Management of stimulant use disorders in adults

Stimulant use disorder is characterized by a pattern of misuse of stimulants (eg, cocaine, methamphetamine, or diverted pharmaceutical stimulants) that are taken in greater amounts for longer than intended. There are unsuccessful attempts to cut down despite desire and a great amount of time is spent craving, obtaining, using, or recovering from its effects. The recurrent use leads to failure fulfilling obligations, reduction in social, recreational, or occupational activities and use in physically hazardous situations. Tolerance or withdrawal may be present.

• Mild stimulant use disorder has 2 to 3 of the diagnostic criteria.
• Moderate stimulant use disorder has 4 to 5 of the diagnostic criteria.
• Severe stimulant use disorder has up to 6 of the diagnostic criteria.

The continuing care model for addiction is customized to the needs and preferences of the patient and may include psychosocial interventions such as (refer to UpToDate content for further discussion of the continuing care model and counseling for substance use disorders):

• Intensive outpatient program is a treatment of variable length that includes group and individual counseling, psychosocial interventions, and other support services.
• Individual or group substance use disorder counseling is a broadly defined term that includes psychosocial interventions and mutual support and often encourages 12-step involvement.
• Contingency management provides incentives to individuals with substance use disorder contingent upon treatment attendance and/or verifying abstinence.
• Motivational interviewing is a counseling type that guides a person through a patient-centered conversation to help them consider whether there is a health-related behavior to change, how to do it, and why to do it.
• Mutual help groups consist of individuals with common experiences or problems coming together to share their experience and provide support.