Facts and Myths Surrounding Methamphetamine Addiction and Treatment

Editor's Note: This article is adapted from an article in the September 2005 issue of Counselor, The Magazine for Addiction Professionals. Read the entire article, or visit the magazine's web site at www.counselormagazine.com. 

True or False:

•  99 percent of first-time meth users are hooked after just the first try.

•  Only 5 percent of meth addicts are able to kick it and stay away.

•  From the first hit to the last breath, the life expectancy of a habitual meth user is only five years.

All three ‘facts' are false – The first two have never been studied and would be very difficult, if not impossible, to determine; the third is false. These ‘statistics' are cited on a website established by a State's Attorney General's Office. The statements are widely cited around the United States and in Canada as true statistics and have actually been used to argue against using money for apparently an almost hopeless task of treating meth users. This article reviews what is currently known about the effectiveness of treatment for methamphetamine users.

Treatment for MA Addiction

 The ‘only 5 percent' statistic stated at the beginning of this article is widely and frequently cited at national and regional meetings as evidence of the poor outcomes to be expected from treating MA users. A similar picture of dismal treatment outcome was presented in the January 23, 2003, issue of Rolling Stone Magazine in the article titled “Plague in the Heartland,” which included the statement “only 6 percent of MA freaks get and stay sober, the lowest number by far for any drug,” among others attributed to the self-interested stakeholders, such as local law enforcement. In some cases, these ‘statistical' statements are used to support the position that money spent on treatment is wasted and that the only fruitful investment is to reduce the availability of the drug through criminal justice, supply reduction approaches. An extensive literature search has failed to find any data to provide support for these statistics. 

Medications: Currently there are no medications with evidence to support their efficacy in treating MA intoxication, psychosis, withdrawal, or dependence. The National Institutes of Drug Abuse (NIDA) has a very active program of research underway to test the safety of potential medications and to examine their efficacy for treating MA-related disorders. Sites in Kansas City, Des Moines, Honolulu, San Diego, and Costa Mesa (California), coordinated by UCLA have tested several mediations, and several other promising medications are planned for testing in the near future. In those circumstances when individuals with MA-induced psychosis present in emergency rooms or other health facilities, a common clinical practice is for physicians to use a combination of atypical anti-psychotics and benzodiazepines to help calm the individual and prevent them from injuring themselves or others until the psychosis-inducing effects of MA have dissipated. 

Psychosocial/Behavioral Treatments: Presently, there are two approaches that have evidence to support their efficacy for the treatment of MA dependence, but there is a much larger literature on treatments that work with the other major illicit stimulant problem in the United States , cocaine dependence. Although there are a number of differences in the pharmacology and physiological effects produced by MA and cocaine, these drugs have many common properties and similar effects. Research examining the treatment responses of MA and cocaine users suggests that cocaine and MA users have very similar outcomes when exposed to the same treatments. In addition, large-scale treatment system evaluations have reported comparable outcomes for cocaine and MA users. To date, despite extensive examination of multiple data sources, no data have been found to support the frequently misused ‘statistics' mentioned above, or the contention of poorer treatment outcomes with adult MA users.

Matrix Model : During the 1980s, the Matrix Institute on Addictions group in Southern California (including the present author, Rawson), created a multi-element treatment manual with funding support from NIDA, designed for application with stimulant users on an outpatient basis. The Matrix approach evolved over time, incorporating treatment elements with support from scientific evidence, including cognitive behavioral therapies (i.e., relapse prevention techniques), a positively reinforcing treatment context, many components of motivational interviewing, family involvement, accurate psychoeducational information, 12-step facilitation efforts, and regular urine testing. The approach is delivered using a combination of group and individual sessions delivered approximately three times per week over a 16-week period followed by a 36-week continuing care support group and 12-step program participation. Over 15,000 cocaine and MA users have been treated with this approach during the past 20 years. The treatment manual and other related materials have been published by Hazelden and SAMHSA. (For more details see www.Hazelden.org and www.SAMHSA.gov .)

In 1999, CSAT funded a large-scale evaluation of the Matrix Model for the treatment of MA users, which was coordinated by UCLA. Roughly 1,000 MA-dependent individuals were admitted into eight different treatment study sites. In each of the eight sites, 50 percent of the participants were assigned to either Matrix treatment or to a ‘treatment as usual' (TAU) condition, which was comprised of a variety of counseling techniques idiosyncratic to each site. The study result showed that individuals assigned to treatment in the Matrix approach received substantially more treatment services; were retained in treatment longer; gave more MA-negative urine samples during treatment; and completed treatment at a higher rate than those in the TAU condition. These in-treatment data suggested a superior response to the Matrix approach. When data at discharge and follow -up were examined, it appeared that both treatment conditions produced comparable post-treatment outcomes. Participants in both conditions showed very significant reductions in MA use; significant improvements in psychosocial functioning; and substantial reductions in psychological symptoms, including depression. Follow-up data indicated that more than 60 percent of both treatment groups reported no MA use and gave urine samples that tested negative for MA (and cocaine) use. Use of other drugs, such as alcohol and marijuana also were significantly reduced.

A particularly interesting finding was that across the eight treatment sites, the ‘drug court site' (e.g., the one that enrolled individuals who were participating under a drug court program), produced superior results compared to the other seven sites, suggesting a substantial beneficial influence of drug court involvement. Overall, this evaluation is the largest controlled study of MA treatments that has yet to be conducted. 

Contingency Management (CM): Positive reinforcement is a powerful tool in increasing desired behaviors. School teachers who have given ‘special prizes' for superior performance; companies who give employee incentive bonuses for meeting production goals; and Alcoholics Anonymous meetings that give ‘chips' and cakes to acknowledge successful progress in achieving sobriety all are examples of the effective use of positive reinforcement. Many existing treatment programs informally use positive reinforcement as part of their treatment milieu. Frequently, the reinforcement takes the form of verbal praise; earning program privileges; ‘graduating' to a higher level of status in the program; or some other practice to acknowledge and reward progress in treatment. CM is simply the systematic application of these same reinforcement principles. In many of the studies investigating CM approaches, treatment participants can earn ‘vouchers' that are exchangeable for non-monetary desired items (e.g., free movie tickets, restaurant dinners, grocery vouchers, gasoline coupons, etc.). Typically the individual can earn larger valued rewards for longer periods of continuous abstinence from drugs and alcohol.

Over the past 30 years, a number of researchers and research groups at Johns Hopkins (Stitzer, Silverman), Vermont (Higgins and colleagues), Connecticut (Petry and colleagues), and UCLA (Roll and colleagues) have demonstrated the powerful effect of CM techniques to reduce heroin, benzodiazepine, cocaine, and nicotine use. Recently, CM techniques have been implemented with MA users in Southern California by the group at UCLA and by researchers in the NIDA Clinical Trials Network. The results of these investigations have provided powerful support to the efficacy of this behavioral strategy as treatment for MA abuse. Individuals who have been assigned to CM conditions have shown better retention in treatment, lower rates of MA use, and longer periods of sustained abstinence over the course of their treatment experience. Without question, CM is a powerful technique that can play an extremely valuable role in improving the treatment response of MA-dependent individuals.

Response to treatment: Cocaine vs. Methamphetamine

To date, t he majority of studies investigating the effectiveness of treatment for stimulant addiction have focused on cocaine abuse, with fewer studies on MA. Despite differences between the two stimulants in individual health, psychological and cognitive effects, both groups tend to show comparable responses to psychosocial behavioral treatments. In one large study using the Matrix Model, 500 MA-dependent individuals were treated alongside 250 cocaine- dependent individuals at the same clinic, by the same staff, over the same time period, using the same approach. Treatment outcomes were identical both during treatment and at follow-up. Similar findings have been reported from treatment studies in San Francisco and from data collected in Los Angeles County and throughout California . While there is absolutely no evidence that MA users and other drug user populations respond differently to treatment, there are multiple controlled and large-scale treatment outcome studies that suggest treatment outcomes for MA and cocaine users is very comparable. Taken together, these results tend to dispel the false beliefs about treatment effectiveness for MA addiction circulating within the public sphere.

Rachel Gonzales, MPH, has several years of experience in the field of substance abuse practice and research, and has worked in various capacities for the UCLA Integrated Substance Abuse Programs. 

Richard Rawson, PhD, is the Associate Director of the UCLA Integrated Substance Abuse Programs in the UCLA School of Medicine. Dr. Rawson currently oversees a portfolio of addiction research ranging from brain imaging studies to numerous clinical trials on pharmacological and psychosocial addiction treatments, to the study of how new treatments are applied in the treatment system.