ATS Literature Review, Consultations & Trial - Odyssey House

Amphetamine‐Type Stimulants: Development of a Treatment Protocol
intervention treatment sessions significantly increased their likelihood of remaining abstinent from
amphetamine use over time.
Recommendations from this study include a stepped‐care approach, with the first stage the
provision of a structured assessment of amphetamine use and related problems; self‐help material;
and regular monitoring of amphetamine use and related harms. This would be followed by a brief
intervention, comprising either two or four sessions of CBT, depending on the person’s severity of
use and associated issues, including levels of depression.
In Australia, the current ‘gold standard’ of treatment for methamphetamine use and dependency is
a brief psychological intervention, developed and tested in Australia (Baker, Kay‐Lambkin, Lee, et.al.,
2003). This is a two or four‐session combination of motivational interviewing and CBT, which was
found to significantly increase abstinence amongst dependent methamphetamine users. At six‐
month follow‐up, close to half (49.4%) the treatment group were abstinent, compared to only 27.1%
of the control group who received only the self‐help information in booklet form.
Participants in the study were 282 people, screened to take part between October 2001 and
September 2002. Of these, 214 regular (at least weekly) users of amphetamines were randomly
assigned to either an active intervention (two or four sessions of CBT in addition to a self‐help
booklet) or control condition (self‐help booklet only). The self‐help booklet was developed by
NDARC in 2001.
The CBT intervention focused on developing skills to reduce amphetamine use. Four sessions were
conducted individually and lasted 45‐60 minutes. In the two‐session intervention, the procedure
and content was the same as that for the four hour intervention (Baker, et.al., 2003). At pre‐
intervention, subjects were a group of regular amphetamine users with long using histories, high
dependence, injecting risk taking behaviour, polydrug use, depression, psychiatric illness and poor
quality of life (Baker, et.al., 2003).
In this study all groups, including the no‐treatment group, significantly reduced their substance use
(Jenkinson, et.al., 2008). However, being in the intervention group was significantly associated with
abstinence, which implies active therapy gave subjects an added incentive for abstinence.
The brief treatment intervention, developed as a result of this research, is based on the assumption
of the motivational enhancement therapy (MET) approach, which maintains that responsibility for
change lies within the client (Miller, Zweben, DiClemente & Rychtarik, 1995). Under this model, the
role of the therapist is to enhance the client’s own motivation and commitment for change through
the five basic motivational principles of:
1. Express empathy;
2. Develop discrepancy;
3. Avoid argumentation;
4. Roll with resistance; and
5. Support self‐efficacy.
The main goal of the intervention is to reduce the level of drug use and harm, including mental and
physical health, financial, social and occupational harms (Baker, et.al., 2003). The manualised
approach provides guidelines for the delivery of sessions, including activities, worksheets and
homework tasks.
Page 46 © Lynne Magor‐Blatch & James A. Pitts: Odyssey House McGrath Foundation 2008‐2009