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Clyde Davis has battled addiction to methamphetamine and heroin for more than nine years. He tried various treatment programs, but none worked for him before reaching the highest level of insurance and he was forced to leave.
“I was trying to die; I just tortured myself because I didn't feel like I deserved to live and be happy,” Davis said.
Then three years ago, Montana's oldest nonprofit addiction treatment center became one of the first participants in the Rimrock Foundation's new crisis management program.
Crisis management uses positive reinforcement as a behavioral treatment for stimulant addiction. People are rewarded with low-value gift cards or vouchers for submitting a positive urine drug test.
Decades of research have shown it to be the most effective treatment for stimulant addiction, but it has not been widely implemented due to policy barriers and stigma.
The program changed the game for Davis. He said the award and advice gave him hope and made him more willing to accept help.
“I was able to get clothes for myself, something to eat,” he said. “It really motivated me to keep showing up and stay clean. [drug tests]He said.
Davis successfully graduated from the 12-week program and has been drug-free ever since. He now works as a rehabilitation technologist at the Rimrock Foundation alongside the people he says helped save his life.
“I'm living a life I never dreamed of living. It's beautiful,” he said.
Stimulants are a class of drugs that speed up the body's systems and lead to feelings of alertness, energy, and happiness. These drugs can be highly addictive because they flood the brain with dopamine, hijacking reward pathways, a Report Management of substance abuse and mental health services.
Prescription stimulants are used to treat ADHD and narcolepsy. Other stimulants, such as methamphetamine and cocaine, are considered drugs of abuse. Drug Enforcement Agency. Abuse of these drugs is associated with agitation, hostility, panic, aggression, and suicidal or suicidal tendencies.
Illicit stimulants such as methamphetamine and cocaine are playing a major role in the national overdose problem. They called him experts.“The Fourth Wave” The opioid epidemic. While First waveOpioid overdose deaths are attributed to prescription opioids, the second wave to heroin, the third wave to synthetic opioids, this “fourth wave” characterized by highly potent synthetic opioids such as fentanyl and concurrent stimulant use.
Data fromUS Centers for Disease Control and PreventionIn the United States, cocaine-related overdose deaths have increased more than 5-fold, and methamphetamine-related overdose deaths have increased more than 14-fold between 2011 and 2021. States — and more than half of those deaths involve a stimulant.
Michael McDonnell, a professor of community and behavioral health at the Elson S. Floyd College of Medicine at Washington State University, said the increased potency of stimulants is one of the factors contributing to the rise in overdose deaths. Another reason, he said, is that stimulants and opioids can be used at the same time. Some people intentionally mix the two to compensate for the stimulant “high” effect caused by opioids, while others unknowingly end up taking stimulants contaminated with opioids.
“In most cases, the supply is so mixed that people don't even know what to use,” McDonnell wrote in an email.
Given the risk of dangerous overdoses from this mixed supply, effective treatments for opioid and stimulant addiction are necessary and urgent, he said.
When they liveDrug-based therapiesUnlike methadone and buprenorphine, which are approved by the US Food and Drug Administration for opioid addiction, there are no such treatments for stimulant addiction.
“What we're finding in our program is that many of our patients are having success in recovery from opioid use disorder, but at the same time, stimulant use disorder is causing many problems and interfering with treatment,” said Kathy Chiasson-Downs, lead clinician for Addiction Services at West Virginia University.
Contingency treatment is the most effective behavioral treatment for stimulant addiction, yet remains underutilized.US Department of Health and Human Services .
“We are in the midst of a fatal overdose crisis in the United States. It's mostly driven by opioids, but it's also driven by stimulant use disorder,” said Dominic DeFilippi, deputy national mental health director for substance use disorders at the Veterans Health Administration. “There is a moral obligation to make this highly effective treatment available to patients. It can save lives,” he said.
Contingency management encourages abstinence using positive reinforcement. The method was found to be very effectiveSeveral clinical trialsIn treatment, people can become addicted to stimulants and stop their drug use for short periods of time long term.
Program structures vary, but most are 12 weeks long and require participants to submit to two urine drug tests a week — a schedule based on a two- to three-day booster testing window, DeFilippis said. When a participant submits a negative urine drug test, they receive a reward ranging from $5 to $25 in the form of a voucher or gift card. Participants cannot purchase firearms, alcohol, other drugs or anything related to gambling because the prize is restricted to them, he added.
Often, programs increase the amount of the reward to encourage consistent behavior, DeFilippi said. For example, the first two negative drug tests are rewarded with $5, the next two with $6.25, and so on. If participants present a positive urine drug test after multiple negatives, the reward value will revert to the original amount.
Consistency is critical to recovery, DeFilippis said. When a person's brain is exposed to stimulants for long periods of time, their reward center becomes dysfunctional to the point where they are unable to enjoy everyday activities such as being with loved ones or eating good food. however,ResearchIt has shown that the brain can heal if given time away from the drugs.
“Emergency management is like a wound that we put on the brain to allow the brain to heal, so that when we remove the stimuli in the long term, the natural stimuli from the recovery can maintain the behavior,” DePhilippis said.
DePhillips is leaving.Veterans Health Administration Emergency Management ProgramFor stimulant addiction since 2011 – the biggest application to date. The program has been able to treat more than 6,800 participants and the results are comparable to those found in studies, he said. Of more than 88,000 urine drug tests, more than 92% were negative for the target drug.
“You can take this treatment from the bench to the bedside. It translates effectively into a complex health care organization,” DeFilippis said.
Emergency treatment has been shown to reduce the complexity of drug use and promote better health outcomes, including better heart health and reduced risk of high-risk sex in people who use drugs.HHS report. It is also associated with positive social outcomes such as improvement in work and family and social relationships.
Matt Cottrell began abusing prescription opioid pills when he was a senior in high school in West Virginia. Things spiraled from there – for the next 22 years, he struggled with opioid and methamphetamine addiction.
“It's a bigger struggle than anyone can imagine,” he said. “That's one thing I wouldn't wish on any human being, not even my worst enemy.”
Cottrell, now 41, In the spring of 2022, he entered West Virginia University's Comprehensive Opioid Addiction Treatment Program, which is run by Chaisson-Downs. He successfully graduated from the program and this spring marked his second year of drug abstinence.
The emergency management program “makes you feel better, it really gives you hope,” he said. “It makes you feel like there's someone who wants to see you succeed rather than fail.”
He said the program gave him a sense of self-direction and helped him realize that he could do something good in life if he tried. He used the reward for a negative urine drug test to buy gas, drive to the treatment center and buy snacks at work.
Gradually, the rewards of natural recovery became clear to him and motivated him to stay sober even after the program ended.
“It's a better life to be able to go to work and work,” he said. “I don't want to feel this pain anymore.”
These days, Cottrell spends his time working in a lumber yard and fixing cars — he's currently working on restoring a Ford Bronco. He said these activities give him a new sense of purpose.
While emergency treatment has been life-changing for both Cottrell and Davis, treatment is not a perfect solution for everyone struggling with stimulant addiction, Chiasson-Downs said.
“I see it as a tool in a big toolbox,” she said. “There's the medical department, the peer support department, the emergency management department. We want the recovery of patients to be well-integrated, so we need to be well-rounded as a medical system.
Dr. Nora Volkow, director of the National Institute on Drug Abuse, echoed this sentiment, saying that combining crisis management with other approaches, such as community strengthening programs, can improve long-term outcomes.
Volkow said emergency management has been criticized as a short-term solution that does not lead to long-term recovery. When they liveStudiesWhile it has been shown to be effective in reducing drug use for up to one year, more research is needed to evaluate and improve the long-term effectiveness of the approach. She said more research is needed to develop medication-assisted treatment for stimulant addiction.
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