Methamphetamine

1. Methamphetamine • South Dakota Day 2

2. Methamphetamine Treatment Contingency Management Matrix Model

3. Combined data from several pilot studies (Roll, Huber, et al., in press; Roll & Shoptaw, in press • All studies provided vouchers with specified monetary values for the provision of urine samples which indicated no recent methamphetamine use. • Urines were collected under direct observation. • Vouchers could be exchanged for goods or services that were congruent with developing a drug free lifestyle

6. CTN 006 methamphetamine data(Roll, et al.,in prep.) • Used the variable magnitude of reinforcement procedure developed by Petry. • 113 methamphetamine abusing individuals were part of the larger trial. • Received the chance to win prizes for the provision of stimulant negative urine samples.

7. Methamphetamine Outcomes from CTN 006

8. The CSAT Methamphetamine Treatment Project

9. The Matrix Model:It is many treatments in one • Out-patient, office-based • Easy to understand • Structure, structure, structure • Continuing attendance is important

10. Organizing Principles of Matrix Treatment • Program components based on scientific literature promoting behavior change • Program elements and schedule selected based on empirical support in literature and application

11. Organizing Principles of Matrix Treatment • Program focus is on behavior change in the present, not on assumed underlying psychopathology • Matrix treatment is a process of “coaching”, supporting, reinforcing and supporting positive behavior change

12. Organizing Principles of Matrix Treatment • Non-confrontational, non-judgmental relationship between therapist and patient creates positive bond which promotes program participation. • Positive reinforcement, incentives and contingencies used extensively to promote treatment engagement and retention.

13. Organizing Principles of Matrix Treatment • Accurate, understandable scientific information used to educate patient and family members • Cognitive behavioral strategies used to promote drug cessation and relapse prevention

14. Organizing Principles of Matrix Treatment • Family therapy interventions used to engage families in recovery process • Self help resources introduced and participation encouraged

15. Organizing Principles of Matrix Treatment • Urine and breath/alcohol testing used to monitor drug/alcohol use and support abstinence. • Social support activities provided to help maintain abstinence

16. Matrix Model of Outpatient Treatment How it looks in Practice

17. Matrix ModelPutting It All Together

18. 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

19. Baseline Demographics

20. Gender Distribution of Participants

21. Ethnic Identification of Participants

22. Route of Methamphetamine Administration

23. Changes from Baseline to Treatment-end

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

25. Beck Depression Inventory (BDI) Total Scores Possible is 0-63; tpaired=16.87; p-value<0.000 (highly sig.)

26. Positive Symptom Total (PST) from Brief Symptom Inventory (BSI) Possible is 0-53; tpaired=14.33; p-value<0.000 (highly sig.)

27. Mean Number of Weeks in Treatment

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

29. Figure 4. Percent completing treatment, by group

30. 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

31. Treatments for Stimulant-Use Disorders with Empirical Support • Motivational Interviewing • Cognitive-Behavioral Therapy (CBT) • Community Reinforcement Approach • Contingency Management • Matrix Model

32. Motivational Interviewing • Based upon Prochaska and DiClemente Stages of Change Theoretical Model • Also referred to as Motivational Enhancement Therapy • Applied with many substances, data primarily with alcoholics • Major Publications/Studies: Miller and Rollnick, 1991; Project MATCH

33. Motivational Interviewing • Basic Assumptions • People change their thinking and behavior according to a series of stages • Individuals may enter treatment at different “stages of change” • It is possible to influence the natural change process with MI techniques • MI can be used to engage individuals in longer term treatment and to promote specific behavior changes • Confrontation of “denial” can be counterproductive and or harmful to some individuals

34. Motivational Interviewing • Key Concepts • Empathy and therapeutic alliance • Give feedback and reframe • Create dissonance • Focus of discrepancy of expected and actual • Reinforce change • Roll with resistance

35. Motivational Interviewing • Resources • Miller and Rollnick 1991 • NIAAA Project MATCH manual • CSAT TIP on Motivational Techniques • NIDA Tool Box

36. Substance Abuse Treatment 2004The Increasing Role of Science MotivationCarrots and Sticks

37. One Way of Thinking • Change is motivated by discomfort. • If you can make people feel bad enough, they will change. • People have to “hit bottom” to be ready • Corollary: People don’t change because they haven’t suffered enough The Stick

38. Another Way of Thinking • People are ambivalent about change • Constructive behavior change comes from connecting with something valued, cherished and important • Intrinsic motivation for change comes out of an accepting, empowering, safe atmosphere where the painful present can be challenged • People get stuck because of their ambivalence The Carrot

39. Motivational Interviewing, 2nd Edition. Miller and Rollnick We can’t help wondering, why don’t people change? You would think: • that having had a heart attack would be enough to persuade a man to quit smoking, change his diet, exercise more, and take his medication

40. Matrix Early Recovery Groups

41. Scheduling and Calendars Triggers Questionnaires and Chart 12 Step Introduction Alcohol Issues Thoughts Emotions and Behaviors KISS (and other 12-step slogans) Early RecoveryGroups

42. Early Recovery Issues Engaging and Retaining TRIGGERS

43. I.P. Pavlov (1849-1936) Triggers and Cravings

44. Triggers and Cravings Pavlov’s Dog: UCR

45. Triggers and Cravings Pavlov’s Dog: CR

46. TriggerThoughtCravingUse Early Recovery Issues Engaging and Retaining

47. Trigger Thought Craving Use Early Recovery Issues Engaging and Retaining

48. MATRIX MODEL TREATMENT Triggers - Places • Drug dealer’s home • Bars and clubs • Drug use neighborhoods • Freeway offramps • Worksite • Street corners

49. MATRIX MODEL TREATMENT Triggers - Things • Paraphernalia • Sexually explicit magazines/movies • Money/bank machines • Music • Movies/TV shows about alcohol and other drugs • Secondary alcohol or other drug use

50. MATRIX MODEL TREATMENT Triggers - Times • Periods of idle time • Periods of extended stress • After work • Payday/AFDC payment day • Holidays • Friday/Saturday night • Birthdays/Anniversaries