Moderate or conditional recommendations are often based on lower-certainty evidence that shows benefits more closely balanced with harms or variability in patient preferences. Implementation is often determined by variation in individual clinical situations—including disease factors, patient preferences and characteristics, and resource use—and usually involves a shared decision-making process. Existing guidelines on relevant topics were listed in the corresponding EtD table.
Can Medicine Help With Alcohol Use Disorder?
Some studies suggest that simply getting help — whether through medication, counseling, or both — is what matters for successful management of this addiction. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Data sources include Micromedex (updated 6 May 2024), Cerner Multum™ (updated 6 May 2024), ASHP (updated 10 Apr 2024) and others.
Stimulant Intoxication
The evidence base is still accumulating in many areas of addiction treatment, but the urgency and severity of SUD-related issues demand that clinicians act, even in the face of imperfect empirical evidence. Recommendations based solely on clinical consensus are clearly indicated and their rationale explained. A search for systematic reviews, clinical guidelines, and meta-analyses was conducted in the PubMed and PsycInfo literature databases on June 1, 2021. All text fields were searched, and the search was limited to articles published about humans in the prior ten years and available in English. Where authors or recommending bodies had published updates of an analysis or guideline, only the most recent version was included.
What is considered 1 drink?
“And primary care doctors tend to shy away from these meds because they weren’t trained to use them in med school.” Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition. SAMHSA offers tools, training, and technical assistance to practitioners in the fields of mental health and substance use disorders.
In terms of convenience, long-acting injectable naltrexone was developed to offset the adherence problems noted with daily oral naltrexone dosing. Given that acamprosate has a dosing schedule of three times daily, it is recommended that patients keep their medication in a weekly pill organizer with day and time indicated for each dose. Patients are also advised to link commonly missed doses with an activity of daily living such as eating meals or brushing teeth as a reminder to take their medication at that time. Monitoring medication compliance is paramount to successful treatment outcomes. Finally, clinicians should check their state’s PDMP prior to prescribing psychostimulant medications.
It is critical to appreciate that those clinical trials included either the nonpharmacological treatment routinely provided for AUD in a given setting or protocol-specific behavioral treatments for all participants. Therefore, the medication (plus behavioral treatment) demonstrated a significant benefit over placebo (plus behavioral treatment) on drinking outcomes. While direct evidence for referral to treatment is relatively weak, the CGC judged the clinical benefits of facilitating treatment for those who need it to be substantial. Therefore, the CGC recommended that for patients who screen positive for risky stimulant use, clinicians should conduct or offer a referral for comprehensive assessment for potential StUD. When making referrals, linkage support—including warm handoffs—should be provided.
Buprenorphine, methadone, and naltrexone are the most common medications used to treat OUD. Waiving a full workup saves time and resources, including avoiding an overnight hospital stay and follow-up appointments. However, missed identification of nontoxicologic causes of seizure is possible. In situations of severe stimulant-induced agitation refractory to benzodiazepines and antipsychotics where rapid control of agitation is necessary for patient and/or staff safety (most commonly related to methamphetamine intoxication), clinicians can consider IV or intramuscular (IM) ketamine.
However, once a drug is in generic formulations, there is little financial incentive for a pharmaceutical company to incur the cost of the additional research required for FDA approval of AUD as a new indication. Acidosis from stimulant intoxication is typically due to a combination of excessive movement or muscle activity and drug-specific effects (eg, temperature elevation). In this context, control of agitation, seizures, and neuromuscular hyperactivity is alcohol use disorder critical. No studies were identified on managing acidosis specific to stimulant intoxication or withdrawal. The CGC did not propose any clinical recommendations for treating acidosis specific to stimulant intoxication or withdrawal; in general, treating agitation will help address acidosis. Given limited evidence, these recommendations are based on the experiences of clinicians with subject matter expertise in treating adolescents and young adults with StUD.
- According to the principles of harm reduction, clinicians can engage patients who use stimulants in treatment and prevention services, accounting for patients’ desires and levels of interest, motivation, and engagement.
- Despite these potential barriers, the CGC concluded that in certain patients, this treatment option may be useful in reducing cocaine use and other co-occurring symptoms.
- The CGC agreed that they would expect key stakeholders to accept CM, especially when presented with evidence of its effectiveness.
- While implementation of this practice is straightforward, clinicians may require training on trauma-sensitive and culturally humble approaches to ask about the context of substance use in a nonjudgmental and destigmatizing manner.
- Especially in the context of the lack of strongly supported medication alternatives, the CGC supported consideration of bupropion for ATS use disorder, specifically in patients with low- to moderate-frequency (ie, less than 18 days per month) stimulant use.
Because addiction can affect so many aspects of a person’s life, treatment should address the needs of the whole person to be successful. Counselors may select from a menu of services that meet the specific medical, mental, the ultimate guide to microdosing psychedelics social, occupational, family, and legal needs of their patients to help in their recovery. Behavioral therapies help people in drug addiction treatment modify their attitudes and behaviors related to drug use.
Sign up for free and stay up to date on research advancements, health tips, current health topics, and expertise on managing health. “The most robust finding in the study is that those receiving any medication did much better than those who received no pills at all,” says Professor Barbara Mason, of Scripps Research Institute, and an author of the study. Hosted by therapist Amy Morin, LCSW, this episode of The Verywell Mind Podcast shares strategies for coping with alcohol cravings and other addictions, featuring addiction specialist John Umhau, MD.
Clinicians should stay abreast of which stimulants are prevalent within certain demographics in their region; testing laboratories often track this information. As discussed in ASAM’s Appropriate Use of Drug Testing in Clinical Addiction Medicine consensus statement, there are known limitations to urine immunoassays for amphetamines, and providers should be cautious when interpreting their results. The CGC recognized that clinicians may be hesitant to prescribe higher-than-typical doses of these medications but also emphasized that risk of misuse or diversion can be managed. As discussed at the beginning of the Psychostimulant Medications section, careful monitoring and management of risk of misuse and diversion is important when prescribing these medications. For cocaine use disorder, the certainty of the evidence was judged to be modest given that CRA did not outperform other treatments in all studies.42,64 However, the quality of the evidence favoring CRA is high, coming from well-conducted randomized controlled trials (RCTs). CM interventions require programs to develop protocols around its use and dedicate resources, including staff training and time, toward its implementation.
Many patients with StUD also experience persistent challenges with post-acute symptoms of withdrawal—including depression, anxiety, insomnia, and paranoia, among others—that can last for weeks to months. It is important to assess for and treat these symptoms to reduce the risk for decompensation and return to stimulant use. Breastfeeding has numerous benefits to the patient and infant; however, breastmilk may contain high levels of stimulants, which has the potential to harm infants. Although no known data exist for outcomes in neonates, the CGC recommended against breastfeeding by patients who are actively using stimulants.
An appropriate treatment setting allows for assessment of acute issues and complications, screening for acute intoxication potential, monitoring of the intoxication syndrome, and administration of appropriate clinical interventions. If any of these are not possible in the current setting due to patient agitation or limitations in staff capability or resources, the patient should be transferred to a more intensive level of care with the appropriate capabilities. However, transfers involve some risk, as patients may choose to leave treatment rather than initiate and engage in treatment elsewhere. The use of health information technologies and patient navigators may help facilitate effective transfers by bridging care between settings.
CBT does require resources—namely, the availability of highly trained clinicians for proper delivery. On the other hand, CBT can be delivered in group sessions, which makes it more feasible for many programs compared to other behavioral interventions. Different types of medications may be useful at different stages of treatment to help rehab for women a patient stop abusing drugs, stay in treatment, and avoid relapse. Additionally, medications are used to help people detoxify from drugs, although detoxification is not the same as treatment and is not sufficient to help a person recover. Detoxification alone without subsequent treatment generally leads to resumption of drug use.
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