S1 Ep5: #5 Amp Up Your Treatment of Stimulant Use Disorder with Dr. Paxton Bach
Aug 4, 2022
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Dr. Paxton Bach, Co-Medical Director at the British Columbia Centre on Substance Use, delves into stimulant use disorder. He discusses the intricacies of stimulant consumption and effective patient communication. Key topics include recognizing signs of 'overamping,' managing stimulant intoxication in emergency settings, and the role of contingency management in treatment. The conversation highlights harm reduction strategies and the importance of a supportive environment for patients on their recovery journey.
Stimulant use, particularly cocaine and methamphetamine, often stems from self-medication for issues like ADHD or anxiety, necessitating tailored treatment approaches.
Acute stimulant intoxication requires compassionate care strategies focusing on de-escalation techniques and avoiding coercive methods like restraint to ensure patient-centered support.
Contingency management, which uses positive reinforcement for achieving treatment goals, is a proven effective strategy but faces implementation challenges in many healthcare settings.
Deep dives
Understanding Stimulant Use and Disorders
Stimulants encompass a wide range of substances, with cocaine and methamphetamine being the most commonly misused in North America. These drugs work primarily by increasing levels of neurotransmitters in the brain, leading to heightened alertness, euphoria, and improved concentration. Many individuals start using stimulants to self-medicate for issues such as ADHD or anxiety, or to counterbalance the effects of other substances like opioids. Understanding the reasons behind stimulant use is essential for creating effective treatment plans, as recognizing the specific roles these substances play in a person's life can directly inform therapeutic approaches.
Management of Stimulant Intoxication
Acute stimulant intoxication can present a range of symptoms, progressing from mild euphoria to severe agitation, paranoia, and potentially life-threatening disturbances. Treatment generally focuses on creating a calm environment, using supportive measures such as providing reassurance and hydration to help patients de-escalate. In more severe cases of agitation or anxiety, benzodiazepines can be administered to provide relief. It is crucial to avoid coercive measures like restraint, which can exacerbate the situation, emphasizing the need for compassionate and patient-centered care.
Developing a Treatment Plan for Stimulant Use Disorder
When developing a treatment plan for stimulant use disorder, it is essential to assess social determinants of health and any co-occurring mental health issues. Effective treatment should integrate both pharmacological and non-pharmacological approaches, with psychosocial therapies being the gold standard in treating stimulant use disorders. While medications like mirtazapine and bupropion show promise based on emerging research, they are not FDA-approved for stimulant use and should be considered within a broader treatment framework. Collaboration with addiction specialists is necessary, as they can help navigate the complexities of treatment for substance use disorders.
The Role of Contingency Management
Contingency management has emerged as a highly effective behavioral strategy for managing stimulant use disorders, utilizing positive reinforcement to encourage desirable behaviors. This approach typically involves setting specific goals for patients, such as reducing or abstaining from substance use, and providing rewards for achieving these goals. Evidence indicates that this technique significantly improves treatment outcomes, making it a valuable tool in addiction interventions. However, implementation remains limited in many healthcare settings due to systemic barriers, underscoring the need for greater access to contingency management programs.
Harm Reduction Approaches in Substance Use
For individuals who wish to continue using stimulants but want to reduce harm, discussing safer consumption strategies is critical. Key components include educating patients about the risks of sharing paraphernalia and emphasizing the importance of using within safe environments, such as overdose prevention sites. Furthermore, encouraging the distribution of naloxone can help mitigate the risks associated with a volatile drug supply, particularly as it becomes increasingly common for stimulants to be laced with dangerous substances like fentanyl. Establishing a support network, including apps that facilitate safety monitoring, can also provide patients with additional layers of protection.
Amp up your learning on stimulant use disorder! We are joined by Dr. Paxton Bach (@PaxBach) who is the Co-Medical Director for the British Columbia Centre on Substance Use and Director of their Clinical Addiction Medicine Fellowship Program. We discuss commonly used stimulants, how to recognize when someone is “overamping,” different treatment options, and so much more!
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