Definition and Diagnosis
Methamphetamine use disorder is a problematic pattern of use of methamphetamine, including its smokable crystalline form ("ice" or "crystal meth"), leading to clinically significant impairment, marked tolerance, and a withdrawal syndrome dominated by fatigue and dysphoria rather than prominent physical symptoms.
Epidemiology
Methamphetamine use disorder has risen substantially in various regions in recent decades, particularly involving the smokable crystal form, and is associated with high rates of co-occurring psychiatric illness and significant healthcare burden.
Risk Factors
Risk factors include co-occurring substance use, existing mental illness, environments where the drug is highly available, and use for performance enhancement, weight loss, or to counteract fatigue.
Symptoms and Subtypes
Features include intense craving, prolonged binge use with sleep and appetite suppression, tolerance, and complications including agitation, paranoia, aggression, and stimulant-induced psychosis with heavy or prolonged use. Withdrawal typically involves severe fatigue, increased appetite, and depressed mood.
Diagnosis
Diagnosis follows DSM-5-TR criteria for stimulant use disorder, based on pattern and consequences of use; psychiatric evaluation for co-occurring psychosis or mood symptoms is an important part of assessment.
Treatment
Treatment is primarily psychosocial, including CBT, contingency management, and the Matrix Model; no medication is currently approved specifically for methamphetamine use disorder, though co-occurring psychiatric symptoms are treated directly, including antipsychotics for stimulant-induced psychosis when present.
Prognosis
Course can be severe, with high relapse rates and significant psychiatric and physical morbidity with prolonged heavy use; structured, sustained treatment improves outcomes, and psychotic symptoms often improve with abstinence.
Reference
New Oxford Textbook of Psychiatry (2nd ed.); Sadock, B. J., Sadock, V. A., & Ruiz, P. Kaplan & Sadock's Synopsis of Psychiatry (11th ed.).