Overview of management of disorders of stimulant use

Overview of substance use and addictive behaviours explains key principles of care. Establishing a therapeutic relationship that engages the person (and ideally those close to them) is central to the management of substance dependence.

Note: The most important element of treatment for substance use is a therapeutic relationship.

Specialist advice on any aspects of care for patients with stimulant and other substance use is available and contact is encouraged; see Contact details for substance use clinical advisory services for clinicians.

Note: Specialist advice is available by phone on any aspect of the management of substance use; contact is encouraged.

Patients using stimulants may present with intoxication, particularly if using large amounts or more than one substance (polysubstance use). Issues to address include:

ensuring the safety of an intoxicated person and those around them, particularly if the person is agitated
implications of substance use for driving
occupational implications of substance use.

For advice on the medical management of stimulant toxicity, see Stimulant poisoning.

Brief interventions can use motivational interviewing to explore a patient’s view of risks associated with use, their goals for treatment, and harm reduction. Stimulants are commonly used for enhancing sexual experiences (as are gamma-hydroxybutyrate (GHB) and amyl nitrite), but use is associated with sexual risk-taking; offer measures for sexual health harm reduction. For broad advice on harm reduction, including a patient information sheet, see Harm reduction in substance use and addictive behaviours.

Management of planned or unplanned withdrawal involves drug therapy to alleviate symptoms, and psychosocial interventions.

Psychosocial interventions are the main treatments to reduce stimulant use and prevent relapse. No drugs are approved to treat stimulant dependence. Maintenance drug treatment options are being investigated; although data on effectiveness are inconclusive, several drugs warrant further investigationChan, 2019 Ronsley, 2020 Siefried, 2020.

Long-term care includes management of physical and mental comorbidities such as anxiety, depression and psychotic episodes. Residential rehabilitation and specialist outpatient services are appropriate options for those who have been more severely affected by their stimulant use.

Considerations for specific populations may be relevant in managing stimulant use. This topic considers pregnant patients and breastfeeding patients. Other populations are discussed in Considerations for specific populations in the management of substance use and addictive behaviours.