Stimulants- Treatment, Therapy and Alternatives
There are several different types of
stimulants, this blog will focus on the treatment and therapy practices of
cocaine use disorder. Cocaine use is a serious worldwide health issue and is
associated with substantial morbidity and mortality. Overdose deaths within the
US are increasing and in some populations are out numbering heroin and opiate
overdoses.
No current medications have been approved at this time through the FDA to treat stimulant abuse. There have been many studies conducted using trials of medications to treat Cocaine Use Disorder, despite these efforts no medications have been proven safe to treat this problem. Although unapproved by the FDA, there are pharmacological strategies that have been developed by physicians whom specialize in cocaine treatments. Some of the strategies used for treatment of Cocaine Use Disorder include the use of dopamine agonists, as example long-acting amphetamines and Modafinil in combination with GABAergic agents as an example Topamax. These of course are off the box treatments and many physicians proceed with caution when prescribing these medications for Cocaine Use Disorder (Laurent Karila, 2010).
Psycho-social treatments remain the treatment
of choice for Cocaine Use Disorder, these include cognitive behavioral therapy
and contingency management. (Daniel Ciccarone, 2011)
Photo 1 Shows a visual guide Cognitive
Behavioral Therapy (Richard Foster, 2019)
Cognitive Behavioral Therapy used for
substance disorders is a “Talk Therapy” that has been proven effective in
treating many different substance use disorders such as cocaine abuse. Cognitive
Behavioral Therapy for substance use disorders was designed to guide clients to
learn how to make healthy choices and maintain changes in the habits of their substance
abuse. It helps them discover ways to cope with cravings, urges, improve communication,
interaction and solve problems (Introduction to Cognitive Behavioral Therapy for
Substance Use Disorders, 2019). Please watch the
video posted below, Introduction to Cognitive Behavioral Therapy for Substance
Use Disorders, it is a YouTube video that explains CBT in layman’s terms https://youtu.be/Otu5Ajlo-_w
Photo 2 Explains Contingency Management (John Schaffer, 2020)
Contingency management is a psychotherapy
that uses reward or reinforcement techniques to encourage abstinence. This type
of therapy is related to the behavioral Psychologist B.F. Skinner and his
operant conditioning theory, which is a learning process that uses rewards to reinforce
specific behaviors. Clients who participate in substance treatment programs that
use contingency management often receive rewards for meeting specific goals.
Some examples of contingency management are requiring daily or weekly urine
drug screening tests. If the test comes back negative the client is eligible
for a reward. If the test result comes back positive then the client is punished.
This type of therapy is commonly used by probation officers when clients are
mandated by the court to report for illegal substance charges. When clients
violate probation orders and have a positive drug screen they are often sent
back to jail or subjected to an extended probationary period, if their urine
remains clean and they follow probationary requirements commonly they are
released early for good behavior. Studies show that the use of contingency management
combined with cognitive therapy significantly improved abstinence among stimulant
users (Daniel Ciccarone, 2011).
References
Daniel Ciccarone, M. M. (2011). Stimulant Abuse
Pharmacology, Cocaine, Methamphetamine, Treatment, Attempts at Pharmacology.
Retrieved from US National Lirbrary of Medicine:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3056348/
Introduction to Cognitive Behavioral Therapy for Substance
Use Disorders. (2019). Retrieved from
YouTube: https://youtu.be/Otu5Ajlo-_w
John Schaffer, L. (2020). Contingency Management Therapy
for Addiction. Retrieved from Rehab Center:
https://www.rehabcenter.net/contingency-management-cm-therapy-for-addiction/
Laurent Karila, A. W.-J. (2010). Pharmacological
Approaches to Methamphetamine Dependence A Focused Review. Retrieved from
US National Library of Medicine:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2883750/
Richard Foster, L.-C. (2019). Treating Drug Addiction
with Cognitive Behavioral Therapy. Retrieved from Rehab Center :
https://www.rehabcenter.net/treating-drug-addiction-with-cognitive-behavioral-therapy/
I like the images you chose for this blog. It is very interesting to learn that there are no known medications approved for treatment of stimulant use disorder. Hallucinogens fall into that same category, although they are not addictive. When looking into possible treatment options for stimulants I found information on combination medications, both current and prospective. As you stated contingency management (CM) is one of the treatments touted for stimulant abuse. In addition to that, Ciccarone (2011) reports that community reinforcement approach and cognitive behavioral therapy (CBT) in addition to combinations of these approaches are effective in treating stimulant abuse. It is also noted that CM and CBT combined are no more effective than CM alone (Ciccarone, 2011). Ciccarone (2011) states that CM effects are short-lived and superior in the trial phase, and CBT was equivalent after the trial phase ended. Treatment of stimulant use disorder takes place in inpatient, outpatient, specialty-addiction programs, and general medical units (UNODC, 2017). Motivational enhancement therapies (MET) and motivational interviewing (MI) are useful tools in treating stimulant use (UNODC, 2017). Drug counseling and educational interventions offer effective alternatives to evidence-based treatments in addition to traditional psychosocial treatments for stimulant use (UNODC, 2017).
ReplyDeleteIn pharmacological trials involving antidepressants, mood stabilizers, dopamine agonists and neuroprotectives, none were found to be effective in treating stimulant abuse necessitating further research in this area (Ciccarone, 2011). Stoops and Rush (2014) offered combination pharmacotherapies effective in treating cocaine and amphetamines. In cocaine treatment, several clinical trials were tested. the combination of disulfiram maintenance with naltrexone was more likely to result in abstinence from both cocaine (Stoops & Rush, 2014). Other combinations that proved effective are that of bromocriptine combined with desipramine, and metyrapone combined with oxazepam (Stoops & Rush, 2014). UNODC (2017) acknowledged that methylphenidate (MPH), dextroamphetamine, bupropion, mirtazapine, topiramate, naltrexone, disulfirum, and N-acetylcysteine (NAC) are all proven to be effective to some degree in treatment. With the lack of a clear definitive pharmacological treatment for stimulant abuse, future research for evidence-based, safe, effective pharmacotherapies are essential to eliminate less effective, ineffective, harmful interventions. I enjoyed reading your blog, it was very informative.
References:
Ciccarone D. (2011). Stimulant abuse: pharmacology, cocaine, methamphetamine, treatment, attempts at pharmacotherapy. Primary care, 38(1), 41–58. https://doi.org/10.1016/j.pop.2010.11.004
Stoops, W., & Rush, C. (2014). Combination pharmacotherapies for stimulant use disorder: a review of clinical findings and recommendations for future research. Expert review of clinical pharmacology, 7(3), 363–374. https://doi.org/10.1586/17512433.2014.909283
Treatment of stimulant use disorders: Current practices and promising perspectives. (2017). United Nations Office on Drugs and Crime. Retrieved from https://www.unodc.org/documents/drug-prevention-and-treatment/Treatment_of_PSUD_for_website_24.05.19.pdf
Very nice blog, I love the background. I still am unable to get on board with substance abuse treatment with other addictive drugs, though. That was an interesting video on cognitive behavior therapy, and I was really glad the CBT helped Frank. I feel that learning those skills of self-care and self-control are important. It seems that we are failing our children of today by not teaching them properly. These strong personal strengths can be a deterrent for addictive behaviors and allow one to “tipple wisely,” as the text called it.
ReplyDeleteOn the other hand, you talk about contingency management. I cannot imagine that this treatment is effective for long-term abstinence. Eventually the rewards will dissipate, leaving the patient to his own devices. Without having properly learned self-control because of conditioning, the patient will most likely go back to seeking his own type of reward, the feeling of being high, and eventually he will be free of court supervision so there will not be much of a legal deterrent short-term. Additionally, throwing an abuser in jail every time they mess up just compounds the societal issues today of poverty, homelessness, and unemployment. One can never get out of the hold of addiction if their CODs are not being treated and their mental health needs not being met in other ways. Experts cite barriers as including negative attitudes and lack of clinical knowledge of contingency management, high implementation costs, and impractical measures requiring a high level of resources (Randall, 2017). Costs include those of rewards or incentives as well as constant drug testing, not to mention the costs passed to the addict or his family in terms of court costs, probation and jail fees, and home monitoring. Based on much research, CBT is much a more effective, and cost effective, method of treatment.
Interesting alternative treatment though. It could be effective for someone with unlimited resources to pay for it, such as children of movie stars for example!
Reference
Randall, J. (2017). Challenges and Possible Solutions for Implementing Contingency Management for Adolescent Substance Use Disorder in Community-Based Settings. Journal of Child & Adolescent Substance Abuse, 26(4), 332–337. Retrieved from Education Research Complete database.
Sara, I enjoyed your blog it was very informative. I never knew that Cocaine overdose has out numbered Heroin. I have always thought Heroin was more common and more deadly. I like the fact that CBT is a treatment option for the client that is suffering from Cocaine abuse. I like that that it promotes positive behaviors and provide the client with tools they can use to beat their addiction. Since studying psychology, talk therapy has been my go-to for client patient interactions so I love that you used it in your blog. I think you did a great job with your blog and the background is very beautiful. It is said that “People who use cocaine often may also have more serious side effects and health problems, like: Headaches, Convulsions and seizures, Heart disease, heart attack, and stroke, Mood problems, Sexual trouble, Lung damage, HIV or hepatitis if you inject it, Bowel decay if you swallow it, Loss of smell, nosebleeds, runny nose, and trouble swallowing, if you snort it ("What Is Cocaine?", 2020).”
ReplyDeleteReference
What Is Cocaine?. (2020). Retrieved 27 April 2020, from https://www.webmd.com/mental-health/addiction/cocaine-use-and-its-effects#1