Cessation of psychostimulants may be a planned (elective) or unplanned experience (e.g. due to incarceration or drugs being unavailable). The planned cessation of drug use in someone who is dependent is termed 'detoxification'. In this monograph the management of someone who has already developed a withdrawal syndrome is termed 'withdrawal management' and may be applicable to various settings including general or psychiatric hospitals or custodial environments such as watch houses or remand centres.
As discussed in Chapter 5: Psychosocial interventions, psychostimulant users are more likely to present for treatment when their use of these drugs has impacted negatively on their lives in regard to behaviour (anger and aggression), aversive psychological symptoms (depression, anxiety, paranoia and panic) and social factors (damage to family or social relationships and unemployment) (Vincent et al., 1999). Beliefs about the relative safety of amphetamines among some users and the lack of identification with treatment-seeking opiate users (Wright et al., 1999), coupled with the inability of many existing drug treatment agencies to appropriately respond to amphetamine users (Lintzeris, Holgate & Dunlop, 1996) may also inhibit treatment-seeking until the adverse consequences are severe. Many psychostimulant users may have had several previous attempts to self-detoxify before seeking formal treatment (Cantwell & McBride, 1998). Hence, the management of people seeking detoxification support should take into account all of these factors to ensure that people are initially engaged in appropriate treatment and retained in aftercare to ensure the best possible outcomes are obtained.
General principles of detoxification from psychostimulantsDetoxification is a process by which the psychostimulant dependent person may withdraw from the effects of the drug in a supervised manner to ensure that withdrawal symptoms and the attendant risks are minimised. As a stand-alone treatment, detoxification is generally considered to be of little long-term value (Gowing et al., 2001), but it is invaluable as a gateway to more extensive services and interventions (National Campaign Against Drug Abuse (NCADA), 1992), which have been discussed in Chapter 5: Psychosocial interventions and Chapter 8: Pharmacological interventions of this monograph. Due to the high rates of relapse following treatment for psychostimulant use disorders (Brecht, von Mayrhauser & Anglin, 2000), psychosocial interventions are an extremely important component of post-detoxification treatment.
Detoxification from psychostimulants is usually undertaken outside a hospital setting if the home environment is supportive and there are no stimulants or other psychoactive drugs available. However, if the person is homeless, has a history of protracted or multiple withdrawals, is severely dependent, or has a concomitant significant medical or psychiatric illness that cannot be appropriately managed in the community, a supervised or hospital setting may be more appropriate.
To date, there is no clear strategy for the psychological and pharmacological management of psychostimulant withdrawal that is based on sound empirical evidence (Proudfoot & Teesson, 2000; Srisurapanont, Jarusuraisin & Kittirattanapaiboon, 2001; Srisurapanont, Jarusuraisin & Kittirattanapaiboon, 2002). However, there is clinical agreement that management strategies essentially involve:
- the provision of psychosocial support in a safe, non-threatening environment; and
- the prescription of symptomatic relief medication when indicated on an individual basis (Murray, Lintzeris, Gijsbers & Dunlop, 2002; Cruickshank & Dyer, unpublished; Pead, Lintzeris & Churchill, 1996).