What do American Society of Addiction Medicine (ASAM) guidelines suggest for treatment of prescribed stimulant misuse in a 37-year-old male admitted to inpatient Substance Use Disorder (SUD) treatment?

ASAM Treatment Guidelines for Prescribed Stimulant Misuse

According to ASAM guidelines, behavioral therapies, particularly contingency management, are the primary recommended treatment for stimulant misuse, as there are currently no FDA-approved medications specifically for stimulant use disorder. 1, 2

Initial Assessment and Treatment Approach

• Patients with stimulant misuse should be referred to specialized addiction treatment services, as primary care management alone is typically insufficient for stimulant dependence 1
• For the 37-year-old male admitted to inpatient SUD treatment for 28 days, a comprehensive evaluation should document:
  • Pattern of stimulant misuse (frequency, dose, route of administration)
  • Presence of co-occurring psychiatric disorders that may influence treatment approach 1
  • History of previous treatment attempts and outcomes 1

Evidence-Based Behavioral Interventions

• Contingency management (CM) has the strongest evidence base for treating stimulant use disorder and should be the first-line behavioral intervention 2, 3

  • CM provides incentives (e.g., vouchers, prizes) for verified abstinence from stimulants
  • This approach has demonstrated effectiveness in reducing stimulant use and improving treatment retention 2

• Cognitive-behavioral therapy (CBT) should be incorporated into the treatment plan 1, 2

  • CBT helps identify triggers for stimulant misuse and develop coping strategies
  • May be combined with motivational enhancement therapy (MET) for improved outcomes 1

Addressing Co-occurring Disorders

• Screening and treatment for co-occurring mental health conditions is essential, as these often contribute to stimulant misuse 1

  • Anxiety, depression, and other psychiatric disorders should be treated concurrently 1
  • Integrated treatment addressing both substance use and mental health yields better outcomes than treating either condition alone 1

• For patients with ADHD who have misused prescribed stimulants, alternative non-stimulant medications should be considered 1, 4

  • Non-stimulant options like atomoxetine may be appropriate for treating ADHD symptoms without abuse potential 1

Pharmacological Considerations

• While no medications are FDA-approved specifically for stimulant use disorder, certain medications may be considered based on individual needs 5, 3

  • N-acetylcysteine has shown some promise but evidence remains insufficient for routine recommendation 3
  • Antidepressants may be used to address co-occurring depression but have limited evidence for directly treating stimulant use disorder 3

• For acute management of stimulant-related agitation or psychosis during early treatment:

  • Benzodiazepines or antipsychotics may be used for symptom control 6
  • These should be used only for short-term management of acute symptoms 6

Continuing Care and Recovery Support

• A continuing care plan should be established before discharge from the 28-day inpatient program 1

  • This should include ongoing monitoring, recovery support, and early re-intervention if needed 1
  • Patients who do not complete recommended treatment often return to substance use soon after discharge 1

• Community and peer support resources should be integrated into the treatment plan 1

  • Mutual help meetings and recovery organizations provide valuable ongoing support 1
  • Family involvement in treatment improves outcomes when appropriate 1

Common Pitfalls to Avoid

• Failing to address the risk of polysubstance use, as stimulant misuse often co-occurs with other substance use disorders 1
• Overlooking the need for harm reduction strategies if complete abstinence is not immediately achieved 1
• Discharging patients without a robust continuing care plan, which significantly increases relapse risk 1
• Focusing solely on the stimulant misuse without addressing underlying psychiatric conditions or psychosocial factors 1