Methamphetamine Abuse Among Men Who Have Sex With Men MSM

1
Methamphetamine Abuse Among Men Who Have Sex With
Men (MSM)

• Thomas E. Freese, PhD
• Director of Training
• UCLA Integrated Substance Abuse Programs
• Semel Institute for Neuroscience and Human
  Behavior
• David Geffen School of Medicine at UCLA
• www.methamphetamine.org
• This work supported by NIDA grants R01 DA
  11031 R21 DA 018075

2
Study questions

• What are the drug use and sexual risk behavior
  changes for gay and bisexual men with
  methamphetamine dependence that result from
  treatment using the following interventions?
• Contingency Management (CM)
• Cognitive-Behavioral therapy (CBT)
• Combined (CBTCM)
• Gay-specific Cognitive-Behavioral Therapy (GCBT)

3
Study questions

• Do standard or tailored behavioral or
  cognitive-behavioral interventions help MSM
  reduce meth use?
• Is behavioral/cognitive-behavioral substance
  abuse treatment for urban meth-abusing MSM an
  effective strategy for reducing HIV transmission
  risks?

4
DESIGN
5
Method

• 286 potential participants gave consent and began
  screening procedures
• 162 patients randomly assigned to 1 of 4
  treatment conditions

6
Sample demographics

• Mean age 36.6 (SD6.4)
• Education
• 95.7 gt HS
• 41 gt 4-year degree

• Ethnicity
• Caucasian 79.6
• Hispanic 12.9
• African-Am 3.1
• Asian-Am 3.1
• Native Am 1.2

7
Baseline drug use

• Drug use behaviors
• Lifetime MA use 8.34 yrs (SD5.9)
• Lifetime heavy MA use 3.39 yrs (SD4.07)
• Lifetime other drugs used 2.3 (SD1.4)
• Lifetime IV MA use 32.1
• MA use in past 30 days 9.7 days (SD7.4)
• spent on MA past 30 days 293 (SD399)

8
Baseline sexual risk behaviors

• Sexual partners, past 30 days 9.9 (SD20.9)
• Sexual partners, past 6 months 44.3 (SD78.3)
• Sex in public place (e.g. bathhouse), past 30
  days 43.8
• Unprotected anal intercourse (UAI) with other
  than primary partner in past 30 days 49.4
• Of these, 83.8 took place while high on MA

9
HIV Status(n162)
10
(Peck et al., 2005)
11
Summary of SCID-diagnosed Lifetime Psychiatric
Disorders at Baseline (n155)

• 41 psychotic disorders (26.5)
• ECA estimates 1-2
• 44 anxiety disorders (28.4)
• ECA estimates 12.7
• 82 mood disorders (52.9)
• ECA estimates 9.5

12
Treatment Outcomes
13
Retention in Treatment
F(3,158)3.78, plt.01 CBT lt CM and CBTCM, plt.05
14
Consecutive Clean UAs
F(3,158)11.08, plt.001 CBT lt CM and CBTCM,
plt.001
15
Full Sample UA Samples Positive for MA
metabolites Baseline to 12 Month FU
McNemars Q 18.69, plt.0001
16
Mean Unprotected Receptive Anal Intercourse
17
Depression Ratings
Avg BDI Score
Baseline to Week 52 reductions plt.01 Peck et
al., 2005
18
Discussion

• Maximal suppression of methamphetamine use
  produced by CM conditions during treatment
• Maximal reductions in high-risk sexual behaviors
  produced by GCBT during treatment
• Self-reported depression ratings show steepest
  decline during first week/month

19
DiscussionPsychiatric

• High degree of ? comorbidity in this population
• Some psychiatric disorders were clearly
  substance-induced
• All psychotic disorders
• 41 of mood disorders
• 25 of anxiety disorders
• However, 59 of mood disorders and 75 of anxiety
  disorders were not substance-induced
• May reflect mental health consequences of HIV
  infection and/or drug use as attempt to cope with
  underlying disorders.

20
DiscussionPsychiatric

• HIV-positive compared to HIV-negative MSM in this
  sample have higher rates of
• Substance-induced anxiety disorders
• Anxiety disorders in general
• Bipolar I disorder
• Substance dependence other than methamphetamine
  and alcohol (most commonly cocaine or marijuana)

21
Contact information

• Thomas E. Freese, PhD
• tfreese_at_mednet.ucla.edu
• www.uclaisap.org
• www.methamphetamine.org