Treating Stimulant Use Disorder: Guidelines and Challenges

In this episode of ASAM Practice Pearls, Dr. Stephen Taylor and Dr. Brian Hurley discuss the complexities of stimulant use disorder (StUD). Topics include challenges in managing StUD without FDA-approved medications, the impact of socioeconomic and cultural factors, and practical insights from the ASAM/AAAP guidelines. 

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Host

Stephen M. Taylor, MD, MPH, DFAPA, DFASAM

Dr. Stephen M. Taylor is ASAM’s President-Elect and is board-certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. With over 30 years of practice experience, Dr. Taylor is dedicated to helping adolescents and adults overcome addiction and co-occurring psychiatric disorders. He has served as the Medical Director of the NBA and NBPA Player Assistance and Anti-Drug Program for 16 years and is the Chief Medical Officer of Pathway Healthcare, which operates multiple outpatient addiction and mental health treatment offices across six states.

Expert

Brian Hurley, MD, MBA, FAPA, DFASAM

Dr. Brian Hurley is ASAM’s President and an addiction physician. He is the Medical Director of the Bureau of Substance Abuse Prevention and Control in the Los Angeles County Department of Public Health. He was the co-chair of ASAM and American Academy of Addiction Psychiatry's Clinical Practice Guideline on the Treatment of Stimulant Use Disorder. He has also led numerous grant-funded projects that advance access to medications for addiction treatment across Los Angeles County and is the program lead for LA County’s Substance Abuse Mental Health Services Administration’s Harm Reduction grant award and the Centers for Disease Control Overdose to Action Local grant award.

📖 Show Segments

• 00:03 - Introduction 
• 00:42 - Personal Experience with StUD 
• 03:38 - Overview of ASAM and AAAP Guidelines 
• 05:59 - Contingency Management Explained 
• 09:03 - Implementing Guidelines in Practice 
• 13:50 - Addressing Socioeconomic and Cultural Factors 
• 21:46 - Geographic Differences in Stimulant Use 
• 23:49 - Future of StUD Treatment 
• 29:15 - Key Takeaways 
• 31:01 - Conclusion and Additional Learning Opportunities 

📋 Key Takeaways

• Patients with StUD should be assessed and placed in the appropriate level of care using the ASAM Criteria. 
• Contingency management is the most effective treatment for StUD and can be delivered alone or in combination with psychosocial approaches like cognitive behavioral therapy, the Matrix Intensive Outpatient Treatment curriculum, or the community reinforcement approach. 
• If contingency management is unavailable, explore grants and local resources to implement it effectively. 
• While no FDA-approved medications exist for StUD, some have shown clinical effectiveness in helping patients reduce stimulant use. 
• Healthcare professionals need to actively work to address health disparities stemming from long-standing community inequities by ensuring their workforce reflects the communities served, understanding systemic barriers, integrating care into communities, and adopting health-focused, non-carceral approaches. 
• Treating StUD is not hopeless. Effective treatments exist, and care plans should be tailored to reflect the drug use patterns of the community served. 
• When administered under specialized care, controlled substances can be clinically effective in managing StUD. 

🔗 Resources

• Clinical Practice Guideline on the Management of Stimulant Use Disorder, developed by ASAM and AAAP; Access here! 
• ASAM’s 56th Annual Pre-conference: Stimulant Use Disorder on Thursday, April 24, 2025; Register here! 
• FREE Webinar Series: Management of Stimulant Use Disorder 
  • Topics: 
    • Stimulant Use Prevention and Harm Reduction  
    • Management of Stimulant Intoxication and Withdrawal  
    • Behavioral Treatments for Stimulant Use Disorder  
    • Medication Management for Stimulant Use Disorder  
      
• ASAM’s 56th Annual Conference session on GLP-1 on Friday, April 25, 2025; Register here! 
• Matrix Intensive Outpatient Treatment for People with Stimulant Use Disorders: Counselor's Treatment Manual; Access here! 

📢 Join the Discussion

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