Across the board, there is a paucity of research into interventions for young psychostimulant users (Deas & Thomas, 2001; Deas-Nesmith, Brady & Campbell, 1998; Gilvarry, 2000; Muck, Zempolich, Titus, Fishman et al., 2001). Most studies utilise samples of older, predominantly cocaine users. The translation and applicability to younger, primary psychostimulant users can be problematic. This review of management and treatment options will, where possible, discuss the effectiveness of these interventions with psychostimulants, but will also cover these interventions as they apply to young drug users generally.

Management of psychostimulant intoxication

Accepted practice in working with clients presenting with intoxication-induced psychosis and aggression or violence is stabilisation in a medically supervised treatment setting, where short-term use (48–72 hours) of antipsychotics and tranquilliser medications can be administered to reduce symptoms (Rawson, Gonzales & Brethen, 2002). A Cochrane Review of the literature found no controlled trials of treatment for amphetamine psychosis (Srisurapanont, Kittiratanapaiboon & Jarusuraison, 2003).

Withdrawal management

Detoxification, particularly medically supervised or hospital-based, is rarely required for young people because of their often more limited history of overall drug use and their enhanced capacity to recover from long-term use of psychostimulants (Bailey, 1989; Buckstein et al., 1997). Rather, the provision of a caring and soothing environment is seen as the most effective method of assisting young psychostimulant users during the withdrawal period. In this environment, the young person should:
  • have a high level of support;

  • be surrounded by people who can understand what they are going through;

  • be comfortable;

  • be provided with guidance;

  • have their levels of depression and signs of potential suicide/deliberate self-harm, monitored and responded to; and

  • be assisted with any cravings, taught relaxation strategies (e.g. oils, massages, guided imagery and warm baths) and provided with nutritious meals and assistance in gaining professional help if required.Top of page
Acupuncture and a variety of herbal preparations are becoming more and more popular as a means for withdrawal management. While they lack an evidence base, they have anecdotally been found to alleviate withdrawal symptoms and may assist with engagement. There is a need for these procedures to be subject to more rigorous evaluation. The role of medication to assist the management of ATS withdrawal is limited and no agents have been identified which reliably and demonstrably improve the situation (see Chapter 7: Psychostimulant withdrawal and detoxification and Chapter 8: Pharmacological interventions for reviews).The prescription of benzodiazepines and antidepressants has become common practice. Because of the high potential toxicity in overdose of some tricyclic antidepressants, such as amitriptyline, the newer, safer antidepressants should be considered for this group, but none are side-effect free (Cantwell & McBride, 1998).

It needs to be remembered that withdrawal is merely a part of treatment, and in order to maintain change it should be linked with support and other interventions. During withdrawal, young people have time away from substance-using peers and their community to contemplate their situation, appropriate information and to explore their ambivalence about and receive encouragement to make a decision about changing their substance use.