There are no studies that focus on any maintenance treatment for stimulants abuse; besides, craving to stimulants remains for many years. For instance, methamphetamine craving remains for many years and this craving could resulting in relapsing; So why there are no evidences about maintenance treatment for stimulants?
Aripiprazole low dose can be used to treat ATS dependence. Pleae refer to paper by Hatim et al from University of Malaya..
This highlights the need for therapy, talk therapy that is, when dealing with substance abuse. While the psychological cravings may persist for years, they don't have to. Long term recovery from substance abuse is really about changing the way we think. We start by assessing our conscious thoughts, and practice our response to those thoughts until our response gets to be more automatic, or subconcious. With stimulants, the physiological need for a maintenance drug is significantly reduced after a few days or a couple of weeks. I agree that aripiprazole is a good drug for this time period. I think that the use of a maintenance drug for stimulant abuse over a long period of time would be counter-productive for the individual. But using certain drugs short term in order to facilitate the changes in thinking patterns are a good use for these types of drugs.
Long-term maintenance for any addiction should be taught prior to the patient being discharged from treatment after an appropriate length of engagement (90 days no matter what setting), followed by at least 3 months of once-week aftercare. The best maintenance treatment for addiction is long-term involvement in mutual self help groups. Dr. Ben Kelch
Yes. In the UK there are a dozen or more treatment agencies which prescribe dexamphetamine tablets or syrup to injecting amphetamine users, usually on the condition that they agree to stop or reduce injecting. I wrote a review of the literature on this topic about 10 years ago, and presented it to a conference in 2010 (attached). I concluded that there is enough preliminary evidence of the effectiveness of this form of substitute prescribing for a larger roll-out and research evaluation to be conducted. If anyone wants a copy of the full review paper, email me at: [email protected]
Thank you for those articles, Ali. And the slide presentation (Russell Newcombe) has some great information and is appreciated also.
I'm not an expert of the neurophysiology of stimulants, but it is my understanding that most act indirectly as reuptake inhibitors (for dopamine primarily) whereas opioids hit receptors directly. Perhaps this has something to do with the relative lack of success in stimulant maintenance therapy as compared to opioid maintenance therapy. Then again, the success of any maintenance therapy comes down to proper administration. Methadone has a terrible reputation, but when properly administered is considered the "gold standard" for opioid substitution therapy. In the US, the DEA has strongly opposed all maintenance medication, but methadone is legal (though highly restricted to clinics - e.g. not monthly supply of pills, etc) leaving buprenorphine as the only viable option for many patients. The efficacy of buprenorphine has been demonstrated in some studies - see for example the work of Roger Weiss (Harvard) comparing the efficacy of buprenorphine to therapy.
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