From the Research
According to the American Society of Addiction Medicine guidelines, as stated in the 2024 guideline 1, contingency management represents the current standard of care for treatment of stimulant use disorders, and pharmacotherapies may be utilized off-label to treat stimulant use disorders. The lack of approved pharmacotherapy reflects the complex neurochemistry of stimulant addiction, which involves multiple neurotransmitter systems including dopamine, norepinephrine, and serotonin. Some key points to consider in the treatment of stimulant use disorder include:
- The use of contingency management as the primary treatment approach 1
- The potential off-label use of pharmacotherapies, such as antidepressants (bupropion, mirtazapine), anticonvulsants (topiramate), stimulants (modafinil, methylphenidate), and dopaminergic agents (disulfiram) 2, 3, 4
- The importance of addressing co-occurring psychiatric conditions that may require medication management 1
- The need for ongoing research to explore potential pharmacological interventions, including vaccines and novel compounds targeting specific neurotransmitter systems involved in stimulant addiction 2, 3, 4 It is essential to note that the evidence for pharmacotherapy in stimulant use disorder is limited, and treatment should be individualized based on the patient's specific needs and circumstances. The most recent and highest quality study, published in 2024 1, provides guidance on evidence-based strategies for the treatment of stimulant use disorders, and should be consulted for further information on the management of stimulant use disorder.