Treatment of Methamphetamine Dependence: Does Treatment Work

1
Treatment of Methamphetamine Dependence Does
Treatment Work?

• Mary Lynn Brecht, Ph.D.
• Richard A. Rawson, Ph.D
• Semel Institute for Neuroscience and Human
  Behavior
• David Geffen School of Medicine
• University of California at Los Angeles
• www.uclaisap.org
• rrawson_at_mednet.ucla.edu
• Supported by
• National Institute on Drug Abuse (NIDA)
• Pacific Southwest Technology Transfer Center
  (SAMHSA)
• International Network of Treatment and
  Rehabilitation Resource Centres (UNODC)

2
U.S. Treatment Admissions for Primary
Methamphetamine Abuse
3
Are Treatment Outcomes for Individuals with
Methamphetamine Dependence Different than for
Other Drug Dependencies?
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.
• Representatives for some commercial treatment
  concerns have suggested there are no effective
  treatments for methamphetamine dependence.

5
CA Treatment System Outcomes Using in Past 30
Days by Type of Drug
Based on 81,382 episodes of treatment Source
ISAP Evaluation of CalOMS, Rawson et al., 2008
6
Completing Treatment--CA SACPA Meth Users
Source Anglin et al., Criminal Justice Treatment
Admissions, J. of Psychoactive Drugs, 2007
7
Do Methamphetamine Users Respond Differently to
Treatment than Cocaine Users?
8
Comparability of Treatment Outcome Cocaine vs
Methamphetamine Alice Huber, Walter Ling and
Richard Rawson

• Cohorts of methamphetamine dependent patients
  (N500) and cocaine dependent patients (N224)
  treated with a standardized, outpatient treatment
  protocol (Matrix Model) at the same clinic site,
  by the same staff over the same time period,
  demonstrated very similar treatment response on
  virtually all treatment participation and outcome
  measures
• Jnl of Addictive Diseases, 18, 1997, P 41-50.

9
(No Transcript)
10
Differences between methamphetamine users and
cocaine users in treatmentAmy L. Copeland and
James L. Sorensen

• The two populations did not differ in
  treatment adherence, as measured by clinic
  attendance, drug-free urines, and successful
  completion of treatment.
• Drug and Alcohol Dependence, Volume 62, March
  2001, Pages 91-95

11
Treatment response by primary drug of abuse Does
methamphetamine make a difference? Bill
Luchansky, Antoinette Krupski, and Kenneth Stark

• For both adults and youth, the results showed
  that across outcomes, there were few differences
  between MA users and users of other hard drugs,
  whereas there were consistent differences between
  MA users and users of alcohol and marijuana.
  Alcohol and marijuana users tended to have more
  positive outcomes than the other groups.
• Journal of Substance Abuse Treatment Vol 32,
  2007, Pages 89-96

12
Summary

• Treatment outcome data indicate that psychosocial
  treatments used in community treatment programs
  produce comparable outcomes for methamphetamine
  dependent individuals and those with other forms
  of drug dependency

13
Treatments for Stimulant-use Disorders with
Empirical Support

• Cognitive-Behavioral Therapy (CBT)
• Community Reinforcement Approach
• Contingency Management
• 12 Step Facilitation
• All have empirical support for the treatment of
  cocaine dependence

14
Methamphetamine Treatment Controlled Clinical
Trials

• Cognitive Behavioral Therapy
• Contingency Management
• Matrix Model

15
CBT Basic Assumptions

• Emphasizes cognitive aspects of drug/alcohol use
  as learned behavior
• Role of cognitions in abstinence
• Treatment is a teaching process, coaching and
  reinforcing therapist is a teacher/coach
• No assumption of underlying psychopathology
• New, alternative behaviors must be established
• Can be delivered in group or individual settings

16
Contingency Management

• A technique employing the systematic delivery of
  positive reinforcement for desired behaviors. In
  the treatment of methamphetamine dependence,
  vouchers or prizes can be earned for submission
  of methamphetamine-free urine samples.

17
Cognitive Behavioral Therapy and Contingency
Management for Stimulant Dependence

• Participants Stimulant-dependent individuals (n
  171).
• Intervention CM, CBT, or combined CM and CBT,
  16-week treatment conditions. CM condition
  participants received vouchers for stimulant-free
  urine samples. CBT condition participants
  attended three 90-minute group sessions each
  week..
• Results CM procedures produced better retention
  and lower rates of stimulant use during the study
  period Self-reported stimulant use was reduced
  from baseline levels at all follow-up points for
  all groups and urinalysis data did not differ
  between groups at follow-up. While CM produced
  robust evidence of efficacy during treatment
  application, CBT produced comparable longer-term
  outcomes. There was no evidence of an additive
  effect when the two treatments were combined. The
  response of cocaine and methamphetamine users
  appeared comparable.
• Conclusions This study suggests that CM is an
  efficacious treatment for reducing stimulant use
  and is superior during treatment to a CBT
  approach. CBT also reduces drug use from baseline
  levels and produces comparable outcomes on all
  measures at follow-up.
• Rawson, RA et al. Addiction, Jan 2006

18
FIGURE 1. Program Retention by Group
19
FIGURE 2. Stimulantfree Urine Samples by Group
20
FIGURE 3. Self-Reported Stimulant Use
21
Contingency Management An Evidence-Based
Component of Methamphetamine Use Disorder
Treatments
Roll, J. Contingency management an evidence
based component of methamphetamine use disorder
treatments. Addiction. 2007102 (Suppl.
1)114-120.
22
Contingency Management for Treatment of
Methamphetamine Dependence

• Design RTC
• Method 113 patients diagnosed with
  methamphetamine abuse or dependence were randomly
  assigned to receive either treatment as usual
  (TAU) or TAU plus contingency management.
• Results indicate that both groups were retained
  in treatment for equivalent times but those in
  the combined group accrued more abstinence and
  were abstinent for a longer period of time.
  These results suggest that contingency management
  has promise as a component in methamphetamine use
  disorder treatment strategies.
• Roll JM, Petry NM, Stitzer ML, et al
  Contingency management for the treatment of
  methamphetamine use disorders. Am J Psychiatry
  163(11)1993-1999, 2006

23
(No Transcript)
24
(No Transcript)
25
Matrix Model

• Is a manualized, 16-week, non-residential,
  psychosocial approach used for the treatment of
  drug dependence.
• Manuals Can be downloaded at SAMHSA.gov
• Designed to integrate several interventions into
  a comprehensive approach. Elements include
• Individual counseling
• Cognitive behavioral therapy
• Motivational interviewing
• Positive reinforcement for behavior change
• Family education groups
• Urine testing
• Participation in 12-step programs

26
Treatment Components of the Matrix Model

• Individual Sessions
• Early Recovery Groups
• Relapse Prevention Groups
• Family Education Group
• 12-Step Meetings
• Social Support Groups
• Relapse Analysis
• Urine Testing

MATRIX
27
The CSAT Methamphetamine Treatment Project
A Multi-site Trial of a Manualized Psychosocial
Protocol for the Treatment of Methamphetamine
Dependence

• Rawson, R.A., Marinelli-Casey, P., Anglin, M.D.,
  Dickow, A., Frazier, Y., Gallagher, C., Galloway,
  G.P., Herrell, J., Huber, A., McCann, M.J.,
  Obert, J., Pennell, S., Reiber, C., Vandersloot,
  D., Zweben, J., and the Methamphetamine Treatment
  Project Corporate Authors. (2004). A multi-site
  comparison of psychosocial approaches for the
  treatment of methamphetamine dependence.
  Addiction, 99, 708-717.

28
Mean Number of Weeks in Treatment
29
Mean Number of UAs that were MA-free during
treatment
30
Urinalysis Results

• Results of Ua Tests at Discharge, 6 months and 12
  Months post admission
• Matrix Group TAU Group
• D/C 66 MA-free 65 MA-free
• 6 Ms 69 MA-free 67 MA-free
• 12 Ms 59 MA-free 55 MA-free
• Over 80 follow up rate in both groups at all
  points

31
Predictors of In-treatment Performance and
Post-Treatment Outcomes in a Methamphetamine-Depen
dent Adults
32
Predictors of Long-Term Abstinence

• Predictors of no MA use at treatment discharge,
  and at the 6- and 12-mos follow-ups includes
• MA use of lt 15 days at baseline,
• Lifetime MA use of lt 2 years
• No previous drug abuse treatment
• Providing 3 consecutive MA-free UAs during
  treatment

33
Thank yourrawson_at_mednet.ucla.eduwww.uclaisap.or
gwww.methamphetamine.org