National Amphetamine-Type Stimulant Strategy Background Paper

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102 users, data that may be generalisable to ATS use (e.g., Crits-Cristoph et al., 1999). Brief CBT may also be effective in reducing psychological distress among amphetamine users. Feeney and colleagues (2006) found that a program consisting of refusal self-efficacy, improved coping, improved problem solving and planning for relapse prevention resulted in significantly improved scores on measures of somatic symptoms, anxiety, social dysfunction and depression among an Australian sample of 168 amphetamine users. Baker and colleagues (2005) recommended that a stepped-care approach should be adopted. This involves the provision of intervention tailored to individual needs, with the employment of more intensive interventions as indicated by the degree of dependence and severity of problems experienced by the individual. Thus, those presenting at non-treatment settings may be involved in a structured assessment of amphetamine use and related problems, provided with self-help materials, and their use and harms regularly monitored. Those presenting to treatment settings may be offered two or more sessions of CBT, depending on extent of use and co-existing problems (e.g., depression). Contingency management Contingency management (CM) is based on principles of reinforcement by decreasing the appeal of the drug via delivery of a reward for behaviour change/abstinence. Thus, clients receive incentives upon reaching therapeutic goals. In the United States, contingency management has been proposed as ‘best treatment practice’ for psychostimulant problems (Rawson, 1999; Shoptaw et al., 2006), largely based on research with cocaine users, although there has also been application to methamphetamine dependence. The most often cited reasons for not employing such techniques are the perceived cost and complexity, and doubt over whether it promotes enduring behaviour change (Kirby et al., 2006). As part of the multi-site trial of the NIDA <strong>National</strong> Drug Abuse Treatment Clinical Trials Network, Roll and colleagues (2006) evaluated a contingency management intervention in which methamphetamine abusers submitting drug-free urine samples earned draws for chances to win prizes. No differences were found between this group and those in standard treatment for number of counselling sessions attended or retainment in treatment. However, significant differences were found for more drug-free urine samples collected and longer period of continuous abstinence. In a recent review of the literature on contingency management, Roll (2007) identified one laboratory study and four clinical assessments of the efficacy of CM in treating methamphetamine use disorders, and the most common method was voucher-based reinforcement therapy (VBRT). Roll concluded that adding such methods to other treatment strategies would increase in-treatment abstinence in many methamphetamine treatment settings. However, Roll cautioned against using CM in isolation to address methamphetamine use due to high levels of co-occurring problems. The results discussed in this manuscript suggest that adding CM to many treatment strategies would increase in-treatment abstinence in many methamphetamine treatment settings. Given the relatively high levels of psychiatric comorbidity, medical comorbidity and criminal activity associated with methamphetamine use, I believe it would be unwise to treat this disorder with only CM. Instead, I recommend that CM be a component of
103 a holistic treatment strategy that addresses the psychosocial, medical, psychiatric and criminal justice issues that often co-occur with methamphetamine use disorders (Roll, 2007, pp.118-119). The Matrix Model The Centre for Substance Abuse Treatment (CSAT) has been involved in developing and implementing a multimodal approach to methamphetamine dependence. The US Methamphetamine Treatment Project (MTP) appears to be the largest randomised clinical trial of psychosocial treatments for methamphetamine dependence to date. The Matrix Model utilised in the project is a manualised 16-week outpatient treatment approach combining approaches and resources developed within cognitive-behavioural principles, including positive reinforcement, family education, relapse prevention and 12-step program participation. The program also includes breath testing and urine screening for drug use. Rawson and colleagues (2004) evaluated the model in comparison to ‘treatment as usual’ with methamphetamine dependent patients. This resource-intensive intervention was found to result in some positive outcomes. 38% of participants were more likely to stay in treatment, 27% were more likely to complete treatment, and 31% were more likely to have negative methamphetamine urine test results. However, the Matrix Model did not produce superior outcomes at discharge or follow-up. 5.6 Pharmacotherapy Various drug treatments, or pharmacotherapies, are used in relation to ATS dependence, to aid in withdrawal, to block drug effects, as replacement or substitution therapy, and/or to treat co-occurring and related psychological disorders. In reviewing the literature, Shearer and Gowing (2004) found the following pharmacotherapies had been used in response to psychostimulant use: • Antidepressants; • Dopamine agonists and antagonists; • Disulfram; • Central nervous system stimulants; • Modafinil; • Vaccines; • Calcium blockers; and • Opioid agonists and antagonists. Despite this diverse range of options, clinical studies of pharmacotherapies for ATS are sparse and controlled studies are rare. However, research is ongoing and a number of trials are currently being conducted to determine the utility of a range of medications. Vocci and Appel (2007) provide an overview of the approaches currently being used to develop medications for the treatment of methamphetamine dependence. This includes medications
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National Amphetamine-Type Stimulant
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ii Acknowledgments This research wo
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iv Table of contents Acknowledgemen
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vi List of tables Table 1.1: Amphet
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viii
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2 The NDS framework and the Law Enf
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4 Table 1.1: Amphetamine-type stimu
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6 particularly on the Pacific Coast
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8 Figure 1.1: MDMA (ecstasy) tablet
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10 a 10-year period. While some of
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12 Figure 1.4: Forms of methampheta
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14 Figure 1.5: Median purity of met
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16 As noted, the route of administr
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18 Chapter 2: Setting the Context T
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20 Figure 2.2: Prevalence of ecstas
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22 19 years (Dunn et al., 2007). Th
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24 The use of MDMA among police det
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26 this survey is conducted with th
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28 models might be useful. On the o
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30 the questionnaire in February 20
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32 2.5 Summary According to the lat
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34 anxiety, agitation, tremor, teet
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36 may be stronger than the link wi
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38 Srisurapanot and colleagues (200
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40 Psychiatric problems appear to o
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42 In 2005, there was a total of 68
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44 The most recent EDRS survey foun
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46 same reasons they use the drugs
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48 Shoptaw and Reback (2007) review
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50 It has also been speculated that
Page 62 and 63: 52 Parental ATS use In addition to
Page 64 and 65: 54 The Minnesota Department of Heal
Page 66 and 67: 56 Chapter 4: Prevention and Harm R
Page 68 and 69: 58 should cover the full range of d
Page 70 and 71: 60 specific drug (Spoth et al., 200
Page 72 and 73: 62 be applied regularly and systema
Page 74 and 75: 64 Strategies targeting vulnerable
Page 76 and 77: 66 Examples of particular periods t
Page 78 and 79: 68 At-risk workplaces There is incr
Page 80 and 81: 70 The consultation forum with Abor
Page 82 and 83: 72 young people was noted in the su
Page 84 and 85: 74 and/or others); mental health ef
Page 86 and 87: 76 of the fact that frequently peop
Page 88 and 89: 78 Sexual risk behaviour is a furth
Page 90 and 91: 80 • Cleaning up; • Transport o
Page 92 and 93: 82 Assessing the risks of illicitly
Page 94 and 95: 84 4.4 Challenges of applying preve
Page 96 and 97: 86 but a number of studies are now
Page 98 and 99: 88 The pack included a video, train
Page 100 and 101: 90 Chapter 5: Treatment and Service
Page 102 and 103: 92 to the occurrence of amphetamine
Page 104 and 105: 94 In relation to the need for spec
Page 106 and 107: 96 These studies replicate earlier
Page 108 and 109: 98 addressed not only the drug user
Page 110 and 111: 100 Research conducted in the subse
Page 114 and 115: 104 that limit brain exposure to me
Page 116 and 117: 106 only significant difference was
Page 118 and 119: 108 through the use of antipsychoti
Page 120 and 121: 110 to develop the capacity of the
Page 122 and 123: 112 It was also suggested that link
Page 124 and 125: 114 as new evidence emerges. New ps
Page 126 and 127: 116 border in 2000 (McKetin et al.,
Page 128 and 129: 118 Table 6.1: Number of clandestin
Page 130 and 131: 120 Table 6.2: Examples of domestic
Page 132 and 133: 122 Tasmania In 2004, strengthened
Page 134 and 135: 124 Recommendations from the consul
Page 136 and 137: 126 Although there are a number of
Page 138 and 139: 128 illegal drugs. When incarcerate
Page 140 and 141: 130 heroin) (Payne et al., 2007). I
Page 142 and 143: 132 Some examples of diversion prog
Page 144 and 145: 134 Other research has compared psy
Page 146 and 147: 136 Rehabilitation in Corrections T
Page 148 and 149: 138 Synthetic Drugs measure will im
Page 150 and 151: 140 • Stealing from motor vehicle
Page 152 and 153: 142 criminal offences There continu
Page 154 and 155: 144 • Increase international coll
Page 156 and 157: 146 • Ensuring offence and penalt
Page 158 and 159: 148 Law enforcement agencies are pl
Page 160 and 161: 150 Appendix 1 National consultatio
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152 Appendix 2 Written submissions
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154 Australian Institute of Health
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156 Bowers, J. & Johnson, S. (2003)
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158 Crits-Christoph, P., Siqueland,
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160 Drug & Alcohol Services South A
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162 Halkitis, P.N., Parsons, J.T.,
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164 Hull, P., Rawstorne, P., Zablot
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166 Leek, L., Seneque, D., & Ward,
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168 McKetin, R., McLaren, J., Kelly
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170 NSW Health (2006). Psychostimul
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172 Ressler, K.J., & Nemeroff, C.B.
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174 Small, W., Kerr, T., Charette,
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176 United Nations Office for Drug
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178
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