Abstract
Stimulant use disorder contributes to a substantial worldwide burden of disease, although evidence-based treatment options are limited. This systematic review of reviews aims to: (i) synthesize the available evidence on both psychosocial and pharmacological interventions for the treatment of stimulant use disorder; (ii) identify the most effective therapies to guide clinical practice, and (iii) highlight gaps for future study. A systematic database search was conducted to identify systematic reviews and meta-analyses. Eligible studies were those that followed standard systematic review methodology and assessed randomized controlled trials focused on the efficacy of interventions for stimulant use disorder. Articles were critically appraised using an assessment tool adapted from Palmeteer et al. and categorized for quality as 'core' or 'supplementary' reviews. Evidence from the included reviews were further synthesized according to pharmacological or non-pharmacological management themes. Of 476 identified records, 29 systematic reviews examining eleven intervention modalities were included. The interventions identified include: contingency management, cognitive behavioural therapy, acupuncture, antidepressants, dopamine agonists, antipsychotics, anticonvulsants, disulfiram, opioid agonists, N-Acetylcysteine, and psychostimulants. There was sufficient evidence to support the efficacy of contingency management programs for treatment of stimulant use disorder. Psychostimulants, n-acetylcysteine, opioid agonist therapy, disulfiram and antidepressant pharmacological interventions were found to have insufficient evidence to support or discount their use. Results of this review do not support the use of all other treatment options. The results of this review supports the use of contingency management interventions for the treatment of stimulant use disorder. Although evidence to date is insufficient to support the clinical use of psychostimulants, our results demonstrate potential for future research in this area. Given the urgent need for effective pharmacological treatments for stimulant use disorder, high-quality primary research focused on the role of psychostimulant medications for the treatment of stimulant use disorder is needed.
Highlights
Stimulant use and stimulant use disorder are associated with a range of health and social harms, including psychiatric and cardiovascular morbidity, infectious disease transmission (i.e. HIV and hepatitis C), drug associated crime, and homelessness [1,2,3,4,5]
There was sufficient evidence to support the efficacy of contingency management programs for treatment of stimulant use disorder
The results of this review supports the use of contingency management interventions for the treatment of stimulant use disorder
Summary
Stimulant use and stimulant use disorder are associated with a range of health and social harms, including psychiatric and cardiovascular morbidity, infectious disease transmission (i.e. HIV and hepatitis C), drug associated crime, and homelessness [1,2,3,4,5]. North America maintains the highest prevalence of methamphetamine use worldwide, at 2.1 percent of the population aged 15–64 [6]Australia has seen rising rates of methamphetamine use with related-deaths having doubled between 2009 and 2015 [7]. The growing problem of stimulant use globally has emphasized a pressing need to expand access to evidence-based treatment for stimulant use disorder. Of those accessing publicly funded treatment for substance use disorder in the United States, less than one in five individuals (17.8%) are doing so for cocaine or other stimulant treatment [8]. While there is still no medication on the market, some psychosocial interventions have shown promising results
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