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Adult Stimulant Use Disorder
Adult Stimulant Use Disorder
Diagnosis
Medication
Recommendation
Is a comorbid disorder (such as bipolar disorder or ADHD) present?
Yes
No
Severity of stimulant use disorder?
Mild
Moderate/Severe
Type of Stimulant
Cocaine
Methamphetamine
Prescription Stimulant
X
Inadequate
response
Inadequate
Response
Inadequate response
Stimulant Use Disorders
Complete psychiatric
and medical history
Comorbid mood disorder present
See corresponding
decision support tool
If substance use or cravings to use persist despite
treatment of comorbidites, continue with stimulant
use specific treatment
Comorbid ADHD present
See corresponding
decision support tool
No comorbidities
Assess severity of
substance use disorder
Mild
Behavioral Interventions
CBT for substance use
Peer support (i.e., 12-steps)
Moderate to Severe
Behavioral Interventions
+
Pharmacotherapy
Pharmacotherapy
Cocaine
Topiramate
Consider modafinil
Methamphetamine
Treat based on specific indication/comorbidity
None
Bupropion
+
Naltrexone
Consider trial of alternate agent above if no contraindications
Clinically indicated opioid use
(including treatment of opioid use
disorder with buprenorphine products)
First: Mirtazapine
Second: Bupropion
Prominent concern for
insomnia or weight loss
Mirtazapine
Prescription stimulants
Consider monitored supply of a
long-acting prescription stimulant such
as Vyvanse for select patients