What are the treatment options for methamphetamine (meth) use disorder?

From the Guidelines

Methamphetamine use disorder is a serious condition that requires comprehensive treatment, including a combination of behavioral therapies and support services, with the most effective approach being contingency management and community reinforcement approach, as evidenced by a systematic review and network meta-analysis 1. The treatment of methamphetamine use disorder typically involves a combination of behavioral therapies, such as:

• Cognitive-behavioral therapy (CBT)
• Contingency management
• Community reinforcement approach
• The Matrix Model, which combines behavioral therapy, family education, counseling, and 12-step support 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. Recovery from methamphetamine use disorder typically requires long-term treatment of 12 months or more, with ongoing support through groups like Narcotics Anonymous. The disorder develops because methamphetamine causes massive dopamine release in the brain's reward system, leading to intense euphoria followed by dopamine depletion, which drives continued use. Physical effects of methamphetamine use include:
• Severe dental problems
• Weight loss
• Skin sores
• Cardiovascular issues Psychological effects include:
• Psychosis
• Aggression
• Cognitive impairment Withdrawal symptoms include:
• Fatigue
• Depression
• Increased appetite
• Intense drug cravings Making recovery challenging without proper support. According to a systematic review and network meta-analysis, the combination of contingency management and community reinforcement approach was the most efficacious and most acceptable treatment both in the short and long term 1. Additionally, a position paper by the American College of Physicians recommends that substance use disorder be managed as a chronic medical condition, and that multiple stakeholders should cooperate to address the epidemic of prescription drug misuse, including implementation of evidence-based guidelines for pain management and expansion of access to medication-assisted treatment of opioid use disorders 1.

From the Research

Treatment Options for Methamphetamine Use Disorder

The following treatment options are available for methamphetamine use disorder:

• Non-pharmacological interventions, such as:
  • Cognitive behavioural therapy (CBT) 2, 3
  • Contingency management (CM) 2, 3, 4
  • Exercise 2
  • Residential rehabilitation based therapies 2
  • Repetitive transcranial magnetic stimulation (rTMS) 2
  • Matrix model 2
• Pharmacotherapeutic strategies, including:
  • Methylphenidate, which may reduce methamphetamine use 5, 6
  • Mirtazapine, which may be effective in certain subgroups of methamphetamine users 5
  • Other medications, such as antidepressants, antipsychotics, anticonvulsants, and opioid antagonists, which have shown limited or no effectiveness in reducing methamphetamine use 5, 6

Effectiveness of Treatment Options

The effectiveness of these treatment options varies, with:

• CBT and CM showing strong evidence of promoting abstinence and reducing methamphetamine use 2, 3
• Contingency management showing the strongest evidence of favouring outcomes assessed 2
• Methylphenidate showing low-strength evidence of reducing methamphetamine use 6
• Other medications showing low- to moderate-strength evidence of no significant benefit 6

Limitations and Future Directions

The current evidence has several limitations, including:

• Small sample sizes and high dropout rates in some studies 2, 3
• Limited long-term follow-up and relapse rates 5
• Heterogeneous nature of the methamphetamine-dependent population, which may require tailored treatment approaches 5
• Need for further research to improve the longevity of treatment effects and effectiveness among complex presentations 3, 5