Social determinants to lifetime methamphetamine use among a national sample of adults

The study purpose was to examine social determinants associated with lifetime methamphetamine use among a national sample of adults. A secondary analysis of the 2012 National Survey on Drug Use and Health was conducted. The results from the final multivariable logistic regression model revealed that adults at increased odds for lifetime methamphetamine use were those who were male, 26 years of age or older, participated in a government assistance program, reported their health as good/fair/poor, and used cigarettes, alcohol, and/or marijuana before the age of 21. Recommendations for future studies are included.     

Methamphetamine use and sexual risks for HIV infection in Cape Town,South Africa

Aims: The current study examined the use of methamphetamine (Meth) in relation to HIV risks in a South African community sample.

Design and setting: Street intercept methods were used to collect surveys of substance use and sexual behavior from 441 men and 521 women living in a racially mixed township in Cape Town South Africa.

Findings: Results showed that 78 (18%) men and 63 (12%) women had used Meth, and 49 (11%) men and 34 (6%) women ever had used Meth in the preceding 6 months. Other than alcohol, cannabis was the most commonly used drug followed by Meth. We found that Meth use was closely associated with other drug use, indicating a pattern of poly‐substance use among Meth users. Recent Meth use was associated with being male, engaging in unprotected intercourse and having multiple sex partners in the previous 6 months. Meth users also demonstrated greater condom use than non‐users, although less than half of all intercourse occasions among Meth users were condom protected.

Conclusions: Meth is used by a substantial number of people in one area of South Africa and the close association of Meth and sexual risk practices raises concern that Meth could fuel the spread of HIV infection in new South African sub‐populations.     

Violence perpetrated by women who use methamphetamine

Methamphetamine (meth) is widely recognized as being associated with violence and aggression. This association is found among women and men, with rates of meth-related violence among women possibly being equal to or even exceeding rates among men. This study examined female-perpetrated violence from the phenomenological point of view of 30 women (aged 18–45 years; mean age of 28.5 years) in residential treatment for meth dependence. Of the 30 participants, 80% (n = 24) reported experiencing violence in their lifetimes: 67% (n = 20) had violence perpetrated against them, and 57% (n = 17) had perpetrated violence. Most participants described perpetrating violence when they were ‘coming down’ off of meth (i.e. withdrawing). Five women (29%) attributed their violent behaviors to meth and said they would not have been violent had they not been using meth. In contrast, 10 women (59%) described pre-existing ‘anger issues’ that were ‘enhanced’ by meth. This article describes the timing of meth-related violence, bi-directional violence, men's responses to female-perpetrated violence, aggression in the context of sexual activities, and violence perpetrated against non-partners. A biopsychosocial theoretical framework is useful to interpret the complex explanations that women provide for their perpetration of violence under the influence of chronic meth use.     

Estimated lifetime drug use,impulsivity, and psychopathology in recreational ecstasy users

Previous research suggests elevated levels of impulsivity and psychopathology in recreational ecstasy users. However, most recreational ecstasy users tend to be poly-drug users. The present study aimed to investigate impulsivity and psychopathology in a sample of recreational ecstasy polydrug users compared with samples of non-ecstasy users, while statistically controlling for estimated life-time drug usage. Sixty-eight non-drug controls, 79 non-ecstasy poly-drug users, 11 ‘light’ ecstasy poly-drug users, and 47 ‘heavy’ ecstasy poly drug users completed the Barratt Impulsivity Scale (BIS-11) and the SCL-90R and a drug history questionnaire. When estimated life-time drug-use was statistically controlled for, heavy ecstasy users exhibited significantly higher levels of non-planning and cognitive impulsivity, and increased obsessive compulsion, anxiety and positive symptom total than non-ecstasy users. This study provides evidence of some elements of elevated impulsivity and psychopathology in heavy ecstasy users, but not in lighter ecstasy users. The results should be seen in the context of the heavy ecstasy group as poly-drug users and should be interpreted with caution.     

Delinquency and drug use among adolescents and emerging adults: The role of aggression,impulsivity, empathy,and cognitive distortions

Risk behaviors are well known to be higher in adolescents and emerging adults. Drug use and delinquency present several common predictive factors. The aim of the present study was to assess the contribution of individual factors (aggression, impulsivity, empathy, and cognitive distortions) to delinquent behaviors, alcohol use and cannabis consumption among adolescents and emerging adults. Participants were between 15 and 25 years of age (M = 18.64 years, SD = 2.61); 325 were adolescents (15–18 years of age, M = 16.56, SD = 1.11, 56.31% of women) and 283 were emerging adults (19–25 years, M = 21.03, SD = 1.62, 50.88% of women). They completed self-report validated questionnaires. Multiple regression analyses showed that all individual factors significantly predicted delinquency. Impulsivity and empathy significantly predicted alcohol use. Concerning cannabis use, impulsivity is the only significantly associated predictor. Moderation analysis showed that specific associations were stronger in adolescents, whereas others were stronger in emerging adults. All these variables explained 69% of the variance of delinquency, 31% of the variance of alcohol use, and 18% of the variance of cannabis use. This model demonstrated acceptable goodness-of-fit criteria. These results may have implications for prevention and intervention.     

Central nervous system malformation associated with methamphetamine abuse during pregnancy

Introduction: Prenatal methamphetamine exposure is related to prematurity, fetal growth restriction, neurobehavioral effects and long-term motor and cognitive sequelae.

Patient presentation: We report the case of a newborn from a Filipina with no prenatal care with a complex brain malformation. Methamphetamine was identified in maternal and neonatal urine and in maternal hair, raising our suspicion of methamphetamine as a cause of this malformation.

Discussion: Methamphetamine abuse is a growing problem worldwide. There are little data on its effect on the fetus. To our knowledge, no fetal brain abnormalities have been associated with its use. In our case, the lack of antenatal control does not allow us to date when this malformation appeared.

Conclusion: The aim of our report is to generate awareness of the possible association between methamphetamine abuse during pregnancy and central nervous system malformations.     

A review of psychological and pharmacological treatment options for methamphetamine dependence

Methamphetamine (MA) is a public health problem both in Australia and internationally and very little is known about the most cost-effective treatment options. This study is a review of recent studies and an assessment of current treatment options for MA dependence. Treatment options for MA dependence can be divided into outpatient and inpatient modality settings according to the level of drug use. Moderate improvements through higher rates of retention in treatment (especially residential rehabilitation) have been found in individuals who completed either cognitive-behavioural therapy or counselling as a form of outpatient treatment and in those users who completed a residential rehabilitation treatment programme at an inpatient treatment modality. There remains a need for further research to investigate the efficacy of existing treatment options in individuals with MA use problems and to address the economic impact of those interventions in terms of cost-effectiveness/cost utility.     

Methamphetamine use and heart failure: Prevalence,risk factors,and predictors

Objectives

To compare methamphetamine users who develop heart failure to those who do not and determine predictors.

Efficacy of the Marlatt cognitive-behavioral model on decreasing relapse and craving in women with methamphetamine dependence: A clinical trial

Methamphetamine use is now a global concern, which warrants a thorough assessment of the effectiveness of its different treatment modalities. To evaluate the efficacy of the Marlatt cognitive-behavioral model on decreasing the rate of relapse and craving in women with methamphetamine dependence, we conducted the present quasi-experimental study with a pretest–posttest and control group design in which 80 women with methamphetamine dependence who referred to Farabi Hospital of Kermanshah were chosen through convenience sampling and randomly allocated to two groups of intervention and control. Before and after the intervention, the members of both groups completed the Craving Belief Questionnaire (by Clark and Beck) and the Desire for Drug Questionnaire (by Franklin et al.). The results showed that in the intervention group, the Marlatt cognitive-behavioral treatment led to decreased relapse and craving. Cognitive-behavioral therapy can, therefore, be a treatment option to diminish relapse and craving in individuals with methamphetamine dependence.     

甲基苯丙胺急性暴露对小鼠神经元的损伤作用研究

目的 探讨甲基苯丙胺(METH)急性暴露后引起神经元的损伤作用.方法 甲基苯丙胺给与小鼠后,对小鼠的刻板行为进行评分,通过Y水迷宫的方法评估小鼠空间记忆能力.分子水平,试剂盒法检测皮层区诱导型NO释放水平,利用Western-blot法观察神经元凋亡标志性蛋白Bax、Bcl2及Caspase 3表达水平.在细胞水平,利用彗星实验,观察甲基苯丙胺对原代培养神经元DNA的损伤情况.利用JC-1探针观察甲基苯丙胺对神经元线粒体膜电位的改变.此外,通过Western-blot法,阐述MAPKs通路在METH引起神经元损伤中的潜在作用.结果 METH显著增加小鼠的刻板行为,且明显降低小鼠空间识别能力.在分子层面,发现诱导型NO含量显著增高,相应凋亡蛋白Bax和cleaved caspase-3的表达增高,神经元细胞膜电位的下降.进一步研究发现,MAPKs在METH处理后,通路激活,磷酸化水平显著增高.预孵p38 MAPK抑制剂SB203580后,METH引起凋亡蛋白表达增高的趋势降低.结论 METH可多途径引起神经元损伤,激活MAPKs通路,而p38-MAPK可能参与了METH引起的神经元的损伤.     

Psychotherapy of adults with comorbid attention-deficit/hyperactivity disorder and psychoactive substance use disorder

Psychotherapy for comorbid attention-deficit/ hyperactivity disorder (ADHD) and psychoactive substance use disorder (PSUD) is described. The authors suggest that relapse prevention is an appropriate initial treatment because it is well suited to manage both substance abuse and comorbid symptomatology such as impulsivity, distractibility, and avoidance associated with ADHD. Clinical vignettes describe typical interactions between patients and their therapists, highlighting opportunities for therapists to focus on overlapping symptoms. ADHD is one of the most common comorbid diagnoses with PSUD, and it is important that efficacious psychotherapies be developed to complement psychopharmacological approaches. Clinicians should consider psychotherapy as part of a multimodal treatment approach that includes medication and perhaps family therapy. Additional contributions from clinicians who have experience conducting psychotherapy with this population are needed in order to develop effective treatments.     

Methylphenidate substitution for methamphetamine addiction and implications for future randomized clinical trials: a unique case series

Background: Methamphetamine Use Disorders (MUD) pharmacotherapy research yields contradictory results.

Objective: Our objective was to identify treatment outcome features of intravenous users of methamphetamine (IUM) treated by one healthcare provider using stable methylphenidate (MPH) substitution protocols over an extended interval.

Method: We retrospectively examined a database of all intravenous MUD cases (24 patients) treated with short acting MPH and psychotherapy between 2007 and 2013 in a single outpatient addiction treatment facility.

Results: Mean duration of treatment was 8 months (<1–31 months). Treatment resulted in full abstinence in 10 cases – maintained until the end of the observation period. Patients who stayed in treatment for more than a month and remained abstinent were more likely to be regular pattern users of methamphetamine (MA), female and characterized as having co-occurring psychiatric disorders that responded to treatment. These patients discontinued intravenous MA use and demonstrated stabilization of their health conditions. One adverse effect was reported by one patient who required emergency department treatment for accidental alcohol poisoning.

Conclusion: Our clinical series indicated favorable outcomes and low dropout rates in patients with MUD who were treated several months with short acting MPH with individualized dosing. Adverse effects were rare. Keeping patients engaged in treatment in the first four weeks was critical for good clinical outcomes. Our findings indicated the need for the possible application of pre-selective criteria regarding patterns of use prior to initiation of (MPH) agonist pharmacotherapy of MA dependence. Prospective studies are needed to confirm or reject these clinical observations.     

美沙酮维持治疗者滥用甲基苯丙胺的因素分析

目的 探讨美沙酮维持治疗(methadone maintenance treatment,MMT)者滥用甲基苯丙胺的影响因素。 方法 选取2013年1月-2016年6月在MMT门诊接受治疗的255例患者为调查对象,自拟调查问卷统计社会学特征、对甲基苯丙胺的认知情况、MMT治疗情况,进行单因素及多因素Logistic回归分析。 结果 255例MMT患者中,甲基苯丙胺尿检阳性者28例,占11.0%,单因素分析结果表明不同性别、年龄、居住方式、对甲基苯丙胺的了解情况、甲基苯丙胺对性行为影响的认知、近3个月是否吸食毒品的患者,其甲基苯丙胺尿检阳性率存在统计学差异,多因素Logistic回归分析结果表明年龄(OR=2.190)、甲基苯丙胺对性行为影响的认知(OR=1.237)及近3个月吸食毒品(OR=2.876)是造成甲基苯丙胺滥用的危险因素。 结论 针对MMT患者滥用甲基苯丙胺的危险因素,应当加强教育,以减少甲基苯丙胺的使用,预防艾滋病感染。     

Amantadine reduces persistent fatigue during post-acute withdrawal phase in methamphetamine abstained individuals: A randomized placebo-controlled trial

Background: Persistent fatigue is a common symptom of methamphetamine withdrawal. It disrupts the individual’s social and professional lives as well as increasing the risk of relapse. This study aimed to assess the effects of amantadine in the treatment of persistent fatigue in methamphetamine-abstained individuals.Methods: A double-blind, placebo-controlled trial was conducted on 42 methamphetamine-abstained individuals who sought treatment for persistent fatigue. Participants were randomly assigned to two groups, receiving either amantadine 100 mg/day or placebo for 4 weeks. Treatment response was evaluated using Fatigue Severity Scale (FSS) and Chalder Fatigue Scale (CFS), recorded at the beginning and end of trial.Results: A substantial reduction in both fatigue scales was found in the amantadine group, while there was no significant change in the placebo group. Fatigue reduction in the amantadine and placebo groups was, respectively, 28% versus 6% (p < 0.001) using the FSS and 24.3% and 4.5% (p < 0.001) using the CFS. In addition, both scales showed that the rate of fatigue recovery was significantly higher in the amantadine versus placebo group (p < 0.05).Conclusions: Persistent fatigue in methamphetamine-abstained individuals was significantly reduced, and higher rate of fatigue recovery achieved, from daily administration of 100 mg amantadine for 4 weeks.     

Role of ethnicity in social anxiety disorder: A cross-sectional survey among health science students

AIM: To investigate the influence of ethnicity in social anxiety disorder (SAD), and the relationship with symptom severity, depression and substance use or abuse, in health sciences'' students .METHODS: This was a cross-sectional survey of 112 1^st, 2^nd and 3^rd year students from the Faculty of Medicine and Health Sciences at Stellenbosch University, Cape Town, South Africa. The self-reported Social Anxiety Spectrum questionnaire was used to assess for SAD. The Social Phobia Inventory (SPIN) was adapted to a version called the E-SPIN (Ethnic-SPIN) in order to evaluate the effects of ethnicity. Two sub-questions per stem question were included to assess whether SAD symptoms in social interactions were ethnicity dependent. Substance use was assessed with the Alcohol Use Disorders Identification Test and Drug Use Disorders Identification Test, and depression with the Centre for Epidemiological Studies Depression Scale.RESULTS: Of 112 students who completed the E-SPIN questionnaire, 54.4% (n = 61) met criteria for SAD, with significantly more females than males meeting criteria. Ethnicity had a significant effect on SAD symptomatology, but there was no effect of ethnicity on the rates of drug and alcohol abuse in students with and without SAD. Overall significantly more students with SAD met criteria for depression compared with students without the disorder.CONCLUSION: Among university students, SAD is prevalent regardless of whether interactions are with individuals of the same or different ethnic group. However, ethnicity may be an important determinant of social anxiety for some ethnic groups. SAD was significantly associated with major depression but not significantly associated with drug or alcohol abuse.