Stimulant Use Disorder Treatment in St. Louis
Stimulant use disorder encompasses problematic use of cocaine, methamphetamine, and prescription stimulants such as Adderall or Ritalin when used outside of a prescription. Unlike opioid use disorder, there are currently no FDA-approved medications specifically for stimulant use disorder — but this does not mean treatment is ineffective. Highly evidence-based behavioral treatments exist and produce real outcomes. If you are struggling with cocaine or meth, you are not out of options.
What Is Stimulant Use Disorder?
The DSM-5 defines stimulant use disorder as a problematic pattern of stimulant use leading to significant impairment or distress, with at least 2 of the following occurring within a 12-month period:
- Using more than intended: Using stimulants in larger amounts or over a longer period than you planned.
- Failed attempts to cut back: Wanting to stop or reduce stimulant use but finding yourself unable to.
- Significant time spent: Spending a great deal of time obtaining stimulants, using them, or recovering from their effects.
- Cravings: A strong desire or urge to use stimulants.
- Failure to meet obligations: Stimulant use interferes with your responsibilities at work, school, or home.
- Continued use despite problems: Continuing to use stimulants even though they are causing relationship, health, or legal problems.
- Giving up activities: Withdrawing from social, occupational, or recreational activities you used to value because of stimulant use.
- Use in dangerous situations: Using stimulants in physically hazardous situations.
- Tolerance: Needing significantly more stimulant to achieve the same effect, or noticing a reduced effect with the same amount.
- Withdrawal: Experiencing withdrawal symptoms — fatigue, depression, increased sleep, irritability — when cutting back or stopping.
2–3 criteria indicate mild stimulant use disorder; 4–5 moderate; 6+ severe. Stimulant withdrawal is not medically dangerous the way alcohol withdrawal can be, but it can be psychologically intense — particularly the depression and anhedonia that follow heavy use.
What Stimulant Use Disorder Actually Looks Like
Stimulants produce intense euphoria, energy, and confidence — and an equally intense crash. The high from cocaine typically lasts 15–30 minutes; the high from methamphetamine can last hours. In both cases, the crash that follows — fatigue, depression, irritability, inability to feel pleasure — drives people back to use far sooner than they intended. This cycle can become consuming very quickly.
The psychological withdrawal from stimulants is often underestimated. Unlike opioid withdrawal, stimulant withdrawal is not physically dangerous — but it can be profoundly difficult. Heavy users coming down from cocaine or meth frequently experience days of deep fatigue, inability to feel pleasure (anhedonia), disturbed sleep, and depression severe enough to include suicidal thoughts. This is a neurological consequence of dopamine system dysregulation, not a sign of weakness.
Methamphetamine and cocaine differ in important ways beyond duration of effect. Methamphetamine is more neurotoxic with prolonged heavy use, more likely to produce psychosis — paranoia, hallucinations, delusional thinking — and has a longer recovery arc in terms of cognitive function and emotional regulation. Cocaine is more likely to be associated with high-functioning use that erodes over time. Both can become severe and both respond to treatment.
The relationship between stimulant use and mental health is significant. Stimulant use produces anxiety, paranoia, and mood instability acutely. Heavy or prolonged use can precipitate or worsen underlying anxiety disorders, bipolar disorder, and psychotic disorders. These effects can persist into early recovery, which is why treating co-occurring mental health conditions is an important part of comprehensive stimulant use disorder treatment.
How We Treat Stimulant Use Disorder
There is no FDA-approved medication for stimulant use disorder, but the behavioral treatments that exist are among the most rigorously studied in addiction medicine. We lead with contingency management and CBT, and we treat co-occurring mental health conditions as part of the same plan — not as a separate issue to be addressed later.
Contingency Management
Contingency management (CM) is the most evidence-supported treatment specifically for stimulant use disorder. It uses structured incentives — rewards for verified abstinence or treatment engagement — to reinforce behavior change. It sounds simple, and the mechanism is straightforward, but the clinical evidence is substantial. CM produces significantly better outcomes for cocaine and methamphetamine use disorder than most other interventions.
Cognitive Behavioral Therapy
CBT for stimulant use disorder addresses the high-risk situations, thought patterns, and emotional states that drive use. It builds concrete coping skills — how to handle cravings, how to navigate social situations where use is expected, how to respond to stress without returning to stimulants. These skills generalize well and support long-term recovery.
Treating Co-Occurring Mental Health Conditions
Depression and anxiety are extremely common in stimulant use disorder — both as causes and consequences of use. We assess for and treat co-occurring conditions as part of your overall care. Stabilizing your mental health is not separate from addressing stimulant use; the two are deeply intertwined, and treating them together produces better outcomes than treating them sequentially.
Motivational Interviewing
Ambivalence about change is normal and expected. Motivational interviewing helps you clarify your own values and goals, and work through the mixed feelings that almost everyone has about stopping something that has also served a function in their life. We don't lecture or argue — we listen and help you find your own reasons to change.
Family Therapy
Stimulant use disorder strains relationships in specific ways — the unpredictability, the secrecy, the financial consequences, the personality changes during use. Family therapy helps repair those relationships, establishes healthy boundaries, and builds a support system that can sustain recovery.
Common Questions
Other Resources
12-step fellowship specifically for methamphetamine — 860+ meetings in 44 U.S. states and 17 countries. Helpline: 1-855-METH-FREE (638-4373).
12-step fellowship open to anyone seeking freedom from cocaine and all mind-altering substances — meetings worldwide, no fees.
12-step fellowship for recovery from any drug — stimulants are now the most commonly cited primary drug among NA members worldwide.
Science-based, secular alternative using CBT and motivational tools — 1,500+ meetings weekly including online. All substances and behavioral addictions.
Secular, present-focused mutual support — no higher-power requirement. A strong alternative for those who don't connect with 12-step.
Women-only nonprofit recovery program — addresses the emotional and self-esteem dimensions of recovery that are often especially relevant for women.
Call or text 988 — free, confidential, 24/7 crisis support for mental health emergencies and suicidal thoughts.