Treatment for amphetamine dependence and abuse

Abstract

© 2014 The Cochrane Collaboration. Background: Amphetamine use is of concern because it causes a variety of devastating health physical and neurological consequences, including amphetamine-induced mental disorders. Objectives: To investigate risks, benefits and costs of a variety of treatments for amphetamine dependence or abuse. Search methods: Electronic searches: The specialised register of trials of the Cochrane Group on Drugs and Alcohol (until February 2003), MEDLINE (1966-December 2000), EMBASE (1980-February 2001), CINAHL (1982-January 2001), Cochrane Controlled Trials Register (Cochrane Library 2000 issue 4). References of obtained articles were searched. Selection criteria: All relevant randomised controlled trials (RCTs) and clinical controlled trials (CCTs) were included. Participants were people with amphetamine dependence or abuse, diagnosed by any set of criteria. Any kinds of biological and psychological treatment both alone and combined were examined. A variety of outcomes, for example, number of treatment responders, score changes, were considered. Data collection and analysis: Two reviewers evaluated and extracted the data independently. The dichotomous data were extracted on an intention-to-treat basis, using Relative Risk in to assess data. The Weighted Mean Difference was used to assess the continuous data. Main results: Fluoxetine, amlodipine, imipramine and desipramine have been investigated in four randomised-controlled trials. In comparison to placebo, short-term treatment of fluoxetine (40 mg/day) significantly decreased craving. In comparison to imipramine 10 mg/day, medium-term treatment of imipramine 150 mg/day significantly increased the duration of adherence to treatment. All four drugs had no benefits on a variety of outcomes, including amphetamine use. Authors' conclusions: Fluoxetine, amlodipine, imipramine and desipramine have very limited benefits for amphetamine dependence and abuse. Fluoxetine may decrease craving in short-term treatment. Imipramine may increase duration of adherence to treatment in medium-term treatment. Apart from these, no other benefits can be found. This limited evidence suggests that no treatment has been demonstrated to be effective for the treatment of amphetamine dependence and abuse. Although there is a large number of people with amphetamine dependence and abuse worldwide, very few controlled trials in this issue have been conducted. As the previous treatment trials show no promising result, other treatments, both biological and psychosocial, should be further investigated. However, the results of neurotoxic studies of amphetamines are also crucial for the study designs appropriate for further treatment studies for amphetamine dependence and abuse.