National Amphetamine-Type Stimulant Strategy Background Paper
National Amphetamine-Type Stimulant Strategy Background Paper
National Amphetamine-Type Stimulant Strategy Background Paper
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intoxication – the latter tend to commence towards the end of this period and are more<br />
enduring. The experience of withdrawal is generally related to the frequency and duration<br />
of ATS use, potency of drugs consumed, mode of use, severity of dependence and coexistence<br />
of physical and psychiatric conditions (e.g., see Jenner & Saunders, 2004).<br />
Symptoms include, in order of most frequently reported, irritability, aches and pains,<br />
depressed mood, and impaired social functioning (Cantwell & McBride, 1998). Symptoms<br />
can be protracted over several days to several weeks.<br />
Jenner and Saunders (2004) suggested that ATS withdrawal:<br />
• Can generally be managed on an outpatient basis (except where unsuitable home<br />
conditions or co-existing health concerns exist);<br />
• Provision of safe psychosocial support in a non-threatening environment; and<br />
• Can involve pharmacological symptom relief.<br />
These authors also suggested a range of assessment protocols for assessing the potential<br />
risks of withdrawal to inform treatment planning and protocols to monitor and respond to<br />
the withdrawal syndrome. However, as with other researchers and clinicians, they note that<br />
there is a lack of a good evidence base to guide withdrawal management, and in particular,<br />
despite a range of current studies, their counsel that there is limited evidence about<br />
indicated pharmacotherapies still stands:<br />
Recommendations for psychostimulant detoxification and withdrawal management …<br />
tend to be based on clinical opinion and therefore management strategies may vary<br />
from setting to setting. The role of pharmacotherapies is currently limited, however<br />
benzodiazepines, antipsychotics and antidepressants if necessary are currently<br />
considered by clinicians to be the major components of a medicated psychostimulant<br />
withdrawal program (Jenner & Saunders, 2004, p.117).<br />
These and other researchers (e.g., Vincent et al., 1999) also note that a significant<br />
proportion of people dependent on ATS may also be dependent on other drugs (e.g.,<br />
alcohol, opioids), and therefore, the more established withdrawal management strategies<br />
for these drugs could be employed.<br />
5.5 Psychosocial interventions<br />
Psychosocial treatment modalities have most commonly been used to treat ATS<br />
users, in part because of the absence of a strong evidence base demonstrating the<br />
effectiveness of pharmacotherapies. Kamieniecki and colleagues (1998) reported that<br />
the following non-pharmacological interventions had been used with psychostimulant<br />
users: inpatient programs, therapeutic communities, 12-step programs, peer<br />
interventions, behavioural strategies, cognitive-behavioural interventions, multimodal<br />
treatment packages, and non-traditional methods such as acupuncture. Those which<br />
demonstrated the most efficacy were relapse prevention, cue exposure/response<br />
prevention, and multifaceted behavioural treatment. However, it was noted that many<br />
of the interventions had not been properly evaluated.