Methamphetamine Withdrawal Treatment
Methamphetamine withdrawal should be managed primarily with psychosocial interventions—specifically contingency management combined with community reinforcement approach—as there are no FDA-approved medications and pharmacological evidence remains insufficient. 1, 2
Primary Treatment Approach
Psychosocial interventions are first-line therapy for methamphetamine withdrawal and ongoing addiction treatment. 1
- Contingency management combined with community reinforcement approach is the most effective intervention, achieving abstinence with a number needed to treat (NNT) of 2.1 at 12 weeks, 4.1 at end of treatment, and 3.7 at longest follow-up 2
- This combination improves treatment retention with NNT of 3.1 at 12 weeks and 3.3 at end of treatment 2
- Treatment duration should be at least 12 weeks with long-term follow-up, as methamphetamine addiction is chronic and recurrent 2
- Contingency management plus cognitive behavioral therapy is superior to treatment-as-usual for abstinence (odds ratio 2.84) 2
Acute Withdrawal Phase Management (Days 1-10)
The acute withdrawal phase peaks within 24 hours of last use and declines linearly over 7-10 days 3
Supportive care measures include: 2
- Minimizing environmental stimuli
- Promoting adequate rest and sleep
- Ensuring sufficient caloric intake (patients experience increased sleeping and eating during acute phase) 3
Common symptoms during acute phase: 3, 4
- Depression-related symptom cluster (most prominent)
- Anxiety
- Craving
- Cognitive impairment
- Fatigue and hypersomnia
Symptom-Specific Management
Sleep Disturbance
- Standard sleep hygiene measures should be implemented first 1
- Short-term sedative-hypnotics may be considered for severe insomnia 1
Behavioral and Psychiatric Symptoms
A recent inpatient protocol demonstrated feasibility using behavior-targeted interventions (52% of patients) and pharmacological measures when needed (48% of patients), with 83% protocol completion 5
Pharmacological options for severe symptoms may include: 5
- Antipsychotics for agitation or psychotic symptoms
- Sedatives for severe anxiety or agitation
- Ascorbic acid (though evidence is limited)
Critical caveat: No medication has demonstrated clear efficacy in meta-analysis for methamphetamine withdrawal, with evidence quality ranging from low to very low 6. Amineptine showed promise in reducing discontinuation rates but is no longer approved 6.
Special Population: Co-occurring Opioid Use Disorder
For patients with both methamphetamine and opioid use disorders, prioritize opioid withdrawal treatment first. 1
- Initiate buprenorphine or methadone for opioid withdrawal per standard protocols 1
- Manage methamphetamine withdrawal symptoms supportively alongside opioid agonist therapy 1
- Proactively address sleep disturbance in this population 1
Subacute Phase (Days 10-21+)
Following the acute phase, most withdrawal symptoms stabilize at low levels but may persist for at least 2 additional weeks 3
- Continue psychosocial interventions throughout this phase 2
- Monitor for persistent depression, cognitive impairment, and fatigue 4
- Some symptoms may last from days to months, requiring ongoing support 4
Treatment Setting
Outpatient management is appropriate for most patients with intensive programming: 7
- Three to five visits per week
- Comprehensive counseling
- Minimum duration of 3 months for initial intensive phase
Inpatient hospitalization may be indicated for: 7
- Severe cases of long-term methamphetamine dependence
- Co-occurring severe psychiatric symptoms
- Failed outpatient attempts
Assessment Tools
Two validated withdrawal scales exist for monitoring symptoms: 4
- Amphetamine Withdrawal Questionnaire
- Amphetamine Cessation Symptom Assessment
Key Clinical Pitfalls
- Avoid relying solely on pharmacological management—the evidence base is insufficient and psychosocial interventions are superior 6, 1
- Do not discontinue treatment prematurely—contingency management alone loses effectiveness after treatment completion, emphasizing need for extended intervention 2
- Do not underestimate withdrawal duration—symptoms can persist beyond the acute 7-10 day phase for weeks to months 3, 4
- In polysubstance users, do not neglect opioid withdrawal—it must be addressed first to enable effective methamphetamine withdrawal management 1