How to approach meth dependence

[Animal Mother]

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Anyone who can share some evidence-based strategies for treating meth use disorder in the real world? There are no FDA approved medications obviously. I’ve seen the studies on naltrexone, Wellbutrin, some others, but doesn’t seem like there any real effective treatments. Ideally, these patients would go into a residential program, get contingency management/CBT, but this doesn’t seem like a realistic option for most. Many seem to have cognitive impairments, have no real interest in quitting, and only come in when they are psychotic and get in trouble or are drug in by their CM/care home owner. I’ve been putting some chronic users who have a history of drug-induced psychosis on LAIs. I’m not sure if this is good/ideal, but it seems like a decent harm reduction strategy to reduce some of the negative consequences of their drug use. A significant percent of substance-induced psychosis will eventually convert to schizophrenia anyway. Thoughts/tips?

 

[whopper]

TMS was found to possibly have benefit but more studies need to be done and it's not anywhere to the degree where insurance will pay for it.

My best approach is to try to figure out what led the person to have these problems. E.g. untreated ADHD? Depression?, then treat those aspects. Also make sure they have good therapy either from you or from someone else.

While it's not FDA approved N-Acetylcysteine has been found to offer benefits in addiction not yet treated by other meds. E.g. it works for Pathological Gambling. I'd also at least give it a try. I've had success with it in several addiction cases but unfortunately from my own clinical experience while it offers a noticeable benefit most patients tell me it's not very strong.

N-acetylcysteine in psychiatry: current therapeutic evidence and potential mechanisms of action