From the Guidelines
Treatment for methamphetamine use disorder should involve a combination of contingency management and community reinforcement approach, as this has been shown to be the most efficacious and acceptable treatment in both the short and long term, according to a systematic review and network meta-analysis published in 2018 1. The most effective treatment approach for methamphetamine use disorder is not a single intervention, but rather a comprehensive program that incorporates multiple components.
- Contingency management, which provides incentives for abstinence, is a key component of effective treatment.
- Community reinforcement approach, which focuses on rebuilding the patient's social environment and providing support for recovery, is also crucial.
- Cognitive-behavioral therapy (CBT) and the Matrix Model, which combines behavioral therapy, family education, counseling, and 12-step support, may also be beneficial. While medications such as bupropion or naltrexone may be used off-label to help reduce cravings, the evidence for their effectiveness is limited, and they should not be relied upon as the sole treatment approach. Mirtazapine may be helpful in managing sleep disturbances during withdrawal. Treatment should also address common co-occurring conditions like depression, anxiety, and psychosis. The withdrawal period typically lasts 1-2 weeks, characterized by fatigue, depression, increased appetite, and intense cravings. Recovery requires long-term support through ongoing therapy, support groups, and addressing social determinants like housing and employment. This comprehensive approach is necessary because methamphetamine causes profound changes to brain dopamine systems, creating powerful reinforcement patterns that make recovery challenging without multiple interventions working together. Recent guidelines and recommendations, such as those from the International Antiviral Society-USA panel in 2025, support the use of contingency management and other behavioral therapies as the most effective treatment approach for stimulant use disorders, including methamphetamine use disorder 1.
From the Research
Treatment Options for Methamphetamine Use Disorder
- Contingency management is among the most effective interventions for reducing methamphetamine use, with studies showing broad benefits including greater drug abstinence, higher utilization of other treatments and medical services, and reductions in risky sexual behavior 2, 3, 4
- Cognitive behavioral therapy (CBT) is also a promising approach for treatment of methamphetamine abuse and dependence, with studies showing reductions in methamphetamine use and other positive changes 3, 5
- The Matrix Model of outpatient treatment is a manualized approach that has been evaluated in a multisite study, providing data on its effectiveness for methamphetamine use disorder 5
- Pharmacotherapy development research is currently being sponsored by the National Institute on Drug Abuse (NIDA) to address the lack of FDA-approved medication for methamphetamine use disorder 5, 6
Effectiveness of Contingency Management
- Contingency management has been shown to be effective in reducing methamphetamine use, with 20 out of 21 studies reporting abstinence outcomes showing an effect of contingency management on abstinence 2
- Contingency management has also been shown to reduce risky sexual behavior, with 7 out of 9 studies reporting sexual risk behavior outcomes showing an effect of contingency management in reducing risky sexual behavior 2
- The effectiveness of contingency management has been demonstrated in various populations, including men who have sex with men (MSM), community programs, and research treatment programs 2
Current and Emerging Treatments
- Current treatments for methamphetamine use disorder include behavioral therapies such as CBT and contingency management, but these therapies have limitations and would benefit from the addition of a pharmacotherapy 6
- Clinical trials have not yet found consistently effective pharmacotherapy for methamphetamine use disorder, but research is ongoing to develop new treatments 6