Approach to treatment of stimulant use disorder in adults
- Kyle Kampman, MD
Kyle Kampman, MD
- Associate Professor of Psychiatry
- Perelman School of Medicine, University of Pennsylvania
Cocaine, methamphetamine, and other stimulant use disorders are significant public health problems. In the United States, for example, there are 1.5 million regular cocaine users and approximately 353,000 regular methamphetamine users . Cocaine and methamphetamine users have significantly elevated rates of medical morbidity and utilization of health care resources .
Only psychosocial interventions have proven efficacious in reducing stimulant use in patients with stimulant use disorders, but these treatments alone are insufficient for many patients. No medications have been shown in randomized trials to be consistently efficacious for stimulant use disorders.
Our approach to selecting treatment for stimulant use disorder is described here (algorithm 1). Pharmacotherapy and psychosocial interventions for stimulant use disorder are described in detail separately. The epidemiology, clinical manifestations, course, consequences, assessment, and diagnosis of cocaine use disorder and methamphetamine use disorder are described separately. (See "Cocaine use disorder in adults: Epidemiology, pharmacology, clinical manifestations, medical consequences, and diagnosis" and "Methamphetamine use disorder: Epidemiology, clinical manifestations, course, assessment, and diagnosis" and "Pharmacotherapy for stimulant use disorders in adults" and "Prescription drug misuse: Epidemiology, prevention, identification, and management".)
Cocaine, methamphetamine, and diverted pharmaceutical stimulants all have similar mechanisms of action, and addiction to them leads to similar clinical manifestations. Thus, it is reasonable to try a psychosocial intervention with efficacy in one of them on patients addicted to another.
Cocaine — The reinforcing properties of cocaine are mediated by its ability to block the dopamine transporter and increase dopaminergic activity in critical brain regions. (See "Cocaine use disorder in adults: Epidemiology, pharmacology, clinical manifestations, medical consequences, and diagnosis" and "Cocaine: Acute intoxication".)
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