Indications for Treating Adderall Use Disorder
Treatment for amphetamine/Adderall use disorder is indicated for any individual with problematic amphetamine use, and should include medication-assisted therapy (specifically contingency management as the most efficacious intervention) combined with behavioral therapies, harm reduction services, and integration with HIV/infectious disease prevention services. 1
Primary Treatment Approach
Behavioral Interventions (First-Line)
Contingency management is the most efficacious treatment for stimulant use disorders, including amphetamine-type use disorder, and should be implemented as first-line therapy. 1 This involves financial incentives (cash or gift cards) for periods of recovery from stimulants or other substances. 1
Cognitive and behavioral therapies are effective treatments for abuse of amphetamine-type stimulants and have demonstrated reductions in illicit drug use and high-risk behaviors. 1
Nonpharmacologic psychotherapies are valuable when medications are not available, and adherence interventions may greatly enhance their effects and reduce high-risk behaviors. 1
Medication-Assisted Therapy Considerations
Currently, there are no FDA-approved medications specifically for amphetamine/stimulant use disorder. 1 However, treatment should not be delayed waiting for pharmacological options.
If the patient has comorbid opioid use disorder, all FDA-approved medications for opioid use disorder (buprenorphine, methadone, extended-release naltrexone) should be offered, as these reduce nonmedical opioid use and improve overall substance use outcomes. 1
If the patient has comorbid alcohol use disorder, FDA-approved medications (extended-release naltrexone, oral naltrexone) should be prescribed, as these reduce alcohol use and improve treatment adherence. 1
Harm Reduction Services (Essential Component)
Naloxone dispensation should be provided to all patients who report drug use, as overdose risk is elevated. 1
Safe use education, fentanyl and xylazine drug test strips, and referral to syringe services and safe injection sites should be offered to all who report drug use. 1
Substance abuse treatment can serve as an entry point to medical care and improve adherence to medical treatment regimens for infectious diseases. 1
Integrated Medical Care
All patients with amphetamine use disorder should be tested for HIV, hepatitis B, and hepatitis C, as substance use treatment reduces risk behaviors including needle-sharing and exchange of sex for money or drugs. 1
Vaccination against hepatitis A and hepatitis B should be provided. 1
For patients who inject drugs and are at sexual risk of HIV acquisition, oral or injectable PrEP should be offered to reduce sexual transmission risk. 1
Treatment Setting and Delivery
Longer substance abuse treatment programs that include both medication-assisted therapy and behavioral interventions are more effective than short detoxification programs for preventing HIV infection, viral hepatitis, STDs, and TB. 1
Innovative service delivery options should be implemented to improve retention, including extended hours, mobile clinics, walk-in clinics, telehealth, pharmacy delivery, and use of patient navigators or peer support staff. 1
Rapid linkage to treatment services is recommended, with screening for barriers to retention including lack of transportation, insurance, housing, criminal legal barriers, poverty, mental illness, and stigma. 1
Special Considerations for Comorbid ADHD
If the patient has legitimate ADHD that was being treated with Adderall prior to developing use disorder, non-stimulant medications (atomoxetine, guanfacine, or clonidine) should be used as first-line pharmacotherapy instead of returning to stimulants. 2
Atomoxetine provides around-the-clock effects without rebound/crash and has minimal abuse potential, though full therapeutic effect may take 4-6 weeks. 2
Traditional stimulants should generally be avoided in patients with active amphetamine use disorder due to abuse potential. 2
Common Pitfalls to Avoid
Do not offer only short-term detoxification, as this has limited success in leading to sustained abstinence. 1
Do not withhold substance use disorder treatment due to lack of patient motivation—address barriers to enrollment including poverty, lack of insurance, and fear of stigma. 1
Do not prescribe stimulant medications to patients with active or recent amphetamine use disorder, even if ADHD is present—use non-stimulant alternatives. 3, 2
Do not neglect screening for and treating comorbid psychiatric conditions (depression, anxiety, PTSD) that commonly co-occur and complicate treatment. 2