What are the treatment options for Methamphetamine (meth) use disorder?

From the Guidelines

Treatment for methamphetamine use disorder typically involves a comprehensive approach combining behavioral therapies and supportive care, as there are currently no FDA-approved medications specifically for this condition. The most effective treatment begins with a structured detoxification period in a supervised setting, followed by intensive behavioral interventions. Cognitive-behavioral therapy (CBT), contingency management, and the Matrix Model (a 16-week comprehensive behavioral treatment) have shown the best outcomes, as supported by a systematic review and network meta-analysis 1. These approaches help patients identify triggers, develop coping strategies, and build skills to maintain abstinence. 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, though evidence for their effectiveness is limited 1. Mirtazapine (15-45 mg daily) may help with sleep disturbances during recovery. Treatment should also address co-occurring mental health conditions like depression or anxiety, which are common among methamphetamine users, as highlighted in a position paper on substance use disorders 1. Recovery support groups provide ongoing community reinforcement. The neurobiological basis for methamphetamine addiction involves profound disruption of dopamine systems, which explains why recovery often requires extended treatment periods of at least 3-6 months, with ongoing support recommended for 12-24 months to prevent relapse. Some key considerations in treating methamphetamine use disorder include:

• A comprehensive approach that combines behavioral therapies and supportive care
• The use of CBT, contingency management, and the Matrix Model as effective behavioral interventions
• The potential use of off-label medications like bupropion or naltrexone to reduce cravings
• The importance of addressing co-occurring mental health conditions
• The role of recovery support groups in providing ongoing community reinforcement
• The need for extended treatment periods and ongoing support to prevent relapse, as supported by a review of the present state of the science on transcranial electrical and magnetic stimulation for addiction medicine 1.

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.