Non-pharmacotherapy for craving in methamphetamine use disorder: A systematic review and network meta-analysis of randomised controlled trials

Clinical Snapshot

Key Findings

• P Value: Statistically significant for exercise and TMS vs conventional rehabilitation

• Effect Size: Not reported in abstract

• Primary Outcome: Craving reduction in methamphetamine use disorder

• Nnt Or Sensitivity: Combined aerobic/resistance exercise and 10 Hz repetitive TMS to left DLPFC identified as most effective protocols

• Confidence Interval: Not reported in abstract

Clinical Application

Exercise interventions highly feasible; TMS requires specialized equipment and trained operators Relevant to Australian addiction services; TMS available through some public and private facilities; exercise therapy aligns with RACGP guidelines for holistic addiction treatment Adults with methamphetamine use disorder seeking non-pharmacological treatment options

Abstract

OBJECTIVES: We evaluated the effects of non-pharmacotherapy on quality of life (QOL) and craving in individuals with methamphetamine use disorder (MUD), ranking the efficacy of various protocols. METHODS: We searched multiple databases for randomized controlled trials from inception to Dec 2025. The analysis included 53 studies with 3174 participants, investigating interventions such as exercise, transcranial magnetic stimulation (TMS), transcranial direct current stimulation, behavioral therapy, and acupuncture. The protocol was prospectively registered in PROSPERO (CRD42023443291). RESULTS: For craving reduction, both exercise and TMS demonstrated statistically significant benefits compared to conventional rehabilitation. Combined aerobic/resistance exercise and 10 Hz repetitive TMS targeting the left dorsolateral prefrontal cortex emerged as the most effective specific protocols within their respective categories. Furthermore, preliminary evidence from a limited number of studies indicated that exercise, acupuncture, and behavioral therapy improved patients' QOL. CONCLUSION: This study confirms that several non-pharmacotherapies are effective for managing craving in MUD. Exercise and TMS are particularly promising for reducing craving. The findings, synthesized within a novel "Intervention-Circuit-Symptom" integrative framework, provide a robust evidence base to inform clinical decision-making and guide the future development of MUD treatment guidelines.

References

1. 1.Xu, J., Li, X., Zhu, Z., Wang, J., Yang, Y., Zhou, X., & Ying, G. (2026). Non-pharmacotherapy for craving in methamphetamine use disorder: A systematic review and network meta-analysis of randomised controlled trials. Behavioural Brain Research, 116084. https://doi.org/10.1016/j.bbr.2026.116084