In Behavioral Health, Cognitive Behavioral Therapy (CBT), Family Treatment Approach, Matrix Model, Substance Use Disorder, Treatment

What the Research Says About Addressing Stimulant Use Disorders: A Resource Review for Behavioral Health Providers

The Problem

According to Richard Rawson, PhD, Research Professor, University of Vermont and Professor Emeritus, UCLA, most current data shows that of the two major types of stimulant drugs, Cocaine, and Amphetamine Type Stimulants (ATS), about 16-21 million users in the world use Cocaine, about 40-60 millions users worldwide use ATS, primarily Methamphetamine and Amphetamine. In the U.S., nearly 5 million people reported using cocaine, almost 2 percent of the population, and cocaine was involved in almost 1 in 5 deaths during 2017 (CDC, 2018). Overdose deaths from other psychostimulants, methamphetamine, ecstasy, and prescription stimulants have been increasing since 2010 with over 10,000 people dying in 2017 (Scholl et al., 2019). Approximately 16 million U.S. adults used prescription stimulants in the past year, and 4.5% (or 11 million) used prescription stimulants appropriately (without misuse). 2.1% (or 5 million) misused prescription stimulants at least once; and 0.2% (or 0.4 million) had prescription stimulant use disorders (SUD).

… prescription stimulant use without misuse, misuse without use disorders, and use disorders were all higher among adults with major depressive episodes, suicidal ideation, and substance use problems. More than half (56.3%) cited cognitive enhancement as the reason for misusing prescription stimulants. Although purportedly used to increase alertness and concentration, research has shown that cognitive improvement from prescription stimulants is minimal and often inconsistent. The scientists point out that actions should be taken to expand safe, evidence-based treatment for Attention Deficit Hyperactivity Disorder and to decrease prescribing that may leave unused stimulants available for potential misuse. Clinicians can also screen for, and identify adults with, an increased risk for prescription stimulant misuse and pay attention to their motivations for misuse” (NIDA, 2018).

In his Strategies to Address Cocaine and Methamphetamine Use, Part 1 of the Great Lakes ATTC/NW ATTC 3-part webinar series on Stimulant Use Disorders, Dr. Rawson describes research showing the rise of methamphetamine use in chronic users of opioids, citing findings of a study of past month use of methamphetamine supporting significantly increased use among treatment-seeking users of opioids (Ellis et al., 2018). In the webinar presentation which is available to view as an archived version, Dr. Rawson also describes the differences between cocaine and methamphetamine that make the effects of methamphetamine last longer and act as a neurotoxin. He also describes the challenges clinicians face in treating people with a stimulant use disorder:

  • Limited understanding of stimulant use disorder
  • Patient ambivalence about needing to stop using
  • Patient impulsivity and poor judgement
  • Memory and cognitive impairment issues
  • Inability to feel pleasure (anhedonia)
  • Strong cravings triggered by environmental cues
  • Poor treatment retention
  • High rates of co-occurring disorders

He also suggested that special treatment consideration should be made for some groups, such as:

  • People who used drugs by injection
  • People who take stimulants daily or in high doses
  • People who are homeless, have chronic mental illness and/or people with severe psychiatric symptoms at time of admission
  • Men who have sex with men (MSM)
  • People who are under age 21
  • People being treated for Opioid Use Disorder with medication

One important fact to remember is that despite the fact that different types of stimulants have longer or shorter-term effects or dissimilar neurotoxicity, published studies show that there is no significant difference in the response of users of cocaine and users of methamphetamines to behavioral treatments (Huber et al., 1997; Roll et al, 2006; Copeland and Sorenson, 2001).

Additional research highlighted in this webinar presentation included meta-analysis findings showing that contingency management and community reinforcement approaches are the most effective and suitable treatment approaches for either short or long term (Knapp et al., 2007). Other empirically supported approaches include

  • Contingency Management/Incentives (CM/I)
  • Community Reinforcement Approach (CRA)
  • Cognitive-Behavioral Therapy (CBT)
  • Other approaches with interest
    • Matrix Model
    • Motivational Interviewing
    • Physical Exercise
    • Mindfulness Meditation

For additional information on these and other promising interventions and how they work, view the 3-part webinar series on the ATTC Network website. Part 2 of the series, Provider perspectives on effective strategies for treating people with stimulant use disorders, includes an expert panel of top treatment providers who explain some of the challenges and strategies of working with people with comorbid opioid use and stimulant use disorders, how to implement contingency management, and use of the MATRIX Model. Part 3 of the series, Implementing EBPs to address Stimulant Use Disorders, features three presenters who provide change management strategies for implementing evidence-based practices successfully.

Additional information on related topics and on a variety of strategies for treatment of stimulant use disorders and opioid use disorders can be found on the CASAT OnDemand Catalyst page:

Cognitive Behavioral Therapy (CBT):

Anger: Helping Behavioral Health Clients to Choose Their Responses to This Very Normal Emotion

TIP 34 and Cognitive Behavioral Therapy: Tools for Working with Psychosis…and So Much More!

Motivational Interviewing:

Motivational Interviewing: The One Tool Every Behavioral Health Provider Needs\

So You Want to be a Motivational Interviewing (MI) Trainer!

How Can a Professional Become a MINT Trainer?

Community Reinforcement Approach:

Getting Loved Ones to Accept Help: The Community Reinforcement Approach

Stimulants:

Stimulants on Track to Surpass Opioid Misuse in Nevada

Be part of the conversation:

What treatment modality do you find the most effective for stimulant use disorder or for co-occurring disorders including stimulants and opioids?


References

Centers for Disease Control and Prevention. 2018 Annual Surveillance Report of Drug-Related Risks and Outcomes — United States. Surveillance Special Report 2pdf icon. Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. Published August 31, 2018.

Copeland, A. L., & Sorensen, J. L. (2001). Differences between methamphetamine users and cocaine users in treatment. Drug and Alcohol Dependence, 62(1), 91-95. doi:10.1016/S0376-8716(00)00164-2

Ellis, M. S., Kasper, Z. A., & Cicero, T. J. (2018). Twin epidemics: The surging rise of methamphetamine use in chronic opioid users. Drug and Alcohol Dependence, 193, 14-20. doi:10.1016/j.drugalcdep.2018.08.029

Huber, A., Ling, W., Shoptaw, S., Gulati, V., Brethen, P., & Rawson, R. (1997). Integrating treatments for methamphetamine abuse: A psychosocial perspective. Journal of Addictive Diseases, 16(4), 41.

Kariisa M, Scholl L, Wilson N, Seth P, Hoots B. Drug Overdose Deaths involving Cocaine and Psychostimulants with Abuse Potential – United States, 2003-2017. Morb Mortal Wkly Rep. ePub. 3 May 2019.

Knapp, W. P., Soares, B. G. O., Farrel, M., & Lima, M. S. (2007). Psychosocial interventions for cocaine and psychostimulant amphetamines related disorders. The Cochrane Database of Systematic Reviews, (3), CD003023.

NIDA. (2018, April 16). Five million American adults misusing prescription stimulants. Retrieved from https://www.drugabuse.gov/news-events/news-releases/2018/04/five-million-american-adults-misusing-prescription-stimulants on 2019, November 13

Roll, J. M., Petry, N. M., Stitzer, M. L., Brecht, M. L., Peirce, J. M., McCann, M. J., . . . Kellogg, S. (2006). Contingency management for the treatment of methamphetamine use disorders. American Journal of Psychiatry, 163(11), 1993-1999. doi:10.1176/ajp.2006.163.11.1993

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