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Advances in Psychiatric Treatment (2005) 11: 262-269
© 2005 The Royal College of Psychiatrists

Stimulant use still going strong

REVISITING... MISUSE OF AMPHETAMINES AND RELATED DRUGS

Nicholas Seivewright, Charles McMahon and Paul Egleston

Nicholas Seivewright was senior lecturer in drug dependence in Manchester before moving to his present post as consultant psychiatrist in substance misuse with Sheffield Care NHS Trust (Norfolk House, 4 Norfolk Street, Sheffield S1 2JB, UK. Tel: 0114 271 6802; fax: 0114 271 6814; e-mail: amy.robinson{at}sct.nhs.uk). His research interests include personality disorder, dual diagnosis and pharmacological treatments in addictions, and he has written a practically oriented textbook on drug misuse treatment. Charles McMahon was specialist registrar in substance misuse in Sheffield before taking up his post as consultant psychiatrist in addictions, for NHS Argyll and Clyde. His interests include the treatment of non-opiate drug misuse and psychiatric comorbidity, and managing clinical services. Paul Egleston is a specialist registrar in general psychiatry in Sheffield and was recently an expert contributor to an evidence-based review of drug dependence treatment. He is involved in neuroimaging research and has a career interest in forensic psychiatry.

Amphetamines, cocaine and methylenedioxymethamphetamine (MDMA, ‘ecstasy’) have been prominent on the UK drugs scene over the past decade. Much cocaine is now in the form of ‘crack’, which produces particularly acute versions of well-known complications including paranoid psychosis, mood disorders and cardiovascular problems. Ecstasy has additional hallucinogenic properties, and the slightly different range of psychiatric effects can be long-lasting. Assessment for stimulant misuse should include drug screening more than is currently common in general settings. Management comprises psychosocial (particularly behavioural counselling) and pharmacological approaches. A wide range of dopaminergic and other medications have been studied in cocaine misuse, and specialised substitute prescribing may be appropriate for heavy amphetamine injecting. There has been recent focus on problems of dual diagnosis, with particular strategies required to address stimulant misuse by people with severe mental illnesses.




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