
Weapons play a key role in winning the game. Each time the health bar is fully depleted, the player loses a life.

The difficulty level the game is set on determines how much of the vehicle's health is replenished and how fast the stations recharge once the player has used them. The player can replenish a portion of their vehicle's health bar by driving through blue ramps called "Health Stations" scattered throughout the environments. The length of each of the player's lives is tied to their health bar (located to the left of the life boxes), which decreases whenever the player's vehicle is damaged by enemy attacks. The player begins the game with three lives, indicated by the stacked green boxes on the bottom right corner of the screen. The game lasts until all of the player's lives have expired or until all six levels have been cleared. To clear a level, the player must destroy all of the enemy vehicles in that level. In the one-player mode, the player must progress through six combat arenas of progressively increasing size and featuring progressively more opponents. The game can be played in either the one-player mode (in which the game's story takes place) or the Duel Mode (in which two human players can select a battleground on which to compete in). While in control of a vehicle, the player can accelerate, steer, brake, reverse, activate the turbo, turn tightly, toggle between and activate weapons using the game controller's d-pad and buttons.

Twisted Metal is a vehicular combat game in which the player takes control of one of twelve unique vehicles. An example of gameplay in Twisted Metal featuring Sweet Tooth in the Rooftop Combat stage.
