Bulimia nervosa among methamphetamine dependent adults: association with outcomes three years after treatment.

Although weight loss is among the most commonly cited reasons for using methamphetamine (MA), little is known about the association between eating disorders and treatment outcomes in this population. This study examined psychiatric, substance use, and functional outcomes of MA users (N = 526) with bulimia nervosa 3 years after treatment for MA dependence. Bulimia nervosa was observed among 2.4% (N = 13) of the participants and was associated with poorer MA use outcomes, increased health service utilization, and higher levels of functional impairment. Addressing MA use among adults with eating disorders may be helpful as a means of improving treatment outcomes.

Anxiety disorders among methamphetamine dependent adults: association with post-treatment functioning.

Although anxiety is one of the most prominent psychiatric complaints of methamphetamine (MA) users, little is known about the association between anxiety disorders and treatment outcomes in this population. Using data from 526 adults in the largest psychosocial clinical trial of MA users conducted to date, this study examined psychiatric, substance use, and functional outcomes of MA users with concomitant anxiety disorders 3 years after treatment. Anxiety disorders were associated with poorer alcohol and drug use outcomes, increased health service utilization, and higher levels of psychiatric symptomatology, including suicidality. Addressing anxiety symptoms and syndromes in MA users may be helpful as a means of optimizing treatment outcomes.

Depression among methamphetamine users: association with outcomes from the Methamphetamine Treatment Project at 3-year follow-up.

Although depression is highly comorbid with substance use disorders, little is known about the clinical course and outcomes of methamphetamine (MA) users with depressive symptoms and syndromes. In this study of MA-dependent individuals entering psychosocial treatment, we predicted that (1) depressive symptoms would decline during treatment, an effect that would vary as a function of MA use and (2) depression diagnoses post-treatment would be associated with poorer outcomes. Participants (N = 526) were assessed for depression, substance use, and psychosocial outcomes at baseline, treatment discharge, and 3-year follow-up. Depressive symptoms declined significantly during treatment, an effect that was greatest among those who abstained from MA. Major depression at follow-up was associated with poorer MA use outcomes and impairment across multiple domains of functioning. The findings highlight the relationship of depressive symptoms and diagnoses to treatment outcomes, and suggest a need for further studies of depression in populations using MA.

Identifying methamphetamine users at risk for major depressive disorder: findings from the methamphetamine treatment project at three-year follow-up.

Little is known about risk factors for depression in methamphetamine users. Using data from 526 adults in the largest psychosocial clinical trial of methamphetamine users conducted to date, this study examined clinical, demographic, and substance use characteristics that predict the presence of a diagnosis of major depressive disorder (MDD) three years after treatment for methamphetamine dependence. The results indicate that two risk factors predict a diagnosis of MDD: a Beck Depression Inventory total score greater than 20, and one or more prior suicide attempts. These risk factors identify methamphetamine users who may benefit from early interventions for psychiatric symptoms.

Drug court treatment for methamphetamine dependence: treatment response and posttreatment outcomes.

Relatively little is known about the impact of drug court treatment programs for methamphetamine (MA) dependence. This article examines treatment performance among a subsample of 287 MA-dependent adults who participated in the Methamphetamine Treatment Project from 1999 to 2001. To gain a preliminary indication of MA users' response to drug court intervention, we compared a group of 57 MA-dependent participants treated in outpatient treatment within the context of a drug court to a group of comparable MA-dependent individuals treated in outpatient treatment but not supervised by a drug court (n = 230). Analyses reveal that drug court participation was associated with better rates of engagement, retention, completion, and abstinence, compared to outpatient treatment without drug court supervision. Six- and 12-month outcome analyses indicated that participants who were enrolled in drug court intervention used MA significantly less frequently. These findings suggest that drug court supervision coupled with treatment may improve the outcomes of MA-dependent offenders beyond that seen from treatment alone.

Childhood adverse events and methamphetamine use among men and women.

Women report extensive histories of childhood abuse, often leading to addiction. Studies assessing the same effects for men are lacking. This study describes childhood adverse events (CAEs) among methamphetamine (MA)-dependent men and women and assesses the relationship of CAEs to the onset and severity of dependence. Baseline and three-year interview data were collected for 236 men and 351 women. Dependent variables included onset of MA and severity of dependence. Women reported greater occurrence of all types of CAEs than men (28% vs. 13%,p < .01). Familial substance abuse was most predictive of onset for men and of dependence severity for women. The collective impact of CAEs was related to both age of onset and severity. This demonstrates the intergenerational cycle of addiction, and indicates the need for early intervention, which could prevent the onset of MA use and reduce the course of addiction.

Predicting in-treatment performance and post-treatment outcomes in methamphetamine users.

AIMS: This study examines the utility of individual drug use and treatment characteristics for predicting in-treatment performance and post-treatment outcomes over a 1-year period. DESIGN, SETTING AND PARTICIPANTS: Data were collected from 420 adults who participated in the Methamphetamine Treatment Project (MTP), a multi-site study of randomly assigned treatment for methamphetamine dependence. Interviews were conducted at baseline, during treatment and during three follow-up time-points: treatment discharge and at 6 and 12 months following admission. MEASUREMENTS: The Addiction Severity Index (ASI); the Craving, Frequency, Intensity and Duration Estimate (CFIDE); and laboratory urinalysis results were used in the current study. FINDINGS: Analyses addressed both in-treatment performance and post-treatment outcomes. The most consistent finding is that pre-treatment methamphetamine use predicts in-treatment performance and post-treatment outcomes. No one variable predicted all in-treatment performance measures; however, gender, route of administration and pre-treatment methamphetamine use were significant predictors. Similarly, post-treatment outcomes were predicted by a range of variables, although pre-treatment methamphetamine use was significantly associated with each post-treatment outcome. CONCLUSIONS: These findings provide useful empirical information about treatment outcomes for methamphetamine abusers, and highlight the utility of assessing individual and in-treatment characteristics in the development of appropriate treatment plans.

Hepatitis C virus infection among methamphetamine-dependent individuals in outpatient treatment.

Research on the relationship between illicit drug use and infectious diseases have primarily focused on the major problem of heroin injection and HIV transmission. Over the past decade, however, research have shown that rates of hepatitis C infection among injection drug users have surpassed those of HIV infection. There has been little systematic study on the relationship between hepatitis C virus (HCV) and the role of methamphetamine (MA) use in the transmission of the virus. This study examined the prevalence of hepatitis C infection among a sample of 723 MA-dependent individuals who sought outpatient treatment from 1999 through 2005. Roughly 15% of the total sample and 44% of the injectors were found to be infected with HCV. Controlling for participant characteristics, we found through multiple logistic regression analyses that HCV infection was more associated with injection use, older age, and female sex. Findings suggest a need for targeted education and prevention efforts about hepatitis C among high-risk MA users, including HCV testing coupled with referrals to HCV treatments.

A multi-site comparison of psychosocial approaches for the treatment of methamphetamine dependence.

AIMS: The Center for Substance Abuse Treatment (CSAT) Methamphetamine Treatment Project (MTP) is the largest randomized clinical trial of treatments for methamphetamine (MA) dependence to date. The objective of the study was to compare the Matrix Model, a manualized treatment method, with treatment-as-usual (TAU) in eight community out-patient settings in the Western United States. DESIGN: Over an 18-month period between 1999 and 2001, 978 treatment-seeking, MA-dependent people were randomly assigned to receive either TAU at each site or a manualized 16-week treatment (Matrix Model). SETTING: The study was conducted as an eight-site out-patient trial, with six sites located in California and one each in Montana and Hawaii. FINDINGS: In the overall sample, and in the majority of sites, those who were assigned to Matrix treatment attended more clinical sessions, stayed in treatment longer, provided more MA-free urine samples during the treatment period and had longer periods of MA abstinence than those assigned to receive TAU. Measures of drug use and functioning collected at treatment discharge and 6 months post-admission indicate significant improvement by participants in all sites and conditions when compared to baseline levels, but the superiority of the Matrix approach did not persist at these two timepoints. CONCLUSIONS: Study results demonstrate a significant initial step in documenting the efficacy of the Matrix approach. Although the superiority of the Matrix approach over TAU was not maintained at the post-treatment timepoints, the in-treatment benefit is an important demonstration of empirical support for this psychosocial treatment approach.

The gap between research and practice in substance abuse treatment.

Integrating science-based practices into clinical care has become an increasingly important theme in the substance abuse field. The authors describe various factors that have traditionally kept researchers and practitioners from collaborating with one another and outline steps being taken to encourage a partnership between these two groups. Strategies for continuing to close the gap between research and practice are provided, including the incorporation of policy makers and consumers and their families into the process. The implementation of science-based treatment strategies into mainstream substance abuse care will depend partly on the new relationships that are built on the communication and cooperation between researchers and practitioners.

Dancing with strangers: will U.S. substance abuse practice and research organizations build mutually productive relationships?

The scientific knowledge gained from research has not been extensively integrated into the U.S. substance abuse treatment system. A clear call to arms has been issued by the U.S. federal treatment and research agencies to bring research and practice together to create a better treatment system and a more responsive research agenda. The current federally sponsored initiatives to "close the gap" between research and practice are large and well funded. The field appears ready to change and realize the mutual benefits that can be achieved from the increased "bleeding" of research and practice. However, while the music has started and the partners seem willing, there are still many obstacles to a successful dance.

American indians/alaska natives and substance abuse treatment outcomes: positive signs and continuing challenges.

Limited information is known with regard to substance abuse treatment outcomes among AI/ANs. Data retrieved from the Treatment System Impact (TSI) project and Methamphetamine Treatment Project (MTP) were used to compare treatment measures between a sample of AI/ANs and a matched comparison group. Our results revealed no significant differences between AI/ANs and the matched comparison group in treatment outcomes at 12-months post-treatment based on legal, employment, medical, and psychiatric measures. AI/ANs also received more family-related services (29.9% vs. 17.1%) and abuse-related services (21.3% vs. 7.6%). Addressing barriers to receiving substance abuse treatment and enhancing screening methods for AI/ANs are suggested.

Psychopathology in methamphetamine-dependent adults 3 years after treatment.

INTRODUCTION AND AIMS: Although psychiatric symptoms are frequently observed in methamphetamine (MA) users, little is known about the prevalence of psychiatric disorders in MA-dependent individuals. This is the first study to examine the association of psychiatric disorders with substance use and psychosocial functioning in a large sample of MA users 3 years after treatment. We predicted that psychiatric diagnoses and severity would be associated with substance use and poorer overall functioning over the 3 year post-treatment course. DESIGN AND METHODS: Participants (N = 526) received psychosocial treatment for MA dependence as part of the Methamphetamine Treatment Project and were reassessed for psychosocial functioning and substance use at a mean of 3 years after treatment initiation. DSM-IV psychiatric diagnoses were assessed at follow-up using the Mini-International Neuropsychiatric Interview. Psychosocial functioning was assessed using the Addiction Severity Index. RESULTS: Overall, 48.1% of the sample met criteria for a current or past psychiatric disorder other than a substance use disorder. Consistent with prior reports from clinical samples of cocaine users, this rate was largely accounted for by mood disorders, anxiety disorders and antisocial personality. Those with an Axis I psychiatric disorder evidenced increased MA use and greater functional impairment over time relative to those without a psychiatric disorder. DISCUSSION AND CONCLUSIONS: This initial investigation of psychiatric diagnoses in MA users after treatment indicates elevated rates of Axis I and II disorders in this population and underscores the need for integrated psychiatric assessment and intervention in drug abuse treatment settings.

Health-related quality of life trajectories of methamphetamine-dependent individuals as a function of treatment completion and continued care over a 1-year period.

This study applies a chronic illness framework to evaluate treatment outcomes among individuals dependent on methamphetamine (MA). Using growth curve modeling, health-related quality of life (HRQOL) trajectories of MA-dependent individuals (N = 723) were examined over a 1-year period. Results show greater improvements in mental HRQOL trajectories as a function of treatment completion and continued care, although fairly static trajectories in physical health status. Other factors affecting HRQOL trajectories included gender, psychosocial functioning, drug use severity, and health impairment. Results extend research on treatment evaluations for MA dependence, highlighting the importance of continued service utilization for improved quality of life outcomes.

Health conditions in methamphetamine-dependent adults 3 years after treatment.

OBJECTIVES: : Medical conditions in methamphetamine (MA) users have not been well characterized. Using both self-report and physical examination data, the aims of this study were to (1) describe the frequency of medical conditions in a sample of MA users 3 years posttreatment; (2) evaluate the association between medical conditions and MA use frequency; and (3) examine the relationship of route of administration with medical outcomes. METHODS: : MA-dependent adults (N = 301) who participated in the Methamphetamine Treatment Project were interviewed and examined 3 years after treatment. Medical, demographic, and substance use characteristics were assessed using the Addiction Severity Index and Life Experiences Timeline. Current and lifetime medical conditions, electrocardiogram characteristics, and physical examination abnormalities were assessed. RESULTS: : Among the most frequently reported lifetime conditions were wounds and burns (40.5%, N = 122) and severe dental problems (33%, N = 99), and a significant proportion of the sample evidenced prolonged corrected QT interval (19.6%, N = 43). Although health conditions were not associated with MA use frequency during follow-up, intravenous MA use was significantly associated with missing teeth (odds ratio = 2.4; 95% confidence interval, 1.2-4.7) and hepatitis C antibodies (odds ratio = 13.1; confidence interval, 5.6-30.1). CONCLUSION: : In this sample of MA users, dental problems and corrected QT prolongation were observed at elevated rates. Although posttreatment MA use frequency was not associated with a majority of medical outcomes, intravenous MA use exacerbated risk for dental pathology and hepatitis C. Longer term follow-up research is needed to elucidate health trajectories of MA users.

Methamphetamine dependence and human immunodeficiency virus risk behavior.

We examined human immunodeficiency virus (HIV)-related risk behaviors among methamphetamine (MA)-dependent users. Secondary data analysis was performed on data from a large clinical trial: The Methamphetamine Treatment Project (N = 784). All MA-dependent participants were enrolled in an outpatient treatment program, receiving either a standardized psychosocial protocol (Matrix model) or treatment-as-usual. HIV-related risk behavior, including injection and unsafe sexual practices, was assessed using the AIDS Risk Assessment at baseline, treatment discharge, and 6, 12, and 36 months following treatment participation. Results indicated that HIV risk behaviors substantially decreased over time. Treatment factors (retention and completion) and frequency of MA use were both positively associated with increased reduction of HIV risk behaviors. The findings suggested that treatment of MA dependence is promising for reducing behaviors that have been shown to transmit HIV.

Clinical course and outcomes of methamphetamine-dependent adults with psychosis.

Little is known about the association between psychosis and treatment outcomes in methamphetamine (MA) users. Using data from 526 adults in the largest psychosocial clinical trial of MA users conducted to date, this study examined psychiatric, substance use, and functional outcomes of MA users with concomitant psychotic illness 3 years after treatment. The presence of a psychotic disorder was associated with increased health service utilization and higher levels of psychiatric symptomatology across multiple domains over time. MA users with co-occurring psychotic illness may therefore benefit from early psychosocial and/or pharmacologic interventions to address psychiatric symptoms.

Risk factors for suicide attempts in methamphetamine-dependent patients.

The purpose of this study was to identify risk factors for suicide attempts (SA) in methamphetamine (MA)-dependent patients. MA-dependent adults (N = 526) who participated in the Methamphetamine Treatment Project were interviewed before and three years after treatment. Baseline psychiatric, medical, demographic, and substance use characteristics were assessed using the Addiction Severity Index and the Beck Depression Inventory (BDI). Lifetime history of SA was assessed at follow-up. Risk factors for SA included gender, intravenous MA use, BDI > 20 at baseline, and clinically significant psychiatric history. Psychiatric characteristics of MA users are strongly associated with SA, warranting careful assessment of psychiatric history.

Methamphetamine dependence: a closer look at treatment response and clinical characteristics associated with route of administration in outpatient treatment.

Relatively little is known about the clinical treatment response characteristics associated with route of methamphetamine (MA) administration. We examined sociodemographic, drug use, treatment response, as well as psychiatric and medical characteristics associated with route of administration among 974 methamphetamine abusers in outpatient treatment during 1999-2001. Injectors had the poorest treatment prognosis: poorer treatment engagement, greater drug use during treatment, lower treatment completion rates, and more MA use at 12 months post-admission than did smokers and intranasal users. On many treatment response measures, MA smokers were almost as severely impaired as injectors, and in general, intranasal users were least impaired. Psychological and medical impairment, before and after treatment, was also highest among injectors. This study contributes new insights about clinical treatment response and outcomes associated with route of administration among MA-dependent users.