Home > Treatment for stimulant use disorders.

Substance Abuse and Mental Health Services Administration. (2021) Treatment for stimulant use disorders. Rockville, MD: Substance Abuse and Mental Health Services Administration. Treatment Improvement Protocol (TIP) Series 33. SAMHSA publication no. PEP21-02-01- 004.

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Overall key messages:
Stimulant use disorders are a growing problem in the United States, with more than 5 million people age 12 and older reporting past-year cocaine use, nearly 2 million reporting MA use, and almost 5 million reporting prescription stimulant misuse in 2019. Stimulant-related overdose fatalities are also on the rise, with the incidence of stimulant-related deaths more than tripling between 2010 and 2017.

Stimulant use disorders have a powerful neurobiological basis that includes changes in brain chemistry and functioning that in turn help drive stimulant use behaviors. But stimulant use disorders also have a social and environmental component that clinicians need to consider in trying to understand patients’ stimulant use behaviors, diffculties in achieving and maintaining abstinence, and potential unwillingness to engage in formal SUD treatment. Healthcare providers need to understand the medical complications of stimulant use, their clinical signs and symptoms, and appropriate management approaches. Behavioral health service providers should learn to recognize the medical complications of stimulant use so they can make quick and successful referrals to medical treatment as needed.

Ample research supports the use of CM as the primary psychosocial treatment for stimulant use disorders. The lack of FDA-approved pharmacotherapies for stimulant use disorders makes it vital for clinicians to learn about and offer psychosocial interventions (e.g., CM, CBT) and other nonpharmacologic services that have empirical support (e.g., mindfulness practices, family/couples counseling, the Matrix model of treatment).

Clinicians should consider a variety of factors in assessing why people with stimulant use disorders have sought treatment and what their individual treatment needs are. Clinicians can make treatment engagement—as well as treatment completion— more likely by maximizing access; addressing treatment ambivalence; training staff on how to provide respectful, patient-centered services; developing a well-thought-out treatment plan; and using techniques that help patients initiate and maintain abstinence.

Certain populations may be at an increased risk for stimulant use or, once they start using stimulants, may be at higher risk for negative outcomes (like contracting HIV). Such populations—including women, people living in rural areas, people of diverse racial/ethnic backgrounds, MSM, and people experiencing homelessness/housing instability—may beneft from targeted treatment engagement techniques, interventions, and monitoring approaches that are tailored to their unique needs and challenges.

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