Because the amphetamine intoxication and delusional disorder are generally self-limiting, treatment usually requires little more that supportive measures. In suspected overdose, acidification of the urine with ammonium chloride may help with elimination of amphetamine.
Treatment of daily use or intravenous use of amphetamine may require a period of inpatient hospitalization for depression, suicidal ideation during withdrawal, psychosis, or violence during intoxication.
Antipsychotics may be prescribed for the first few days of paranoid or delusional symptoms.
The withdrawal depression may be treated with tricyclic antidepressants for a month or longer.
In the absence of psychosis, diazepam (Valium) is useful for agitation and hyperactivity (5 to 10 mg PO or IM every 3 hours). Tachyarrhythmias may be treated with propranolol (Inderol) 10 to 20 mg PO every 4 hours.
If a user is to remain drug-free, follow-up treatment, usually with psychiatric help and resort to community resources, is vital.
Life-style changes such as avoiding people, places, and things related to stimulant use should be encouraged.
Initial psychosocial treatment should focus on confronting denial, teaching the disease concept of addictions, fostering an identification as a recovering person, recognition of the negative consequences of stimulant abuse, avoiding situational and intrapsychic cues that stimulate craving, and formulation of support plans.
Drug urine tests should be used to ensure compliance.
It is likely that some heavy amphetamine users, like other heavy drug users, suffer from chronic anxiety, depression, or feelings of inadequacy. In these cases, the drug abuse is a symptom rather than the central problem. These cases can benefit from psychotherapy.
Psychotherapy is useful when it focuses on the reasons for the patient's drug abuse. The drug abuse itself - past, present, and future consequences - must be given firm emphasis. Involving an interested and cooperative parent or spouse in conjoint therapy is often very beneficial.
Because many of these patients are heavily dependent on the drug, psychotherapy may be especially difficult.
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