This clinical guide provides a deep dive into the neurobiology and management of stimulant use, with a specific focus on how these substances impact individuals with SMI. It offers essential diagnostic tools using DSM-5-TR criteria and critical protocols for managing acute intoxication, withdrawal, and stimulant-induced psychosis. By detailing both off-label pharmacotherapies and the gold-standard Contingency Management approach, this resource equips clinicians to effectively handle complex cases and improve treatment adherence in high-stakes clinical settings.