What's the Best Treatment for Methamphetamine Addiction?

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Summary: The best treatment for methamphetamine addiction, called methamphetamine use disorder, is a comprehensive, integrated, multimodal approach that addresses all the factors that may contribute to or exacerbate the disorder.

Key Points:

Over the past several years, rates of methamphetamine use among the adult population in the U.S. have increased.
Rates of methamphetamine use disorder have also increased over the past several years.
Fatalities associated with methamphetamine overdose have increased alongside rates of methamphetamine use and addiction.
Methamphetamine addiction is associated with polysubstance misuse, co-occurring substance use, and co-occurring mental health disorders.
The presence of fentanyl in the illicit drug supply in the U.S. increase risk of addiction and fatal overdose among people who use methamphetamine.

The Increase in Methamphetamine Use Disorder: Our Next Overdose Crisis?

In 2022 and 2023, rates of drug-related overdose fatalities decreased by close to 5 percent overall, with rates of opioid overdose decreasing by 4.5 percent. This was largely driven by a decrease in opioid overdose fatalities as a result of our nationwide commitment to harm reduction policies, increased access to addiction treatment, and changes in federal restrictions around medication-assisted treatment (MAT) with medications for opioid use disorder (OUD).

However, ratees of methamphetamine related overdose fatality, after a dramatic increase of over 700 percent between 2013 and 2022, dropped only 2 percent between 2022 and 2023.

Here’s the data.

Methamphetamine Overdose Fatalities, 2013-2023

2013 – 2019: 1.2 per 100,000 to 5.0 per 100,000
- A 316% percent increase
2019: 5.0 per 100,000
2020: 7.4 per 100,000
2021: 9.7 per 100,000
2022: 10.5 per 100,000
2023: 10.3 per 1000,000

This difference in rates of decrease is an issue of significant concern. As a nation, we invested considerable resources in learning about opioid use disorder, how to prevent opioid addiction, how to treat opioid addiction, and how to reduce fatal opioid overdose. We still have a very long way to go, but what we’re doing now is working: that’s because we now know what works.

But since we haven’t seen the same reduction in methamphetamine overdose fatalities, the current situation begs the question we pose in the title of this article:

What is the best treatment for methamphetamine addiction?

First, let’s learn everything we can about methamphetamine and methamphetamine addiction. Throughout this article, we’ll use the new publication from the Journal of the American Medical Association (JAMA), “Methamphetamine Use Disorder.”

What is Methamphetamine?

A report from the National Institutes of Health (NIH) offers this definition of methamphetamine:

“Methamphetamine is a central nervous system stimulant that blocks uptake and increases release of norepinephrine, serotonin, and dopamine, causing euphoria, wakefulness, and increased attention.”

Illicit methamphetamine is typically sold in crystalline or powder form. Methods of consumption include:

Smoking
Snorting
Oral ingestion
Intravenous injection

The Diagnostic and Statistical Manual of Mental Disorders – 5th Edition (DSM-5) defines stimulant disorder of which methamphetamine use disorder is a subtype – as follows:

“A stimulant use disorder is defined as a pattern of amphetamine-type substance, cocaine, or other stimulant use leading to clinically significant impairment or distress, as manifested by at least two of the ten primary symptoms/behaviors within a 12-month period.”

The eleven primary symptoms/behaviors /criteria for methamphetamine use disorder include:

Using methamphetamine in larger amounts for longer than planned.
Desire to reduce use, or unsuccessful attempts to reduce or discontinue use.
Significant time and energy spent finding, using, and recovering from methamphetamine use.
Powerful cravings for methamphetamine.
Chronic use causes significant impairment in fulfilling work, school, or family responsibilities
Ongoing use despite significant, recuring interpersonal/social problems caused by methamphetamine use.
Cessation of important life activities – work, social, recreational – because of methamphetamine use.
Continued methamphetamine use in physically dangerous situations.
Continued methamphetamine use despite significant physical, emotional, or behavioral problems caused by continued use.
Tolerance, defined as:

Need for larger doses to achieve same effect.
Reduced effect over time with same dose.

Withdrawal, defined as the presence of stimulant withdrawal syndrome, which includes the following:
- Presence of depression, anhedonia, anxiety, irritability, physical discomfort, physical pain, excess sleep, intense cravings, problems thinking/concentrating lasting 2-3 weeks, with cognitive dysfunction, depression, anxiety, problems thinking/concentrating, and cravings potentially lasting up to 6 months.
- Taking methamphetamine to avoid stimulant withdrawal syndrome

Criterion 11 does not apply to people taking stimulant medication under medical supervision.

If a patient meets criteria for methamphetamine use disorder, the assessing clinician will define the disorder as mild, moderate, or severe, based on the number of symptoms present:

2-3 symptoms: mild methamphetamine use disorder
4-5 symptoms: moderate methamphetamine use disorder
6 symptoms or more: severe methamphetamine use disorder

The information above establishes what methamphetamine is, the defining characteristics and diagnostic criteria for methamphetamine use disorder, and the distinction between mild, moderate, and severe methamphetamine use disorder.

Before we discuss the best treatment for methamphetamine addiction, we’ll address the scope of the problem of methamphetamine use in the U.S.

Methamphetamine Use Disorder in the U.S.: The Latest Facts and Figures

The 2024 National Survey on Drug Use and Health (2024 NSDUH) shows the following prevalence of methamphetamine use and methamphetamine use disorder in the U.S.:

Past Year Methamphetamine Use

Total, age 12+: 0.9% (2.7 million)
By age group:
- 12-17: 0.1% (40,000)
- 18+: 1.0% (2.6 million)
- 18-25: 0.3% (108,000)
- 26+: 1.1% (2.5 million)

Here we see that nearly 3 million people used methamphetamine in 2023, with the greatest rate of use among older adults, and the least rate of use among adolescents.

Among adults 18+ who reported past-year methamphetamine use, 53.9% met DSM-5 criteria for methamphetamine use disorder.

Next, the full data set on methamphetamine use disorder from the NSDUH.

Past Year Methamphetamine Use Disorder

Total, age 12+: 0.6% (1.8 million)
By age group:
- 12-17: 0.1% (23,000)
- 18-25: 0.2% (71,000)
- 26+: 0.8% (1.7 million)
Methamphetamine use disorder is more common among some demographic groups:
- Males
- People who identify as a sexual and or gender minority
- People experiencing homelessness

In addition, experts indicate that methamphetamine use disorder is more common among people who engage in polysubstance misuse, and have a diagnosis of co-occurring:

Cannabis use disorder
Opioid use disorder
Cocaine use disorder
Benzodiazepine use disorder
Alcohol use disorder
Tobacco use disorder

With these facts and figures in mind, let’s take a look at what clinicians and researchers identify as the best treatment for methamphetamine addiction.

The Best Treatment for Methamphetamine Addiction: Comprehensive, Integrated, Holistic, Multi-Modal

The Substance Abuse and Mental Health Services Administration (SAMHSA) indicates the best and most effective treatment for methamphetamine addiction, particularly when accompanied by a co-occurring substance use or mental health diagnosis, is one that identifies and works to health the whole person. This comprehensive, integrated, holistic model must address, at the same time or sequentially, all aspects of life and function affected by methamphetamine use, including:

The disordered use of methamphetamine
Co-occurring mental health disorders
Co-occurring substance use disorders
Psychosocial issues: family and peer relationships

In addition, the best treatment for methamphetamine addiction includes support to help patients seek and find employment, continue academic pursuits, and seek appropriate medical care for the significant, long-term physical consequences of methamphetamine addiction.

Components of a treatment plan that meet the criteria above include psychosocial interventions, psychotherapy, family participation in treatment when recommended, peer/social support, and medication in rare cases. We’ll review these core components of the best treatment for methamphetamine addiction now.

Methamphetamine: Evidence-Based Treatment Modalities

Therapy and related techniques include:

Contingency Management (CM):

This is an intervention wherein counselors offer rewards designed to reinforce/incentivize desired behavior, adhere to treatment, and achieve treatment goals. Past effective rewards/incentives include vouchers, prizes, and access to employment. Evidence indicates CM is most effective when combined with a psychotherapeutic modality such as cognitive behavioral therapy (CBT).

Community Reinforcement Approach (CRA):

CRA counselors collaborate with patients to identify and resolve habits in their life that disrupt health and wellness, with the goal of finding value in behavior unrelated to substance use. Evidence indicates CRA increases:

Duration of abstinence
Rates of abstinence
Treatment retention

Cognitive Behavioral Therapy (CBT)

CBT therapists collaborate with patients to identify and resolve cognitive distortions – i.e. false/incorrect beliefs about themselves and the world – that may exacerbate and perpetuate substance use. CBT therapists help patients develop stress tolerance skills, distress tolerance techniques, an tools to effectively manage high-risk circumstances, and revise unhealthy, life-interrupting patterns of behavior.

Experts indicate CBT therapists, when supporting patients with methamphetamine use disorder, refer to the following resources:

The Matrix Model

The Matrix Model is a multimodal approach that occurs over a 16-week period, focused on creating a safe, healthy, and effective beginning to long-term recovery from substance use disorder. Components of the model include, but are not limited to:

Individual CBT
Group CBT
Family counseling
Social support groups
Community self help groups, such as AA-derived support groups for stimulant/methamphetamine addiction

Evidence indicates the Matrix model is effective in reducing methamphetamine use, cravings for methamphetamine, and risky behavior associated with methamphetamine addiction.

Medication

There are no medications approved by the Food and Drug Administration for the treatment of any stimulant use disorder, including methamphetamine use disorder. In some cases, off-label use of the medications bupropion, naltrexone, topiramate, and mirtazapine. However, the evidence for these medications is of low strength, and use of these medications is only appropriate in specific circumstances, with risks and benefits reviewed ahead of time by patient and provider.

Ongoing Care/Support/Relapse Prevention

When a person with methamphetamine engages in treatment, their official treatment program will typically last anywhere from two weeks to six months. During treatment, the patient and the treatment team collaborate on an ongoing care plan or a relapse prevention plan. These plans include resources for:

Engaging in ongoing counseling or psychotherapy
Staying in touch with treatment peers
Connecting with medical support for medical conditions
Connecting to social services for vocational, educational, food, and housing support
Resources for overdose/overdose emergencies
Resources for craving/relapse emergencies
Connections to mutual support groups, i.e AA-derived support groups for stimulant/methamphetamine addiction

Finally, experts recommend that any person diagnosed with methamphetamine use disorder have access to the overdose reversing medication naltrexone. The presence of fentanyl in the illicit drug supply in the U.S., including illicit stimulants such as methamphetamine, dramatically increases the risk of accidental overdose, which can lead to fatality. Naltrexone saves lives, can immediately reverse an opioid-related overdose, and is effective for people who engage in polysubstance use with opioids and stimulants.

The Challenge of Co-Occurring Mental Health Disorders and the Fentanyl Problem

Evidence shows that people with methamphetamine use disorder are at increased risk of the following mental health disorders:

Depression
Anxiety
Post-traumatic stress disorder
Bipolar disorder

In addition, methamphetamine use increases risk of:

Paranoia
Psychosis
Substance-induced psychosis
Substance-induced schizophrenia

This increased risk can create a cycle wherein methamphetamine use exacerbates specific symptoms and elicits uncomfortable, painful emotions, which increases the likelihood an individual will continue or increase methamphetamine use – a phenomenon called self-medication – which exacerbates the disordered use of methamphetamine and amplifies the symptoms that led to self-medication.

Escalation of this negative cycle can increase the severity of methamphetamine addiction and the associated co-occurring mental health disorders. That’s why the following statement bears repeating:

Addressing all the factors associated with methamphetamine is essential to successful treatment, including addressing co-occurring mental health disorders, co-occurring substance use disorders, and disruptions to social functioning.

That statement is also supported by the conclusion published in the study “Methamphetamine Use Disorder”:

“Methamphetamine use is increasing in the US and has negative health consequences. Clinicians caring for individuals who use methamphetamine should treat coexisting neuropsychiatric and cardiovascular conditions, offer preventive care and harm-reduction resources, refer to evidence-based behavioral therapies, and consider off-label medications for treatment of methamphetamine use disorder.”

We’ll report on any news associated with developments in what experts consider the best treatment for methamphetamine addiction as soon as we learn about them. We also need to close with a warning about fentanyl: it’s a drug that’s 100 times more powerful than heroin, one dose is enough to cause a fatal overdose, and the DEA reports the presence of fentanyl in the supply of a wide range of illicit drugs, including methamphetamine.

As we search for the best treatments for methamphetamine addiction, it’s important for any person who uses drugs to understand the dangers of both methamphetamine: separately, they’re dangerous, and together, the combination is deadly – and many people who use methamphetamine aren’t aware they’re also likely ingesting fentanyl. We encourage anyone in a position to pass this vital information on to do so: saying something could save a life.

What’s the Best Treatment for Methamphetamine Addiction?