Models of intervention and care for psychostimulant users, 2nd edition - monograph series no. 51

Chapter 7: Psychostimulant withdrawal and detoxification

Page last updated: April 2004

Linda Jenner a and John B Saunders b

a Centre for Mental Health Studies, University of Newcastle, New South Wales
b Department of Psychiatry, University of Queensland

Key points:
  • Agreement on the natural history of psychostimulant withdrawal is yet to be reached.

  • The phasic model of withdrawal is commonly applied but not well supported.

  • The 'crash' period is not universally experienced but where it exists, it should be viewed as a recovery period and does not in itself constitute a clinically significant withdrawal syndrome.

  • The withdrawal syndrome for psychostimulants, unlike CNS depressants, may mimic intoxication.

  • Symptoms of depression and associated suicidal ideation may complicate psychostimulant withdrawal.

  • Dependence on other substances, particularly alcohol, is common among those who are psychostimulant dependent.

  • Attempts to self-detoxify from amphetamines may be common and relapse rates are high following both self and hospital detoxification.

  • A thorough mental health and AOD assessment is recommended for those undergoing psychostimulant detoxification.

  • Detoxification on its own is of little long-term value and should be considered only as the first component of an individually tailored intervention plan that at least addresses motivational enhancement and relapse prevention.

  • Due to the high prevalence of comorbid mental health and other drug use disorders, careful and thorough assessment of both areas should be undertaken prior to detoxification with particular emphasis on depression and psychotic symptoms. Training should be provided to clinicians unfamiliar with these assessments.

  • Detoxification from psychostimulants can usually be undertaken in the home or community, but evidence of severe psychotic symptoms that cannot be safely managed in the community, significant poly drug dependence, severe depression or other risk factors indicate that a hospital setting might be more suitable.

  • The use of medications is of little general value in psychostimulant withdrawal and should be informed by individual presentation and specific circumstances according to existing guidelines until further research is undertaken.

  • No strategy for specific psychological therapy during detoxification has as yet been evaluated, but due to the variability of withdrawal syndromes, people undertaking detoxification from psychostimulants should be informed about the range of potential symptoms that they could experience.