Treatment of Methamphetamine Treatment of Methamphetamine Dependence: Dependence: Does Treatment Work? Does Treatment Work? Mary Lynn Brecht, Ph.D. Mary Lynn Brecht, Ph.D. Richard A. Rawson, Ph.D Richard A. Rawson, Ph.D Semel Institute for Neuroscience and Human Behavior Semel Institute for Neuroscience and Human Behavior David Geffen School of Medicine David Geffen School of Medicine University of California at Los Angeles University of California at Los Angeles www.uclaisap.org www.uclaisap.org [email protected][email protected]Supported by: Supported by: National Institute on Drug Abuse (NIDA) National Institute on Drug Abuse (NIDA) Pacific Southwest Technology Transfer Center Pacific Southwest Technology Transfer Center (SAMHSA) (SAMHSA) International Network of Treatment and International Network of Treatment and Rehabilitation Resource Centres (UNODC) Rehabilitation Resource Centres (UNODC)
Transcript
Treatment of Methamphetamine Treatment of Methamphetamine Dependence: Dependence:
Does Treatment Work?Does Treatment Work?
Mary Lynn Brecht, Ph.D. Mary Lynn Brecht, Ph.D. Richard A. Rawson, Ph.DRichard A. Rawson, Ph.D
Semel Institute for Neuroscience and Human BehaviorSemel Institute for Neuroscience and Human BehaviorDavid Geffen School of MedicineDavid Geffen School of Medicine
University of California at Los AngelesUniversity of California at Los Angeleswww.uclaisap.orgwww.uclaisap.org
Supported by:Supported by: National Institute on Drug Abuse (NIDA)National Institute on Drug Abuse (NIDA)
Pacific Southwest Technology Transfer Center (SAMHSA)Pacific Southwest Technology Transfer Center (SAMHSA)International Network of Treatment and Rehabilitation Resource International Network of Treatment and Rehabilitation Resource
Centres (UNODC)Centres (UNODC)
U.S. Treatment Admissions for Primary U.S. Treatment Admissions for Primary Methamphetamine AbuseMethamphetamine Abuse
Are Treatment Outcomes for Are Treatment Outcomes for Individuals with Methamphetamine Individuals with Methamphetamine Dependence Different than for Other Dependence Different than for Other
A pervasive rumor has surfaced in many A pervasive rumor has surfaced in many geographic areas with elevated MA problems:geographic areas with elevated MA problems:
MA users are virtually untreatable with negligible recovery MA users are virtually untreatable with negligible recovery rates.rates.
Rates from 5% to less than 1% have been quoted in Rates from 5% to less than 1% have been quoted in newspaper articles and reported in conferences.newspaper articles and reported in conferences.
Representatives for some commercial treatment concerns Representatives for some commercial treatment concerns have suggested there are no effective treatments for have suggested there are no effective treatments for methamphetamine dependence.methamphetamine dependence.
CA Treatment System OutcomesCA Treatment System Outcomes% Using in Past 30 Days by Type of Drug% Using in Past 30 Days by Type of Drug
7482
63 6156 56
44
56
36
26 28 28
0
50
100
Alcohol Heroin/op Coc/crack Marijuana Meth/amph Other
Pe
rce
nt
admission discharge
Based on 81,382 episodes of treatmentSource: ISAP Evaluation of CalOMS, Rawson et al., 2008
Source: Anglin et al., Criminal Justice Treatment Admissions, J. of Psychoactive Drugs, 2007
Do Methamphetamine Users Respond Do Methamphetamine Users Respond Differently to Treatment than Cocaine Differently to Treatment than Cocaine
Users?Users?
Comparability of Treatment Outcome: Cocaine vs Comparability of Treatment Outcome: Cocaine vs MethamphetamineMethamphetamine
Alice Huber, Walter Ling and Richard Rawson * Alice Huber, Walter Ling and Richard Rawson *
Cohorts of methamphetamine dependent patients (N=500) Cohorts of methamphetamine dependent patients (N=500) and cocaine dependent patients (N=224) treated with a and cocaine dependent patients (N=224) treated with a standardized, outpatient treatment protocol (Matrix standardized, outpatient treatment protocol (Matrix Model) at the same clinic site, by the same staff over the Model) at the same clinic site, by the same staff over the same time period, demonstrated very similar treatment same time period, demonstrated very similar treatment response on virtually all treatment participation and response on virtually all treatment participation and outcome measures outcome measures
* Jnl of Addictive Diseases, 18, 1997, P 41-50.* Jnl of Addictive Diseases, 18, 1997, P 41-50.
Differences between methamphetamine users and Differences between methamphetamine users and cocaine users in treatmentcocaine users in treatment
Amy L. Copeland and James L. Sorensen*Amy L. Copeland and James L. Sorensen*
The two populations did not differ in treatment The two populations did not differ in treatment adherence, as measured by clinic attendance, adherence, as measured by clinic attendance, drug-free urines, and successful completion of drug-free urines, and successful completion of treatment. treatment.
* Drug and Alcohol Dependence* Drug and Alcohol Dependence, , Volume 62, Volume 62, March 2001, Pages 91-95March 2001, Pages 91-95
Treatment response by primary drug of abuse: Does Treatment response by primary drug of abuse: Does methamphetamine make a difference? methamphetamine make a difference?
Bill Luchansky, Antoinette Krupski, and Kenneth Stark*Bill Luchansky, Antoinette Krupski, and Kenneth Stark*
For both adults and youth, the results showed For both adults and youth, the results showed that across outcomes, there were few that across outcomes, there were few differences between MA users and users of differences between MA users and users of other hard drugs, whereas there were consistent other hard drugs, whereas there were consistent differences between MA users and users of differences between MA users and users of alcohol and marijuana. Alcohol and marijuana alcohol and marijuana. Alcohol and marijuana users tended to have more positive outcomes users tended to have more positive outcomes than the other groups. than the other groups.
**Journal of Substance Abuse TreatmentJournal of Substance Abuse Treatment Vol 32, 2007, Pages 89-96 Vol 32, 2007, Pages 89-96
SummarySummary
Treatment outcome data indicate that Treatment outcome data indicate that psychosocial treatments used in community psychosocial treatments used in community treatment programs produce comparable treatment programs produce comparable outcomes for methamphetamine dependent outcomes for methamphetamine dependent individuals and those with other forms of drug individuals and those with other forms of drug dependencydependency
Treatments for Stimulant-use Disorders with Treatments for Stimulant-use Disorders with Empirical SupportEmpirical Support
Cognitive-Behavioral Therapy (CBT)Cognitive-Behavioral Therapy (CBT) Community Reinforcement Approach Community Reinforcement Approach Contingency ManagementContingency Management 12 Step Facilitation12 Step Facilitation
All have empirical support for the treatment All have empirical support for the treatment of cocaine dependenceof cocaine dependence
Emphasizes cognitive aspects of drug/alcohol use Emphasizes cognitive aspects of drug/alcohol use as learned behavioras learned behavior Role of cognitions in abstinenceRole of cognitions in abstinence
““Treatment” is a teaching process, coaching and Treatment” is a teaching process, coaching and reinforcing; “therapist” is a teacher/coachreinforcing; “therapist” is a teacher/coach
No assumption of underlying psychopathologyNo assumption of underlying psychopathology New, alternative behaviors must be established New, alternative behaviors must be established Can be delivered in group or individual settingsCan be delivered in group or individual settings
Contingency ManagementContingency Management
A technique employing the systematic delivery of A technique employing the systematic delivery of positive reinforcement for desired behaviors. In positive reinforcement for desired behaviors. In the treatment of methamphetamine dependence, the treatment of methamphetamine dependence, vouchers or prizes can be “earned” for vouchers or prizes can be “earned” for submission of methamphetamine-free urine submission of methamphetamine-free urine samplessamples..
Cognitive Behavioral Therapy and Contingency Cognitive Behavioral Therapy and Contingency Management for Stimulant DependenceManagement for Stimulant Dependence
Intervention CM, CBT, or combined CM and CBT, 16-week treatment conditions. CM 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 received vouchers for stimulant-free urine samples. CBT condition participants attended three 90-minute group sessions each week.. condition participants attended three 90-minute group sessions each week..
Results CM procedures produced better retention and lower rates of stimulant use 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 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 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 at follow-up. While CM produced robust evidence of efficacy during treatment application, CBT produced comparable longer-term outcomes. There was no application, CBT produced comparable longer-term outcomes. There was no evidence of an additive effect when the two treatments were combined. The response evidence of an additive effect when the two treatments were combined. The response of cocaine and methamphetamine users appeared comparable. of cocaine and methamphetamine users appeared comparable.
Conclusions: This study suggests that CM is an efficacious treatment for reducing 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 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 drug use from baseline levels and produces comparable outcomes on all measures at follow-up.follow-up.
Rawson, RA et al. Addiction, Jan 2006Rawson, RA et al. Addiction, Jan 2006
FIGURE 1. Program Retention by GroupFIGURE 1. Program Retention by Group
15.5
27.6 28.6
0
8
16
24
32
Cognitive-Behavioral Therapy
(CBT)
ContingencyManagement (CM)
CBT+CM
Group (F = 10.2, df = 2, P < 0.0001)
Mea
n N
umbe
r FIGURE 2. Stimulant–free Urine Samples by GroupFIGURE 2. Stimulant–free Urine Samples by Group
0
2
4
6
8
10
12
Cognitive-Behavioral Therapy
(CBT)
ContingencyManagement (CM)
CBT+CM
Mea
n D
ays
of S
tim
ulan
t U
se
Baseline 17 Weeks 26 Weeks 52 Week
FIGURE 3. Self-Reported Stimulant UseFIGURE 3. Self-Reported Stimulant Use
Contingency Management: An Evidence-Based Contingency Management: An Evidence-Based Component of Methamphetamine Use Disorder Component of Methamphetamine Use Disorder
Treatments*Treatments*
*Roll, J. Contingency management: an evidence based component of methamphetamine use disorder treatments. Addiction. 2007;102
(Suppl. 1):114-120.
Contingency Management for Treatment of Contingency Management for Treatment of Methamphetamine DependenceMethamphetamine Dependence
Design: RTCDesign: RTC Method: 113 patients diagnosed with methamphetamine abuse or Method: 113 patients diagnosed with methamphetamine abuse or
dependence were randomly assigned to receive either treatment as dependence were randomly assigned to receive either treatment as usual (TAU) or TAU plus contingency management. usual (TAU) or TAU plus contingency management.
Results indicate that both groups were retained in treatment for Results indicate that both groups were retained in treatment for equivalent times but those in the combined group accrued more equivalent times but those in the combined group accrued more abstinence and were abstinent for a longer period of time. These abstinence and were abstinent for a longer period of time. These results suggest that contingency management has promise as a results suggest that contingency management has promise as a component in methamphetamine use disorder treatment strategies.component in methamphetamine use disorder treatment strategies.
* Roll JM, Petry NM, Stitzer ML, et al: Contingency management for * Roll JM, Petry NM, Stitzer ML, et al: Contingency management for the treatment of methamphetamine use disorders. Am J Psychiatry the treatment of methamphetamine use disorders. Am J Psychiatry 163(11):1993-1999, 2006163(11):1993-1999, 2006
Mean number of abstinences
0
5
10
15
20
25
CM Control
Mean weeks of consecutive abstinence
0
1
2
3
4
5
6
CM Control
Matrix ModelMatrix Model Is a manualized, 16-week, non-residential, psychosocial Is a manualized, 16-week, non-residential, psychosocial
approach used for the treatment of drug dependence.approach used for the treatment of drug dependence.
Manuals Can be downloaded at SAMHSA.govManuals Can be downloaded at SAMHSA.gov
Designed to integrate several interventions into a Designed to integrate several interventions into a comprehensive approach. Elements include:comprehensive approach. Elements include: Individual counselingIndividual counseling Cognitive behavioral therapyCognitive behavioral therapy Motivational interviewingMotivational interviewing Positive reinforcement for behavior changePositive reinforcement for behavior change Family education groupsFamily education groups Urine testingUrine testing Participation in 12-step programsParticipation in 12-step programs
Treatment Components of Treatment Components of the Matrix Modelthe Matrix Model
Herrell, J., Huber, A., McCann, M.J., Obert, J., Pennell, S., Reiber, C., Vandersloot, D., Zweben, J., and 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 the Methamphetamine Treatment Project Corporate Authors. (2004). A multi-site comparison of
psychosocial approaches for the treatment of methamphetamine dependence. psychosocial approaches for the treatment of methamphetamine dependence. AddictionAddiction, 99, 708-, 99, 708-
717.717.
The CSAT The CSAT Methamphetamine Methamphetamine Treatment ProjectTreatment Project
A Multi-site Trial of a Manualized Psychosocial Protocol for the Treatment of Methamphetamine
Dependence
Mean Number of Weeks in Treatment
02468
1012
SITE
mea
n nu
mbe
r of
vis
its MatrixTAU
Mean Number of UA’s that were MA-free Mean Number of UA’s that were MA-free during treatmentduring treatment
0
2
4
6
8
10
SITE
mea
n nu
mbe
r of
MA
-fre
e U
A's Matrix
TAU
Urinalysis Results Urinalysis Results
Results of Ua Tests at Discharge, 6 Results of Ua Tests at Discharge, 6 months and 12 Months post admission **months and 12 Months post admission **
**Over 80% follow up rate in both groups at all points**Over 80% follow up rate in both groups at all points
Predictors of In-treatment Predictors of In-treatment Performance and Post-Treatment Performance and Post-Treatment Outcomes in a Methamphetamine-Outcomes in a Methamphetamine-
Dependent AdultsDependent Adults
Predictors of Long-Term AbstinencePredictors of Long-Term Abstinence
Predictors of no MA use at treatment Predictors of no MA use at treatment discharge, and at the 6- and 12-mos discharge, and at the 6- and 12-mos follow-ups includes:follow-ups includes:
MA use of MA use of << 15 days at baseline, 15 days at baseline, Lifetime MA use of < 2 yearsLifetime MA use of < 2 years No previous drug abuse treatmentNo previous drug abuse treatment Providing 3 consecutive MA-free UAs Providing 3 consecutive MA-free UAs
