Treatment for Treatment for Methamphetamine Abuse and Methamphetamine Abuse and

DependenceDependence

Richard A. Rawson, Ph.D.Richard A. Rawson, Ph.D.

Alice Huber, Ph.D.Alice Huber, Ph.D.

Paul Brethen, M.A.Paul Brethen, M.A.

Walter Ling, M.D.Walter Ling, M.D.

Matrix/UCLA/LAARCMatrix/UCLA/LAARC

Supported by NIDA and CSATSupported by NIDA and CSAT

MA Treatment IssuesMA Treatment Issues

• Acute MA OverdoseAcute MA Overdose• Acute MA PsychosisAcute MA Psychosis• MA “Withdrawal”MA “Withdrawal”• Initiating MA AbstinenceInitiating MA Abstinence• MA Relapse PreventionMA Relapse Prevention• Protracted Cognitive Impairment Protracted Cognitive Impairment

and Symptoms of Paranoiaand Symptoms of Paranoia

Acute MA OverdoseAcute MA Overdose

• Slowing of Cardiac ConductionSlowing of Cardiac Conduction

• Ventricular IrritabilityVentricular Irritability

• Hypertensive EpisodeHypertensive Episode

• Hyperpyrexic EpisodeHyperpyrexic Episode

• CNS Seizures and AnoxiaCNS Seizures and Anoxia

Acute MA PsychosisAcute MA Psychosis

• Extreme Paranoid IdeationExtreme Paranoid Ideation

• Well Formed DelusionsWell Formed Delusions

• Hypersensitivity to Environmental Hypersensitivity to Environmental StimuliStimuli

• Stereotyped Behavior “Tweaking”Stereotyped Behavior “Tweaking”

• Panic, Extreme FearfulnessPanic, Extreme Fearfulness

• High Potential for ViolenceHigh Potential for Violence

Treatment of MA Treatment of MA PsychosisPsychosis

• Typical ER Protocol for MA PsychosisTypical ER Protocol for MA Psychosis– Haloperidol - 5mgHaloperidol - 5mg– Clonazepam - 1 mgClonazepam - 1 mg– Cogentin - 1 mgCogentin - 1 mg– Quiet, Dimly Lit RoomQuiet, Dimly Lit Room– Restraints?Restraints?

Treatment of MA Treatment of MA DisordersDisorders

• Traditional TreatmentsTraditional Treatments– Therapeutic CommunityTherapeutic Community– Minnesota ModelMinnesota Model– Outpatient CounselingOutpatient Counseling– PsychotherapyPsychotherapy

MA “Withdrawal”MA “Withdrawal”

- Depression- Depression - Paranoia- Paranoia

- Fatigue- Fatigue - Cognitive - Cognitive ImpairmentImpairment

- Anxiety- Anxiety - Agitation- Agitation

- Anergia- Anergia - Confusion- Confusion

• Duration: 2 Days - 2 WeeksDuration: 2 Days - 2 Weeks

Treatment of MA Treatment of MA “Withdrawal”“Withdrawal”

• Hospitalization/Residential Supervision Hospitalization/Residential Supervision if:if:– Danger to Self or Others, or, so Cognitively Danger to Self or Others, or, so Cognitively

Impaired as to be Incapable of Safely Impaired as to be Incapable of Safely Traveling to and from Clinic.Traveling to and from Clinic.

– Otherwise Intensive Outpatient TreatmentOtherwise Intensive Outpatient Treatment

Treatment of MA Treatment of MA “Withdrawal”“Withdrawal”

• Intensive Outpatient TreatmentIntensive Outpatient Treatment– No Pharmacotherapy AvailableNo Pharmacotherapy Available– Positive, Reassuring ContextPositive, Reassuring Context– Directive, Behavioral InterventionDirective, Behavioral Intervention– Educate Regarding Time Course of Symptom Educate Regarding Time Course of Symptom

RemissionRemission– Recommend Sleep and NutritionRecommend Sleep and Nutrition– Low StimulationLow Stimulation– Acknowledge Paranoia, DepressionAcknowledge Paranoia, Depression

Treatment of MA Treatment of MA DisordersDisorders

• State of Empirical EvidenceState of Empirical Evidence– No Information on TC or “Minnesota No Information on TC or “Minnesota

Model” ApproachesModel” Approaches– No Pharmacotherapy with Demonstrated No Pharmacotherapy with Demonstrated

EfficacyEfficacy– Results of Cocaine Treatment Research Results of Cocaine Treatment Research

Extrapolated to MA TreatmentExtrapolated to MA Treatment

Initiating MA AbstinenceInitiating MA Abstinence

• Key Clinical IssuesKey Clinical Issues– DepressionDepression– Cognitive ImpairmentCognitive Impairment– Continuing ParanoiaContinuing Paranoia– AnhedoniaAnhedonia– Behavioral/Functional ImpairmentBehavioral/Functional Impairment– HypersexualityHypersexuality– Conditioned CuesConditioned Cues– Irritability/ViolenceIrritability/Violence

Initiating MA AbstinenceInitiating MA Abstinence

• Key Elements of TreatmentKey Elements of Treatment– StructureStructure– Information in Understandable FormInformation in Understandable Form– Family SupportFamily Support– Positive ReinforcementPositive Reinforcement– 12-Step Participation12-Step Participation

• No Pharmacologic Agent Currently No Pharmacologic Agent Currently AvailableAvailable

Follow-up of 114 MA Follow-up of 114 MA Users Treated with Matrix Users Treated with Matrix

ModelModelPatient Characteristics

MaleFemale

Ethnicity Caucasian African-American Hispanic

Age of First UseMonths of Use Before Rx

54%46%

84%2%14%

21 yrs44 mos

Follow-up of 114 MA Follow-up of 114 MA Users Treated with Matrix Users Treated with Matrix

ModelModelAmount of Treatment Received

Less than 1 Month1-3 Months3-6 Months6+ Months

16%13%33%38%

Mean Duration of Follow-up - 40 MonthsMean Duration of Follow-up - 40 Months

MA Use

Frequency ofMA Use

Baseline Follow-up

0 in 30 Days1-3 Times in 30 days1-2 Times Per Week3-6 Times Per WeekDaily

15%8%14%14%49%

53%5%7%5%30%

Follow-up of 114 MA Follow-up of 114 MA Users Treated with Matrix Users Treated with Matrix

ModelModel

Medical/Psychiatric Symptoms

Symptoms inPast 30 Days

Baseline Follow-up

HallucinationsParanoia“Psychiatric Problems”Chest PainsDepressionHeadaches

30%24%24%23%62%44%

9%7%5%12%59%40%

Follow-up of 114 MA Follow-up of 114 MA Users Treated with Matrix Users Treated with Matrix

ModelModel

Employment Status

Status Baseline Follow-up

Full-TimePart-TimeUnemployed

26%13%62%

62%16%22%

Follow-up of 114 MA Follow-up of 114 MA Users Treated with Matrix Users Treated with Matrix

ModelModel

MA - CocaineMA - CocaineFollow-up ComparisonFollow-up Comparison

• Matrix Clinic in Rancho Cucamonga, Matrix Clinic in Rancho Cucamonga, San Bernardino County located 50 miles San Bernardino County located 50 miles East of Los AngelesEast of Los Angeles

• One to five years follow-up of 100 MA One to five years follow-up of 100 MA and 100 cocaine users in a CSAT funded and 100 cocaine users in a CSAT funded studystudy

MA - CocaineMA - CocaineFollow-up ComparisonFollow-up Comparison

Participant Characteristics

MA Cocaine

MaleFemaleEthnicity Caucasian African Amer Hispanic Other/UnknownAvg Age

56.8%43.2%

78.3%0.0%18.9%2.8%34 yrs

70.3%29.7%

40.5%35.1%16.2%8.2%

35.7 yrs

MA - CocaineMA - CocaineFollow-up ComparisonFollow-up Comparison

Study Participation

MA Cocaine

Selected for Follow-upCompleted Follow-upUnable to LocateIn JailDeceasedRefused Follow-up

100%37%38%8%0%17%

100%37%36%11%2%14%

MA - CocaineMA - CocaineFollow-up ComparisonFollow-up Comparison

Drug of Choice

Frequency of DOCUse at Follow-up

MA Cocaine

None1-3x in 30 Days1-2x Per Week3-6x Per WeekDaily

44%9%3%6%37%

47%10%6%10%27%

MA - CocaineMA - CocaineFollow-up ComparisonFollow-up Comparison

Employment

Status MA Cocaine

Full-TimePart-TimeUnemployed

54%16%30%

51%14%35%

MA - CocaineMA - CocaineFollow-up ComparisonFollow-up Comparison

Legal Status

Status MA Cocaine

Parole/ProbationNone

11%89%

11%89%

MA - CocaineMA - CocaineFollow-up ComparisonFollow-up Comparison

Family Situation

Situation MA Cocaine

No ProblemsSome ProblemsConstant ProblemsNo Comment

56%19%16%9%

50%21%24%6%

MA - CocaineMA - CocaineFollow-up ComparisonFollow-up Comparison

Psychological Complaints

Complaints MA Cocaine

HeadachesIrritabilityDepressionLow EnergyWeakness

44%72%75%78%66%

25%47%56%44%38%

MA - CocaineMA - CocaineFollow-up ComparisonFollow-up Comparison

Medical Complaints

Complaints MA Cocaine

Emer Med Attn (1 yr)Hospitalized (2 yrs)“Liver” ProblemsMultiple Phys ProbOn Disability

3%8%3%14%0%

14%30%44%14%14%