Stimulants, or “uppers,” are a potent class of drugs that include substances like methamphetamine, cocaine, and ecstasy, as well as prescribed medications (called “central nervous system stimulants”) such as Ritalin, Concerta, and Adderal. According to the National Library of Medicine, around 7% of adults in the United States are prescribed stimulants to manage physical or mental health conditions. Nearly 5 million adults in the United States suffer from dependence, misuse, or addiction to these substances, but only a small percentage actually seek professional help.
Understanding stimulant addiction can help prevent misuse and guide those struggling with addiction or dependence to an effective recovery program.
Because stimulants have less associated withdrawal symptoms than opioids, it may be more difficult for someone to realize that they have an addiction or dependency. It is also often less obvious to loved ones. This is one reason why a strong, supportive recovery community is so important. That may consist of group therapy, peer support, or even a community dedicated to maintaining sobriety.
A comprehensive care plan for stimulant use disorder will include regular medical visits, social support, counseling and therapy, as well as peer support from someone with lived experience. Depending on the person’s medical and use history, acuity, and other factors, medications may be prescribed as part of a comprehensive care program.
It is important to recognize that the FDA has not approved any medications for treating stimulant use disorder. However, they are actively working to promote the research and development of new therapies and medications. There is some evidence that in certain situations, mental health medications may support brain and psychological stability for those diagnosed with stimulant use disorder.
Medication-Assisted Treatment (also called “Medication for Addiction Treatment” or simply “MAT”) is a comprehensive approach that combines medications with counseling and therapy, peer support, social services, and regular medical visits. This approach to care is geared to
Disulfiram (Antabuse®) is indicated for the treatment of alcohol use disorder however several randomized clinical trials have shown disulfiram decreases cocaine use. Disulfiram and its metabolite diethyldithiocarbamate bind copper. Decreased copper levels inactivates copper-dependent enzymes such as dopamine-β hydroxylase (DβH), which converts DA to NE. DβH Inhibition increases DA and decreases the synthesis of NE. Disulfiram also inhibits carboxylesterase and cholinesterase enzymes that metabolize cocaine thereby increasing plasma levels of cocaine. Inhibition of DβH by disulfiram and subsequent decrease in central NE levels is likely responsible for its ability to decrease cocaine use.
Studies testing medications that target specific NE receptor sub-types show promise as possible treatments for SRDs. Doxazosin is a selective α1-adrenergic receptor (α1R) antagonist indicated for the treatment of hypertension. Prazosin is also an α1R receptor antagonist but with a much shorter half-life (4-5hrs) compared to doxazosin (11hrs). α1R receptors are located within mesocorticolimbic structures such as the NAc where they modulate cocaine-induced increases in DA. Centrally or peripherally administered prazosin and doxazosin block cocaine’s behavioral effects in rodents.
Modafinil is indicated for narcolepsy but also used to treat shift work sleep disorder and attention deficit hyperactivity disorder. Modafinil binds to the DAT inhibiting DA re-uptake but also acts on other neurotransmitter systems. Imaging studies in humans confirmed that modafinil binds to the DAT within mesolimbic circuits. Studies show modafinil administration decreases neural reactivity provoked by cocaine-associated cues, attenuates cocaine craving and improves cognitive function in individuals with CUD.
Methylphenidate is a potent NE and DA reuptake inhibitor primarily used to treat attention-deficit hyperactivity disorder (ADHD). Imaging studies indicate that methylphenidate reverses a number of neural deficits in mesocorticolimbic regions and decreases reactivity to cocaine-associated cues in cocaine users.
Topiramate (TOPAMAX®) is an antiepileptic indicated for seizure disorder and migraine prophylaxis. Topiramate’s therapeutic action for seizures appears to be through glutamate and GABA modulation yet it acts on multiple neurotransmitter systems. An initial clinical trial showed topiramate decreased heavy alcohol use and a pilot study indicated this effect extended to cocaine. Based on these positive results a current report tested the impact of topiramate (N=83, 300mg/day, 13 weeks) compared to placebo (N=87) on cocaine use in individuals with CUD and alcohol use disorder. All participants received CBT. Primary outcome measures were self-reported alcohol and cocaine use and urine drug screens three times per week. Secondary measures included cocaine and alcohol craving measures. Overall, treatment with topiramate was no better than placebo on any outcome. Yet study retention favored topiramate and individuals with more severe cocaine withdrawal symptoms on entering the study responded better to topiramate. A randomized, double-blind, within-subjects cross-over designed laboratory study by Johnson et al. assessed the effects of topiramate (100mg twice daily for 5 days; N=24) compared to placebo in combination with low (0.325 mg/kg, iv) and high (0.65 mg/kg) doses of cocaine. Interestingly, topiramate treatment reduced cocaine craving and monetary value of the high dose of cocaine but increased the subjective effects (e.g. euphoria) and monetary value of the low dose of cocaine. Overall, evidence is not entirely convincing for the use of topiramate as a treatment for CUD. That topiramate increased the positive subjective effects of cocaine is concerning.
Addiction Therapy
Addressing the psychological and behavioral aspects of opioid addiction is a major part of lasting recovery. Various addiction therapies, also called “interventions,” can help support individuals in developing coping strategies, identifying triggers, and addressing the root causes of substance use.
Some commonly utilized therapies include:
Cognitive-Behavioral Therapy (CBT): This approach helps individuals identify and modify harmful thought patterns and behaviors associated with opioid use.
Contingency Management: This method uses incentives or rewards to reinforce positive behaviors, such as attending treatment sessions or achieving sobriety milestones.
Motivational Interviewing: This client-centered approach aims to enhance an individual’s motivation for change by exploring disengagement and highlighting the contradictory nature between their current behavior and personal goals.
Family Therapy: Involving loved ones in the treatment process can provide invaluable support and address familial dynamics that may contribute to or exacerbate opioid addiction.
Peer Support and Community Resources
Overcoming opioid addiction is often a lifelong journey, and having a strong support system can be invaluable. Peer support gives people a chance to connect with others who understand what they’re going through. It provides a safe place to share experiences, challenges, and successes in recovery. These support groups can help people stay accountable, give encouragement during tough times, and offer practical advice from those who have been through similar situations.
Opioid addiction is a complex and multifaceted condition that requires a comprehensive and compassionate approach to treatment. By understanding the underlying causes, recognizing the signs, and embracing evidence-based interventions, individuals struggling with opioid use disorder can find hope and support on their journey to recovery.
Eleanor Health offers online medication-assisted treatment for opioids, alcohol, meth, and more. We create individualized treatment plans that include medications that are fit to your recovery goals as well as addiction counseling to support lasting sobriety. Fill out our online form or call us today to learn more about our addiction treatment services.
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