Management of stimulant withdrawal

Withdrawal from stimulants requires planning to provide support for several phases of withdrawal that span 3 weeks or more. The safety of the setting for planned stimulant withdrawal (at home, in a community facility or in hospital) depends on the likelihood of severe withdrawal and the extent of the patient’s social supports. For guidance on selecting a withdrawal setting, see Choice of setting for planned withdrawal management in substance use. Seek specialist advice from a clinical advisory service if unsure about assessing these factors.

Management of stimulant withdrawal is mainly medication to alleviate symptoms, and psychosocial interventionsGrigg, 2018NSW Health, 2022.

Evidence to guide choice of medication for symptomatic management is limited, and most medications used are not approved for this indication. Limit the use of sedative medication for withdrawal (eg olanzapine, diazepam) to 1 week to reduce risk of overdose or dependenceGrigg, 2018. For other considerations in managing medications during withdrawal management, see Safe prescribing and supply during planned substance withdrawal in a home setting.

More details on symptomatic treatment are discussed in clinical guidance on withdrawal from alcohol and other drugs available on the New South Wales Health website. Psychosocial interventions in the first 7 to 10 days of stimulant withdrawal focus on psychoeducation (education about the process of withdrawal and its treatment) and reassurance to alleviate anxiety and increase the patient’s motivation to continue treatment. Once withdrawal symptoms are less severe, psychological interventions can be used to promote retention in treatment, abstinence and reduce mood symptoms in the short-termGrigg, 2018. Psychological and behavioural interventions for insomnia may also be helpful; advice includes a printable patient handout on good sleep practices.

Psychological interventions for long-term management of stimulant use are the mainstay of promoting abstinence and relapse prevention.

For further advice on managing stimulant withdrawal, consult local state or territory guidelines or contact a clinical advisory service.