10
Treatment
Co-occurring Disorders: General Guidance
21. Clinicians should treat both StUD and co-occurring psychiatric
disorder(s) concurrently (VL-S).
22. Clinicians should use an integrated behavioral treatment approach
that addresses both conditions when available (VL-S). Otherwise,
clinicians should tailor recommended behavioral therapy for
StUD (eg, contingency management, cognitive behavioral therapy,
community reinforcement approach) to address possible interactions
between a patient's StUD and co-occurring disorder(s) (VL-S).
23. Symptoms of psychosis or mania should be treated with indicated
pharmacotherapy (M-S).
a. If stimulant-induced psychosis or mania is suspected, clinicians should consider
a gradual taper off antipsychotic medication after a period of remission of
psychotic symptoms (M-S).
24. When developing a treatment plan for symptoms of depression,
anxiety, insomnia, and/or attentional problems observed during
periods of stimulant use or withdrawal, clinicians should:
a. consider pharmacotherapy based on symptom severity and duration, even if
symptoms are stimulant induced (VL-S); and
b. consider whether the patient's clinical presentation follows the expected time
course of stimulant-induced symptoms given the phase of use (ie, active use,
waning intoxication, acute withdrawal, post-acute withdrawal, post-withdrawal
abstinence) or are present at other times (VL-S).
25. Clinicians initiating treatment for StUD in a patient with a
preexisting co-occurring psychiatric diagnosis should:
a. review the patient's existing treatment plan, ideally in coordination with the
patient's existing treatment provider(s) (CC-S); and
b. continue current medications as appropriate (CC-S), with consideration for
safety in the context of the patient's potential continued use of stimulants and
other substances (CC-S).
