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Methamphetamine-Related Disorders
Euphrosyne Gouzoulis-Mayfrank1, Roland Härtel-Petri, Willem Hamdorf
1*All of the authors of the S3 guideline are listed in eTable1. They contributed equally to this article; Landschaftsverband Rheinland (Rhineland Regional Council, LVR)-Klinik Köln; Psychotherapeutic Practice Bayreuth; Allgemeine Hospitalgesellschaft (AHG) Klinik Mecklenburg; University Medical Center Göttingen; Technische Universität Chemnitz; Department of Psychiatry and Psychotherapy, University Hospital of Regensburg.
Background:
Methamphetamine is considered more dangerous than other stimulants because of its acute complications, long-term neurotoxicity, and potential for drug dependence. Until now, there have been no evidence-based guidelines for the treatment of methamphetamine-related disorders, either in Germany or abroad.
Methods:
A systematic literature search was performed on the treatment of methamphetamine-related disorders. Based on this literature review, a multidisciplinary expert panel developed recommendations using the nominal group technique.
Results:
The evidence base for the treatment of methamphetamine-related disorders is sparse. The efficacy of psychotherapeutic techniques such as cognitive behavioral therapy and contingency management and the efficacy of complex, disorder-specific treatment programs have been proven in ran - domized controlled trials, but it remains unclear which method is best. Persons carrying a diagnosis of substance abuse should be offered psychotherapy. Structured exercise programs, whether self-directed or professionally led, can improve addiction-specific endpoints as well as comorbid disorders and should, therefore, be offered as well. Pharmacotherapy has shown little to no effect in relatively low-quality clinical trials with low case numbers and high dropout rates, and therefore only a few weak recommendations were made. These include tranquilizers for the short-term treatment of agitation and atypical antipsychotics if necessary. Attempts to substitute other substances, such as methylphenidate or dexamphetamine, for methamphetamine have not yielded any robust evidence to date. Sertraline should not be administered due to serious adverse events.
Conclusion:
Many of the recommendations in the guideline are made with a weak grade of recommendation because of the poor evidence base and the modest size of the reported therapeutic effects. In acute situations, symptomoriented treatment is recommended. Psychotherapy and exercise should be offered as well.