1. Methamphetamine: User Characteristics and Treatment Response Alice Huber, Ph.D. Steven Shoptaw, Ph.D. Richard A. Rawson, Ph.D. Paul Brethen, M.A. Walter Ling, M.D. Matrix Center / LAATRC Research supported by NIDA R18-06185-05

2. Topics of Discussion n Project overview n Characteristics of methamphetamine users n Description of treatment process n Response to treatment model n Implications

3. Project Overview n Matrix clinic in Rancho Cucamonga n Located in San Bernardino County u 50 miles east of Los Angeles n Significant stimulant abuse in past decade n Matrix model of treatment u Standardized treatment n Comprehensive chart review

4. Project Overview n Charts of all stimulant users included n Clients entered treatment between 1988-95 n Large sample u 500 methamphetamine users u 224 cocaine users n Demographics, drug use information, urine toxicology, and treatment outcome ratings

5. Participant Characteristics MA UsersCOC Users n Gender * 60.0% Male68.8% Male n Ethnicity * u Caucasian80.5%48.0% u Hispanic16.7%15.8% u Afr Amer 1.9%34.2% n Education (yrs) * 11.812.4 * all tests p<.01 * all tests p<.01

6. Participant Characteristics MA UsersCOC Users n Age at Admission * 29.031.6 n Marital Status * u Never Married48.9%36.1% u Married25.8%37.5% u Sep/Div/Widow25.3%26.4%

7. Participant Characteristics MA UsersCOC Users n Employment Status * u Work Full Time27.5%31.2% u Work Part Time10.8%17.6% u Not Working61.6%50.9% n Type of Employment * u White Collar 15.1%18.3% u Blue Collar84.9%81.7%

8. Alcohol Use MA UsersCOC Users n Alcohol * u > 1 day/week 22.5%31.1% u Weekly/Monthly 43.7%48.8% u None 33.8%20.1% n Standard Drinks/Occasion * u 1-2 Drinks 29.4%24.8% u 3-6 Drinks 51.4%46.6% u > 6 Drinks 17.9%28.6% * all tests p<.01 * all tests p<.01

9. Alcohol Use MA UsersCOC Users n With Drug of Choice * 34.3% 46.9% 34.3% 46.9% n Need Alcohol Treatment? * 12.6%24.6% 12.6%24.6% * all tests p<.01 * all tests p<.01

10. Other Substance Use MA UsersCOC Users n Cocaine, past yr.10.8%100.0% n Meth, past yr.100.0%17.9% n Marijuana, past yr. * 56.2%42.4% n Halluc./PCP, past yr. * 6.4%0.0% n Barbiturates, past yr.2.8%2.2%

11. Drug Use Information MA UsersCOC Users n Age First Used * 21.423.7 n Heavy Use 41.2 mos.39.7 mos. n Route * u Intranasal55.5%21.5% u Smoking7.2%48.0% u Multiple Routes 22.7%16.7% u Any IV use13.5%13.1%

12. Drug Use Information MA UsersCOC Users n Frequency of Use * u None in 30 days14.8%17.4% u 1-2 times/week24.8%44.6% u 3-6 times/week17.0%16.8% u daily43.6%21.2% n Recent Use * u Days / past mo.12.88.8 u Money / past mo.$123$275 n Longest Abstinence * 1-2 mos.2-3 mos.

13. Drug Use Information MA UsersCOC Users n Believe they are addicted * 82.1% 89.6% addicted * 82.1% 89.6% n Had prior treatment for drug use * 24.6%44.7% for drug use * 24.6%44.7% * all tests p<.01 * all tests p<.01

14. Self-Reported Medical Problems MA UsersCOC Users n Chest pain29.8%25.5% n Headaches * 42.4%32.8% n Seizures2.0%4.2% n Loss of consciousness7.7%6.5% n Need medical tx.10.7%5.8% NOTE: Answers reflect current medical problems.

15. Self-Reported Psych Problems MA UsersCOC Users n Previous psych tx.14.4%16.5% n Current psych problems u Depressed, “a lot” * 19.3%12.1% u Suicide thoughts * 6.9%2.8% u Hallucinations * 34.8%25.1% u Paranoid thoughts28.8%25.5% NOTE: Answers reflect current psychiatric problems.

16. Comparisons of IV/non-IV Users IV UsersOther Users n Use > 3g/ week * 38.1%11.4% n Use daily * 65.1%40.1% n Severe withdrawal * 36.5%22.0% n Buy direct / deal * 33.3%13.2%

17. Comparisons of IV/non-IV Users IV UsersOther Users n Felony convictions * 36.8%17.4% n No Family Rels. * 22.2%5.8% n Bankruptcy * 44.3%19.3% n Unemployed > 1yr. * 58.0%28.2%

18. Comparisons of IV/non-IV Users IV UsersOther Users n Hallucinations/paranoia * 55.5%33.2% n Seizures/loss of consc * 30.2%14.2% n Problems with Sex * 29.7%12.8% n Drug/sex connected * 22.5%9.6%

20. Summary of User Characteristics n Typical user is an unemployed male Caucasian, with a high school education n Higher percentage of MA users are female and married, compared to Cocaine users n Started using drug at younger age; entered treatment at younger age n Primary route was intranasal, now see more smokers; most use daily

21. Summary of User Characteristics n More likely using other drugs; less likely to be using alcohol n Fewer feel “addicted”, despite more involvement with other users n Medical and psychological problems u Hallucinations very common u Appear more psychiatrically disturbed and more out of control u May be physically sicker

22. Treatment: Matrix Model n Combination of individual, family, and group sessions n Program to last 6 months n Strong emphasis on cognitive-behavioral approach n Designed in phases that decrease in intensity

23. Treatment Services Received MA UsersCOC Users n Individual Sessions13.3 hrs.16.3 hrs. n Stabilization Group3.4 hrs.3.7 hrs. n Relapse Prevention 23.7 hrs.21.0 hrs. n Family Education11.6 hrs.12.2 hrs. n Social Support 4.4 hrs.4.3 hrs.

24. Urinalysis Results n Tested randomly, about once a week u Samples not always collected when patient self- reported drug use MA usersCOC users MA usersCOC users n Number of urine samples collected 8.3 8.1 samples collected 8.3 8.1 n Percent positive (dirty) for drug of choice 10.4% 8.1% for drug of choice 10.4% 8.1%

25. Treatment Retention

26. Summary of Treatment Findings n A structured, manualized psychosocial treatment program is a viable treatment for methamphetamine abuse/dependence n This treatment retains more than 50% of patients for a clinically meaningful treatment episode

27. Summary of Treatment Findings n Response to treatment for MA addicts is not different than that seen in cocaine addicts n Equal numbers of drug-positive urines n Retention is similar for both groups n A significant percentage of stimulant addicts do not complete treatment successfully

28. Treatment Outcome n Current project measures primarily the response to a particular model n Follow-up necessary to evaluate treatment outcome n Center for Substance Abuse Treatment has funded a follow-up study with this group of patients

29. Follow-up Project n Randomly select 100 methamphetamine and 100 cocaine patients from the sample n Admissions from 1991 - 1995 n Contact for in-person interview, ASI, medical and psychiatric symptom report, and urine sample n Expect completion of project in 2/97

30. Implications n Methamphetamine a serious drug problem n The use of methamphetamine continues to increase, even in areas where it has been available for years n Methamphetamine use is initiated at a younger age n Methamphetamine may be somewhat more popular among women

31. Implications n Now see more addicts who smoke methamphetamine n Addicts may turn to smoking and then intravenous routes as their history of use lengthens n Some routes (particularly IV use) associated with more serious physical, psychological, psychosocial, and societal outcomes

32. Implications n Psychosocial treatment can be quite effective for some addicts n Even extended psychosocial treatment leave a significant percentage of addicts impaired n Need to develop psychosocial and pharmacological approaches specific to methamphetamine