From the Guidelines
Methamphetamine use disorder requires a comprehensive treatment approach that combines behavioral therapies with supportive medications, with the most effective treatment being a combination of contingency management and community reinforcement approach, as evidenced by a 2018 systematic review and network meta-analysis 1.
Treatment Approach
The recommended treatment approach for methamphetamine use disorder involves a combination of behavioral therapies, including:
- Cognitive-behavioral therapy (CBT)
- Contingency management
- Motivational interviewing These therapies have shown the most effectiveness in managing methamphetamine addiction.
Medications
While there are no FDA-approved medications specifically targeting methamphetamine addiction, some medications may help manage symptoms:
- Bupropion (150-300mg daily) can reduce cravings
- Naltrexone (50mg daily) may decrease the rewarding effects
- Mirtazapine (15-45mg daily) can help with sleep and anxiety symptoms
Withdrawal Management
For withdrawal management, benzodiazepines like diazepam (5-10mg every 6-8 hours as needed) may be prescribed short-term for severe agitation or anxiety.
Treatment Duration
Treatment typically requires at least 90 days of intensive intervention followed by ongoing support.
Recovery
Recovery from methamphetamine use disorder is challenging due to the significant changes the drug causes to brain chemistry, particularly affecting dopamine pathways that regulate pleasure and motivation. Successful treatment addresses both physical and psychological factors, often requiring a combination of professional help, peer support groups, and lifestyle changes to achieve lasting recovery.
Policy and Prevention
Substance use disorder, including methamphetamine use disorder, is a chronic medical condition that should be managed as such, with a focus on prevention, early intervention, and treatment, as highlighted in a 2017 position paper by the American College of Physicians 1.
From the Research
Treatment Options for Methamphetamine Use Disorder
- Cognitive-behavioral therapy (CBT) and contingency management (CM) are effective treatments for methamphetamine dependence, as shown in studies 2, 3, 4, 5.
- CBT appears to be associated with reductions in methamphetamine use and other positive changes, even over short periods of treatment 2.
- CM has been demonstrated to be effective in reducing methamphetamine use, with broad benefits including greater drug abstinence, higher utilization of other treatments and medical services, and reductions in risky sexual behavior 3, 4, 5.
Effectiveness of Contingency Management
- Contingency management has been shown to increase the likelihood of providing methamphetamine-free urine samples during treatment 4, 5.
- Studies have found that CM can lead to significant reductions in methamphetamine use, with 20 out of 21 studies reporting abstinence outcomes showing an effect of CM on abstinence 3.
- CM has also been found to reduce risky sexual behavior, with 7 out of 9 studies reporting sexual risk behavior outcomes showing an effect of CM in reducing risky sexual behavior 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 includes complex cardiovascular and cerebrovascular signs and symptoms that need to be identified by clinicians 6.
- There is a need to better understand the complex neurobiology of methamphetamine use disorder and to develop interventions aimed at novel biological targets 6.