D’Arcy Gebert, a psychiatric nurse practitioner and lead prescriber at CHD’s Stimulant Treatment and Recovery Team (START) at our Pine Street Outpatient Behavioral Health Clinic in Springfield, is part of a multidisciplinary group that treats individuals with primary and co-occurring stimulant use disorder.

She pointed out that the overdose crisis has long been associated with opioids, but there has also been a steady rise in the use of stimulants: in the last five years, overdose deaths involving cocaine have doubled nationally, and those linked to methamphetamine have tripled. “We clearly have more than just an opioid crisis,” according to Gebert. Stimulant use has also reached epidemic proportions in the US, “and the problem has been costing lives,” she said.

To be sure, Gebert is proud to be part of a program that has been expanding access to stimulant use disorder treatment. Earlier this summer, START’s effectiveness was recognized with an Innovation Award from the Western Mass Substance Use Providers Association (WMSAPA).  “This program taps into a population that has been historically underserved,” she said.

The START program was launched after CHD received a $900,000 grant (each year for five years) from the federal Bureau of Substance Addiction Services (BSAS).

“We’ve had a lot of success in the short amount of time we’ve had this program going,” she said. “It has been rewarding, to say the least. We’ve had people tell us during treatment that this is the first time in years they haven’t had cravings for cocaine. One woman told me she hadn’t done cocaine in 27 days, and that was the longest she had gone without using it in 15 years.”

Gebert said cocaine dependence is difficult to overcome, especially because of absence of broadly effective pharmacological treatment. “We don’t have the equivalent of Suboxone, which treats opioid dependence,” she said. What has been proven to be effective in combating stimulant use disorder are behavioral and psychosocial interventions, including Contingency Management, in which individuals receive rewards or incentives in exchange for positive behavior change. Exercise, for example, produces positive outcomes. “It triggers the release of dopamine,” she said. “People who have been using cocaine have had their whole pleasure sensation system corrupted, so they have to relearn how to feel good naturally. It’s part of rebuilding a more stable, normalized dopamine system.”

She said 90 percent of the individuals served in the START program have Attention Deficit Hyperactivity Disorder (ADHD). Because cocaine use can improve concentration, it has the potential to be appealing to someone with ADHD. “Undiagnosed, untreated ADHD can lead to cocaine use,” she said. “Generally, when people with ADHD use cocaine, all of a sudden they feel they can focus and interact with people in a more normal way—they’re not as impulsive, and they can function better. But cocaine use causes a spiral of addiction. That’s the nature of the drug.”

Gebert, who earned her BSN at Elms College and her Psychiatric Mental Health Nurse Practitioner degree at Frontier Nursing University in Hyden, KY, came to CHD in 2022 as an intern after serving has a registered nurse care partner at Commonwealth Care alliance in Springfield. She has a strong background in treating children with ADHD and other mental health conditions—experience that she feels translated well into CHD’s START program.

“I didn’t expect how effective this personalized treatment would be in the program—how receptive and motivated people are,” she said. “I think stimulant use is a topic that people weren’t openly discussing with their providers, and now having an open, honest environment makes a big difference. I’m really enjoying the work.”