Patient uneasiness complicates treatment for stimulant use

The adage of “a drug is a drug is a drug” might apply to certain aspects of substance use treatment, but a clear difference appears to come into play with misuse of psychostimulants such as Adderall and Ritalin. A clinical fellow at the South Florida-based Hanley Center at Origins tells Addiction Professional that more than in the case of other drugs, young patients entering treatment cannot envision life without stimulants.

Unlike the incoming patient who knows he has a problem with alcohol, or one who thinks she may have a problem with the ambivalence-inducing marijuana, those with a stimulant misuse history “think they absolutely, positively need their Adderall or they can't survive,” says John Dyben, DHSc. “People come in expecting that we'll keep them on the stimulant.”

Dyben adds, “You'll often hear a parent say, 'You can't take him off it. His doctor said he needs it.'”

Hanley Center of course does not allow its patients to remain on psychostimulants. But Dyben says this effort requires a great deal of patient education—not to mention support to assist them through a withdrawal period where they are likely to feel tired and restless and have difficulty focusing (“even if they haven't had attention deficit disorder,” he says).

“It's about helping them realize there is a goal to this,” Dyben says. He adds that the facility also makes sure to tell patients before they arrive for treatment that they will not be allowed to continue on a psychostimulant, so that there are no surprises at admission.

Use is reinforced

Part of the challenge in treating stimulant addiction, says Dyben, lies in the multiple reinforcers of use of psychostimulants. These influencers range from educators who often practically demand that a young student be prescribed a stimulant, to the simple fact that psychostimulants are so easy for young people to obtain, whether legally with a prescription or illegally from friends or family members.

Dyben believes that amid the opioid crisis that has dominated the addiction field's attention, the problem of stimulant abuse never really went away. What hasn't taken hold yet, unlike in the case of the opioid crisis, is widespread scrutiny of physician prescribing patterns that likely are exacerbating the problem, he says.

He adds that while psychostimulant use almost always is observed with other substance use problems, he recently has observed two cases of pure psychostimulant use without other substance use, in patients in their early 20s.