According to the Substance Abuse and Mental Health Administration (SAMHSA), 4.3 million people in the United States had a stimulant use disorder, or addiction, in 2024.1 And, per the CDC, over 50% of all overdose deaths in 2024 involved stimulants like cocaine or meth.2
Despite these millions of people struggling and dying from stimulants, stimulant addiction is still difficult to treat. Unlike alcohol or opioid use disorder, there are no FDA-approved medications to treat stimulant use disorder.
While this may sound discouraging, especially if you have a loved one struggling with stimulant use, it can still be effectively treated with behavioral health strategies. Let’s look at three different therapy approaches and medications that can help.
Note: These approaches can be use in both inpatient (Rehab) and outpatient settings (e.g., Counseling, Intensive Outpatient Program, Partial Hospitalization Programs) Additionally, if your loved one has other mental health problems, specialized care is needed to treat both at the same time and may involve other approaches and medications.
Stimulants are substances that boost dopamine and other brain chemicals that affect attention, motivation, and energy. They can be prescription medications, illicit drugs, or synthetic substances. Common examples of stimulants include:
Teens might misuse stimulants to help them study longer, improve athletic performance, or lose weight. What may start as a short-term boost, though, can lead to a serious health problem called stimulant use disorder. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5, the official book used for mental health diagnoses), stimulant use disorder happens when a person keeps using stimulants even though it causes major problems in their life. For more information on what stimulant use disorder is, check out our article here.
Contingency management (CM) is considered the most effective way to treat stimulant use disorder. It’s a treatment approach that uses rewards to help someone stop using stimulants and make healthier choices. A patient will set goals – such as a negative urine test next week – and if they meet it, they get a reward, like a gift card. If they don’t meet the goal – in this case, if drugs are detected in their urine – they don’t get the reward.
It’s based on the psychological idea of “positive reinforcement” (rewarding what you want to happen) rather than punishment. To read more about contingency management, check out our article here.
Cognitive behavioral therapy (CBT) is another top treatment for many patients with stimulant use disorder. It focuses on identifying and changing patterns of negative thoughts and behaviors.3 CBT focuses on aspects of a person’s behavior and environment that could be triggering or enforcing their substance use. It can help an individual with SUD increase awareness and consequences of their use as well as build up skills and resilience. CBT used in combination with contingency management can be especially effective.
Here’s an example of how this might play out in a therapist’s office:
John is a 28-year-old man who uses cocaine on weekends. He notices that he often uses after stressful days at work. He wants to cut down but finds himself using it whenever he feels stressed or anxious.
In CBT, the therapist helps John recognize the situations, thoughts, and feelings that lead to cocaine use.
By mapping this out, John sees the cycle of: stress → use → temporary relief → negative consequences.
CBT helps John question and reframe the beliefs that lead to use. While his original thought was “I can’t relax without cocaine”, the CBT approach examines the evidence, asking if he has ever relaxed without cocaine. And the answer is yes: through exercise, listening to music, or talking to a friend.
CBT helps him change his thinking from “I can’t relax without cocaine” to “I have other ways to manage stress that don’t involve drugs.”
The therapist teaches John healthy coping strategies to replace cocaine use, including:
John will be asked to practice these strategies in real life and tracks his progress. CBT also focuses on preventing relapse by preparing him for high-risk situations:
Over time, John will start to use cocaine less often or not at all depending upon his goals and feel more control of his choices.
Motivational interviewing (MI) can be helpful for people with less severe stimulant use disorder. It is a patient-centered approach that helps people who might be unaware of how their behavior conflicts with their goals and subsequently motivates them to change.4
Using John’s situation with cocaine, here’s an example of how this might work.
The therapist or counselor doesn’t lecture or force advice. Rather, they show empathy for John: “It sounds like using cocaine helps you cope when life feels stressful.” This helps him feel understood, not judged, hopefully making him more open to talking.
Next, the focus is on the mixed feelings John might have related to his use: “I know it’s risky, but it helps me relax.”
MI helps bring out both sides without pushing so the therapist might say, “On one hand, it relaxes you. On the other hand, you feel guilty and stressed afterward. Which side worries you more?”
The counselor asks open-ended questions and reflects John’s statements to help him hear his own reasons for change:
The goal is for John to discover his own reasons to cut back or quit rather than being told what to do.
Instead of demanding total abstinence right away, MI encourages manageable goals:
The counselor reinforces John’s own ideas and successes: “You said you want to focus on doing better at work. Cutting back even a little shows you’re serious about that goal.”
While CBT focuses on changing thoughts and behaviors, MI focuses on helping the person find their own motivation and reasons to change. Often, MI is used before or alongside CBT to get someone ready for action.
It is important to note that withdrawal from stimulants, meaning the mental and physical symptoms someone can develop when they stop using them, can be very difficult. Unlike alcohol or opioid withdrawal, it is not usually life-threatening. However, the resulting symptoms, particularly depression, can be very severe.5
Although there are no FDA-approved medications for stimulant use disorder, treatment providers may offer medications to help address anxiety, depression, insomnia, and other aspects of withdrawal. The chart below highlights some of the symptoms your loved one may experience as well as possible treatment options and medications.
Stimulant use disorder can be challenging to navigate. However, these forms of therapy can be very effective in helping patients recover. Additionally, there’s promising research underway for potential medications to treat stimulant addiction – so it’s very possible that there will soon be more options for treatment.6
If you’re seeking treatment for a loved one and aren’t sure how to navigate the system, check out our Treatment Roadmap for guidance. And don’t hesitate to reach out to us for support; our trained helpline specialists are here to help.