Millions of Americans either abuse or are dependent on illegal drugs like cocaine, methamphetamine (also known as speed, meth, ice, or crank), and methylenedioxymethamphetamine (often called MDMA or "ecstasy"). These stimulants are among the most commonly abused drugs in the world. They are also some of the toughest substances for addicts to quit.
Some stimulants — such as methylphenidate (Ritalin) and dextroamphetamine (Adderall) — are prescribed for conditions like attention deficit disorder and some sleep disorders. But they can also be abused. When they are crushed, snorted or injected, these drugs create a euphoric sensation.
Most mental health professionals see psychotherapy as the primary way to treat stimulant addiction. If depression or anxiety are aggravating the addiction, medications can help to treat those problems. Although researchers have been working to find medicines to specifically treat stimulant addiction, as yet none are specifically approved by the U.S. Food and Drug Administration for this purpose.
Addictive behavior is sometimes called "over-learned" because it is almost completely automatic. Thus, an important goal of psychotherapy is to help addicts "unlearn" their addiction, to adopt routines that may combat cravings and to use techniques that will help them slowly build a drug-free life.
Here are some of the medications being studied as treatments for stimulant addiction.
Researchers have been working for decades on ways to use the immune system to fight stimulant addiction.
The idea behind drug vaccines is to prod the immune system to make antibodies that recognize and bind to the stimulant. The new molecule that is formed is too large to pass through the membrane that separates the brain from the bloodstream. By blocking the drug's access to the brain, scientists hope to reduce both the pleasurable effects of drug use and the subsequent drug cravings. Scientists are using several methods to try to achieve this.
Researchers are also investigating a technique called "passive immunization." Rather than using a vaccine to stimulate the body to actively produce antibodies, the idea is to inject drug-specific antibodies. Theoretically such antibodies could have the same helpful effect, that is, to bind to the addictive drug and prevent it from getting into the brain.
Researchers haven't yet discovered a simple medicine or vaccine that could relieve stimulant addiction. Behavioral therapies and selective use of medication are still the best hope.
The good news is that new statistics give a more encouraging picture of addiction. It turns out that 7 out of 10 Americans do eventually seek treatment for their addictions, even if it takes them a while — sometimes years — to do so. And among the people who don’t seek help, many find a way to limit drug use.
Attitudes about addiction are changing, too. Clinicians have an increasing appreciation that addiction is based on powerful biological processes that are not so easy to resist. Like other mental disorders, addiction cannot be seen as a moral failing.
Clinicians also know that relapse is an almost inevitable part of recovery, so "tough love" and "zero tolerance" approaches are giving way to more respectful attitudes.
The biggest step may be to seek help in the first place. Maybe more people who are struggling with addiction will reach out if they believe they will be treated with respect and understanding, rather than punitive toughness.
Michael Craig Miller, M.D. is editor-in-chief of the Harvard Mental Health Letter and an assistant professor of psychiatry at Harvard Medical School. Dr. Miller has an active clinical practice and has been on staff at Beth Israel Deaconess Medical Center for more than 25 years.