From the Guidelines
Methamphetamine use disorder treatment should prioritize a combination of cognitive-behavioral therapy (CBT) and contingency management (CM), as this approach has been shown to be more effective than other psychosocial interventions in achieving abstinence and reducing dropout rates 1.
Key Components of Treatment
- Cognitive-behavioral therapy (CBT) to address underlying psychological issues and develop coping strategies
- Contingency management (CM) to provide incentives for abstaining from methamphetamine use
- The Matrix Model, which integrates multiple therapeutic approaches over a 16-week outpatient program
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
- Mirtazapine (15-45 mg daily) has shown some promise in reducing use in some studies
Supportive Care
- Withdrawal management typically focuses on supportive care rather than specific medications
- Symptoms of withdrawal include fatigue, depression, increased appetite, and disturbed sleep that can last for weeks
- Recovery support groups and ongoing therapy are crucial for maintaining long-term abstinence
Importance of Addressing Co-occurring Conditions
- Treatment should address co-occurring mental health conditions, which are common in methamphetamine users
- A structured environment with regular drug testing and accountability measures significantly improves treatment outcomes
Brain Chemistry and Relapse
- Methamphetamine addiction causes significant changes to brain chemistry, particularly affecting dopamine systems
- This explains the intense cravings and high relapse rates, highlighting the need for comprehensive and ongoing treatment.
From the Research
Treatment Approaches for Methamphetamine Use Disorder
- Non-pharmacological interventions, such as cognitive behavioural therapy (CBT), contingency management (CM), and matrix model, have shown efficacy in promoting abstinence and reducing methamphetamine use or craving 2.
- Contingency management has been found to be an effective intervention for reducing methamphetamine use, with benefits including greater drug abstinence, higher utilization of other treatments and medical services, and reductions in risky sexual behavior 3.
- Cognitive-behavioural therapies, including CBT and CM, have been shown to be effective in reducing methamphetamine use and promoting positive changes, even over short periods of treatment 4.
Effectiveness of Contingency Management
- Contingency management has been found to be a promising component in treatment strategies for methamphetamine use disorder, with participants receiving CM submitting significantly more negative samples and remaining abstinent for longer periods of time 5.
- CM has been shown to be effective in reducing methamphetamine use, with 20 out of 21 studies reporting abstinence outcomes showing an effect of CM on abstinence 3.
Neurobiology and Clinical Presentation
- Methamphetamine use disorder has a complex neurobiology, extending beyond the acute effect of the drug to include intracellular pathways focused on oxidative stress, neurotoxic and excitotoxic effects, and neuroinflammation 6.
- The clinical picture of methamphetamine use disorder extends beyond acute psychostimulatory symptoms to include complex cardiovascular and cerebrovascular signs and symptoms that need to be identified by clinicians 6.
Future Directions
- There is a need to better understand the complex neurobiology of methamphetamine use disorder and to develop interventions aimed at novel biological targets 6.
- Parsing the disorder into different processes, such as craving or mood-associated alterations, and targeting the neural systems and biological pathways underlying these processes may lead to greater success in identifying disease-modifying interventions 6.