Treatment of Methamphetamine Abuse

2015

Treatment of Methamphetamine Abuse — Lack of Evidence for the Efficacy of Any of the Models Currently in Use

Traditional treatment programs based on the Minnesota Model (28-day in-patient treatment) have been shown to be ineffective for the treatment of stimulant addiction. Both the National Institute of Drug Abuse (NIDA) and the Center for Substance Abuse Treatment (CSAT) have sponsored research into the efficacy of treatments for methamphetamine (methamphetamine) abuse. A third program that has been put forward as a potentially useful model for the treatment of methamphetamine abuse is the Haight Ashbury Outpatient Model. Although the program that is currently receiving the greatest national attention, the Matrix Model, has been shown to be promising, none of these models has been effectively evaluated for its efficacy for the treatment of methamphetamine abuse.

Treatment of Methamphetamine: Matrix Model of Outpatient Treatment

NIDA Treatment Guidelines

NIDA has published treatment guidelines for stimulant abusers that have been empirically tested and their efficacy validated. However, these manuals were developed and tested on a population of cocaine users. A recent report () identified a variety of differences between methamphetamine and cocaine users. methamphetamine users report more daily use of marijuana and hallucinogens, more headaches, depression, suicidal thoughts, and hallucinations than cocaine users. Further, methamphetamine users report spending less money on stimulants, using less drugs, consuming less alcohol, needing less treatment for co-morbid alcohol use, and, perhaps most importantly, a “significantly shorter length of longest abstinence prior to treatment entry” than do cocaine users. Moreover, methamphetamine users report more family problems, more friends who use drugs, and more sex associated with drug use than do cocaine users. Because of these differences, we cannot assume that treatment strategies that work for cocaine users will also work to reduce or eliminate substance use in methamphetamine users. Empirical evaluation of the efficacy of this and other models for the treatment of methamphetamine use is needed.

Haight Ashbury Outpatient Model

The Haight Ashbury Model () was taken from the Haight Ashbury Drug Detoxification, Rehabilitation and Aftercare Project. This organization has been involved in psychoactive drug treatment and education since 1967. The model consists of four stages, each characterized by an assessment and plan to be developed for that stage. Although the components of this model are based on sound empirical evidence for the effective treatment of substance abuse, the model itself has not been evaluated for its efficacy in the treatment of methamphetamine abuse.

The first stage is detoxification, which lasts for the first 3 to 7 days. During stage 1 individuals are assessed to determine whether they need hospitalization, and to determine if they are an emotional risk to harm themselves or others. Further, a physical exam is used to identify any medical emergencies caused by the stimulant abuse. Finally, individuals are assessed for dual diagnosis, and to determine their social and environmental needs. The assessment is followed by a commitment from the client to remain abstinent. Daily outpatient interactions, either group or individual counseling, are scheduled.

The Haight Ashbury model relies heavily on pharmacological mechanisms. If psychosis or speed toxicity is present then haloperdol or other neuroleptic drugs can be used to block the excessive dopamine and catecholamine toxicity. Antidepressant drugs can be prescribed if depression is present. Desipramine (Norparamine), trazadone (Desyrel), and fluoxetine (Prozac) are all typically used as antidepressants. The initial craving is treated with bromocriptine and amantadine (dopamine agonists). Amino acid precursors (e.g., Renew or Tropamine) that can lead to increased levels of the neurotransmitters dopamine, serotonin, adrenalin, noradrenalin, and acetylcholine can also be prescribed.

The second stage of the model, initial abstinence, begins with the first week of the treatment episode and may continue for as long as 3 months. The patient is assessed for dual diagnosis, to fully evaluate any medical needs, to review social and environmental problems and needs, and to identify environmental triggers that may pose a problem for the client.

Abstinence is contracted for 3 months. During this time the patient is required to go to 90 12-step meetings. A structured daily activity plan is developed. A life journal or log of events is maintained. A sober support network is developed. A recovery “sponsor” is found. A personal history of the client’s addiction is developed. The client begins this stage with daily meetings with his or her counselor. By the end of the period the client is expected to meet with the counselor three times per week. The client with a dual diagnosis begins psychiatric intervention. The client is taught to identify and to avoid triggers.

Further, during this stage a strategy is developed to address drug cravings. Activities to address this issue may include exercise, proper eating, 12-step meetings, working, meditation, hot or cold baths, or networking with other recovering addicts. Desensitization strategies or deconditioning techniques are used to dispel drug craving in response to triggers.

The third stage, sobriety, usually lasts 3 months to 18 months, and longer in some cases. At this stage psychological and social variables are assessed. Vocational or educational needs of the client are established. The client’s recognition of the addiction and recovery processes is assessed. The client’s ability to accept the concept of lifelong abstinence from all drugs of abuse is also assessed.

After the third stage assessments are performed, the client must develop plans for a lifetime of sobriety. During this time the client will progressively decrease contact with the program, moving from weekly to monthly visits. Concurrent with a progressive decrease in program visits the client is expected to increase his or her attendance at 12-step meetings.

During stage three clients are required to write a personal history that identifies the effect of drug abuse on their own life and the lives of others. This history includes a list of personal shortcomings, and a list of the people who have been hurt by the user’s addiction. The recovering person is instructed to think about how to make restitution to the people who have been hurt. This “history” is then reviewed by others, and input given. This is followed by the development of a list of all of the positive achievements that the individual has made during the recovery process. The completed story is then shared with support groups, counselors, friends, and relatives. Issues from stage two are then revisited before the client moves on to stage four.

Stage four is recovery. This step lasts a lifetime. Continual self-assessments are performed. Plans for abstinence are made. The client must periodically reaffirm his or her decision for lifetime sobriety. The client must also reaffirm that he or she has no interest in drugs and is not questioning the decision to remain drug free. The client will eventually disengage with program services but will continue various recovery support groups.

Conclusions

Although there are a variety of models that have been proposed for the treatment of methamphetamine addiction, none has been adequately supported with empirical evidence. All these models have a high level of face validity. That is, they all look good on the surface, but the lack of evidence for their usefulness is troubling. Large sums of public and private monies have been put into developing these models. We must begin to demand outcome measures that support their usefulness.

Selections from the book: “Methamphetamine Use Clinical and Forensic Aspects” (2003)