What therapy options are available for a patient with methamphetamine use disorder?

From the Guidelines

The most effective treatment for methamphetamine use disorder is a combination of Contingency Management (CM) and Cognitive Behavioral Therapy (CBT), as it has been shown to be more effective than other treatments in achieving abstinence and reducing dropout rates 1.

Treatment Options

The treatment of methamphetamine use disorder typically involves a combination of behavioral therapies and supportive approaches. Some of the most effective behavioral therapies include:

• Cognitive Behavioral Therapy (CBT): helps patients identify and change harmful thought patterns
• Contingency Management (CM): provides tangible rewards for maintaining abstinence
• The Matrix Model: a 16-week structured program combining behavioral therapy, family education, counseling, and drug testing
• Motivational Interviewing: helps build motivation for change
• Support groups like Crystal Meth Anonymous: provide peer support

Medications

While no medications are specifically approved for methamphetamine addiction, some clinicians may use bupropion (150-300 mg daily) or naltrexone (50 mg daily) off-label to help reduce cravings, though evidence for their effectiveness is limited 1.

Comprehensive Treatment

Treatment should be comprehensive, addressing co-occurring mental health conditions, which are common in methamphetamine users. Recovery typically requires long-term engagement in treatment, as methamphetamine alters brain chemistry significantly, particularly affecting dopamine pathways, which explains why recovery can be challenging and relapse rates are high.

Key Considerations

• The strength of evidence for CM plus community reinforcement approach versus treatment as usual was rated as “moderate” for abstinence and as “high” for dropout due to any cause 1.
• The strength of evidence for CM plus CBT and CM alone versus treatment as usual was rated as “moderate” for abstinence, while the strength of evidence for dropout due to any cause was rated as “very low” and “moderate”, respectively 1.

From the Research

Therapy Options for Methamphetamine Use Disorder

The following therapy options are available for patients with methamphetamine use disorder:

• Contingency management (CM): a type of behavioral therapy that provides rewards for achieving specific goals, such as abstaining from methamphetamine use 2, 3, 4, 5
• Cognitive behavioral therapy (CBT): a type of psychotherapy that helps patients identify and change negative thought patterns and behaviors associated with methamphetamine use 3, 4, 6
• Residential rehabilitation based therapies: a type of therapy that provides a supportive environment for patients to recover from methamphetamine use disorder 4
• Repetitive transcranial magnetic stimulation (rTMS): a type of non-invasive brain stimulation therapy that has shown promise in reducing methamphetamine use 4
• Matrix model: a type of behavioral therapy that provides a structured program for patients to recover from methamphetamine use disorder 4
• Exercise: a type of behavioral therapy that has shown promise in reducing methamphetamine use and improving overall health 4

Key Findings

• Contingency management has been shown to be an effective treatment for methamphetamine use disorder, with strong evidence favoring its use 2, 3, 4, 5
• Cognitive behavioral therapy has also been shown to be effective in reducing methamphetamine use and improving overall health 3, 4, 6
• Patients who use methamphetamine have positive attitudes towards contingency management as a potential treatment option, but may require greater flexibility in meeting treatment goals 5
• Digital technologies, such as text messaging, may be a useful adjunct to traditional therapies for methamphetamine use disorder 6