ASAM Pocket Guidelines and Patient Guide

3 Key Takeaways 1. Contingency management (CM) has demonstrated the best effectiveness in the treatment of StUDs compared to any other intervention studied and represents the current standard of care. CM can be combined with other psychosocial interventions and behavioral therapies, such as community reinforcement approach (CRA) and cognitive behavioral therapy (CBT) (See Recommendations 5-6). 2. Pharmacotherapies, including psychostimulant medications, may be utilized off-label to treat StUD (See Recommendations 9-20). • When prescribing controlled medications, clinicians should closely monitor patients and perform regular ongoing assessment of risks and benefits for each patient. • Psychostimulant medications should only be prescribed to treat StUD by: ▶ physician specialists who are board certified in addiction medicine or addiction psychiatry; and ▶ physicians with commensurate training, competencies, and capacity for close patient monitoring. • Non-psychostimulants such as bupropion, mirtazapine, topiramate and naltrexone can also be used to treat StUD. 3. Co-occurring conditions—including but not limited to attention- deficit/hyperactivity disorder (ADHD), depression, anxiety, eating disorders, and other substance use disorders (SUDs)—are common in patients with StUD. Any co-occurring psychiatric disorders or SUDs should be treated concurrently alongside StUD with care coordination (See Recommendations 21-25). • Evidence supports the use of pharmacotherapy, including psychostimulant medication, to treat ADHD in individuals with co-occurring StUD. • Some pharmacotherapies that can be considered to treat StUD off-label have demonstrated efficacy in treating common co-occurring psychiatric disorders and SUDs and can be given additional consideration. 4. Clinicians should provide adolescents and young adults who use stimulants with the same treatment, harm reduction, and recovery support services (RSS) as adults in a developmentally responsive manner (See the Adolescent and Young Adult Section). 5. Acute stimulant intoxication can result in several life-threatening complications that include but are not limited to cardiovascular complications (eg, acute coronary syndrome [ACS], hypertensive emergency, myocardial infarction), hyperthermia, and acidosis, among others. These acute issues should be addressed immediately in an appropriate level of care (See Recommendations 55-72). 6. Treating symptoms of stimulant withdrawal may help support ongoing treatment engagement (See the Stimulant Withdrawal section). • Post-acute symptoms of stimulant withdrawal—which include depression, anxiety, insomnia, and paranoia—can last for weeks to months. It is important to assess for and treat these symptoms to reduce the risk for decompensation and return to stimulant use. 7. Secondary and tertiary prevention strategies should be used to reduce harms related to overdose risk, risky sexual practices, injection drug use, tooth decay, and nutritional deficiencies (See Recommendations 79-92).

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