This TIP, Treatment for Stimulant Use Disorders, supplies substance use disorder treatment providers with vital information on the effects of stimulant abuse and dependence, discusses the relevance of these effects to treating stimulant users, describes treatment approaches that are appropriate and effective for treating these clients, and makes specific recommendations on the practical application of these treatment strategies. Research on animals has demonstrated the profound effects that stimulants can have on the central nervous system, and new technologies have begun to document the stimulant-induced neurological impairments in humans. Researchers now believe that these impairments underlie the cognitive deficits that are often seen in chronic stimulant users.

Effective treatment strategies must recognize the impact that stimulant abuse and dependence have on the user's ability to respond to treatment. The treatment strategies that are described in this TIP have been scientifically validated as effective in treating people with stimulant use disorders. These strategies address the specific problems and needs that are inherent to chronic stimulant users.

This document discusses in detail the practical application of these treatment strategies and makes recommendations to improve treatment outcomes for stimulant abuse and dependence. The document also provides for clinicians and primary care providers an overview of the medical aspects of stimulant use. Furthermore, treatment issues for special groups and settings are reviewed.

Contents

• What Is a TIP?
• Editorial Advisory Board
• Consensus Panel
• Foreword
• Executive Summary and Recommendations
• Chapter 1—Introduction
  • Purpose of the TIP
  • Importance of Science in Building the Treatments Of the Future
  • Scope of the TIP
  • A Brief History of Stimulant Use in the United States
  • The Current Situation
  • Summary
• Chapter 2—How Stimulants Affect the Brain and Behavior
  • Stimulant Abuse And the Brain
  • Abuse and Dependence
  • General Effects Of Stimulants
  • Cocaine
  • Methamphetamine
  • Summary
• Chapter 3—Approaches to Treatment
  • Documented Treatment Approaches
  • Treatment Approaches With Supportive Research
  • Other Interventions With Supportive Research
  • Other Models of Psychosocial Treatment
  • Pharmacological Treatments for Stimulant Abuse and Dependence
• Chapter 4—Practical Application of Treatment Strategies
  • Treatment-Seeking Stimulant Users
  • Treatment Needs of Cocaine Users Versus Methamphetamine Users
  • Maximizing Treatment Engagement
  • Assessment Procedures To Enhance Treatment Engagement
  • Staff Behaviors To Enhance Treatment Engagement
  • The Treatment Plan
  • Strategies for Initiating Treatment
  • Strategies for Initiating Abstinence
  • Strategies To Maintain Abstinence
  • Abstinence Maintenance Techniques
  • Other Strategies Useful in Maintaining Abstinence
  • Next Steps
• Chapter 5—Medical Aspects of Stimulant Use Disorders
  • Toxicity, Addiction, and Other Adverse Reactions
  • Clinical Manifestations And Medical Management
  • Identification and Management of Medical Complications
  • Identification and Management of Psychological Complications
  • Co-Occurring Disorders Among People With Stimulant Use Disorders
  • Assessment and Diagnosis
  • Developing Linkages Between Treatment Programs and Medical Facilities
• Chapter 6—Treatment Issues for Special Groups and Settings
  • Intravenous Drug Users
  • Gay Men
  • Methadone Maintenance Clients
  • Individuals With Co-Occurring Mental Disorders
  • Medically Ill Clients
  • Criminal Justice Clients
  • Racial/Ethnic Considerations
  • Rural Populations
  • Women's Issues
  • Adolescents
• Appendices
  • Appendix A—Bibliography
  • Appendix B—Client Worksheets
  • Appendix C --Screening Tests for Cognitive Impairments
  • Appendix D—Glossary
  • Appendix E --Resource Panel
  • Appendix F --Field Reviewers

This publication is part of the Substance Abuse Prevention and Treatment Block Grant technical assistance program. This publication was written under contract number 270-95-0013 with The CDM Group, Inc. (CDM). Sandra Clunies, MS, ICADC, served as the CSAT government project officer. Rose M Urban, MSW, JD, CSAC, served as the CDM TIPs project director. Other CDM TIPs personnel included Cara Smith, editorial assistant; Raquel Ingraham, MS, project manager; Mark A Meschter, former editor/writer; Mary Smolenski, EdD, CRNP, former project director; and MaryLou Leonard, former project manager. Special thanks go to consulting writers Warren Bickel, PhD; Gregory L Greenwood, PhD, MPH; Mitchell Markinem, MA, NCAC II; Sara Simon, PhD; and Ronald D Stall, PhD, MPH, for their considerable contributions to this document.

The opinions expressed herein are the views of the Consensus Panel members and do not reflect the official position of CSAT, SAMHSA, or the U.S. Department of Health and Human Services (DHHS). No official support or endorsement of CSAT, SAMHSA, or DHHS for these opinions or for particular instruments or software that may be described in this document is intended or should be inferred. The guidelines proffered in this document should not be considered as substitutes for individualized client care and treatment decisions.