National Amphetamine-Type Stimulant Strategy Background Paper

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108 through the use of antipsychotics and antidepressants was also raised. Issues of managing withdrawal were also seen as an issue for detention centre staff who were usually not medically trained. 5.7 Other interventions 12-Step Programs Donovan and Wells (2007) performed a review of the available literature on the role of 12- step mutual support groups in the recovery process for consumers of methamphetamine. Few, if any, data were found on methamphetamine dependent clients and their use of these programs. However, the evidence with alcohol- and cocaine-dependent individuals was associated with improved outcomes. The researchers concluded that actively integrating 12-step programs into the treatment process may provide low- or no-cost options for methamphetamine consumers and increase the capacity for providing treatment. Residential treatment There is some evidence that the residential treatment outcomes for ATS dependent clients is similar to other drug dependent groups (e.g., Hawke et al., 2000). However, it is a relatively expensive treatment option, and it may be appropriate to target it to particular patients. For example, Taylor and Gold (1990) suggested that residential treatment for people affected by ATS use may be appropriate when there is polydrug dependence; severe withdrawal; medical complications; psychiatric comorbidity; inadequate living conditions; and absence of social supports. Community based interventions Community-based treatment programs in California, comprised of 12 residential and 20 out-patient programs, were recently evaluated in a longitudinal study examining treatment outcomes among 1,073 methamphetamine consumers (Hser et al., 2005). Data were collected at intake (baseline measures), and at 3 and 9 months following admission, with significant improvements found at 9-month follow-up in all key life areas (except for medical severity for males) as measured by the composite scores of the Addiction Severity Index. Gender differences were observed with women demonstrating greater improvements in family relationships and medical problems, but more likely to be unemployed, have childcare responsibilities and report more psychiatric symptoms. 5.8 Managing co-occurring mental health and amphetaminetype stimulant problems Consideration of the co-occurrence of ATS use and mental health problems, as outlined in Chapter 3, has many implications for treatment. Differential diagnosis depends on the temporal and possible causal relationship between the issues and can be challenging for clinicians (Baker & Dawe, 2005). It is often easier to create the categories than it is to accurately identify the temporal relationship. ATS use may contribute to the development of mental health problems, or be a means of managing a pre-existing psychological difficulty,
109 or the two problems may have common underlying causes. Thus, people can experience both drug-induced and drug-independent psychological issues (Bakken, Landheim & Vaglum, 2003). It is worth considering some of the co-existing mental health problems. <strong>Amphetamine</strong> users have higher rates of affective disorders such as anxiety and depression, psychosis, self-mutilation and self-harm, paranoia, hostility, agitation and aggression (Baker, Lee & Jenner 2004). To illustrate, Hall and colleagues (1996) interviewed a sample of 301 regular amphetamine users about their experiences of psychological symptoms prior to, and subsequent to, initiation of amphetamine use. Psychological morbidity was implicated in 44% of the sample according to scores on the General Health Questionnaire. The most commonly reported symptoms were depression (79%), anxiety (76%) and paranoia (52%), with all these symptoms increasing in prevalence after the onset of amphetamine use. In their review of the literature, Baker and Dawe (2005) identified only a small number of studies that investigated co-occurring psychological problems among amphetamine users. The research to date suggested that anxiety disorders were more likely to follow the onset of amphetamine use than to precede it, but the evidence was less clear in regards to the temporal sequence of depressive symptoms. Again they found that depression and anxiety are the most common co-occurring psychological problems found in amphetamine users (Baker & Dawe, 2005). Determination as to whether these conditions are distinct from ATS use is complicated by the frequent presence of agitation and anxiety during amphetamine intoxication, and low mood, sleep difficulties and psychomotor retardation during amphetamine withdrawal (American Psychiatric Association, 2000). Dawe and McKetin (2004) suggested that diagnosis of amphetamine-induced anxiety disorder or amphetamineinduced affective disorder involves identification of the occurrence of symptoms following a substantial period of amphetamine use and remittance after 2 weeks. Dyer and Cruickshank (2005) conducted a series of studies investigating the prevalence of depression and other psychological problems among patients receiving treatment for methamphetamine dependence. A study of individuals entering the inpatient treatment unit found that 46% had been previously diagnosed with an Axis I disorder, with depression diagnosed in 35% of patients. A second study administering the Beck Depression Inventory-II found that the average score for methamphetamine dependent patients was in the moderate range of depression and similar to that of psychiatric outpatients with clinical depression. More recently, Gonsalves and colleagues (2007) collected data from a Midwestern dual diagnosis substance abuse facility in the United States to determine if predictors of methamphetamine use could be identified. The total sample of 281 admissions included 93 participants who met criteria for methamphetamine abuse or dependence and were only using methamphetamine. Of these participants, 18% had a diagnosed anxiety disorder, 12% a depressive disorder and 6.5% a psychotic disorder. Fourteen possible predictors were analysed and nine were found to be significant associated with primary methamphetamine use: gender, age, race, legal status, anxiety diagnosis, previous treatment, emotional abuse, level of care and program completion. Given the prevalence of a range of co-occurring psychological problems, there is a need for clinical staff to be adequately trained and skilled to manage such presentations. The need
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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
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52 Parental ATS use In addition to
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54 The Minnesota Department of Heal
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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 112 and 113: 102 users, data that may be general
Page 114 and 115: 104 that limit brain exposure to me
Page 116 and 117: 106 only significant difference was
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
Page 162 and 163: 152 Appendix 2 Written submissions
Page 164 and 165: 154 Australian Institute of Health
Page 166 and 167: 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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