treatment for methamphetamine abuse and dependence richard a. rawson, ph.d. alice huber, ph.d. paul...
TRANSCRIPT
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%