Methamphetamine Addiction: Cause for Concern-Hope for the Future

1. Methamphetamine Addiction: Cause for Concern-Hope for the Future Richard A. Rawson, Ph.D Adjunct Associate Professor Department of Psychiatry and Biobehavioral Sciences David Geffen School of Medicine University of California at Los Angeles rrawson@mednet.ucla.edu www.uclaisap.org

2. IHS-Wide Outpatient Encounters for Amphetamine Related Visit by Calendar Year

3. Is Treatment for Methamphetamine Effective? A major demand that competes for scarce community resources are for the treatment needs of those who have become addicted to methamphetamine (MA).

4. Meth Treatment Effectiveness? A pervasive rumor has surfaced in many geographic areas with elevated MA problems: • MA users are virtually untreatable with negligible recovery rates. • Rates from 5% to less than 1% have been quoted in newspaper articles and reported in conferences. **The resulting conclusion is that spending money on treating MA users is futile and wasteful, BUT no data exists that supports these statistics**

5. Meth Treatment Statistics During the 2002-2003 fiscal year: • 35,947 individuals were admitted to treatment in California under the Substance Abuse and Crime Prevention Act funding. • Of this group, 53% reported MA as their primary drug problem

6. Statistics Analysis of: • Drop out rates • Retention in treatment rates • Re-incarceration rates • Other measures of outcome All these measures indicate that MA users respond in an equivalent manner as individuals admitted for other drug abuse problems.

7. Why the “MA treatment doesn’t work” perceptions? • Many of the geographic regions impacted by MA do not have extensive treatment systems for severe drug dependence. • Medical and psychiatric aspects of MA dependence exceeds program capabilities. • High rate of use by women, their treatment needs and the needs of their children can be daunting. • Although some traditional elements may be appropriate, many staff report feeling unprepared to address many of the clinical challenges presented by these patients

8. Treatment Options

9. Psychosocial/Behavioral Treatments • NIDA has also produced several manuals that have been empirically tested with stimulant-using populations, including: • Cognitive Behavioral Therapy (CBT) • Contingency Management (CM)

10. Psychosocial/Behavioral • Materials were tested with cocaine and crack users, but there is evidence that cocaine and MA users respond similarly to behavioral and cognitive strategies. • Both CBT and CM produce substantial reduction of cocaine and virtually identical reduction in MA. • Treatments with evidence of efficacy for treating cocaine appear to be equally effective with MA users.

11. Contingency Management • Preliminary finding appear very positive. • Powerful tool to improve engagement and retention and to reduce MA use

13. Methamphetamine Outcomes from CTN 006

14. Matrix Model • Is a manualized, 16-week, non-residential, psychosocial approach used for the treatment of drug dependence. • Designed to integrate several interventions into a comprehensive approach. Elements include: • Individual counseling • Cognitive behavioral therapy • Motivational interviewing • Family education groups • Urine testing • Participation in 12-step programs

15. Project Structure: Study Sites Billings, MT Honolulu, HI San Mateo, CA (2) San Diego, CA Concord, CA Costa Mesa, CA Hayward, CA Coordinating Center UCLA Integrated Substance Abuse Programs Steering Committee Scientific Advisory Board Community Advisory Board

16. Baseline Demographics

17. Gender Distribution of Participants

18. Ethnic Identification of Participants

19. Route of Methamphetamine Administration

20. Changes from Baseline to Treatment-end

21. Days of Methamphetamine Use in Past 30 (ASI) Possible is 0-30; tpaired=20.90; p-value<0.000 (highly sig.)

22. Mean Number of Weeks in Treatment

23. Mean Number of UA’s that were MA-free during treatment

24. Figure 6. Participant self-report of MA use (number of days during the past 30) at enrollment, discharge, and 6-month follow-up, by treatment condition

25. Treatment Length by Route P<.05

26. Treatment Completion by Route P<.05

27. MA-Free Samples by Route P<.05

28. Hepatitis C by Route P<.05

29. Women and Meth

30. Meth and Women: Typical gender ratio of heroin users in treatment : 3 men to 1 woman Typical gender ratio of cocaine users in treatment : 2 men to 1 woman Typical gender ratio of methamphetamine users in treatment : 1 man to 1 woman * *among large clinical research populations

31. Drug Use by Gender

32. Self-Reported Reasons for Starting Methamphetamine Use

33. Gender Differences in Violence History

34. Gender Differences in Sexual Abuse History

35. Behavior Symptom Inventory (BSI) Scores at Baseline

36. Analyses reveal that a history of physical or sexual violence (controlling for gender) is significantly related to a number of negative outcomes. These results suggest the importance of understanding client background factors before they enter treatment.

37. Methamphetamine and Sexual Risks Baseline: 76% of clients had sex while high or feeling the effects of crystal within the past 30 days 82% of clients report that methamphetamine and sexual activities “always” or “often” go together 52-week Follow-Up: 33% of clients had sex while high or feeling the effects of crystal within the past 30 days Sexual behavior changes accrued in the following areas: _ Number of Sex Partners _ Sexual Activities _ Condom Use _ Disclosure of HIV Status

38. Methamphetamine and Sexual Risks: Number of Sex Partners p =.004 Baseline 16-week 52-week Follow-up Follow-up • Baseline: • 76% of clients report that sex while using crystal is “compulsive” • Clients report hyper-focus on sex contributes to sexual acting out, obsessive thoughts of sex, and accumulation of many sexual partners • 52-week Follow-up: • Clients report a lessened or absent sexual compulsion • Clients report a diminished desire for multiple sexual partners