A: Dr. Jean Lud Cadet
How do you treat methamphetamine use disorder?
The treatment of individuals who suffer from methamphetamine use disorder is very complex. There is, at present, no FDA-approved medication for methamphetamine use disorder.
During the past decades, many pharmacological agents have been tried with different populations of methamphetamine with very little or no success. These medications that are available for other neurological or psychiatric conditions include aripiprazole, baclofen, bupropion, ibudilast, mirtazapine, modafinil, naltrexone, perindopril, and several antidepressant medications. Because ketamine is effective in some patients who suffer from major affective disorders, clinicians may be tempted to try it in the case of methamphetamine users. This is not advisable in view of the potential toxic interactions of these two drugs.
Because there is no effective FDA-approved medication, the clinician will need to devise a treatment program that is focused on the needs of each individual user. Such a program should include an initial hospitalization for a complete neurocognitive assessment.
Non-pharmacological approaches should then include cognitive behavioral therapy, contingency management, and exercise. The addition of cognitive enhancers, especially in users who show cognitive deficits on comprehensive evaluation, is paramount to help improve cognitive functions.
A program should include an initial hospitalization for a complete neurocognitive assessment. Nonpharmacological approaches should then include cognitive behavioral therapy, contingency management, and exercise.
Because there are no magic bullets, the treatment team will need to try different medications under the supervision of a very skilled psychopharmacologist. This approach is important because the nature and magnitude of cognitive deficits and medical problems associated with chronic methamphetamine use increase the risk of poorer health outcomes, unemployment, high-risk behaviors, and treatment non-adherence and repeated relapses. For example, during treatment, drug-seeking behaviors are maintained to a higher level in patients who exhibit deficits in executive function and memory and these patients end up with poor treatment outcomes.
Finally, interventions with repeated transcranial magnetic stimulation may be added to the armamentarium against methamphetamine use disorder.
Dr. Jean Lud Cadet
Dr. Cadet is a Neurologist and also a Psychiatrist who is a senior NIH investigator and the Chief of the Molecular Neuropsychiatry Research Branch.
An excerpt from Navigating Addiction and Treatment: A Guide for Families, Addiction Policy Forum, 2020.
A Note From Addiction Policy Forum
Substance use disorders get worse over time. The earlier treatment starts the better the chances for long-term recovery. Many families are wrongly told to “wait for rock bottom” and that their loved one needs to feel ready to seek treatment in order for it to work. The idea that we should wait for the disease to get worse before seeking treatment is dangerous. Imagine if we waited until stage 4 to treat cancer. Decades of research has proven that the earlier someone is treated, the better their outcomes—and that treatment works just as well for patients who are compelled to start treatment by outside forces as it does for those who are self-motivated to enter treatment.
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