Stimulant Abuse and Dependence: Are Novel Treatment Approaches on the Horizon?
Although recent statistics from the National Institute on Drug Abuse (NIDA) have shown a downward trend over the last several years in patterns of recent or lifetime methamphetamine use and abuse, the problem continues to be a priority public health issue in the US. Among the nearly one million visits to emergency departments in 2009 that were drug and alcohol related, approximately 10% involved the illicit use of stimulants (NIDA, May 2011). Of those who were treated in 2008 for chemical dependency in publicly funded treatment programs, approximately 10% were addicted to stimulants, with methamphetamine dependence comprising the majority of these cases (NIDA, March 2011). According to the NIDA (2005), patterns of methamphetamine abuse are becoming less clustered and more widely distributed geographically, and the demographic profile of methamphetamine abusers is becoming less homogenous than ever before. Methamphetamine is a highly addictive drug of abuse because of its ability to easily cross the blood brain barrier to produce its “high” through dopaminergic activation in the mesolimbic pathway (NIDA, 2005; Stahl, 2008). Methamphetamine also produces a more sustained and intense euphoria or “high” than many other psychostimulants due to a longer half-life in vivo (NIDA, 2005). The neurotoxic effects of methamphetamine and other stimulants can result in long-term physiological and psychological sequelae that include neurodegenerative changes and neurotransmitter dysregulation, and these changes are clinically manifested among abusers as loss of cognition, perceptual disturbances, mood alterations, and dependence (NIDA, 2005). Treatment for methamphetamine and other stimulant dependence has primarily relied on behavioral modalities to date, given the limited research data on pharmacological treatment options to reduce abuse and to support abstinence (NIDA, 2005).
In response to major public health concerns and the lack of available pharmacological treatment options for methamphetamine dependence, the NIDA issued a report to Congress in 2005 reaffirming the agency's continued support for clinical drug trials and other research on the epidemiology, neurobiology, prevention, and behavioral treatment of methamphetamine dependence. The purpose of this review is to examine new research developments that have emerged in the treatment of stimulant abuse since the NIDA-issued report in 2005. Hopefully, these studies will begin to bridge the gap in effective treatment options for methamphetamine and other stimulant dependence. An overview of four research studies with multi-faceted approaches to assessment and treatment will be presented, along with a discussion of clinical significance and implications for practice.