National Amphetamine-Type Stimulant Strategy Background Paper

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112 It was also suggested that links are weak because services use different practice guidelines and models of care. A variety of guidelines to manage ATS problems have been developed. Among these are clinical treatment guidelines, developed by Turning Point specifically for methamphetamine dependence. These guidelines, which include a focus on management of acute presentations and interventions for methamphetamine use and dependence, are similarly based on a stepped care approach, defined as: Stepped care involves the provision of a series of interventions, from the least to the most intensive, with each incremental step made available on the basis of the client’s response to the previous one (Lee et al., 2007, p.13). The manual outlines a step-by-step approach to managing methamphetamine-related presentations, illustrated with use of a decision tree (see Figure 1, p. 16 of the manual). Guidelines are provided for managing acute toxicity, managing aggressive or agitated behaviour, managing acute psychotic symptoms, various assessments (e.g., dependence, co-morbid psychological problems), managing withdrawal, harm reduction approaches, brief interventions, and longer interventions based on CBT. However, as noted in their submission, Turning Point observed that guideline development is not sufficient: Multiple guidelines are now available for frontline workers and health workers. Dissemination is a major impediment to their uptake and significant funding is required to translate these very useful guidelines into practice. The potential role of psychologists was also discussed, particularly in combination with GP care. One suggestion was to adopt a case management approach between GPs and psychologists in order to provide both pharmacological and psychosocial support and assistance. However, as noted in the submission from the Australian Psychological Society (APS), there will be a need to accompany such approaches with workforce development: Psychologists and other practitioners working with those using or affected by ATS need up-skilling to improve their understanding of new forms of amphetamines, in addition to information about the symptoms and problems associated with ATS. In addition to improving training within and coordination across different health services (e.g., alcohol and drug workers and mental health services), this was also needed across sectors, such as between health services and criminal justice. For example, the written submission from the WA Department of the Attorney General stated: There is a need for further education of judicial officers, lawyers, police, other prosecuting agencies and community corrections officers to increase their understanding of ATS and best practice when dealing with users. Interventions and effective cross-agency working relationships would be improved if education were extended to better ensure that training for treatment and support service providers includes improved understanding of the total case processing requirements of courts and other justice agencies within the criminal justice system.
113 The APS, and other submissions, particularly emphasized the need for more coordinated and collaborative responses among services. This included improving pathways between services, establishing effective referral systems and a unified case management approach. In their submission, Headspace not only emphasized the need to ensure a coordinated approach, but noted the need to facilitate multiple entry points into care: the strategy should emphasise an integrated and coordinated service response between mental health services, AOD services, general welfare and youth services and dual diagnosis services. There should be ‘no wrong door’ for ATS users who are seeking information, support and treatment. 5.10 Summary Treatment for ATS use and associated problems is impeded by relatively low rates of access by ATS users and tenuous links with services. Research suggests that those least likely to receive treatment are females, persons born outside Australia and those in fulltime employment. Furthermore, poor treatment retention is associated with frequent use, injecting and use during treatment. Nevertheless, recent Australian national data suggest that approximately 11% of those seeking treatment for drug use reported amphetamine as the principal drug of concern. Of this group, the most common form of treatment was counselling. The first point of contact for many ATS users is with frontline services, often due to intoxication or related problems including violence and psychotic behaviours. The high burden on frontline services posed by ATS use, particularly methamphetamine, is largely due to the nature of the presentations rather than the actual numbers of ATS-related presentations. As a result, national guidelines have been developed for police, ambulance staff, emergency departments and general practitioners in managing psychostimulant users, including pharmacological management of toxicity. The extent of dissemination and utilisation of these guidelines remains unclear. A related issue is that of withdrawal management for ATS. Current research suggests the amphetamine withdrawal syndrome is comprised of hyperarousal symptoms, reversed vegetative symptoms and anxiety-related symptoms. Symptoms of depression have also been found during the first several days of withdrawal. At present there appears to be a lack of clear protocols for appropriate withdrawal management for dependent meth/amphetamine users. Pharmacotherapies currently being trialled include various antidepressants, mirtazepine and modafinil. Several psychosocial interventions have been used in treatment for ATS users. These include brief interventions, inpatient programs, therapeutic communities, 12-step programs, peer interventions, contingency management, behavioural strategies, cognitive-behavioural interventions, multimodal packages (such as the Matrix Model used in the United States) and non-traditional methods such as acupuncture. Research to date suggests that cognitive behavioural therapy (CBT) applied in a stepped care approach is the treatment of best practice for ATS use. CBT is typically comprised of motivational interviewing, instruction in cognitive-behavioural coping strategies and relapse prevention. However, there is a limited evidence base and consideration of what is best practice may be confirmed or change
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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
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58 should cover the full range of d
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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 118 and 119: 108 through the use of antipsychoti
Page 120 and 121: 110 to develop the capacity of the
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)
Page 168 and 169: 158 Crits-Christoph, P., Siqueland,
Page 170 and 171: 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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National Amphetamine-Type Stimulant Strategy Background Paper

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