Methamphetamine Thomas E. Freese, Ph.D. Director, Pacific Southwest Addiction Technology Transfer Center Director of Training, UCLA Integrated Substance Abuse Programs 4TC Collaboration Meeting Albuquerque, NM October 17-19, 2006

How can we help each other? Training issues related to methamphetamine How can the 4TCs collaborate?

Training Issues We don’t have a problem…

Primary Amphetamine/Methamphetamine TEDS Admission Rates: 1992 (per 100,000 aged 12 and over) < 12 No data > 58 SOURCE: 2002 SAMHSA Treatment Episode Data Set (TEDS).

< < 12 No data > 58 Primary Amphetamine/Methamphetamine TEDS Admission Rates: 1997 (per 100,000 aged 12 and over) SOURCE: 2002 SAMHSA Treatment Episode Data Set (TEDS).

58-99 < or more Primary Amphetamine/Methamphetamine TEDS Admission Rates: 2002 (per 100,000 aged 12 and over) SOURCE: 2002 SAMHSA Treatment Episode Data Set (TEDS).

Treatment is a lagging indicator What do lab data show us?

Clandestine Lab Incidents: , < >1000 Source: national Clandestine Laboratory Database (

Clandestine Lab Incidents: , , , < >1000 Source: national Clandestine Laboratory Database (

Clandestine Lab Incidents: , , , < >1000 Source: national Clandestine Laboratory Database (

Clandestine Lab Incidents: ,272 2, , , , < >1000 Source: national Clandestine Laboratory Database (

Clandestine Lab Incidents: , ,335 2, , < >1000 Source: national Clandestine Laboratory Database (

Training Issues We don’t have a problem… Rumors speak louder than truth

Methamphetamine Rumors It causes holes in the brain Use it once and you are addicted Only truckers and gay men use It is not associated with sex in heterosexuals

Rumor based policy? 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. **The resulting conclusion is that spending money on treating MA users is futile and wasteful, BUT… no data exists that supports these statistics**

Training Issues We don’t have a problem… Rumors speak louder than truth Which meth problem are we talking about?

There are at least 3 meth “epidemics” Urban Rural Performance enhancement Longer hours of work Weight loss Better sex These overlap and intersect with each other

Training Issues We don’t have a problem… Rumors speak louder than truth Which meth problem are we talking about? Meth treatment is the same as treatment for other drugs…isn’t it?

Statistics During the fiscal year: 35,947 individuals were admitted to treatment in California under the Substance Abuse and Crime Prevention Act funding. Of this group, 53% reported MA as their primary drug problem

Statistics Analysis of: Drop out rates Retention in treatment rates Re-incarceration rates Other measures of outcome All these measures indicate that MA users respond in an equivalent manner as individuals admitted for other drug abuse problems.

Methamphetamine and Treatment Treatment outcomes with meth users identical to results with cocaine users. Outcomes using traditional methods are poor. Training resources seriously inadequate to educate clinicians in areas affected by meth Retention in treatment is the ballgame

Treatments for Methamphetamine Cognitive Behavioral Therapies Contingency Management Motivational Interviewing MATRIX Model

Methamphetamine and the Brain: Implications for Treatment

Dopamine Transporters in Methamphetamine Abusers p < Normal Control Methamphetamine Abuser Time Gait(seconds) Dopamine Transporter (Bmax/Kd) Motor Activity Delayed Recall (words remembered) Dopamine Transporter Bmax/Kd Memory

PET Scan of Long-Term Meth Brain Damage

Training Issues We don’t have a problem… Rumors speak louder than truth Which meth problem are we talking about? Meth treatment is both the same as treatment for other drugs…isn’t it? HIV and Meth are intimately connected across many populations.

Methamphetamine and HIV in MSM: Time-to-Response Association? * Deren et al., 1998, Molitor et al., 1998; ** Reback et al., in prep, *** Reback, 1997; **** Shoptaw et al., 2002; ****VNRH, unpublished data

Q.10: I am more likely to have sex (e.g., intercourse, oral sex, masturbation, etc.) when using …

Results from the CADDs Data System (2001) *The statewide data collection system, CADDs has information on the relative usefulness of treatment for MA users, by comparing them to cocaine users.

Predictors of Retention in Treatment for more than 90 days 1. Higher rates of retention for men 2. Legal supervision increases treatment retention 3. Those who began use at an older age were retained better than those who started when younger 4. Those who are older at admission were retained better 5. Injection users were retained more poorly 6. Those with chronic mental illness were retained more poorly 7. Daily users are retained more poorly than those who use less often than daily

Training Issues We don’t have a problem… Rumors speak louder than truth Which meth problem are we talking about? Meth treatment is both the same as treatment for other drugs…isn’t it? HIV and Meth are intimately connected across many populations. When are we going to find the sure for addiction?

Investigational Medication for High Blood Pressure Treatment Works!!!

New Behavioral Treatment for Methamphetamine Use Treatment Failed!!!

Relapse Rates Are Similar for Drug Dependence and Other Chronic Illnesses Relapse Rates Are Similar for Drug Dependence and Other Chronic Illnesses Drug Dependence Drug Dependence Type I Diabetes Type I Diabetes Hypertension Asthma 40 to 60% 30 to 50% 50 to 70% Source: McLellan, A.T. et al., JAMA, Vol 284(13), October 4, Percent of Patients Who Relapse

Opportunities for Collaboration

Special Treatment Consideration Should be Made for the Following Groups of Individuals: Female MA users (higher rates of depression; very high rates of previous and present sexual and physical abuse; responsibilities for children). Injection MA users (very high rates of psychiatric symptoms; severe withdrawal syndromes; high rates of hepatitis).

Special Treatment Consideration Should be Made for the Following Groups of Individuals: MA users who take MA daily or in very high doses. Homeless, chronically mentally ill and/or individuals with high levels of psychiatric symptoms at admission. Individuals under the age of 21. Gay men (at very high risk for HIV and hepatitis).

What works in prevention? We need to work together to figure it out.

Montana Methamphetamine Initiative Media campaign Paint the State

Montana Meth Paint the State

An Example of a Successful Collaboration Trainings on the Border on Substance abuse and HIV for last three years. Various community trainings: HIV Task Force Mental Health Nurses Primary care physicians Meth Tip Sheet PAETC and PSATTC

Thomas E. Freese, Ph.D.