Amphetamine is a stimulant that is primarily used to treat narcolepsy and attention-deficit hyperactivity disorder. It is also used recreationally as a club drug and as a performance enhancer.

1. Treatment
?
Drug companies say
that a pill is the cure,
but pills don’t teach
skills and may make
addicts ill!

2. Why not use stimulants?

4. Description
• Amphetamine is a stimulant that is primarily used to treat narcolepsy and
attention-deficit hyperactivity disorder. It is also used recreationally as a club
drug and as a performance enhancer.
• Prescription amphetamines are subject to diversion and are one of the most
frequently- abused drugs in high schools and colleges.
• A Schedule II drug is classified as one that has a high potential for abuse, has a
currently-accepted medical use under severe restrictions, and has a high
possibility of severe psychological and physiological dependence.
HO
HO
NH2
OH
Norepinephrine
(Noradrenaline)
NH2
Amphetamine
CH3
NHCH3
Methamphetamine
CH3
Methylphenidate
(RitalinTM)
H
N
O O
Me

5. 0
100
200
300
400
500
600
700
800
900
1000
1100
0 1 2 3 4 5 hr
Time After Amphetamine
%ofBasalRelease
DA
DOPAC
HVA
Accumbens AMPHETAMINE
0
100
200
300
400
0 1 2 3 4 5 hr
Time After Cocaine
%ofBasalRelease
DA
DOPAC
HVA
Accumbens
COCAINE
0
100
150
200
250
0 1 2 3 4 5hr
Time After Morphine
%ofBasalRelease
Accumbens
0.5
1.0
2.5
10
Dose (mg/kg)
MORPHINE
0
100
150
200
250
0 1 2 3 hr
Time After Nicotine
%ofBasalRelease
Accumbens
Caudate
NICOTINE
Di Chiara and Imperato, PNAS, 1988
Effects of Drugs on Dopamine Release

6. Would these responses
differ between controls
and addicted subjects?
CA
PUT
Striatum
VTA/SN
CG
PreF
OFC
nucleus
accumbens
Would increasingDA
enhance activity
in the OFC?
Compared the response to IV MP
(methylphenidate given in 2 sequential
doses of 0.5 and 0.25 mg/kg) in 15 controls and
21 cocaine abusers using FDG and PET to
measure regional brain glucose metabolism

7. 0
2
4
6
8
10
Controls Abusers
baseline
First MP
Second MP
SelfReportCraving
(0-10)
0
2
4
6
8
10
Controls Abusers
SelfReportHigh
(0-10)
Self Reports of Drug Effects After MP in
Controls and in Cocaine Abusers
P < 0.001 P<0.001

8. MP-induced Increases in
Metabolism
OFC
1.00
1.05
1.10
1.15
1.20
1.25
1.30
Controls Abusers
Baseline
MP
RectalGyrus/Brain
-4.0 -2.0 0.0 2.0 4.0 6.0 8.0 10.0
-0.2
-0.1
0.0
0.1
0.2
0.3
Craving
RectalGyrus
(MP-Placebo)
p < 0.005
Abusers > Controls p = 0.001
p < 0.01

9. How Much of the Differences Between
Controls and Cocaine Abusers Reflect
their Past Experience with Drugs?
Effects of Expectation
on the Brain Metabolic Responses
To iv MP in Cocaine Abusers
Source: Volkow, ND et al.,
Journal of Neuroscience, 23,
pp. 11461-11468, December
2003.

10. Effects of Expectation on the Response to MP on
Brain Glucose Metabolism and Behavior
Increases in Metabolism Were
About 50% Larger When MP Was
Expected Than Unexpected
“High” Was About 50%
Greater When MP Was
Expected Than Unexpected
0
2
4
6
8
10
Pl/PL
PL/MP
MP/MP
MP/PL
FeelDrug
0
2
4
6
8
10
Pl/PL
PL/MP
MP/MP
MP/PL
High
0
2
4
6
8
10
Pl/PL
PL/MP
MP/MP
MP/PL
LikeDrug
0
2
4
6
8
10
Pl/PL
PL/MP
MP/MP
MP/PL
Restlessness
0
5
10
15
20
25
30
%Change
Source: Volkow, ND et al., Journal of Neuroscience, 23, pp. 11461-11468, December 2003.

11. Where the Rubber Meets the Road
Data from Dr. Lloyd Gordon from the treatment of patients at COPAC
Information obtained from CAPTASA 2012 website
• Two interviewers had to agree with diagnosis
(MD, PhD, PNP)
• Hx of stimulant abuse not exclusionary
unless DOC
• Initial poor outcomes on Adderall led to
switch to “safer” drugs (e.g. Concerta,
Vyvanse)
• One psychiatrist did all med. adjustments
• Inclusion
– No discussion on unit
– 1 year enrollment in treatment
– Leaving treatment meant no follow-up
from providers
– 1+ prior CD treatments
• All had CBT manually/workbook driven and special
groups with psychiatrist and psychiatric NP
• Behavioral problems resulted in one verbal warning,
then behavioral contract, then discharge
• N=43
• Ages 18-55

12. AGE DISTRIBUTION CONTROL VS STIMULANT
19
10 8
2
22
12
7
2
0
5
10
15
20
25
18-25 26-35 36-45 46-55
CONTROL STIMULANT

13. RELAPSE AND LOST TO FOLLOW UP FOR STIMULANT TREATMENT
OF ADHD
BY QUARTER
100%(43/43)
2
13
8
1
3
10
5
1
0
2
4
6
8
10
12
14
0-3 4-6 7-9 10-12
RELAPSE LOST TO FOLLOW UP

14. Results and Conclusions of COPAC Study
• 100% (43/43) participants were relapsed and/or lost to follow-up.
• 31% of controls (12/39) relapsed and/or were lost to follow-up
• Only 25% of the stimulant group had abused stimulants in the past
• There were many more behavioral discharges in the stimulant vs. control
groups though the disease severity was equal. (Some of the control group
participants were given Welbutrin or Clonidine. Strattera was not available
at the time of the study.)
• Stimulants do not work in the 1st year of treatment.

15. The Benefits of Recovery
• Living in the solution
– One day at a time, easy does it, first things first, keep
it simple
– Acceptance
– Utilize tools such as smart phones
– Delegate
– View the energy and creativity as wonderful gifts
– Consider safe medications, but don’t expect to be
“normal” (False expectation of stimulants as cure.)