Transcript New Knowledge and Effective Treatment Approaches

Methamphetamine:
New Knowledge and
Effective Treatment Approaches
Thomas Freese, PhD
Beth Rutkowski, MPH
Pacific Southwest Addiction Technology Transfer Center
UCLA Integrated Substance Abuse Programs
Alhambra, CA
December 9, 2005
Speed
•
•
•
It is methamphetamine powder ranging in color from
white, yellow, orange, pink, or brown.
Color variations are due to differences in chemicals
used to produce it and the expertise of the cooker.
Other names: shabu, crystal, crystal meth, crank,
tina, yaba
Ice
High purity
methamphetamine
crystals or coarse
powder ranging
from translucent to
white, sometimes
with a green, blue,
or pink tinge.
Primary Amphetamine/Methamphetamine
TEDS Admission Rates: 1992
(per 100,000 aged 12 and over)
SOURCE: 2002 SAMHSA Treatment Episode Data Set (TEDS).
> 58
35 - 58
12 - 35
< 12
No data
Primary Amphetamine/Methamphetamine
TEDS Admission Rates: 1997
(per 100,000 aged 12 and over)
SOURCE: 2002 SAMHSA Treatment Episode Data Set (TEDS).
> 58
35 - 58
12 - 35
< 12
No data
Primary Amphetamine/Methamphetamine
TEDS Admission Rates: 2002
(per 100,000 aged 12 and over)
< 12
12 - 35
35 -58
58-99
100-149
SOURCE: 2002 SAMHSA Treatment Episode Data Set (TEDS).
150-199
200 or more
Percentage of Arrestees Testing
Positive for Methamphetamine 2002
45
40
Salt Lake City
San Jose
35
Portland
30
25
20
15
10
5
0
San Diego
Sacramento
Males
Spokane
Females
SOURCE: National Institute of Justice, Arrestee Drug Abuse Monitoring Program (ADAM), 2003.
IHS-Wide RPMS PCC Outpatient Encounters for
Amphetamine Related Visit by Calendar Year
Percent (%) of all Admissions
Trends in LA County Treatment Admissions
by Primary Substance of Abuse
50
45
40
35
30
25
20
15
10
5
0
1H00 2H00 1H01 2H01 1H02 2H02 1H03 2H03 1H04 2H04
Alcohol
Marijuana
Cocaine/Crack
Methamphetamine
SOURCE: ADP, California Alcohol and Drug Data System, 2005.
Heroin
Poison Control Center Calls for Major
Substances of Abuse: 2000-2004
Los Angeles County
Total Number of Calls
120
100
80
60
40
20
0
2000
Cocaine
Meth/Amph
2001
2002
Heroin
Ecstasy
SOURCE: California Poison Control System, 2004.
2003
LSD
GHB
2004*
PCP
DAWN Major Substances of Abuse:
Los Angeles County, CY 2004
Amphetamines
N=8,982
326
Meth
909
Marijuana
1,067
Heroin
712
Cocaine
2,348
Alcohol Only (<21)
531
Alcohol
3,307
0
500
1,000
1,500 2,000 2,500
Number of Reports
SOURCE: DAWN, OAS, SAMHSA, updated 4/13-14/2005.
3,000
3,500
NFLIS Illicit Drug Items:
LA County, Jan-Dec 2004
Heroin
4.1%
Cannabis
22.8%
PCP
0.5%
N=53,972
Other
0.6%
Cocaine
39.0%
Meth
32.9%
SOURCE: DEA, National Forensic Laboratory Information System (NFLIS), 2004.
Methamphetamine in
Los Angeles County
Indicators of Use/Abuse
Percentage of All Treatment
Admissions
Value/Percent
23.4% ()
Most Commonly Used Secondary
Drugs
Marijuana (29%)
Alcohol (24%)
Preferred Route of Administration
Smoking (70%)
Presence in DAWN (2004)
909 (10%)
Poison Control Calls (1/03-6/04)
87 (23%)
Midlevel Price (per ounce)
Retail Price (per 1/8 and 1/16 oz)
$450 – 550
$100 – $120/$60
Methamphetamine Lab Equipment
SOURCE: www.stopdrugs.org
Methamphetamine: A Growing
Menace in Rural America
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•
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•
In 1998, rural areas
nationwide reported 949
methamphetamine labs.
Last year, 9,385 were
reported.
This year, 4,589 rural labs
had been reported as of
July 26.
Source: El Paso Intelligence Center (EPIC),
U.S. DEA
Lab Seizure Locations
Desert
3%
Shed
Business 3%
3%
Motel/Hotel
3%
•
Storage
3%
Apartment
11%
Garage
8%
Mobile
Home
11%
Trailer
5%
•
Vehicle
8%
House
42%
Most common meth lab
facilities were singlefamily houses, followed
by apartments, mobile
homes, vehicles in
traffic stops, garages,
trailers, motels/hotels,
businesses, desert, and
storage.
Toxic Effects
of Methamphetamine
•
•
•
Manufacturing
Abuse
Fetal exposure
Clandestine Meth Lab
Clandestine Meth Lab
Drug Endangered Children
High Incidence of Domestic
Violence in MA-Abusing Homes
•
•
Threatening
notes
Dangerous &
stressful
environment for
children
Children
•
•
Children who live in and around the area of
the meth lab become exposed to the drug
and its toxic precursors and byproducts.
80-90% of children found in homes where
there are meth labs test positive for exposure
to meth. Some are as young as 19 months
old.
Children
•
Children can test positive for
methamphetamine by:
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
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Having inhaled fumes during the
manufacturing process
Coming into direct contact with the drug
Through second-hand smoke.
Children
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•
Hundreds of children are neglected by
parents who are meth cooks. Nationally, over
20% of the seized meth labs in 2002 had
children present.
In Washington State, the counties of Grays
Harbor, Spokane, Thurston, and Klickitat all
reported that children were found at half the
labs seized in 2002. In Lewis County,
children were found at 60-70 %, and in ClarkSkamania, 35%.
Children
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•
In 2002, a total of 142 children were
present at lab seizures in Riverside and
San Bernardino Counties.
Most children reported as being present
during a seizure were school age.
Children
•
Social workers now accompany law
enforcement during lab seizures with children
involved.
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Parents are often charged with second-degree
criminal mistreatment, along with manufacturing
charges.
Allowing children to live in a toxic environment
where additional risks of explosion and fire are
high is considered to be neglect at best to child
abuse.
Children are not small adults!
•
Different diet
•
Growing & developing rapidly
•
Higher metabolic & respiratory rate
•
Developing nervous system
•
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Unusual habits (hand-to-mouth behaviors;
close to floor, contact with many surfaces, at
risk for all poisonings)
Biologic & developmental vulnerability
DEC RESPONSE TEAM
•
CORE TEAM MEMBERS:




•
LAW ENFORCEMENT (24/7)
CHILD PROTECTIVE SERVICES (24/7)
DISTRICT ATTORNEY’S OFFICE (24/7)
MEDICAL PERSONNEL (24/7)
“AUXILIARY” TEAM MEMBERS:

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
MENTAL HEALTH & THERAPEUTIC PERSONNEL
FOR CHILDREN
ENVIRONMENTAL SERVICES, FIRE, & PUBLIC
HEALTH
DRUG TREATMENT PROVIDERS FOR PARENTS
AND FAMILY MEMBERS
WWW.NATIONALDEC.ORG
WWW.NATIONALDEC.ORG
Methamphetamine Addiction
The brains of people addicted
to Methamphetamine are
different than those of
non-addicts
Natural Rewards Elevate Dopamine Levels
200
% of Basal DA Output
NAc shell
150
100
Empty
50
Box Feeding
SEX
200
150
100
15
10
5
0
0
0
60
120
Time (min)
180
ScrScr
BasFemale 1 Present
Sample 1 2 3 4 5 6 7 8
Number
Scr
Scr
Female 2 Present
9 10 11 12 13 14 15 16 17
Mounts
Intromissions
Ejaculations
Source: Di Chiara et al.
Source: Fiorino and Phillips
Copulation Frequency
DA Concentration (% Baseline)
FOOD
Accumbens
1100
1000
900
800
700
600
500
400
300
200
100
0
AMPHETAMINE
Accumbens
% of Basal Release
400
DA
DOPAC
HVA
0
1
2
3
4
250
200
100
0
5 hr
0
NICOTINE
Accumbens
Caudate
150
100
0
0
1
2
3 hr
Time After Nicotine
1
Accumbens
250
% of Basal Release
200
COCAINE
DA
DOPAC
HVA
300
Time After Amphetamine
% of Basal Release
% of Basal Release
Effects of Drugs on Dopamine Levels
2
3
4
Time After Cocaine
5 hr
MORPHINE
Dose (mg/kg)
0.5
1.0
2.5
10
200
150
100
0
0
Source: Di Chiara and Imperato
1
2
3
4
Time After Morphine
5hr
PET Scan of Long-Term Impact of
Methamphetamine on the Brain
Decreased dopamine transporter binding in
METH users resembles that in
Parkinson’s Disease patients
%ID/cc
0.030
0.015
0.000
Control
Meth
PD
Source: McCann U.D.. et al.,Journal of Neuroscience, 18, pp. 8417-8422, October 15, 1998.
Methamphetamine Abuser
p < 0.0002
Dopamine Transporter
Bmax/Kd
Normal Control
Dopamine Transporter
(Bmax/Kd)
Dopamine Transporters in
Methamphetamine Abusers
Motor Activity
2.0
1.8
1.6
1.4
1.2
1.0
7
8
9
10
11
12
13
Time Gait (seconds)
Memory
2
1.8
1.6
1.4
1.2
1
16
14
12
10
8
6
Delayed Recall
(words remembered)
4
Cognitive Impairment in
Individuals Currently Using
Methamphetamine
Sara Simon, Ph.D.
VA MDRU
Matrix Institute on Addictions
LAARC
Differences between Stimulant
and Comparison Groups on tests
requiring perceptual speed
Stimulant (n=80)
Comparison (n=80
Mean Scores
100
80
60
40
20
0
Digit Symbol**
Trail Making A*
Trail Making B**
Memory Difference between
Stimulant and Comparison
Groups
Comparison (n=80)
Stimulant (n=80)
7
Mean Scores
6
5
4
3
2
1
0
Word Recall**
Picture Recall**
Longitudinal Memory Performance
25
number correct
20
control
baseline
3 mos
6 mos
15
10
5
0
Word Recall
Picture Recall
Word
Recognition
test
Picture
Recognition
Control
> MA
4
3
2
1
0
MA >
Control
5
4
3
2
1
0
DA Receptor Levels and Response to MP
2.5
unpleasant
response
High Dopamine
Transporters
0
Low Dopamine
Transporters
pleasant response
Subjects with low receptor levels found MP pleasant while
those with high levels found MP unpleasant
How much
does the brain heal?
PET Scan of Long-Term Meth Brain Damage
Partial Recovery of Brain Dopamine
Transporters in Methamphetamine
(METH)
Abuser After Protracted Abstinence
3
0
ml/gm
Normal Control
METH Abuser
(1 month detox)
METH Abuser
(24 months detox)
Source: Volkow, ND et al., Journal of Neuroscience 21, 9414-9418, 2001.
Partial Recovery of Brain Metabolism
in Methamphetamine (METH) Abuser
after Protracted Abstinence
70
0
µmol/100g/min
Control Subject
(30 y/o, Female)
METH Abuser
(27 y/o, Female)
3 months detox
METH Abuser
(27 y/o, Female)
13 months detox
Source: Wang, G-J et al., Am J Psychiatry 161:2, February 2004.
Medical and Psychosocial
Effects of Methamphetamine
Organ Toxicity from MA Abuse
•
•
•
•
•
Central nervous system toxicity
Cardiovascular toxicity
Pulmonary toxicity
Renal toxicity
Hepatic toxicity
Cardiovascular problems
•
•
•
•
•
•
↑ heart rate
Palpitations
Arrhythmia
↑ blood pressure
Chest Pain
Valve thickening
Neurological problems
•
•
•
•
•
Seizures
Stroke
Cerebral
hemorrhage
Cerebral vasculitis
Mydriasis
Respiratory problems
•
Dyspnea
•
Pulmonary
hypertension
•
Pleuritic chest pain
Renal / Hepatic Toxicity
from MA Abuse
•
•
Renal failure
Hepatic failure
Other problems
•
Eye ulcers
•
Over-heating
•
Rhabdomyolysis
•
Obstetric
complications
•
Anorexia / weight loss
•
Tooth wear, cavities
•
“Speed bumps”
Trauma
•
Interpersonal
trauma
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•
•
Assault
Gunshot
Knife
Motor Vehicles
Suicide attempts
Acute Methamphetamine
Intoxication
It feels like excitement
Methamphetamine
Acute Physical Effects
Increases
 Heart rate
 Blood pressure
 Pupil size
 Respiration
 Sensory acuity
 Energy
Decreases
 Appetite
 Sleep
 Reaction time
Methamphetamine
Acute Psychological Effects
Increases
 Confidence
 Alertness
 Mood
 Sex drive
 Energy
 Talkativeness
Decreases
 Boredom
 Loneliness
 Timidity
Chronic Methamphetamine
Effects
It feels like excitement gone bad…
Methamphetamine
Chronic Psychological Effects
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Confusion
Concentration
Hallucinations
Fatigue
Memory loss
Insomnia
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Irritability
Paranoia
Panic reactions
Depression
Anger
Psychosis
Methamphetamine
Chronic Physical Effects
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Tremor
Weakness
Dry mouth
Weight loss
Cough
Sinus infection
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Sweating
Burned lips; sore
nose
Oily skin/complexion
Headaches
Diarrhea
Anorexia
9 years of Meth use…
32 years old
41 years old
METH ADDICTED
7-03-94
2-20-93
2-18-94
Faces of Methamphetamine
Images courtesy Multnomah County Sheriff’s Office
Methamphetamine
Chronic Physical Effects
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Tremor
Weakness
Dry mouth
Weight loss
Cough
Sinus infection
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


Sweating
Burned lips; sore
nose
Oily skin/complexion
Headaches
Diarrhea
Anorexia
Methamphetamine
Psychiatric Consequences
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Paranoid reactions
Permanent memory loss
Depressive reactions
Hallucinations
Psychotic reactions
Panic disorders
Rapid addiction
MA Treatment Issues
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Acute MA Overdose
Acute MA Psychosis
MA “Withdrawal”
Initiating MA Abstinence
MA Relapse Prevention
Protracted Cognitive Impairment and
Symptoms of Paranoia
Acute MA Overdose
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Slowing of Cardiac Conduction
Ventricular Irritability
Hypertensive Episode
Hyperpyrexic Episode
CNS Seizures and Anoxia
Acute MA Psychosis
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Extreme Paranoid Ideation
Well Formed Delusions
Hypersensitivity to Environmental
Stimuli
Stereotyped Behavior “Tweaking”
Panic, Extreme Fearfulness
High Potential for Violence
Treatment of MA Psychosis
•
Typical ER Protocol for MA Psychosis
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Haloperidol - 5mg
Clonazepam - 1 mg
Cogentin - 1 mg
Quiet, Dimly Lit Room
Restraints
Methamphetamine and Sex
Percent Responding
"Yes"
Q.1: My sexual thoughts, feelings, and
behaviors are often associated with …
100
90
80
70
60
50
40
30
20
10
0
73.5
68.4
53.7 52.9
44.4
23.4 22.7
opiates
male
female
22.2
alcohol
cocaine
Primary Drug of Abuse
meth
Percent Responding
"Yes"
Q.2: My sexual drive is increased by the
use of …
100
90
80
70
60
50
40
30
20
10
0
85.3
70.6
55.6
55.3
43.9
male
female
18.1 20.5
11.1
opiates
alcohol
cocaine
Primary Drug of Abuse
meth
Percent Responding
"Yes"
Q.4: My sexual performance is improved by the
use of …
100
90
80
70
60
50
40
30
20
10
0
58.8
61.1
32.4
male
female
24.4
19.1
18.4
15.9
11.1
opiates
alcohol
cocaine
Primary Drug of Abuse
meth
Percent Responding
"Yes"
Q.10: I am more likely to have sex (e.g.,
intercourse, oral sex, masturbation, etc.)
when using …
100
90
80
70
60
50
40
30
20
10
0
79.4
65.8
61.1
50.0
41.5
male
female
27.8
7.4 11.4
opiates
alcohol
cocaine
Primary Drug of Abuse
meth
Percent Responding
"Yes"
Q.12: I am more likely to practice “risky” sex
under the influence of … (e.g., not use
condoms, be less careful about who you
choose as a sex partner, etc.)
100
90
80
70
60
50
40
30
20
10
0
57.9
55.6
48.8
52.9
35.3
male
female
16.7
4.3 6.8
opiates
alcohol
cocaine
Primary Drug of Abuse
meth
Methamphetamine and HIV in MSM:
Time-to-Response Association?
100
90%
Percent HIV+
80
62%
60
41%
40
20
0
26%
8%
Probability
Sample*
Recreational
User**
Chronic Non
Treatment***
Outpatient
Drug-Free****
Residential****
* Deren et al., 1998, Molitor et al., 1998; ** Reback et al., in prep,
*** Reback, 1997; **** Shoptaw et al., 2002; ****VNRH, unpublished data
www.drugabuse.gov
Blood Pressure
Investigational Medication
for High Blood Pressure
Before Tx
Tx
Tx Removed
Treatment Works!!!
Symptom Severity
Investigational Medication
for Asthma
Before Tx
Tx
Tx Removed
Treatment Works!!!
Level of Use
New Behavioral Treatment
for Methamphetamine Use
Before Tx
Tx
Tx Removed
Treatment Failed!!!
100
90
80
40
30
20
50 to 70%
50
30 to 50%
60
50 to 70%
70
40 to 60%
Percent of Patients Who Relapse
Relapse Rates Are Similar for
Drug Dependence and
Other Chronic Illnesses
10
0
Drug
Type I Hypertension Asthma
Dependence Diabetes
Source: McLellan, A.T. et al., JAMA, Vol 284(13), October 4, 2000.
Treatment
Medical & Behavioral
Drugs
Sedatives
Stimulants
Opioids
Alcohol
Medical Treatment Behavioral Treatment
Yes
No
Yes
Yes
Yes
Yes
Yes
Yes
Methamphetamine Addiction Pharmacotherapies
in Clinical Trials
Phase I
Aripiprazole
Atomoxetine
Bupropion
Carvedilol
Clonidine
Lobeline
Modafinil
Perindopril
Prazosin
Rivastigmine
Sertraline
Topiramate
Phase II
Baclofen
Bupropion
Treatments for Methamphetamine
•
Cognitive Behavioral Therapies
•
Contingency Management
•
MATRIX Model
•
New Medications
(treatment and overdose)
are being developed
Clinical Challenges for Treatment
of Methamphetamine Addiction
•
•
•
•
•
•
•
Poor treatment engagement rates
High dropout rates
Severe paranoia
High relapse rates
Ongoing episodes of psychosis
Severe craving
Protracted dysphoria
Many patients may require medical/psychiatric supervision and need ongoing
treatment with antipsychotic medications
Manuals in Psychosocial
Treatment
•
•
•
•
•
Reduce therapist
differences
Ensure uniform set
of services
Can more easily be
evaluated
Enhance training
capabilities
Facilitate research to
practice
Stages of Change
Relapse
Permanent
Exit
Maintenance
Action
Precontemplation
Contemplation
Determination
Prochaska & DiClemente
Motivation Interviewing
Goals
•
•
•
•
Increase
Motivation
Decrease
Resistance
Increase
retention
Better
outcomes
Four Principles of
Motivational Interviewing
1. Express empathy
2. Develop
discrepancy
3. Avoid
argumentation
4. Support selfefficacy
BUILDING MOTIVATION
OARS
•Open-ended questioning
•Affirming
•Reflective listening
•Summarizing
MATRIX MODEL TREATMENT
Components of Stimulant
Addiction Syndrome
Behavioral Disruption
Cognitive Disruption
Emotional Disruption
Family/Relationship
Disruption
STAGES OF RECOVERY STIMULANTS
OVERVIEW
DAY
DAY
DAY
DAY
0
15
45
120
DAY
180
Stages of Recovery - Stimulants
WITHDRAWAL STAGE
PROBLEMS
ENCOUNTERED
DAY
DAY
0
15
•Medical Problems
•Alcohol Withdrawal
•Depression
•Difficulty Concentrating
•Severe Cravings
•Contact with Stimuli
•Excessive Sleep
MATRIX MODEL TREATMENT
Primary Manifestation of
Withdrawal Stage
Behavioral
Cognitive
Behavioral
Inconsistency
Confusion
Inability to
Concentrate
Emotional
Relationship
Depression/AnxietySelf-Doubt
Mutual HostilityFear
Matrix Model Treatment
Key Concept: Structure
•Self-designed structure (scheduling)
•Eliminate avoidable triggers
•Makes concrete the concept of “One day at a time”
•Reduces anxiety
•Counters the addict lifestyle
•Provides basic foundation for ongoing recovery
MATRIX MODEL TREATMENT
STRUCTURE
Recreational/Leisure
Activities
Treatment Program
Activities
12-Step Meetings
Sports
Time Scheduling
Work
School
Being with Drug-free
Friends
Exercise
Family-related Events
Church/Synagogue
Island Building
MATRIX MODEL TREATMENT
Structure - Pitfalls
•Scheduling unrealistically
•Neglecting recreation
•Being perfectionistic
•Therapist imposing schedule
•Spouse/parent imposing schedule
Adaptations to the Matrix Model
Stages of Recovery - Stimulants
HONEYMOON STAGE
DAY
DAY
15
45
•Over-involvement With
PROBLEMS Work
ENCOUNTERED •Overconfidence
•Inability to Initiate
Change
•Inability to Prioritize
•Alcohol Use
•Episodic Cravings
•Treatment
Termination
MATRIX MODEL
Primary Manifestation of
Honeymoon Stage
Behavioral
High EnergyUnfocused Behavior
Emotional
Overconfidence/
Feeling Cured
Cognitive
Inability to Prioritize
Relationship
Denial of
Addiction Disorder
MATRIX MODEL TREATMENT
INFORMATION
MATRIX MODEL TREATMENT
Information - What
- Substance abuse
and the brain
- Sex and recovery
- Relapse prevention issues
- Triggers and cravings
- Emotional readjustment
- Stages of recovery
- Medical effects
- Relationships and recovery
- Alcohol/marijuana
MATRIX MODEL TREATMENT
Information - Why
•Reduces confusion and guilt
•Explains addict behavior
•Gives a roadmap for recovery
•Clarifies alcohol/marijuana issue
•Aids acceptance of addiction
•Gives hope/realistic perspective for family
MATRIX MODEL TREATMENT
Relapse Factors - Honeymoon
Stage
•Overconfidence
•Secondary alcohol or other drug use
•Discontinuation of structure
•Resistance to behavior change
•Return to addict lifestyle
•Inability to prioritize
•Periodic paranoia
Stages of Recovery - Stimulants
THE WALL STAGE
DAY
DAY
45
120
•Return to Old Behaviors
•Anhedonia
PROBLEMS
•Anger
ENCOUNTERED
•Depression
•Emotional Swings
•Unclear Thinking
•Isolation
•Family Problems
•Cravings Return
•Irritability
•Abstinence Violation
MATRIX MODEL
Primary Manifestation of the
Wall Stage
Behavioral
Cognitive
Sluggish
Low Energy/Inertia
Relapse Justification
Emotional
Relationship
Depression/Anhedonia
Irritability/
Mutual Blaming/Impatience
Return to Old Behaviors
Anhedonia
Anger
Depression
Emotional Swings
Unclear Thinking
Isolation
Family Problems
Cravings Return
Irritability
Abstinence Violation
Key Concept: Relapse
Justification
•Definition
•The rational part of the brain attempts to provide
a logical explanation for justifying behavior which
moves the client closer to his drug of choice
•Relapse thoughts gain power when not openly
recognized and discussed
Associates Use; Justifies Own
Use
•My wife used so…
•I was doing fine until he brought
it home…
•I went to the beach with my sister
and …
•My brother came over for dinner
and brought some…
•I wanted to see my friend just
once more and he offered me
some...
I Needed it for a Specific
Purpose
•I was getting fat again and needed to
control my weight
•I couldn’t get the energy I needed without it
•I can’t have a satisfying sexual experience
without it
•Life is too boring without…
•I can’t be comfortable in social situations
without it
•I don’t know how to meet people without
the “social lubricant”, cocaine magnet, etc.
Relapse Factors - The Wall Stage
- Increased emotions
- Dissolution of structure
- Interpersonal conflict
- Behavioral drift
- Relapse justification
- Secondary alcohol or
- Anhedonia/loss of
motivation
- Insomnia/low energy/fatigue
other drug use
- Resistance to exercise
- Paranoia
Stages of Recovery - Stimulants
ADJUSTMENT AND RESOLUTION STAGES
DAY
DAY
120
180
•Relationship Problems
•Boredom
PROBLEMS
ENCOUNTERED •Career Dissatisfaction
•Lack of Goals
• Guilt and Shame
• Underlying Psychopathology May
Surface or Resurface
MATRIX MODEL
Primary Manifestation of
Adjustment Stage
Behavioral
Sloppiness
Regarding Limits
Cognitive
Drifting From
Commitment to Recovery
Emotional
Relationship
Experiencing
Normal Emotions
Surfacing of
Long-Term Issues
Lack of Goals
Relationship Problems
Guilt and Shame
Boredom
Career
Dissatisfaction
Underlying
Psychopathology May
Surface or Resurface
Relapse Factors - Adjustment
Stage
•Secondary alcohol or other drug use
•Relaxation of structure
•Struggle over acceptance of addiction
•Maintenance of recovery momentum/commitment
•Six-month syndrome
•Re-emergence of underlying pathology
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.
Injection users were retained more poorly
4.
5.
6.
7.
Those with chronic mental illness were retained more
poorly
Daily users are retained more poorly than those who
use less often than daily
Those who began use at an older age were retained
better than those who started when younger
Those who are older at admission were retained
better
Successful Outpatient Treatment Predictors
•
•
•
•
•
•
Durations over 90 days (with continuing care for
another 9 months).
Techniques and clinic practices that improve
treatment retention are critical.
Treatment should include 3-5 clinic visits per
week for at least 90 days.
Employ CBT, CM, Community Reinforcement
Approach, Motivational Interviewing, Matrix
Model.
Family involvement and 12-step program appear
to improve outcome.
Urine testing (at least weekly is mandatory)
Optimal candidates for outpatient
treatment include:
•
•
Those who do not inject MA.
Those without chronic mental illness and those
without significant psychiatric symptoms at admission.
•
Those who are using MA less than daily at admission.
•
Those under legal supervision (especially drug court).
•
Older individuals (over 21)Those who are not disabled.
•
Those who have a stable living situation (without
active drug users).
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).
MA users who take MA daily or in very high
doses.
Special treatment consideration should be
made for the following groups of
individuals:
•
•
•
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).