How to Treat Stimulant Addiction?
Stimulant abuse
The use of major stimulants (e.g., amphetamine, methamphetamine, cocaine) is associated with temporary increases in wakefulness, focus, energy, activity, and feelings of euphoria. Stimulants also stimulate the nervous system, causing increased heart rate, blood pressure, and often, body temperature. Not surprisingly, stimulants have considerable abuse potential. For example, from 2015 to 2016, five million Americans misused stimulants. A considerable portion of those who misuse these drugs develop a condition called stimulant use disorder (stimulant addiction).
Stimulant use disorder is associated with a variety of symptoms and behaviors, such as cravings, drug-related physiological responses (e.g., tolerance, withdrawal symptoms), and behaviors like the use of stimulants in dangerous situations, or the use of stimulants even when they cause serious personal or social problems.
Medications for stimulant addiction
A number of psychological and pharmacological treatments for stimulant use disorders have been investigated.2 Though there is no strong evidence for the benefits of pharmacotherapy (i.e. medications) for the treatment of stimulant addiction, there is some evidence for the use of specific medications for some types of stimulant abuse. For instance, topiramate (an anticonvulsant) may be helpful in the treatment of methamphetamine abuse. And bupropion (an antidepressant), topiramate, and some stimulants might be useful in the treatment of cocaine abuse.
Yes, as surprising as that may seem, some stimulants might be helpful in the treatment of addiction to cocaine, a stimulant itself. How would this approach, sometimes called substitution, work?
Since cocaine takes effect quickly but its effects last a short time, it encourages compulsive use. Taking recommended doses of a slow-acting stimulant on a more regular basis, instead, reduces cravings and compulsive use, and helps stabilize the individual’s system.
As mentioned, there is limited evidence regarding the benefits of pharmacotherapy, so more common is the use of psychological treatments. Three psychological interventions, shown to be effective in the treatment of substance abuse, are described below.
Psychological treatments of stimulant addiction
Cognitive-behavioral therapy (CBT) is based on the idea that to change emotions, it is helpful to change automatic thoughts. The same applies to stimulant abuse behaviors and thoughts.
Specifically, therapy examines and challenges beliefs and thinking errors that encourage the continued use of stimulants (e.g., “a little cocaine can’t hurt”). Patients are asked to practice monitoring and challenging their automatic thoughts before and after drug use.
CBT often includes skills training as well. For example, patients learn how to be more assertive (e.g., refusing drug offers) and how to cope with cravings in a healthier way.
Contingency management, like CBT, is an effective intervention for substance use disorders. Unlike CBT, contingency management is based on the view that drug-related behaviors are repeated because they are learned and reinforced.
So, to eliminate bad behaviors, one needs to stop reinforcing them. To replace them with healthier behaviors, one needs to reward healthier behaviors instead.
For instance, during treatment, specific rewards (e.g., vouchers, gift cards, prizes) will be given only when a patient performs the target behavior, be it providing drug-free urine samples, attending therapy, taking his or her prescribed medications, etc. Doing so reinforces these behaviors.
The third psychological intervention, the community reinforcement approach, is another behavioral intervention. The approach is based on the idea that one’s community and social network (e.g., family, friends, coworkers) will significantly influence the recovery process. And a person whose life lacks pleasure is more likely to continue using drugs.
So, part of the work is identifying a sufficiently large number of non-drug-related reinforcers and abstinence reinforcers in the community. Then, the patient works on connecting (or reconnecting) with them, and building a healthier but still pleasurable life without drugs.
This article is provided by Dr. Anthony Mele. Dr. Mele is specialized in the use of dialectical behavior therapy (DBT), motivational interviewing (MI), and attachment theory-based interventions to treat individuals who struggle with multiple addictions, long-standing depression and anxiety, and those who seek to integrate spirituality into their psychological treatment. The most common cannabis use disorder treatment methods are Cognitive-behavioral therapy, Contingency management, and motivational enhancement therapy.
References
1. https://pubmed.ncbi.nlm.nih.gov/31759095
2. https://www.hsrd.research.va.gov/publications/esp/pharmacotherapy-sud.cfm
