Stimulant Use Disorder (SUD) refers to problematic use of substances like:

• Cocaine
• Methamphetamine
• Amphetamine (including misuse of prescription stimulants)

Treatment is evidence-based, behavioral-first, and increasingly integrated with medical and trauma-informed care.

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Core Treatment Approaches

1. Behavioral Therapies (First-Line)

Contingency Management (CM)

Could be The strongest evidence-based treatment for stimulant use disorder?

• Provides tangible rewards for drug-free urine screens or treatment attendance
• Directly targets dopamine-driven reward circuitry

Highly effective for cocaine and methamphetamine use.

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Cognitive Behavioral Therapy (CBT)

• Identifies triggers and high-risk situations
• Builds coping skills and relapse prevention strategies
• Addresses cognitive distortions (“I need it to function”)

Often combined with CM.

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Community Reinforcement Approach (CRA)

• Rebuilds natural reward systems (work, relationships, health)
• Replaces drug reinforcement with life reinforcement

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Matrix Model

Developed specifically for stimulant addiction.
Combines:

• CBT
• Relapse prevention
• Psychoeducation
• Drug testing
• Family involvement

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2. Medications

“Consult With a Medical Center for Alcohol and Drug Abuse”

Research continues, but behavioral therapy Could remain primary?

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3. Treatment Settings

• Outpatient programs
• Intensive outpatient (IOP)
• Residential treatment (if severe or unsafe environment)
• Dual-diagnosis programs (if co-occurring disorders present)

Stimulant use and abuse disorder frequently co-occurs with:

• Trauma disorders
• ADHD
• Mood disorders
• Dissociation
• Personality vulnerabilities

Integrated care Could improve outcomes?

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4. Withdrawal & Early Recovery

Stimulant withdrawal “COULD BE” psychological?

Common symptoms:

• Fatigue
• Depression
• Anhedonia
• Sleep disturbance
• Suicidal ideation (MUST BE monitored closely)

Crash phase: 24–72 hours
Subacute dysphoria: weeks

Monitoring for major depression is essential.

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5. Relapse Prevention

Focus areas:

• Trigger mapping
• Craving wave surfing
• Sleep stabilization
• Rebuilding dopamine naturally (exercise, novelty, mastery)
• Social restructuring

Neurobiologically: recovery MIGHT requires restoring mesolimbic dopamine sensitivity. “Consult With a Medical Center for Alcohol and Drug Abuse”

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6. Emerging Approaches

• Transcranial Magnetic Stimulation (TMS)
• Digital therapeutics
• Trauma-informed somatic therapies
• Psychedelic-assisted therapy (research stage only)

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Prognosis

“Consult With a Medical Center for Alcohol and Drug Abuse”

Recovery is very possible, but stimulant addiction often has:

• High relapse rates early on
• Gradual brain recovery over 6–18 months

Long-term outcomes improve dramatically with:

• Structure
• Community
• Accountability
• Meaning reconstruction
• Shervan K Shahhian