I frequently encounter patients with methamphetamine use disorder, and I don’t know about you, but finding effective interventions in the inpatient psychiatric setting can be a real challenge. Unlike opioid or alcohol use disorders, where we have biological interventions like buprenorphine or naltrexone, methamphetamine use disorder lacks such clear pharmacological treatments. Because of this, many rehab facilities are reluctant to admit patients whose primary issue is methamphetamine use.
In my practice, I often turn to combinations like bupropion and naltrexone since they’re among the few studied pharmacological options for methamphetamine use disorder. However, based on my experience, the results are modest at best—but I suppose it’s better than nothing.
That said, there’s a much simpler, evidence-based option that doesn’t even require inpatient treatment, and it’s been around since the 1980s: Contingency Management. The concept is straightforward: reward patients with small incentives—like gift cards worth $30 or less—for each negative drug screen they produce. As patients continue to test negative, the rewards increase. This approach has been shown to double the chances of success in stopping methamphetamine use.
Of course, there are potential issues, such as concerns about fraud or patients providing fake samples. But let’s be real—how much are we already spending on treating methamphetamine users without seeing much improvement? Probably a lot more. With contingency management, we’re not just spending money—we’re actually seeing patients get better.
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