Senior Associate Rucha Londhe, Ph.D., has 15+ years experience as a child development specialist and researcher focusing on children’s health and education. Her current work for the Substance Abuse and Mental Health Services Administration includes reviewing studies of mental health and substance abuse programs. She and her team are developing an evidence-based guide to address stimulant use disorder (SUD). We sat down with her to discuss the rise in stimulant use as misuse of opioids levels off.
Why are we seeing rising rates of stimulant use? What role does prescription stimulant use play?
Drug epidemics typically follow cyclical patterns. In the 60 and 70s, heroin was a problem, then came along crack and meth. In the past decade, the issue was opioids to a large extent. More recently, meth has made a big comeback, and this time the problem is a lot more complicated. Meth is being mixed with other drugs like fentanyl, making treatment more difficult and increasing deaths due to overdose. The number of psychostimulant-related deaths has climbed sharply over the past few years.
One of the biggest reasons for this rise is that methamphetamine today is far more accessible, cheaper, purer, and more potent compared with the past.
Prescription stimulant use also is rising particularly in the college student demographic. The main motivation to misuse prescription stimulants is cognitive and academic enhancement, although while the stimulants increase alertness, they actually harm academic achievement.
Are some communities more at risk than others for stimulant use?
Research shows typically higher usage of cocaine and meth in the 18-25 age group. In terms of racial differences, you do find higher stimulant use among American Indians and Alaska Natives. Gender differences in why individuals use stimulants have also been documented, with females citing “increased energy” and males citing “enhanced sexual experience” as the prime reasons.
Risk factors for misuse of meth and other drugs include a history of neglect or abuse, drug use by another family member, living in poverty, easy availability of drugs, and mental health problems.
What barriers do community and public health programs face while implementing evidence-based practices (EBPs) for treatment of stimulant use disorder (SUD)?
Funding is the greatest barrier. We know EBPs works in laboratory research, but there has been little funding for evaluation of EBP in real-life program settings.
Another barrier is having your program run at full capacity with trained mental health staff. That’s not always a reality.
EBPs such as contingency management or the computerized part of cognitive-based therapy (CBT) are often not reimbursed by many state Medicare or Medicaid programs or private insurances.
Research shows that the choice of EBP depends on a client’s stage in the addiction cycle. If you think about psychosis or brain functioning associated with stimulant use, if someone is using the day before a treatment program, that person is at a different stage from someone who hasn’t used for 15 days in terms of being able to think and use cognitive skills. Trying to use CBT is going to look vastly different for these two individuals.
Are there promising treatments?
Research suggests that behavioral therapies such as contingency management, CBT, motivational interviewing, and the community reinforcement approach are effective treatments for SUD. Unfortunately, pharmacological treatment for SUD is currently non-existent.
What should communities do to support SUD recovery?
It takes a village. A person dealing with SUD suffers from physical and behavioral health issues and often may be coping with other life circumstances, like low income, housing instability, domestic violence, and child maltreatment. A holistic approach needs to start at the top, with leadership who push for adequate funding and programming in all these areas. Through adequate coordination of health care and community supports, we need to help individuals with SUD become contributing citizens of the community once again.