Background <p>Methamphetamine (METH)-induced psychosis (MAP), characterized by transient schizophreniform symptoms, affects approximately 43% of individuals with methamphetamine use disorders (MUD). However, the cortical atrophy pattern associated with MAP remain unclear.</p> Methods <p>Ninety-four male patients with MUD (62 without psychotic symptoms [MA] and 32 MAP) and 61 healthy controls (HCs) underwent high-resolution T1-weighted MRI and clinical assessments. Surface-based morphological (SBM) analysis using FreeSurfer 7.1.1 was conducted to explore cortical thickness and volume difference among groups. We also examined the correlation between brain structural changes and clinical variables.</p> Results <p>The MAP group showed significant cortical thinning in the left superior temporal gyrus (STG) and the right rostral anterior cingulate cortex (rACC) whether compared to HCs and MA. Additionally, compared to the HCs, the MA group exhibited decreased cortical volume in the left caudal middle frontal gyrus (cMFG) and the superior parietal cortex (SPC). In the MUD cohort, left cMFG volume was positively correlated with craving severity (VAS score, <i>r</i> = 0.341, <i>p</i> &lt; 0.001).</p> Conclusions <p>MAP is associated with distinct region-specific cortical thinning, particularly in temporal and limbic regions, suggesting a structural basis for its psychotic features. These findings provide new insight into the neurobiological mechanisms underlying MAP and may inform future intervention strategies.</p> Clinical trial number <p>Not applicable.</p>