Treatment outcomes for methamphetamine users receiving outpatient counselling from the Stimulant Treatment Program in Australia

Introduction and Aims. The purpose of this study was to document treatment outcomes for methamphetamine users receiving outpatient counselling from the Stimulant Treatment Program (STP) in Australia. Design and Methods. Clients attending the STP for methamphetamine use (n = 105) were assessed on entry to the service and at 3 (n = 86) and 6 months (n = 83) after starting treatment. At each interview methamphetamine use (days of use, severity of dependence), other drug use and health and social functioning (HIV risk behaviour, crime, disability, psychotic symptoms and hostility) were assessed for the past month. Results. Participants received a median of six counselling sessions (interquartile range 1–11) over a period of 89 days (interquartile range 41–148 days). Past month methamphetamine use fell from 79% at treatment entry to 53% at the 3‐month follow‐up (P < 0.001) and 55% at the 6‐month follow‐up (P < 0.001). There were statistically significant reductions in psychotic symptoms, hostility and disability associated with poor mental health. There was no change in other drug use, crime or HIV risk behaviour. Reductions in methamphetamine were more common among younger participants, those who had no history of drug treatment and those without concurrent heroin use. Discussion and Conclusions. Methamphetamine users entering the STP showed reductions in methamphetamine use and improvements in their mental health after treatment. Improved treatment responses are needed to address polydrug use and other harms within in this population.[McKetin R, Dunlop AJ, Holland RM, Sutherland RA, Baker AL, Salmon AM, Hudson SL. Treatment outcomes for methamphetamine users receiving outpatient counselling from the Stimulant Treatment Program in Australia. Drug Alcohol Rev 2013;32:80–87]     

Age-related patterns of drug use initiation among polydrug using regular psychostimulant users

Introduction and Aims. To determine age‐related patterns of drug use initiation, drug sequencing and treatment entry among regular psychostimulant users. Design and Methods. Cross‐sectional study of 269 regular psychostimulant users, administered a structured interview examining onset of use for major licit and illicit drugs. Results. The mean age at first intoxication was not associated with age or gender. In contrast, younger age was associated with earlier ages of onset for all of the illicit drug classes. Each additional year of age was associated with a 4 month increase in onset age for methamphetamine, and 3 months for heroin. By the age of 17, those born prior to 1961 had, on average, used only tobacco and alcohol, whereas those born between 1986 and 1990 had used nine different drug classes. The period between initial use and the transition to regular use, however, was stable. Age was also negatively correlated with both age at initial injection and regular injecting. Onset sequences, however, remained stable. Consistent with the age‐related patterns of drug use, each additional year of age associated with a 0.47 year increase in the age at first treatment. Discussion and Conclusions. While the age at first intoxication appeared stable, the trajectory through illicit drug use was substantially truncated. The data indicate that, at least among those who progress to regular illicit drug use, younger users are likely to be exposed to far broader polydrug use in their teens than has previously been the case.[Darke S, Kaye S, Torok M. Age‐related patterns of drug use initiation among polydrug using regular psychostimulant users. Drug Alcohol Rev 2012;31:784–789]     

Predictors and consequences of incarceration among a sample of young Thai methamphetamine users

Introduction and Aims. Our study examined the incidence of arrest and incarceration, investigated predictors of incarceration and explored the persistence of depression, alcohol use and drug use after incarceration among young methamphetamine users from Thailand. Design and Methods. Participants were aged 18–25 years old and were a part of a 12 month randomised social network trial that aimed to reduce sexual risk and methamphetamine use. Estimates of the incidence of arrest and incarceration over 12 months were calculated. A matched case–control study (n = 73 cases; n = 223 controls) was performed to examine incarceration risk factors using conditional logistic regression. Persistence of drug‐risk behaviours were explored after incarceration. Results. Study participants (n = 950) were 72% male, with a median age of 19 years and a median of 9 years of schooling. Frequent drug and alcohol use were reported at baseline. In total, 35% of the sample reported ever having been arrested and 22% reported ever having been incarcerated at baseline. During the 12 month follow up, 16% of the sample was arrested. In univariate analyses, risk factors for incarceration included frequent drug and alcohol use, being less educated, and a history of arrest and incarceration. A high prevalence of drug and alcohol use and involvement in the drug economy persisted after arrest. Discussion and Conclusions. The study indicates a high prevalence of recidivism among this young sample, with continued involvement in drug‐risk behaviours after incarceration. Appropriate interventions are needed to address root causes of arrest, largely related to substance use.[Sherman SG, Sutcliffe CG, Srirojn B, German D, Thomson N, Aramrattana A, Celentano DD. Predictors and consequences of incarceration among a sample of young Thai methamphetamine users. Drug Alcohol Rev 2010]     

Status of methamphetamine users 2-5 years after outpatient treatment

Increasing numbers of methamphetamine users sought treatment during the decade of the 1990s. Little is known about the post treatment status of methamphetamine users who enter treatment. The data presented in this paper describe the outcome status of a group of a convenience sample of 114 methamphetamine users from a total group of 500 methamphetamine users who were treated 2-5 years prior to a follow up interview. Since the sample was not randomly selected, no specific treatment outcome attribution is possible. Methamphetamine use and other drug use of the follow up sample was substantially reduced from pretreatment levels. In general, the follow up status of the sample was much improved as compared to before treatment. However, headaches and depression were reported at a similar rate at follow up as had been reported at treatment admission.     

Effectiveness of a Brief Home-Based Social Work Motivational Intervention for Male Methamphetamine Users in Tehran: A Randomized Clinical Trial

Methamphetamine, a highly addictive psychostimulant drug, is widely used by substance users who are not motivated to undergo treatment throughout the world, including Iran. This research was conducted to evaluate the effectiveness of a brief home-based social work motivational intervention (HSWMI) to encourage male methamphetamine users to participate in a treatment program. Method: Fifty-six unmotivated male methamphetamine users participated in a randomized controlled trial. The case group received the HSWMI in addition to the usual consulting services in the clinic; the control group just received the usual consulting services. Data were collected 7 and 90 days after the intervention to evaluate participation and retention in a treatment program. Data were analyzed using the chi-square test. Results: Drug users with a mean age of 32.55 years and mean duration of drug use of 7.73 years, participated in the case (n = 28) and control (n = 28) groups. The case group participated in treatment programs significantly more than the control group and the retention rate for the case group was significantly higher than for the control group. Conclusion: This brief HSWMI was effective to increase the motivation of methamphetamine users to participate and remain in treatment programs. This intervention can be implemented by social workers in substance use treatment centers.     

Psychosocial approaches to psychostimulant dependence: a systematic review

This review examines the nature and evidence for the effectiveness of psychosocial interventions for psychostimulant dependence. Psychostimulant dependence and related harms continue to increase in many parts of the world, while treatment responses are predominantly limited to psychosocial interventions. The effectiveness of psychosocial interventions is compromised by poor rates of treatment induction and retention. As with other substance use disorders, increasing the diversity of treatment options is likely to improve treatment coverage and outcomes across a broader range of users. Identifying medications that might enhance treatment induction and retention would also enhance the effectiveness of psychosocial programs. It is concluded that psychosocial interventions are moderately effective in reducing psychostimulant use and related harms among psychostimulant-dependent persons.     

Psychopathology in methamphetamine‐dependent adults 3 years after treatment

Introduction and Aims. Although psychiatric symptoms are frequently observed in methamphetamine (MA) users, little is known about the prevalence of psychiatric disorders in MA‐dependent individuals. This is the first study to examine the association of psychiatric disorders with substance use and psychosocial functioning in a large sample of MA users 3 years after treatment. We predicted that psychiatric diagnoses and severity would be associated with substance use and poorer overall functioning over the 3 year post‐treatment course. Design and Methods. Participants (N = 526) received psychosocial treatment for MA dependence as part of the Methamphetamine Treatment Project and were reassessed for psychosocial functioning and substance use at a mean of 3 years after treatment initiation. DSM‐IV psychiatric diagnoses were assessed at follow‐up using the Mini‐International Neuropsychiatric Interview. Psychosocial functioning was assessed using the Addiction Severity Index. Results. Overall, 48.1% of the sample met criteria for a current or past psychiatric disorder other than a substance use disorder. Consistent with prior reports from clinical samples of cocaine users, this rate was largely accounted for by mood disorders, anxiety disorders and antisocial personality. Those with an Axis I psychiatric disorder evidenced increased MA use and greater functional impairment over time relative to those without a psychiatric disorder. Discussion and Conclusions. This initial investigation of psychiatric diagnoses in MA users after treatment indicates elevated rates of Axis I and II disorders in this population and underscores the need for integrated psychiatric assessment and intervention in drug abuse treatment settings.[Glasner‐Edwards S, Mooney LJ, Marinelli‐Casey P, Hillhouse M, Ang A, Rawson RA, The Methamphetamine Treatment Project Corporate Authors. Psychopathology in methamphetamine‐dependent adults 3 years after treatment. Drug Alcohol Rev 2009]     

A systematic review of cognitive and behavioural therapies for methamphetamine dependence

Introduction and Aims . The use of methamphetamine is widespread and poses significant challenges for treatment providers. Much of the treatment knowledge about this group has been extrapolated from studies of treatment for cocaine dependence. Medications have been shown to be of limited effectiveness for methamphetamine users, making psychological interventions the treatment of choice. Approach . This paper describes a systematic review of cognitive–behavioural and behavioural interventions for methamphetamine users. A systematic search of published literature was undertaken focusing only on randomised trials. Key Findings . There were a relatively small number of intervention studies that compared cognitive–behavioural or behavioural interventions using randomised trial methodology. Most commonly, studies examined cognitive–behaviour therapy (CBT) and/or contingency management (CM). Treatment with CBT appears to be associated with reductions in methamphetamine use and other positive changes, even over very short periods of treatment (two and four sessions). CM studies found a significant reduction of methamphetamine during application of the procedure, but it is not clear if these gains are sustained at post‐treatment follow‐up. Implications . The review highlights that there are effective treatments for methamphetamine dependence. Alcohol and other drug (AOD) clinicians are familiar with these types of interventions and should use them and convey to clients that they are effective. Services and policy makers should ensure that best practice interventions are implemented within AOD services. Conclusion . Psychological intervention is effective in addressing methamphetamine use and dependence. CBT and contingency management are two accessible interventions that are implemented easily within current AOD services. There is still more work to conduct in improving methamphetamine treatment, however, and further research into cognitive–behavioural and behavioural treatments for methamphetamine users is required, with a focus on improving longevity of the effect of intervention and improving effectiveness among more complex presentations.     

Stepping through treatment: reflections on an adaptive treatment strategy among methamphetamine users with depression

Introduction and Aims. Stepped‐care has been recommended in the alcohol and other drug field and adopted in a number of service settings, but few research projects have examined this approach. This article aims to describe a pilot trial of stepped‐care methods in the treatment of methamphetamine use and depression comorbidity. Design and Methods. An adaptive treatment strategy was developed based on recommendations for stepped‐care among methamphetamine users, and incorporating cognitive behaviour therapy/motivational intervention for methamphetamine use and depression. The adaptive treatment strategy was compared with a fixed treatment, comprising an extended integrated cognitive behaviour therapy/motivational intervention treatment. Eighteen participants across two study sites were involved in the trial, and were current users of methamphetamines (at least once weekly) exhibiting at least moderate symptoms of depression (score of 17 or greater on the Beck Depression Inventory II). Results. Treatment delivered via the adaptive treatment (stepped‐care) model was associated with improvement in depression and methamphetamine use, however, was not associated with more efficient delivery of psychological treatment to this population relative to the comparison treatment. Discussion and Conclusions. This pilot trial attests to the potential for adaptive treatment strategies to increase the evidence base for stepped‐care approaches within the alcohol and other drug field. However, in order for stepped‐care treatment in this trial to be delivered efficiently, specific training in the delivery and philosophy of the model is required.[Kay‐Lambkin FJ, Baker AL, McKetin R, Lee N. Stepping through treatment: Reflections on an adaptive treatment strategy among methamphetamine users with depression. Drug Alcohol Rev 2010;29;475–482]     

Trends in methamphetamine use in young injection drug users in San Francisco from 1998 to 2004: the UFO Study

Aims . To describe temporal trends in methamphetamine use among young injection drug users (IDU) in San Francisco. Design and Methods . Secondary analysis of cross‐sectional baseline data collected for a longitudinal study of young IDU from 1998 to 2004. Participants were 1445 young IDU (<30 years old) who reported injection in the previous month, English‐speaking, and recruited by street outreach methods. We examined trends for: lifetime (ever) and recent (30‐day) methamphetamine use, including injected and non‐injected, and by age group and sexual risk behaviour [men who have sex with men injecting drug users (MSM‐IDU), male IDU (non‐MSM) and female IDU]. Results . In 1998, 1999, 2000, 2001, 2003 and 2004 we interviewed 237, 276, 431, 310, 147 and 44 participants, respectively. Overall, median age was 22 years [interquartile range (IQR) 20–25], 30.3% were women and median duration of injecting was 4.4 years (IQR 2–7). Prevalence of methamphetamine use was high, with 50.1% reporting recent injection, but overall there were no temporal increases in reported ‘ever’ injected use. Recent methamphetamine injection (past 30 days) increased significantly, and peaked at 60% in 2003. MSM‐IDU had higher methamphetamine injection ever (92.3%) and recently (59.5%) compared to heterosexual male (non‐MSM) IDU (81.6% and 47.3%, respectively) and to female IDU (78.4% and 46.1%, respectively). Conclusions . Despite reports of ubiquitous increases in methamphetamine use, there were no significant increases in 6 years in ever injecting methamphetamine overall among young IDU. MSM‐IDU who reported the highest methamphetamine use overall reported some increases in recent injected use. The methamphetamine ‘epidemic’ was probably under way among young IDU earlier than other populations.     

A postal intervention for dependent cannabis users

Introduction and Aims. In Australia, many would‐be treatment seekers for problematic cannabis use live in rural and remote areas, thereby limiting their access to face‐to‐face treatments. In order to address this gap in treatment availability, the present study aimed to assess the feasibility of a mail‐based intervention for regular cannabis users. Design and Methods. Treatment was based upon cognitive‐behavioural and motivational interviewing principles, and consisted of six treatment modules posted fortnightly to participants. In addition to the standardised modules, participants received personalised feedback at four points, based upon their mailed‐in responses to the modules. Participants were recruited via advertisements in rural newspapers and a Google advertisement. Results. A total of 268 people expressed interest in this study and 36 participants went on to complete treatment. Treatment completers demonstrated a significant reduction in cannabis use at the 1 month follow‐up. Discussion and Conclusions. Transposing face‐to‐face treatments into a mailed format has shown some promise and future research is warranted to determine the efficacy of such treatments in a controlled study.[Norberg MM, Wright T, Hickey K, Copeland J. A postal intervention for dependent cannabis users. Drug Alcohol Rev 2012;31:320–326]     

Subjective Report of Side Effects of Prescribed and Nonprescribed Psychostimulant Use in Young Adults

Background: Side effects of prescribed and nonprescribed psychostimulant use are understudied. Objectives: The study examined side effects of prescribed and nonprescribed psychostimulant use in a college sample with attention to possible gender differences. Methods: 2716 undergraduates (1448 male) between the ages of 17 and 57 years (M = 19.43 years, SD = 1.7 years) completed an online survey that included questions about the subjective side effects of prescribed and nonprescribed psychostimulant use. Results: Results suggested that prescribed users more frequently reported side effects, compared to nonprescribed users. For prescribed users, females more frequently reported appetite, somatic, and anxiety-related side effects compared to males. For nonprescribed users, while females reported more somatic and anxiety-related side effects, males more frequently reported loss of sex drive and sweating as side effects. Conclusions/Importance: These findings suggest prescribed users of psychostimulants more frequently report side effects with prominent gender differences in line with gender roles.     

Extended adherence support by community pharmacists for patients with hypertension: a randomised controlled trial

Objective — To determine the effects of a patient‐centred intervention by community pharmacists on adherence to treatment for hypertension. Study design — Randomised controlled trial. Method — Randomisation was at pharmacy level. Pharmacists in the intervention group used a structured, brief questioning protocol to identify patients' medication‐related problems and their information needs relating to hypertension and its treatment. Advice, information and referral to the general practitioner (GP) were provided by the pharmacist, based on patients' responses. Pharmacists in the control group provided usual care. The intervention was delivered three times at approximately two‐month intervals. Blood pressure measurements were collected retrospectively from GP medical records. Patients completed feedback questionnaires at baseline and post‐study. The questionnaire comprised a self‐reported adherence measure and explored satisfaction with pharmaceutical services. Setting — Twenty community pharmacy sites (11 intervention and nine controls) in one health authority area in England. Outcome measures — Control of blood pressure; patient satisfaction with pharmaceutical services; self‐reported adherence. Results — In total, 180 patients (101 intervention and 79 control) from 43 general medical practices completed the trial. Patients whose blood pressure was uncontrolled prior to the study were more likely to become controlled in the intervention group (P<0.05). Most of the effect on self‐reported adherence was seen after the first intervention. Patient satisfaction was high prior to the study and was increased in the intervention group after the study. The increase was statistically significant for five items relating to communication between pharmacist and patient. Conclusion — A simple intervention delivered by community pharmacists produces positive effects on blood pressure control, self‐reported adherence and on patient satisfaction with pharmaceutical services.     

Addicted to the ‘life of methamphetamine’: Perceived barriers to sustained methamphetamine recovery

Aims: This qualitative study explores and characterises barriers to methamphetamine recovery that emerge from users discussing anonymously their challenges in an online discussion forum. Methods: Anonymous letters and stories (N?=?202), which were submitted to an online support forum for methamphetamine users and their loved ones, were analysed in Dedoose software using grounded theory methodology. Findings: Six perceived barriers emerged from the narratives, which were categorised as internal or external. The first three perceived barriers – low self-efficacy, conflicting thoughts about methamphetamine use, and side effects of withdrawal – were related to internal barriers, and the other three perceived barriers – escaping the drug environment, friends and family prevented recovery, and inadequate drug rehabilitation programmes – were related to external barriers. Conclusions: Methamphetamine users participating in an online discussion forum faced many internal and external barriers that impeded their recovery. These identified barriers were remarkably similar to barriers reported by users seeking treatment in conventional settings or recruited from drug networks, which suggests that methamphetamine users, in general, use multiple methods to assist with recovery and face many common barriers. Developing behavioural interventions that include online components may help remove some of the barriers and improve methamphetamine recovery.     

Socio-demographic factors associated with methamphetamine treatment contact among dependent methamphetamine users in Sydney, Australia

Australia has a sizable population of dependent methamphetamine users, the majority of whom do not receive treatment for their drug use. The aim of the current study was to identify socio-demographic factors related to not having received treatment for methamphetamine use among dependent users of the drug in Sydney, Australia. A cross-sectional survey of methamphetamine users in Sydney was used to identify a sample of dependent methamphetamine users (n = 173). Dependence was defined as a score of four or greater on the Severity of Dependence Scale. Dependent methamphetamine users who had received treatment for their methamphetamine use (n = 57) were compared with those who had never received treatment for their methamphetamine use (n = 116) on socio-demographic characteristics and drug use. After adjusting for severity of methamphetamine dependence, socio-demographic factors that were predictive of not having received methamphetamine treatment included being female, being born outside Australia and being in full-time employment. Methamphetamine smokers were less likely to receive treatment than people who took the drug via other routes of administration, while primary heroin users who were concurrently dependent on methamphetamine were unlikely to receive treatment for their methamphetamine use. Further research is needed to understand the barriers to receiving methamphetamine treatment among these subgroups of dependent methamphetamine users. [McKetin R, Kelly E. Socio-demographic factors associated with methamphetamine treatment contact among dependent methamphetamine users in Sydney, Australia. Drug Alcohol Rev 2007;26:161 - 168]     

Polydrug Use and HIV Risk Among People Who Inject Heroin in Tijuana,Mexico: A Latent Class Analysis

Background: Although most people who inject drugs (PWID) in Tijuana, Mexico, primarily inject heroin, injection and non-injection use of methamphetamine and cocaine is common. We examined patterns of polydrug use among heroin injectors to inform prevention and treatment of drug use and its health and social consequences. Methods: Participants were PWID residing in Tijuana, aged ≥18 years who reported heroin injection in the past six months and were recruited through respondent-driven sampling (n = 1,025). Latent class analysis was conducted to assign individuals to classes on a probabilistic basis, using four indicators of past six-month polydrug and polyroute use: cocaine injecting, cocaine smoking or snorting, methamphetamine injecting, and methamphetamine smoking or snorting. Latent class membership was regressed onto covariates in a multinomial logistic regression. Results: Latent class analyses testing 1, 2, 3, and 4 classes were fit, with the 3-class solution fitting best. Class 1 was defined by predominantly heroin use (50.2%, n = 515); class 2 by methamphetamine and heroin use (43.7%, n = 448), and class 3 by methamphetamine, cocaine, and heroin use (6.0%, n = 62). Bivariate and multivariate analyses indicated a group of methamphetamine and cocaine users that exhibited higher-risk sexual practices and lower heroin injecting frequency, and a group of methamphetamine users who were younger and more likely to be female. Conclusions: Discrete subtypes of heroin PWID were identified based on methamphetamine and cocaine use patterns. These findings have identified subtypes of heroin injectors who require more tailored interventions to reduce the health and social harms of injecting drug use.     

Mortality,Causes of Death,and Health Status Among Methamphetamine Users

This study examines causes of death, years of life lost, and health and drug use characteristics associated with mortality over an 8 to 10 year period in a sample of methamphetamine users who had and had not received substance use disorder treatment (N = 563). Decedents reported initiating their methamphetamine use for different reasons than surviving methamphetamine users, and some of these differences varied by treatment status. Study findings provide additional detail on long-term health and mortality outcomes in a diverse sample of methamphetamine users, which may inform public health strategies targeting the comparable and divergent needs of treated and untreated populations.     

Binge Use and Sex and Drug Use Behaviors among HIV(–), Heterosexual Methamphetamine Users in San Diego

This study identified sociodemographic factors, drug using practices, sexual behaviors, and motivational factors associated with binge (a period of uninterrupted) methamphetamine (MA) use among heterosexual MA users. Sample and Method: The FASTLANE study provided cross-sectional data collected by audio computer-assisted self-interview (ACASI) between June 2001 and August 2004 from 451 HIV-negative MA users in San Diego, California, USA who had engaged in unprotected sex and used MA in the previous two months. Results: The study sample was 67.8%% male, 49.4%% Caucasian, 26.8%% African-American, and 12.8%% Hispanic with a mean age of 36.6 years; 183 (40.5%%) reported binge use in the past 2 months. Compared with non-binge users, binge users of MA were more likely to report risky drug use and sex behaviors and differed in motivations to initiate and currently use MA. The final logistic regression model for binge use included more days of MA use in the last month, ever treated for MA use, injection drug use, higher Beck Depression Inventory score, “experimentation” as a motivation for initiating MA use, and engaging in sex marathons while high on MA. HIV prevention efforts should differentiate and address these differences in motivations for MA use and the associated HIV-risk sex and drug use behaviors as key targets for effective intervention.     

Characterisation of complementary and alternative medicine use and its impact on medication adherence in inflammatory bowel disease

Background Complementary and alternative medicine (CAM) use among inflammatory bowel disease (IBD) patients is common. We characterised CAM utilisation and assessed its impact on medical adherence in the IBD population. Aim To characterise CAM utilisation and assess its impact on medical adherence in the IBD population. Methods Inflammatory bowel disease patients recruited from an out‐patient clinic at a tertiary centre were asked to complete a questionnaire on CAM utilisation, conventional IBD therapy, demographics and communication with their gastroenterologist. Adherence was measured using the self‐reported Morisky scale. Demographics, clinical characteristics and self‐reported adherence among CAM and non‐CAM users were compared. Results We recruited prospectively 380 IBD subjects (57% Crohn’s disease; 35% ulcerative colitis, and 8% indeterminate colitis). The prevalence of CAM use was 56% and did not significantly vary by type of IBD. The most common reason cited for using CAM was ineffectiveness of conventional IBD therapy (40%). The most popular form of CAM was probiotics (53%). CAM users were younger than non‐CAM users at diagnosis (21.2 vs. 26.2, P < 0.0001) and more likely than non‐CAM users to have a University‐level education or higher (75% vs. 62%P = 0.006). There was no overall difference in adherence between CAM and non‐CAM users (Morisky score: 1.0 vs. 0.9, P = 0.26). Conclusions The use of complementary and alternative medicine is widely prevalent among IBD patients, and is more frequent among those with experience of adverse effects of conventional medications. From this cross‐sectional analysis, complementary and alternative medicine use does not appear to be associated with reduced overall adherence to medical therapy.