What is the treatment for methamphetamine (meth) abuse?

Treatment for Methamphetamine Abuse

The first-line treatment for methamphetamine abuse is the combination of Contingency Management (CM) plus Community Reinforcement Approach (CRA), which has demonstrated superior efficacy with a number needed to treat of 3.7 for achieving abstinence. 1

Why CM Plus CRA is the Gold Standard

This combined psychosocial intervention addresses both immediate behavioral reinforcement and the underlying psychological and social factors that maintain addiction. 1

• Contingency Management (CM) provides tangible rewards (vouchers or prizes) contingent upon drug-free urine samples, creating immediate positive reinforcement for abstinence 1, 2
• Community Reinforcement Approach (CRA) is a multi-layered intervention involving functional analysis, coping-skills training, and social, familial, recreational, and vocational reinforcements 1, 2
• CM alone shows efficacy during active treatment but effects are not sustained at long-term follow-up, demonstrating why the comprehensive approach is necessary 1
• CRA alone performs similarly to treatment as usual in the short term but shows more sustained effects at follow-up, highlighting its importance in long-term recovery 1

Alternative Psychosocial Interventions

When CM plus CRA is unavailable, consider these evidence-based alternatives:

• Cognitive Behavioral Therapy (CBT) is more acceptable than treatment as usual but not significantly more efficacious for abstinence, making it a reasonable second-line option 1, 3
• The Matrix Model has demonstrated treatment efficacy in promoting abstinence and reducing methamphetamine use 3, 4
• Exercise-based interventions have shown some efficacy in reducing methamphetamine use and craving 3
• Residential rehabilitation-based therapies can be effective, particularly for patients with severe addiction or unstable social situations 3

What NOT to Do

Avoid these common pitfalls:

• Do not rely on 12-step programs alone as they are not supported by strong evidence for methamphetamine addiction, though they may serve as an adjunct 1
• Do not use non-contingent rewards (providing rewards regardless of drug use status), as these have not shown effectiveness 1, 2
• Do not rely solely on CM without addressing psychological and social factors, which leads to relapse after treatment completion 1
• Do not fail to provide long-term follow-up and support after initial treatment, which is critical for sustained recovery 1

Pharmacological Considerations

Currently, there are no FDA-approved medications specifically for methamphetamine use disorder. 1

• Psychosocial interventions remain the first-line treatment due to limited evidence supporting pharmacotherapy 1
• Active research is ongoing to develop effective pharmacotherapies, but behavioral treatments are the current standard of care 5, 6

Acute Medical Management

For patients presenting with acute methamphetamine intoxication and cardiovascular complications:

• Benzodiazepines alone or in combination with nitroglycerin are useful for managing hypertension and tachycardia due to their effects on central and peripheral manifestations of acute intoxication 7
• Avoid intravenous beta blockers in patients with signs of acute methamphetamine intoxication (euphoria, tachycardia, hypertension), as unopposed alpha stimulation may worsen coronary spasm 7
• Methamphetamine has similar pathophysiological cardiovascular effects to cocaine, so treatment approaches for acute cardiac complications should be similar 7

Treatment Implementation

Begin treatment promptly upon patient presentation:

• Regular monitoring through urine drug screens provides objective evidence of abstinence and is essential for implementing CM effectively 1
• Address barriers such as lack of motivation and waiting periods, which can prevent treatment engagement 1
• Substance abuse treatment can reduce high-risk behaviors such as needle-sharing and improve adherence to medical treatment for co-occurring conditions 1

Long-Term Complications to Monitor

Chronic methamphetamine use is associated with serious medical sequelae:

• Cardiovascular: myocarditis, necrotizing vasculitis, pulmonary hypertension, and cardiomyopathy 7
• Neurological: significant neurotoxicity, cognitive deficits, and persistent anhedonia that can last for months after discontinuation 5, 6
• Psychiatric: extreme paranoia, anxiety, depression, and psychosis 5, 6