 12-16 weeks.
- While no medications are approved specifically for stimulant use disorder, some clinicians may use bupropion (150-300 mg daily) or modafinil (200 mg daily) off-label to reduce cravings, though evidence for their effectiveness is limited 1.
- For patients experiencing acute stimulant intoxication, benzodiazepines such as lorazepam (1-2 mg) or diazepam (5-10 mg) may be used to manage agitation and cardiovascular symptoms.
- Recovery support services, including 12-step programs like Narcotics Anonymous, can provide ongoing community support.
- Treatment should address co-occurring mental health conditions like depression or ADHD, which often accompany stimulant use disorder, as noted in recent reviews 1.
- A harm reduction approach should be incorporated for patients not ready for abstinence, including education about safer use practices and overdose prevention. The neurobiological basis for these approaches targets the dopamine system disruption caused by stimulants, which creates powerful reward pathways that drive continued use despite negative consequences 1.
From the Research
Treatment Options for Stimulant Use Disorder
- Stimulant use disorder is a significant public health concern with limited evidence-based treatment options 2.
- Psychosocial interventions, such as contingency management and cognitive-behavioral therapy, are the primary treatment modalities for stimulant use disorder 3, 4.
Efficacy of Contingency Management
- Contingency management has been shown to be an effective treatment for stimulant use disorder, with evidence supporting its use in reducing stimulant use and improving treatment retention 2, 5, 4.
- Contingency management may act synergistically with pharmacological treatments to enhance each other's effect 5.
Pharmacological Interventions
- There is currently no FDA-approved pharmacotherapy for stimulant use disorder, and the evidence for pharmacological interventions is inconsistent 2, 6.
- Some medications, such as psychostimulants, n-acetylcysteine, and opioid agonist therapy, have shown potential for treating stimulant use disorder, but more research is needed to fully understand their efficacy 2.
Comparison of Treatment Approaches
- Contingency management has been shown to be superior to cognitive-behavioral therapy in reducing stimulant use during treatment, but cognitive-behavioral therapy may produce comparable longer-term outcomes 4.
- The combination of contingency management and cognitive-behavioral therapy does not appear to have an additive effect in reducing stimulant use 4.
Future Research Directions
- High-quality primary research is needed to fully understand the efficacy of pharmacological interventions for stimulant use disorder, particularly in patients with comorbidities 2, 6.
- Further investigation of the combined approach of medications and contingency management may be a key strategy for effective stimulant use disorder treatment 5.