We have no effective treatment for severe amphetamine dependence. Now, a study from Finland points to an obvious candidate treatment for those meeting DSM- IV criteria for intravenous amphetamine dependence. Patients were randomly assigned to Abilify (aripiprazole--15 mg/day), Concerta (methylphenidate controlled release--54 mg/day) or placebo for 20 weeks. Why was Abilify included? Because it is a partial dopamine agonist and therefore theoretically might decrease craving for the dopamine-stimulating effects of speed. The comparable agent in the world of opiates is Suboxone, a partial opiate agonist.

The results were so significant at a planned interim analysis, the study was terminated early. Patients taking Abilify were nearly four times more likely to have amphetamine-positive urine screens than placebo, while those taking Concerta were less than half as likely to have a positive urine screen (Tiihonen et al., Am J Psychiatry 2007; 164:160-162).