ABSTRACT Introduction Women with substance use disorders (SUDs) are more inclined to use drugs and relapse for regulating emotions compared to men. This study aimed to explore the effects of group music and imagery in alleviating anxiety, depression, emotion regulation difficulties, and craving for women with methamphetamine use disorder (MUD) in a compulsory rehabilitation context. Method A total of 90 women with MUD were randomly assigned to the music therapy treatment arm (n = 45) or control treatment arm (n = 45). Participants in the music therapy treatment arm received 12 biweekly sessions of group music and imagery (GrpMI) and those in the control treatment arm received 6 weeks of usual care. Anxiety, depression, emotion regulation difficulties, and craving were assessed at pre-test and post-test. Results After the intervention, participants in the GrpMI group reported significantly greater improvements than those in the control group for state anxiety (F = 6.27; p = .02; Partial η2 = .13), trait anxiety (F = 4.49; p = .04; Partial η2 = .09), depression (F = 5.48; p = .02; Partial η2 = .11), and craving (F = 4.53; p = .04; Partial η2 = .09). There was no significant difference between groups in emotion regulation difficulties (F = .95, p = .34, Partial η2 = .09). Discussion GrpMI significantly decreased depression, anxiety, and craving for women with MUD. Emotion regulation ability may need a longer period of treatment for significant improvement. Future studies could add long-term follow-up and compare the effects of group music therapy in women versus men with SUDs.