methamphetamine: user characteristics and treatment response alice huber, ph.d. steven shoptaw,...
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Methamphetamine: User Characteristics and Treatment
ResponseAlice Huber, Ph.D.Alice Huber, Ph.D.
Steven Shoptaw, Ph.D.Steven Shoptaw, Ph.D.
Richard A. Rawson, Ph.D.Richard A. Rawson, Ph.D.
Paul Brethen, M.A.Paul Brethen, M.A.
Walter Ling, M.D.Walter Ling, M.D.
Matrix Center / LAATRCMatrix Center / LAATRCResearch supported by NIDA R18-06185-05Research supported by NIDA R18-06185-05
Topics of Discussion
Project overviewProject overview
Characteristics of methamphetamine usersCharacteristics of methamphetamine users
Description of treatment processDescription of treatment process
Response to treatment modelResponse to treatment model
ImplicationsImplications
Project Overview
Matrix clinic in Rancho CucamongaMatrix clinic in Rancho Cucamonga Located in San Bernardino County Located in San Bernardino County
50 miles east of Los Angeles 50 miles east of Los Angeles Significant stimulant abuse in past decadeSignificant stimulant abuse in past decade Matrix model of treatmentMatrix model of treatment
Standardized treatmentStandardized treatment Comprehensive chart reviewComprehensive chart review
Project Overview
Charts of all stimulant users includedCharts of all stimulant users included Clients entered treatment between 1988-95 Clients entered treatment between 1988-95 Large sampleLarge sample
500 methamphetamine users500 methamphetamine users 224 cocaine users224 cocaine users
Demographics, drug use information, urine Demographics, drug use information, urine toxicology, and treatment outcome ratingstoxicology, and treatment outcome ratings
Participant Characteristics
MA UsersMA Users COC UsersCOC Users GenderGender** 60.0% Male60.0% Male 68.8% Male68.8% Male EthnicityEthnicity**
CaucasianCaucasian 80.5%80.5% 48.0%48.0% HispanicHispanic 16.7%16.7% 15.8%15.8% Afr AmerAfr Amer 1.9% 1.9% 34.2%34.2%
EducationEducation (yrs) (yrs)** 11.811.8 12.412.4 * all tests p<.01* all tests p<.01
Participant Characteristics
MA UsersMA Users COC COC UsersUsers
Age at AdmissionAge at Admission** 29.029.0 31.631.6
Marital StatusMarital Status**
Never MarriedNever Married 48.9%48.9% 36.1%36.1% MarriedMarried 25.8%25.8% 37.5%37.5% Sep/Div/WidowSep/Div/Widow 25.3%25.3% 26.4%26.4%
Participant Characteristics
MA UsersMA Users COC UsersCOC Users Employment StatusEmployment Status**
Work Full TimeWork Full Time 27.5%27.5% 31.2%31.2% Work Part TimeWork Part Time 10.8%10.8% 17.6%17.6% Not WorkingNot Working 61.6%61.6% 50.9%50.9%
Type of EmploymentType of Employment**
White CollarWhite Collar 15.1% 15.1% 18.3%18.3% Blue CollarBlue Collar 84.9%84.9% 81.7%81.7%
Alcohol UseMA UsersMA Users COC UsersCOC Users
AlcoholAlcohol**
> 1 day/week> 1 day/week 22.5% 22.5% 31.1%31.1% Weekly/MonthlyWeekly/Monthly 43.7% 43.7% 48.8%48.8% NoneNone 33.8% 33.8% 20.1%20.1%
Standard Drinks/OccasionStandard Drinks/Occasion**
1-2 Drinks1-2 Drinks 29.4% 29.4% 24.8%24.8% 3-6 Drinks3-6 Drinks 51.4% 51.4% 46.6%46.6% > 6 Drinks> 6 Drinks 17.9% 17.9% 28.6%28.6%
* all tests p<.01* all tests p<.01
Alcohol Use
MA UsersMA Users COC UsersCOC Users
With Drug of ChoiceWith Drug of Choice**
34.3%34.3% 46.9% 46.9%
Need Alcohol Treatment?Need Alcohol Treatment?**
12.6%12.6% 24.6%24.6%
* all tests p<.01* all tests p<.01
Other Substance Use
MA UsersMA Users COC UsersCOC Users
Cocaine, past yr.Cocaine, past yr. 10.8%10.8% 100.0%100.0%
Meth, past yr.Meth, past yr. 100.0%100.0% 17.9%17.9%
Marijuana, past yr.Marijuana, past yr.** 56.2%56.2% 42.4%42.4%
Halluc./PCP, past yr.Halluc./PCP, past yr.** 6.4%6.4% 0.0%0.0%
Barbiturates, past yr.Barbiturates, past yr. 2.8%2.8% 2.2%2.2%
Drug Use Information
MA UsersMA Users COC UsersCOC Users
Age First UsedAge First Used** 21.421.4 23.7 23.7 Heavy UseHeavy Use 41.2 mos.41.2 mos. 39.7 mos.39.7 mos. RouteRoute**
IntranasalIntranasal 55.5%55.5% 21.5%21.5% SmokingSmoking 7.2%7.2% 48.0%48.0% Multiple Routes Multiple Routes 22.7%22.7% 16.7%16.7% Any IV useAny IV use 13.5%13.5% 13.1%13.1%
Drug Use Information
MA UsersMA Users COC UsersCOC Users Frequency of UseFrequency of Use**
None in 30 daysNone in 30 days 14.8%14.8% 17.4%17.4% 1-2 times/week1-2 times/week 24.8%24.8% 44.6%44.6% 3-6 times/week3-6 times/week 17.0%17.0% 16.8%16.8% dailydaily 43.6%43.6% 21.2%21.2%
Recent UseRecent Use** Days / past mo.Days / past mo. 12.812.8 8.88.8 Money / past mo.Money / past mo. $123$123 $275$275
Longest AbstinenceLongest Abstinence** 1-2 mos.1-2 mos. 2-3 mos.2-3 mos.
Drug Use Information
MA UsersMA Users COC UsersCOC Users Believe they are Believe they are
addictedaddicted** 82.1% 82.1% 89.6%89.6% Had prior treatment Had prior treatment
for drug usefor drug use** 24.6%24.6% 44.7%44.7%
* all tests p<.01* all tests p<.01
Self-Reported Medical Problems
MA UsersMA Users COC UsersCOC Users
Chest painChest pain 29.8%29.8% 25.5%25.5%
HeadachesHeadaches** 42.4%42.4% 32.8%32.8%
SeizuresSeizures 2.0%2.0% 4.2%4.2%
Loss of consciousnessLoss of consciousness 7.7%7.7% 6.5%6.5%
Need medical tx.Need medical tx. 10.7%10.7% 5.8%5.8%
NOTE: Answers reflect current medical problems.NOTE: Answers reflect current medical problems.
Self-Reported Psych Problems
MA UsersMA Users COC UsersCOC Users
Previous psych tx.Previous psych tx. 14.4%14.4% 16.5%16.5%
Current psych problemsCurrent psych problems Depressed, “a lot” Depressed, “a lot” ** 19.3%19.3% 12.1%12.1% Suicide thoughtsSuicide thoughts** 6.9%6.9% 2.8%2.8% HallucinationsHallucinations** 34.8%34.8% 25.1%25.1% Paranoid thoughtsParanoid thoughts 28.8%28.8% 25.5%25.5%
NOTE: Answers reflect current psychiatric problemsNOTE: Answers reflect current psychiatric problems ..
Comparisons of IV/non-IV Users
IV UsersIV Users Other UsersOther Users Use > 3g/ weekUse > 3g/ week** 38.1%38.1% 11.4%11.4%
Use dailyUse daily** 65.1%65.1% 40.1%40.1%
Severe withdrawalSevere withdrawal** 36.5%36.5% 22.0%22.0%
Buy direct / dealBuy direct / deal** 33.3%33.3% 13.2%13.2%
Comparisons of IV/non-IV Users
IV UsersIV Users Other UsersOther Users
Felony convictionsFelony convictions** 36.8%36.8% 17.4%17.4%
No Family Rels.No Family Rels.** 22.2%22.2% 5.8%5.8%
BankruptcyBankruptcy** 44.3%44.3% 19.3%19.3%
Unemployed > 1yr.Unemployed > 1yr.** 58.0%58.0% 28.2%28.2%
Comparisons of IV/non-IV Users
IV UsersIV Users Other UsersOther Users
Hallucinations/paranoiaHallucinations/paranoia** 55.5% 55.5% 33.2%33.2%
Seizures/loss of conscSeizures/loss of consc** 30.2%30.2% 14.2%14.2%
Problems with SexProblems with Sex** 29.7% 29.7% 12.8%12.8%
Drug/sex connectedDrug/sex connected** 22.5% 22.5% 9.6%9.6%
Methamphetamine Admissions (Percentage of all Stimulant Users)
0
20
40
60
80
100
1988 1989 1990 1991 1992 1993 1994 1995
Admit Year
%M
A U
sers
Summary of User Characteristics
Typical user is an unemployed male Caucasian, Typical user is an unemployed male Caucasian, with a high school educationwith a high school education
Higher percentage of MA users are female and Higher percentage of MA users are female and married, compared to Cocaine usersmarried, compared to Cocaine users
Started using drug at younger age; entered Started using drug at younger age; entered treatment at younger agetreatment at younger age
Primary route was intranasal, now see more Primary route was intranasal, now see more smokers; most use dailysmokers; most use daily
Summary of User Characteristics
More likely using other drugs; less likely to be using More likely using other drugs; less likely to be using alcohol alcohol
Fewer feel “addicted”, despite more involvement with Fewer feel “addicted”, despite more involvement with other usersother users
Medical and psychological problemsMedical and psychological problems Hallucinations very commonHallucinations very common Appear more psychiatrically disturbed and more out of Appear more psychiatrically disturbed and more out of
controlcontrol May be physically sicker May be physically sicker
Treatment: Matrix Model
Combination of individual, family, and group Combination of individual, family, and group sessionssessions
Program to last 6 monthsProgram to last 6 months Strong emphasis on cognitive-behavioral Strong emphasis on cognitive-behavioral
approachapproach Designed in phases that decrease in intensityDesigned in phases that decrease in intensity
Treatment Services Received
MA UsersMA Users COC UsersCOC Users Individual SessionsIndividual Sessions 13.3 hrs.13.3 hrs. 16.3 hrs.16.3 hrs.
Stabilization GroupStabilization Group 3.4 hrs.3.4 hrs. 3.7 hrs.3.7 hrs.
Relapse Prevention Relapse Prevention 23.7 hrs.23.7 hrs. 21.0 hrs.21.0 hrs.
Family EducationFamily Education 11.6 hrs.11.6 hrs. 12.2 hrs.12.2 hrs.
Social Support 4.4 hrs.Social Support 4.4 hrs. 4.3 hrs.4.3 hrs.
Urinalysis Results Tested randomly, about once a weekTested randomly, about once a week
Samples not always collected when patient self-Samples not always collected when patient self-reported drug usereported drug use
MA usersMA users COC usersCOC users Number of urine Number of urine samples collectedsamples collected 8.3 8.3 8.1 8.1 Percent positive (dirty) Percent positive (dirty) for drug of choicefor drug of choice 10.4% 10.4% 8.1% 8.1%
Treatment Retention
0
20
40
60
80
100
1 4 7 10 13 16 19 22 25 28 31 34
Weeks in Treatment
% R
eten
tion
COC
METH
Summary of Treatment Findings
A structured, manualized psychosocial treatment A structured, manualized psychosocial treatment program is a viable treatment for program is a viable treatment for methamphetamine abuse/dependencemethamphetamine abuse/dependence
This treatment retains more than 50% of patients This treatment retains more than 50% of patients for a clinically meaningful treatment episodefor a clinically meaningful treatment episode
Summary of Treatment Findings
Response to treatment for MA addicts is not Response to treatment for MA addicts is not different than that seen in cocaine addictsdifferent than that seen in cocaine addicts
Equal numbers of drug-positive urines Equal numbers of drug-positive urines Retention is similar for both groupsRetention is similar for both groups A significant percentage of stimulant addicts do A significant percentage of stimulant addicts do
not complete treatment successfullynot complete treatment successfully
Treatment Outcome Current project measures primarily the response Current project measures primarily the response
to a particular modelto a particular model
Follow-up necessary to evaluate treatment Follow-up necessary to evaluate treatment
outcome outcome Center for Substance Abuse Treatment has Center for Substance Abuse Treatment has
funded a follow-up study with this group of funded a follow-up study with this group of patientspatients
Follow-up Project
Randomly select 100 methamphetamine and 100 Randomly select 100 methamphetamine and 100 cocaine patients from the samplecocaine patients from the sample
Admissions from 1991 - 1995Admissions from 1991 - 1995 Contact for in-person interview, ASI, medical Contact for in-person interview, ASI, medical
and psychiatric symptom report, and urine sampleand psychiatric symptom report, and urine sample Expect completion of project in 2/97 Expect completion of project in 2/97
Implications Methamphetamine a serious drug problemMethamphetamine a serious drug problem The use of methamphetamine continues to The use of methamphetamine continues to
increase, even in areas where it has been available increase, even in areas where it has been available for yearsfor years
Methamphetamine use is initiated at a younger ageMethamphetamine use is initiated at a younger age Methamphetamine may be somewhat more popular Methamphetamine may be somewhat more popular
among women among women
Implications Now see more addicts who smoke Now see more addicts who smoke
methamphetaminemethamphetamine Addicts may turn to smoking and then Addicts may turn to smoking and then
intravenous routes as their history of use intravenous routes as their history of use lengthenslengthens
Some routes (particularly IV use) associated with Some routes (particularly IV use) associated with more serious physical, psychological, more serious physical, psychological, psychosocial, and societal outcomespsychosocial, and societal outcomes
Implications
Psychosocial treatment can be quite effective for Psychosocial treatment can be quite effective for some addictssome addicts
Even extended psychosocial treatment leave a Even extended psychosocial treatment leave a significant percentage of addicts impairedsignificant percentage of addicts impaired
Need to develop psychosocial and Need to develop psychosocial and pharmacological approaches specific to pharmacological approaches specific to methamphetaminemethamphetamine