Stimulants Maybe the best cure for stimulant abuse is different stimulants (not 12 steps)

[Jabberwocky]

There are lots of posts (and contrary views) here about substituting one drug for another when trying to recover. However, a harm reduction view might be that substituting a less harmful drug for a more harmful drug is always a win. It is also wel documented in this forum that people with stimulant abuse history have a lot of problems when it comes to getting ADHD-type meds (and a lot of grief generally from the medical establishment). This article is a very readable evidence-based argument towards using commonly available and legal prescribed agonist substances to attenuate or reduce the use of illegal stimulants. Of particular interest to me is how effective d-amphetamine is for reducing the use of cocaine and methamphetamine, although unfortunately the effective dose seems slightly larger than the max ADHD dose. It is also interesting how substitution therapy works for people conditioned to the rush of IV stimulant use - which I thought was impossible to overcome cravings for. It's very interesting that maybe as little as 60 mg of d-amp can effectively influence the dopamine system enough to overcome the conditioning associated with IV'ing what I presume are user levels of meth which is probably several points a day.

I've searched the forum to see if this article was already posted and could not find it even though it is 10 years old, but it seems it might be of interest to many people trying to quit stimulants - especially if they have dual diagnosis ADHD. Apologies if its old news - but I'd like to have a conversation about stim substitution therapy anyway. One limitation of the article though is it provides no consideration about legitimate stimulants being a gateway drug to illegal stimulants - for example how many kids go from Adderall to meth or coke. This possibility is maybe what limits substitution therapy for stimulants.

The other thing I wanted to do was open a discussion about why so little stimulant substitution therapy exists when there is solid clinical evidence that it works whereas the clinical evidence for 12 step/abstinence programs is pretty marginal. In Australia there is apparently only a single trial program but a number of large players (like the Salvation Army) who are evangelical about 12 steps / abstinence. People talk about Big-Pharma controlling how health is delivered, but maybe there is also Big-Rehab that has so thoroughly commercialised (or ideologised) the 12 step / abstinence model it has crowded out every other kind of approach. I'm lucky that my maverick psychiatrist believes d-amp neutralises cravings for just about every other stimulant from coffee to nicotine. Has anyone here ever participated in a stimulant substitution program? How did you go?

My understanding is that 12 step programs have about a 3% success rate from first meeting visit to sustained abstinence given their massively high dropout rate. I like the idea of community / people-led recovery programs but they need to be evidence based also. Maybe now there are beginning to be bigger and more widespread trials for things like MDMA/PSTD and LSD microdosing there will be more research into this approach to stimulant abuse.

 

[negrogesic]

Yeah I've always wondered about the viability of stimulant substitution.

Perhaps the problem is the compulsive nature of stimulant abuse, and the lack of a profound withdrawal syndrome, thus the addict could ostensibly blow through a script in a few days with no major ill.

I suppose ultimately there isnt the kind of sympathy for stimulant addicts that exists for opioid and depressant addicts since stimulant withdrawal isnt nearly as painful or potentially life threatening. Also few people (aside from perhaps narcoleptics) need stimulants in the same way people need opioids or depressants.

Still i don't disagree with it im just hypothesizing why it has been poorly explored.

 

[Jabberwocky]

Yeah I've always wondered about the viability of stimulant substitution.

Perhaps the problem is the compulsive nature of stimulant abuse, and the lack of a profound withdrawal syndrome, thus the addict could ostensibly blow through a script in a few days with no major ill.

I suppose ultimately there isnt the kind of sympathy for stimulant addicts that exists for opioid and depressant addicts since stimulant withdrawal isnt nearly as painful or potentially life threatening. Also few people (aside from perhaps narcoleptics) need stimulants in the same way people need opioids or depressants.

Still i don't disagree with it im just hypothesizing why it has been poorly explored.

You make some interesting points but your hypothesis kind of presumes that public health policy on drugs is made mainly on compassionate grounds (i.e. reducing suffering). It might partly be made on reducing social problems caused by addicts. For example, heroin addicts getting public health provided methadone are no longer committing crimes to feed their habit so the cost/benefit of providing the program looks good from a public policy perspective. In some locations stimulant addicts are causing way more social problems (from theft to violence) than opiod addicts so an investment in a program that more effectively reduced stimulant usage might also show a positive cost/benefit ratio.

Also, I think there are quite a number of fatalities or serious injuries from meth withdrawal when people kill themselves or commit self-harm from the comedown feelings. Certainly there is a reason so many people on BL claim to have been a daily user for XX years!