Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

INITIAL

acute intoxication or withdrawal

1st line – individualised management +/- acute inpatient care

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INITIAL
|
acute intoxication or withdrawal
1st line – 

individualised management +/- acute inpatient care

Initial treatment of acute intoxication is focused on preventing further exposure to methamphetamine, amfetamine, and/or related compounds.

Acute toxicity is treated by reducing further absorption if the substance was taken orally, by giving activated charcoal within 1 hour of ingestion, particularly if body packing or stuffing is suspected. Presenting symptomatology and ongoing regular assessment will dictate the need for specific condition management (e.g., hypertension, arrhythmia, rhabdomyolysis, chest pain, agitation and/or psychosis, need for mechanical ventilation and intensive monitoring). For details on the management of acute amfetamine intoxication, see Amfetamine overdose.

For those withdrawing from stimulants, consider the most appropriate care setting; those at risk of harm to self and others require psychiatric inpatient admission.[14]​ Offer support and reassurance; people who are agitated, delirious and/or experiencing psychosis should be managed using verbal and non-verbal de-escalation strategies.[14] Abrupt stimulant withdrawal typically does not produce dangerous medical consequences, although dysphoria and other psychiatric symptoms may be significant in the initial period of drug abstinence. Pharmacological treatment is not always required.[57] Discussion with a psychiatrist/addiction specialist regarding the need for symptomatic pharmacotherapy, for example, with a benzodiazepine or antipsychotic medication, may be warranted in the presence of severe distress, depending on the individual’s clinical presentation (e.g., where there is severe agitation, confusion, psychosis, or severe acute insomnia).[14][57]​​​

In pregnancy, because of the risk of harms of ongoing stimulant use to both the mother and the fetus, there is a lower threshold for inpatient withdrawal management, which may include non-teratogenic medications for the short-term management of psychologically distressing symptoms.[106]​ Where possible, management should be provided by services specialising in substance use in pregnancy, or with close co-ordination between antenatal and substance use care.

Note that withdrawal from stimulants may be associated with significant symptoms of depression and suicidal thinking, with associated increased risk of suicidal behaviours; clinicians should monitor the patient's mood and assess and mitigate against their risk of suicide during this period.[57] As for any patient with suicidal ideation, safety assessment is required, which may include consideration of the need for involuntary psychiatric hospitalisation, see Suicide risk mitigation.

ACUTE

non-pregnant adults and adolescents

1st line – contingency management

Back
ACUTE
|
non-pregnant adults and adolescents
1st line – 

contingency management

Owing to limitations in the evidence base and real-world treatment availability, a number of psychosocial treatments are listed as equal first-line options, which may be used alone or in combination, depending on clinician and patient preference, and on service availability.

Contingency management is a type of behavioural therapy grounded in the principles of operant conditioning, a method of learning in which desired behaviours are incentivised with a reward such as a prize or privilege.

There is a large body of evidence that it modestly increases rates of abstinence in amfetamine use disorder, and increases engagement with treatment; of all of the psychosocial treatment options available for stimulant use disorder, contingency management has the strongest evidence of efficacy.[72][79][80][81][82][83][84]​​ According to one meta-analysis, it is associated with additional positive effects on medical service utilisation and reductions in risky behaviour.[81] Further evidence supports its use for other related stimulant use disorders, such as cocaine use disorder.[85][86][87]​​ A potential limitation of contingency management for other stimulant use disorders is that its positive effects may be short-lasting, particularly for people with complex therapeutic needs.[88]​ Use in conjunction with other psychosocial interventions (e.g., cognitive behavioural therapy [CBT]) may be beneficial.[89]

Treatment does not have a prescribed time period, but in practice may follow a 12-week schedule, with frequent drug screenings.[24]​ Contingency management may be used within a number of settings, including primary healthcare, community outpatient settings, and inpatient settings. Despite the evidence in favour of its efficacy, contingency management is not widely implemented, owing to a number of barriers including cost and regulatory challenges.[14]​ Computerised contingency management may facilitate access.[90][91]

Consider – drug counselling or intensive outpatient treatment

Back
ACUTE
|
non-pregnant adults and adolescents
Consider – 

drug counselling or intensive outpatient treatment

Additional treatment recommended for SOME patients in selected patient group

Drug counselling programmes are often based on the principles of 12-step recovery programmes such as Narcotics Anonymous (NA). They may also offer education and incorporate elements of cognitive behavioural therapy (CBT) and other supportive psychotherapies.

Evidence on the effectiveness of such programmes as a stand-alone intervention is very limited, and therefore, based on the available evidence, this intervention is listed as an adjunct; ideally these programmes have the potential to provide additional input and support to aid recovery.[74]

Standard outpatient drug counselling may consist of one or two sessions weekly, and take place on either an individual or a group basis.

Intensive outpatient therapy (IOT) provides drug counselling on an individual or group basis with varying levels of family involvement. It is typically used if standard drug counselling is insufficient, although there is insufficient evidence of better outcomes.[102] It typically takes place in sessions delivered on several days weekly for a number of weeks. IOT may provide benefit in patients with methamphetamine use disorder even at relatively low intensity (sessions totalling 2-3 hours per week).[102][103]

Consider – mutual help group

Back
ACUTE
|
non-pregnant adults and adolescents
Consider – 

mutual help group

Additional treatment recommended for SOME patients in selected patient group

Advise patients to seek support groups such as Narcotics Anonymous: Narcotics Anonymous Opens in new window

Consider – mental health treatment

Back
ACUTE
|
non-pregnant adults and adolescents
Consider – 

mental health treatment

Additional treatment recommended for SOME patients in selected patient group

Additional psychiatric treatment and/or referral to mental health services may be a consideration in those with a past history of significant mental health issues or those with a current prominent display of psychiatric symptomatology.

1st line – cognitive behavioural therapy (CBT)

Back
ACUTE
|
non-pregnant adults and adolescents
1st line – 

cognitive behavioural therapy (CBT)

Owing to limitations in the evidence base and real-world treatment availability, a number of psychosocial treatments are listed as equal first-line options, which may be used alone or in combination, depending on clinician and patient preference, and on service availability.

CBT is a short-term, goal-directed type of psychotherapy that enables people to understand their current problems in order to change their thinking and behaviour. There is some evidence that CBT results in significant reductions in frequency of methamphetamine use and methamphetamine use disorder severity, although further studies focusing on the longevity of the effect of intervention are needed.​[79][83][92]​​ There is a more extensive body of evidence in favour of CBT for the management of other stimulant use disorders.[85][93][94]​​​[95][96]​​ 

In practice, treatment duration for stimulant use disorders often lasts between 5 and 10 months, with each session lasting around 50 minutes.[24]​ It can be used across a variety of settings, including on both an inpatient and an outpatient (e.g., community-based) basis.

Consider – drug counselling or intensive outpatient treatment

Back
ACUTE
|
non-pregnant adults and adolescents
Consider – 

drug counselling or intensive outpatient treatment

Additional treatment recommended for SOME patients in selected patient group

Drug counselling programmes are often based on the principles of 12-step recovery programmes such as Narcotics Anonymous (NA). They may also offer education and incorporate elements of CBT and other supportive psychotherapies.

Evidence on the effectiveness of such programmes as a stand-alone intervention is very limited, and therefore, based on the available evidence, this intervention is listed as an adjunct; ideally these programmes have the potential to provide additional input and support to aid recovery.[74]

Standard outpatient drug counselling may consist of one or two sessions weekly, and take place on either an individual or a group basis.

Intensive outpatient therapy (IOT) provides drug counselling on an individual or group basis with varying levels of family involvement. It is typically used if standard drug counselling is insufficient, although there is insufficient evidence of better outcomes.[102] It typically takes place in sessions delivered on several days weekly for a number of weeks. IOT may provide benefit in patients with methamphetamine use disorder even at relatively low intensity (sessions totalling 2-3 hours per week).[102][103]

Consider – mutual help group

Back
ACUTE
|
non-pregnant adults and adolescents
Consider – 

mutual help group

Additional treatment recommended for SOME patients in selected patient group

Advise patients to seek support groups such as Narcotics Anonymous: Narcotics Anonymous Opens in new window

Consider – mental health treatment

Back
ACUTE
|
non-pregnant adults and adolescents
Consider – 

mental health treatment

Additional treatment recommended for SOME patients in selected patient group

Additional psychiatric treatment and/or referral to mental health services may be a consideration in those with a past history of significant mental health issues or those with a current prominent display of psychiatric symptomatology.

1st line – motivational interviewing

Back
ACUTE
|
non-pregnant adults and adolescents
1st line – 

motivational interviewing

Owing to limitations in the evidence base and real-world treatment availability, a number of psychosocial treatments are listed as equal first-line options, which may be used alone or in combination, depending on clinician and patient preference, and on service availability.

Motivational interviewing is a treatment approach that empowers people to become motivated to change their behaviour and reduce or stop stimulant use. One Cochrane review found motivational interviewing to be effective for a range of substance use disorders compared with no treatment, with a positive effect lasting up to 12 months after treatment.[97] [ Cochrane Clinical Answers logo ] ​​​ Evidence specific to amfetamine/methamphetamine use disorder is currently lacking, although its use is recommended for a number of stimulant use disorders (including amfetamine/methamphetamine use disorders) according to some treatment guidelines.​[24][57]

In practice, treatment duration varies significantly, from single 15-minute sessions to multiple hour-long sessions; there is currently insufficient evidence to support guidance on what constitutes an optimal length or number of sessions.[24] Sessions may take place in primary or secondary care, on an inpatient or outpatient basis.

Consider – drug counselling or intensive outpatient treatment

Back
ACUTE
|
non-pregnant adults and adolescents
Consider – 

drug counselling or intensive outpatient treatment

Additional treatment recommended for SOME patients in selected patient group

Drug counselling programmes are often based on the principles of 12-step recovery programmes such as Narcotics Anonymous (NA). They may also offer education and incorporate elements of cognitive behavioural therapy (CBT) and other supportive psychotherapies.

Evidence on the effectiveness of such programmes as a stand-alone intervention is very limited, and therefore, based on the available evidence, this intervention is listed as an adjunct; ideally these programmes have the potential to provide additional input and support to aid recovery.[74]

Standard outpatient drug counselling may consist of one or two sessions weekly, and take place on either an individual or a group basis.

Intensive outpatient therapy (IOT) provides drug counselling on an individual or group basis with varying levels of family involvement. It is typically used if standard drug counselling is insufficient, although there is insufficient evidence of better outcomes.[102] It typically takes place in sessions delivered on several days weekly for a number of weeks. IOT may provide benefit in patients with methamphetamine use disorder even at relatively low intensity (sessions totalling 2-3 hours per week).[102][103]

Consider – mutual help group

Back
ACUTE
|
non-pregnant adults and adolescents
Consider – 

mutual help group

Additional treatment recommended for SOME patients in selected patient group

Advise patients to seek support groups such as Narcotics Anonymous: Narcotics Anonymous Opens in new window

Consider – mental health treatment

Back
ACUTE
|
non-pregnant adults and adolescents
Consider – 

mental health treatment

Additional treatment recommended for SOME patients in selected patient group

Additional psychiatric treatment and/or referral to mental health services may be a consideration in those with a past history of significant mental health issues or those with a current prominent display of psychiatric symptomatology.

1st line – matrix model

Back
ACUTE
|
non-pregnant adults and adolescents
1st line – 

matrix model

Owing to limitations in the evidence base and real-world treatment availability, a number of psychosocial treatments are listed as equal first-line options, which may be used alone or in combination, depending on clinician and patient preference, and on service availability.

The Matrix model is a structured, multi-component behavioural therapy programme encompassing individual counselling, cognitive behavioural therapy (CBT), family education, social support groups, and motivation for engagement in mutual support groups, typically conducted over a period of 16 weeks.[14]

There is moderate evidence supporting the effectiveness of the Matrix model for treating methamphetamine use disorder. In comparison to waiting list control groups or standard treatments, it diminishes methamphetamine use, cravings, and risky behaviours.[98][99][100]

The Matrix model is more widely available than many of the other interventions listed in some countries, for example, the US.[14]

Consider – drug counselling or intensive outpatient treatment

Back
ACUTE
|
non-pregnant adults and adolescents
Consider – 

drug counselling or intensive outpatient treatment

Additional treatment recommended for SOME patients in selected patient group

Drug counselling programs are often based on the principles of 12-step recovery programs such as Narcotics Anonymous (NA). They may also offer education and incorporate elements of cognitive behavioural therapy (CBT) and other supportive psychotherapies.

Evidence on the effectiveness of such programmes as a standalone intervention is very limited, and therefore, based on the available evidence, this intervention is listed as an adjunct; ideally these programmes have the potential to provide additional input and support to aid recovery.[74]

Standard outpatient drug counselling may consist of one or two sessions weekly, and take place on either an individual or a group basis.

Intensive outpatient therapy (IOT) provides drug counselling on an individual or group basis with varying levels of family involvement. It is typically used if standard drug counselling is insufficient, although there is insufficient evidence of better outcomes.[102]​ It typically takes place in sessions delivered on several days weekly for a number of weeks. IOT may provide benefit in patients with methamphetamine use disorder even at relatively low intensity (sessions totaling 2-3 hours per week).[102][103]

Consider – mutual help group

Back
ACUTE
|
non-pregnant adults and adolescents
Consider – 

mutual help group

Additional treatment recommended for SOME patients in selected patient group

Advise patients to seek support groups such as Narcotics Anonymous: Narcotics Anonymous Opens in new window

Consider – mental health treatment

Back
ACUTE
|
non-pregnant adults and adolescents
Consider – 

mental health treatment

Additional treatment recommended for SOME patients in selected patient group

Additional psychiatric treatment and/or referral to mental health services may be a consideration in those with a past history of significant mental health issues or those with a current prominent display of psychiatric symptomatology.

1st line – community reinforcement approach

Back
ACUTE
|
non-pregnant adults and adolescents
1st line – 

community reinforcement approach

Owing to limitations in the evidence base and real-world treatment availability, a number of psychosocial treatments are listed as equal first-line options, which may be used alone or in combination, depending on clinician and patient preference, and on service availability.

The community reinforcement approach is a type of comprehensive behavioural therapy based on operant conditioning theory. Moderate certainty evidence exists for a community reinforcement approach for achieving abstinence from cocaine use disorders, particularly when longer durations of treatment are used.[79][101]​ Although there is a lack of evidence on efficacy of this technique for amfetamine-type stimulant use disorder, expert opinion suggests that it is likely to be similarly effective for this patient population.[14] Based on evidence in cocaine use disorder, community reinforcement approach is particularly effective when combined with contingency management.[79]

Note that the community reinforcement approach is costly and resource-intensive, and is not widely implemented beyond research settings.[14]

Consider – drug counselling or intensive outpatient treatment

Back
ACUTE
|
non-pregnant adults and adolescents
Consider – 

drug counselling or intensive outpatient treatment

Additional treatment recommended for SOME patients in selected patient group

Drug counselling programmes are often based on the principles of 12-step recovery programmes such as Narcotics Anonymous (NA). They may also offer education and incorporate elements of cognitive behavioural therapy (CBT) and other supportive psychotherapies.

Evidence on the effectiveness of such programmes as a standalone intervention is very limited, and therefore, based on the available evidence, this intervention is listed as an adjunct; ideally these programmes have the potential to provide additional input and support to aid recovery.[74]

Standard outpatient drug counseling may consist of one or two sessions weekly, and take place on either an individual or a group basis.

Intensive outpatient therapy (IOT) provides drug counselling on an individual or group basis with varying levels of family involvement. It is typically used if standard drug counselling is insufficient, although there is insufficient evidence of better outcomes.[102] It typically takes place in sessions delivered on several days weekly for a number of weeks. IOT may provide benefit in patients with methamphetamine use disorder even at relatively low intensity (sessions totaling 2-3 hours per week).[102][103]

Consider – mutual help group

Back
ACUTE
|
non-pregnant adults and adolescents
Consider – 

mutual help group

Additional treatment recommended for SOME patients in selected patient group

Advise patients to seek support groups such as Narcotics Anonymous: Narcotics Anonymous Opens in new window

Consider – mental health treatment

Back
ACUTE
|
non-pregnant adults and adolescents
Consider – 

mental health treatment

Additional treatment recommended for SOME patients in selected patient group

Additional psychiatric treatment and/or referral to mental health services may be a consideration in those with a past history of significant mental health issues or those with a current prominent display of psychiatric symptomatology.

pregnant

1st line – referral to services specialising in substance misuse in pregnancy + ongoing antenatal care

Back
ACUTE
|
pregnant
1st line – 

referral to services specialising in substance misuse in pregnancy + ongoing antenatal care

Where possible, management should be provided by services specialising in substance use in pregnancy, or with close co-ordination between antenatal and substance use care. In addition to psychosocial interventions (see above), it is important that appropriate social support is given, including assistance with accommodation, life skills and vocational training, legal advice, home-visiting, and outreach.[106]​ Clinicians may refer women locally available programmes addressing psychosocial needs related to pregnancy and parenthood.[14]

Referral for routine antenatal care is important, including screening for fetal and maternal complications, and bloodborne infections, if this has not already taken place, see: Routine prenatal care. Women with high-risk pregnancies may need management by a maternal-fetal medicine specialist.[14] Clinicians may consider offering contingency management to incentivise antenatal appointment attendance, according to US guidance, although the evidence for this approach is limited and mixed.[14][107]

Additional addiction treatment support around the time of birth is recommended, as the postnatal period is often a time of increased stress, with associated risk of return to substance use.[14] Guidance on breastfeeding for those who continue to use amfetamine-type substances is mixed. The World Health Organization advises that mothers with substance use disorders should be encouraged to breastfeed unless the risks clearly outweigh the benefits; they note that clinicians should advise and support breastfeeding women with amfetamine/methamphetamine use disorder to cease drug use, but note that continuing use is not necessarily a contraindication to breastfeeding.[106]​ In contrast, US guidelines recommend that patients should not breastfeed if they are actively using stimulants.[14]

Note that withdrawal may be associated with significant symptoms of depression; clinicians should monitor the patient's mood and assess and mitigate against their risk of suicide during this period.[57] As for any patient with suicidal ideation, safety assessment is required, which may include consideration of the need for involuntary psychiatric hospitalisation, see Suicide risk mitigation.

ONGOING

sustained remission

1st line – continuing care

Back
ONGOING
|
sustained remission
1st line – 

continuing care

Continuing care with drug counselling or intensive outpatient therapy, rather than care limited to periods of acute exacerbation, is likely to help reduce recurrent use, especially for people with family or social issues.[70]

Consider – mutual help group

Back
ONGOING
|
sustained remission
Consider – 

mutual help group

Additional treatment recommended for SOME patients in selected patient group

Advise patients to seek support groups such as Narcotics Anonymous: Narcotics Anonymous Opens in new window

continued use or relapse

1st line – contingency management

Back
ONGOING
|
continued use or relapse
1st line – 

contingency management

Owing to limitations in the evidence base and real-world treatment availability, a number of psychosocial treatments are listed as equal first-line options, which may be used alone or in combination, depending on clinician and patient preference, and on service availability.

Contingency management is a type of behavioural therapy grounded in the principles of operant conditioning, a method of learning in which desired behaviours are incentivised with a reward such as a prize or privilege.

There is evidence from one meta-analysis that this modestly increases rates of abstinence in amfetamine use disorder.[79][80][81][82][83][84]​ A broader body of evidence supports its use for other related stimulant use disorders, such as cocaine use disorder.[85][86][87]​ A potential limitation of contingency management for other stimulant use disorders is that its positive effects may be short-lasting.[88]​ Use in conjunction with other psychosocial interventions (e.g., cognitive behavioural therapy [CBT]) may therefore be recommended.[89]

Treatment does not have a prescribed time period, but in practice may follow a 12-week schedule, with frequent drug screenings.[24]​ Contingency management may be used within a number of settings, including primary healthcare, community outpatient settings, and inpatient settings. Computerised contingency management may facilitate access.[90][91]

Consider – drug counselling or intensive outpatient treatment

Back
ONGOING
|
continued use or relapse
Consider – 

drug counselling or intensive outpatient treatment

Additional treatment recommended for SOME patients in selected patient group

Drug counselling programmes are often based on the principles of 12-step recovery programmes such as Narcotics Anonymous (NA). They may also offer education and incorporate elements of cognitive behavioural therapy (CBT) and other supportive psychotherapies.

Evidence on the effectiveness of such programmes as a stand-alone intervention is very limited, and therefore, based on the available evidence, this intervention is listed as an adjunct; ideally these programmes have the potential to provide additional input and support to aid recovery.[74]

Standard outpatient drug counselling may consist of one or two sessions weekly, and take place on either an individual or a group basis.

Intensive outpatient therapy (IOT) provides drug counselling on an individual or group basis with varying levels of family involvement. It is typically used if standard drug counselling is insufficient, although there is insufficient evidence of better outcomes.[102] It typically takes place in sessions delivered on several days weekly for a number of weeks. IOT may provide benefit in patients with methamphetamine use disorder even at relatively low intensity (sessions totalling 2-3 hours per week).[102][103]

Consider – mutual help group

Back
ONGOING
|
continued use or relapse
Consider – 

mutual help group

Additional treatment recommended for SOME patients in selected patient group

Advise patients to seek support groups such as Narcotics Anonymous: Narcotics Anonymous Opens in new window

1st line – cognitive behavioural therapy (CBT)

Back
ONGOING
|
continued use or relapse
1st line – 

cognitive behavioural therapy (CBT)

Owing to limitations in the evidence base and real-world treatment availability, a number of psychosocial treatments are listed as equal first-line options, which may be used alone or in combination, depending on clinician and patient preference, and on service availability.

CBT is a short-term, goal-directed type of psychotherapy that enables people to understand their current problems in order to change their thinking and behaviour. There is some evidence to suggest that CBT results in significant reductions in frequency of methamphetamine use and methamphetamine use disorder severity, although further studies focusing on the longevity of the effect of intervention are needed.​[79]​​[83][92]​ There is a more extensive body of evidence in favour of CBT for the management of other stimulant use disorders.[85][93][94]​​[95][96]

In practice, treatment duration for stimulant use disorders often lasts between 5 and 10 months, with each session lasting around 50 minutes.[24]​ It can be used across a variety of settings, including on both an inpatient and an outpatient (e.g., community-based) basis.

Consider – drug counselling or intensive outpatient treatment

Back
ONGOING
|
continued use or relapse
Consider – 

drug counselling or intensive outpatient treatment

Additional treatment recommended for SOME patients in selected patient group

Drug counselling programmes are often based on the principles of 12-step recovery programmes such as Narcotics Anonymous (NA). They may also offer education and incorporate elements of CBT and other supportive psychotherapies.

Evidence on the effectiveness of such programmes as a stand-alone intervention is very limited, and therefore, based on the available evidence, this intervention is listed as an adjunct; ideally these programmes have the potential to provide additional input and support to aid recovery.[74]

Standard outpatient drug counselling may consist of one or two sessions weekly, and take place on either an individual or a group basis.

Intensive outpatient therapy (IOT) provides drug counselling on an individual or group basis with varying levels of family involvement. It is typically used if standard drug counselling is insufficient, although there is insufficient evidence of better outcomes.[102] It typically takes place in sessions delivered on several days weekly for a number of weeks. IOT may provide benefit in patients with methamphetamine use disorder even at relatively low intensity (sessions totalling 2-3 hours per week).[102][103]

Consider – mutual help group

Back
ONGOING
|
continued use or relapse
Consider – 

mutual help group

Additional treatment recommended for SOME patients in selected patient group

Advise patients to seek support groups such as Narcotics Anonymous: Narcotics Anonymous Opens in new window

1st line – motivational interviewing

Back
ONGOING
|
continued use or relapse
1st line – 

motivational interviewing

Owing to limitations in the evidence base and real-world treatment availability, a number of psychosocial treatments are listed as equal first-line options, which may be used alone or in combination, depending on clinician and patient preference, and on service availability.

Motivational interviewing is a treatment approach that empowers people to become motivated to change their behaviour and reduce or stop stimulant use. One Cochrane review found motivational interviewing to be effective for a range of substance use disorders compared with no treatment, with a positive effect lasting up to 12 months after treatment.[97] [ Cochrane Clinical Answers logo ] ​​​ Evidence specific to amfetamine/methamphetamine use disorder is currently lacking, although its use is recommended for a number of stimulant use disorders (including amfetamine/methamphetamine use disorders) according to some treatment guidelines.​[24][57]

In practice, treatment duration varies significantly, from single 15-minute sessions to multiple hour-long sessions; there is currently insufficient evidence to support guidance on what constitutes an optimal length or number of sessions.[24] Sessions may take place in primary or secondary care, on an inpatient or outpatient basis.

Consider – drug counselling or intensive outpatient treatment

Back
ONGOING
|
continued use or relapse
Consider – 

drug counselling or intensive outpatient treatment

Additional treatment recommended for SOME patients in selected patient group

Drug counselling programmes are often based on the principles of 12-step recovery programmes such as Narcotics Anonymous (NA). They may also offer education and incorporate elements of cognitive behavioural therapy (CBT) and other supportive psychotherapies.

Evidence on the effectiveness of such programmes as a stand-alone intervention is very limited, and therefore, based on the available evidence, this intervention is listed as an adjunct; ideally these programmes have the potential to provide additional input and support to aid recovery.[74]

Standard outpatient drug counselling may consist of one or two sessions weekly, and take place on either an individual or a group basis.

Intensive outpatient therapy (IOT) provides drug counselling on an individual or group basis with varying levels of family involvement. It is typically used if standard drug counselling is insufficient, although there is insufficient evidence of better outcomes.[102] It typically takes place in sessions delivered on several days weekly for a number of weeks. IOT may provide benefit in patients with methamphetamine use disorder even at relatively low intensity (sessions totalling 2-3 hours per week).[102][103]

Consider – mutual help group

Back
ONGOING
|
continued use or relapse
Consider – 

mutual help group

Additional treatment recommended for SOME patients in selected patient group

Advise patients to seek support groups such as Narcotics Anonymous: Narcotics Anonymous Opens in new window

1st line – matrix model

Back
ONGOING
|
continued use or relapse
1st line – 

matrix model

Owing to limitations in the evidence base and real-world treatment availability, a number of psychosocial treatments are listed as equal first-line options, which may be used alone or in combination, depending on clinician and patient preference, and on service availability.

The Matrix model is a structured, multi-component behavioural therapy programme encompassing individual counselling, cognitive behavioural therapy (CBT), family education, social support groups, and motivation for engagement in mutual support groups, typically conducted over a period of 16 weeks.[14]

There is moderate evidence supporting the effectiveness of the Matrix Model for treating methamphetamine use disorder. In comparison to waiting list control groups or standard treatments, it diminishes methamphetamine use, cravings, and risky behaviours.[98][99][100]

The Matrix model is more widely available than many of the other interventions listed in some countries, for exampe, the US.[14]

Consider – drug counselling or intensive outpatient treatment

Back
ONGOING
|
continued use or relapse
Consider – 

drug counselling or intensive outpatient treatment

Additional treatment recommended for SOME patients in selected patient group

Drug counselling programmes are often based on the principles of 12-step recovery programmes such as Narcotics Anonymous (NA). They may also offer education and incorporate elements of cognitive behavioural therapy (CBT) and other supportive psychotherapies.

Evidence on the effectiveness of such programs as a standalone intervention is very limited, and therefore, based on the available evidence, this intervention is listed as an adjunct; ideally these programmes have the potential to provide additional input and support to aid recovery.[74]

Standard outpatient drug counselling may consist of one or two sessions weekly, and take place on either an individual or a group basis.

Intensive outpatient therapy (IOT) provides drug counselling on an individual or group basis with varying levels of family involvement. It is typically used if standard drug counselling is insufficient, although there is insufficient evidence of better outcomes.[102]​ It typically takes place in sessions delivered on several days weekly for a number of weeks. IOT may provide benefit in patients with methamphetamine use disorder even at relatively low intensity (sessions totaling 2-3 hours per week).[102][103]

Consider – mutual help group

Back
ONGOING
|
continued use or relapse
Consider – 

mutual help group

Additional treatment recommended for SOME patients in selected patient group

Advise patients to seek support groups such as Narcotics Anonymous: Narcotics Anonymous Opens in new window

1st line – community reinforcement approach

Back
ONGOING
|
continued use or relapse
1st line – 

community reinforcement approach

Owing to limitations in the evidence base and real-world treatment availability, a number of psychosocial treatments are listed as equal first-line options, which may be used alone or in combination, depending on clinician and patient preference, and on service availability.

The community reinforcement approach is a type of comprehensive behavioural therapy based on operant conditioning theory. Moderate certainty evidence exists for a community reinforcement approach for achieving abstinence from cocaine use disorders, particularly when longer durations of treatment are used.[79][101] Although there is a lack of evidence on efficacy of this technique for amfetamine-type stimulant use disorder, expert opinion suggests that it is likely to be similarly effective for this patient population.[14] Based on evidence in cocaine use disorder, community reinforcement approach is particularly effective when combined with contingency management.[79]

Note that the community reinforcement approach is costly and resource-intensive, and is not widely implemented beyond research settings.[14]

Consider – drug counselling or intensive outpatient treatment

Back
ONGOING
|
continued use or relapse
Consider – 

drug counselling or intensive outpatient treatment

Additional treatment recommended for SOME patients in selected patient group

Drug counselling programmes are often based on the principles of 12-step recovery programmes such as Narcotics Anonymous (NA). They may also offer education and incorporate elements of cognitive behavioural therapy (CBT) and other supportive psychotherapies.

Evidence on the effectiveness of such programmes as a standalone intervention is very limited, and therefore, based on the available evidence, this intervention is listed as an adjunct; ideally these programmes have the potential to provide additional input and support to aid recovery.[74]

Standard outpatient drug counselling may consist of one or two sessions weekly, and take place on either an individual or a group basis.

Intensive outpatient therapy (IOT) provides drug counselling on an individual or group basis with varying levels of family involvement. It is typically used if standard drug counselling is insufficient, although there is insufficient evidence of better outcomes.[102]​ It typically takes place in sessions delivered on several days weekly for a number of weeks. IOT may provide benefit in patients with methamphetamine use disorder even at relatively low intensity (sessions totaling 2-3 hours per week).[102][103]

Consider – mutual help group

Back
ONGOING
|
continued use or relapse
Consider – 

mutual help group

Additional treatment recommended for SOME patients in selected patient group

Advise patients to seek support groups such as Narcotics Anonymous: Narcotics Anonymous Opens in new window

treatment resistant

1st line – addiction specialist referral

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treatment resistant
1st line – 

addiction specialist referral

If after up to 12 weeks of the most intensive psychosocial treatment a patient continues to relapse, then consider referring them to an expert in addiction for possible adjunctive medication; however, evidence for this is very limited and there is no established guidance.

US treatment guidelines offer a limited degree of support for the use of the following drugs (prescribed by a specialist in addiction medicine/psychiatry) in selected patients with amfetamine-type stimulant use disorder: bupropion monotherapy; bupropion and naltrexone combination therapy; mirtazapine monotherapy; and topiramate monotherapy.[14]

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Choose a patient group to see our recommendations

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

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