Psychosocial approaches to psychostimulant dependence: A systematic review

Shearer, James

doi:10.1016/j.jsat.2006.06.012

Cited by 53 publications

(41 citation statements)

References 108 publications

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“…In support of this hypothesis, a study conducted in New South Wales, Australia noted significant reductions in depression and suicidal thoughts, plans and attempts in a sample of 387 heroin-users, three years following entry in drug addiction treatment (Darke et al, 2009). For stimulant users, pharmacological therapies are still under development (Ciccarone, 2011), and the effectiveness of psychosocial interventions is compromised by poor treatment initiation and retention rates (Shearer, 2007). Compared to heroin users, stimulant users are substantially less likely to initiate drug treatment (John et al, 2001) and are more prone to relapse following cessation of drug use (Nosyk et al, 2014), suggesting that health care services may fail to reach and engage stimulant users into care as effectively as opiate users.…”

Section: Associations Of Stimulant Use Patterns With Suicide Attemptmentioning

confidence: 99%

Associations of substance use patterns with attempted suicide among persons who inject drugs: Can distinct use patterns play a role?

Artenie

Bruneau

Zang

et al. 2015

Drug and Alcohol Dependence

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Background: While the elevated risk of suicide attempt among persons who inject drugs (PWID) is well documented, whether use of different substances is associated with varying degrees of risk remains unclear. We sought to examine the associations between substance use patterns and attempted suicide in a prospective cohort of PWID in Montreal, Canada. Methods: Between 2004 and 2011, participants completed an interviewer-administered questionnaire eliciting information on socio-demographic, substance use patterns, related behaviors, and mental health markers. Generalized estimating equations were used to model the relationship between self-reported use of six common substances (cocaine, amphetamine, opioids, sedative-hypnotics, cannabis and alcohol), associated patterns of use (chronic, occasional and none), and a recent (past six-month) suicide attempt. Results: At baseline, of 1,240 participants (median age: 39.1, 83.7% male), 71 (5.7%) reported a recent suicide attempt. Among 5,621 observations collected during follow-up, 221 attempts were reported by 143 (11.5%) participants. In multivariate analyses adjusting for socio-demographic and psychosocial stressors, among primary drugs of abuse, chronic [Adjusted Odds Ratio (AOR): 1.97] and occasional (AOR: 1.92) cocaine use, and chronic amphetamine use (AOR: 1.96) were independently associated with attempted suicide. Among co-used substances, chronic sedative-hypnotic use was independently associated with an attempt (AOR: 2.29). No statistically significant association was found for the remaining substances. Conclusion: Among PWID at high risk of attempted suicide, stimulant users appear to constitute a particularly vulnerable sub-group. While the mechanisms underlying these associations remain to be elucidated, findings suggest that stimulant-using PWID should constitute a prime focus of suicide prevention efforts

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Section: Associations Of Stimulant Use Patterns With Suicide Attemptmentioning

confidence: 99%

Associations of substance use patterns with attempted suicide among persons who inject drugs: Can distinct use patterns play a role?

Artenie

Bruneau

Zang

et al. 2015

Drug and Alcohol Dependence

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“…The aim of substitution therapy is to achieve a stable dose sufficient to prevent withdrawal and craving, but with a gradual onset of action and longer half-life which diminishes the reinforcing drug effects or 'high' [49,50]. As drug use is stabilised and treatment engagement enhanced, patients may have greater opportunities to benefit from skills, insights and support available from psychosocial interventions [51,52].…”

Section: Indirect Dopamine Agonists For Psychostimulant Dependencementioning

confidence: 99%

The principles of agonist pharmacotherapy for psychostimulant dependence

Shearer

2008

Drug and Alcohol Review

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Issues. Psychostimulant dependence is a chronic, relapsing condition which is highly treatment refractory. No medications to date have been any more successful than placebo in reducing psychostimulant use in dependent patients. Agonist strategies have attracted limited attention. Approach. Successful examples of agonist pharmacotherapy in the treatment of heroin and nicotine dependence are first considered. Agonist pharmacological approaches to the treatment of psychostimulant dependence are then examined, based on the dopamine receptor agonist and indirect dopamine agonist strategies. Finally, the potential extension of the concept of agonist pharmacotherapy to include the novel non-amphetamine-type stimulant, modafinil, is discussed. Conclusions. Agonist approaches appear to be viable with risks outweighed by benefits in carefully selected, monitored and motivated patients. On the other hand, the effectiveness of indirect agonists such as dexamphetamine and methylphenidate are not established. Further research is required to determine optimal treatment models (whether maintenance or withdrawal), effective safe dosages and duration (short or long term). [Shearer J. The principles of agonist pharmacotherapy for psychostimulant dependence. Drug Alcohol Rev 2008;27:301-308]

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“…Twelve-Step programs, such as Narcotics Anonymous, remain a common intervention pursued by many individuals with methamphetamine use concerns (Galanter, Dermatis, Post, & Santucci, 2013) despite a lack of evidence supporting the efficacy of these programs as a stand-alone treatment (Donovan & Wells, 2007;Shearer, 2007). There is some, albeit modest, evidence to suggest that other psychological interventions are effective for stimulant users (Knapp, Soares, Farrel, & Lima, 2007;Shearer, 2007;Vocci & Montoya, 2009). …”

Section: Treatment Of Methamphetamine Use Disordersmentioning

confidence: 99%