Title: Methamphetamine Abuse Among Men Who Have Sex With Men MSM
1Methamphetamine 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
2Study 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)
3Study 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?
4DESIGN
5Method
- 286 potential participants gave consent and began
screening procedures - 162 patients randomly assigned to 1 of 4
treatment conditions
6Sample 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
7Baseline 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)
8Baseline 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
9HIV Status(n162)
10(Peck et al., 2005)
11Summary 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
12Treatment Outcomes
13Retention in Treatment
F(3,158)3.78, plt.01 CBT lt CM and CBTCM, plt.05
14Consecutive Clean UAs
F(3,158)11.08, plt.001 CBT lt CM and CBTCM,
plt.001
15Full Sample UA Samples Positive for MA
metabolites Baseline to 12 Month FU
McNemars Q 18.69, plt.0001
16Mean Unprotected Receptive Anal Intercourse
17Depression Ratings
Avg BDI Score
Baseline to Week 52 reductions plt.01 Peck et
al., 2005
18Discussion
- 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
19DiscussionPsychiatric
- 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.
20DiscussionPsychiatric
- 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)
21Contact information
- Thomas E. Freese, PhD
- tfreese_at_mednet.ucla.edu
- www.uclaisap.org
- www.methamphetamine.org