Transcript Symposium Presentation by Dr. Rawson (power point)

Methamphetamine: Clinical
Challenges and Critical Populations
Richard A. Rawson, Ph.D
Adjunct Associate Professor
Semel Institute for Neuroscience and Human Behavior
David Geffen School of Medicine
University of California at Los Angeles
www.uclaisap.org
[email protected]
Supported by:
National Institute on Drug Abuse (NIDA)
Pacific Southwest Technology Transfer Center (SAMHSA)
Methamphetamine Treatment
CSAT Tip #33
A useful resource that presents a review of the
existing knowledge about treatment effectiveness
with stimulant users.
Treatments for stimulant dependence with
empirical support
Limitations on Current
Treatments
Training and development of knowledgeable
clinical personnel are essential elements to
successfully address the challenges of treating
MA users.
Training alone is insufficient if the funding
necessary to deliver these treatment
recommendations is not available.
Treatment funding policies that promote short
duration or non-intensive outpatient services are
inappropriate for providing adequate funding for
MA users.
Special treatment consideration should be
made for the following groups of
individuals:
Female MA users (higher rates of depression; very high rates of
previous and present sexual and physical abuse; responsibilities for
children).
Injection MA users (very high rates of psychiatric symptoms; severe
withdrawal syndromes; high rates of hepatitis).
MA users who take MA daily or in very high doses.
Homeless, chronically mentally ill and/or individuals with high levels of
psychiatric symptoms at admission.
Individuals under the age of 21.
Gay men (at very high risk for HIV and hepatitis).
Brief cognitive behavioural interventions for
regular amphetamine users: a step in the right
direction
Design: RTC
Intervention: 2 session vs 4 session CBT
Findings The main finding of this study was that there was a
significant increase in the likelihood of abstinence from
amphetamines among those receiving two or more treatment
sessions. In addition, the number of treatment sessions attended had
a significant short-term beneficial effect on level of depression. There
was a marked reduction in amphetamine use among this sample over
time and, apart from abstinence rates and short-term effects on
depression level, this was not differential by treatment group.
Reduction in amphetamine use was accompanied by significant
improvements in stage of change, benzodiazepine use, tobacco
smoking, polydrug use, injecting risk-taking behaviour, criminal
activity level, and psychiatric distress and depression level.
Baker, et al; Addiction: Vol 100, March 2005
Cognitive Behavioral Therapy and
Contingency Management for Stimulant
Dependence
Design Randomized clinical trial.
Participants Stimulant-dependent individuals (n = 171).
Intervention CM, CBT, or combined CM and CBT, 16-week treatment
conditions. CM condition participants received vouchers for stimulant-free
urine samples. CBT condition participants attended three 90-minute group
sessions each week. CM procedures produced better retention and lower rates
of stimulant use during the study period.
Results Self-reported stimulant use was reduced from baseline levels at all
follow-up points for all groups and urinalysis data did not differ between
groups at follow-up. While CM produced robust evidence of efficacy during
treatment application, CBT produced comparable longer-term outcomes. There
was no evidence of an additive effect when the two treatments were combined.
The response of cocaine and methamphetamine users appeared comparable.
Conclusions: This study suggests that CM is an efficacious treatment for
reducing stimulant use and is superior during treatment to a CBT approach.
CM is useful in engaging substance abusers, retaining them in treatment, and
helping them achieve abstinence from stimulant use. CBT also reduces drug
use from baseline levels and produces comparable outcomes on all measures
at follow-up.
Rawson, RA et al. Addiction, Jan 2006
Contingency Management for treatment of
methamphetamine dependence
Design: RTC
Method: 113 patients diagnosed with methamphetamine abuse
or dependence were randomly assigned to receive either
treatment as usual (TAU) or TAU plus contingency
management.
Results indicate that both groups were retained in treatment for
equivalent times but those in the combined group accrued
more abstinence and were abstinent for a longer period of time.
These results suggest that contingency management has
promise as a component in methamphetamine use disorder
treatment strategies.
. Roll, JM et al, Archives of General Psychiatry, (In Press)
Contingency Management
A technique employing the systematic delivery of
positive reinforcement for desired behaviors. In
the treatment of methamphetamine
dependence, vouchers or prizes can be “earned”
for submission of methamphetamine-free urine
samples.
Mean number of abstinences
25
20
15
10
5
0
CM
Control
Mean weeks of consecutive abstinence
6
5
4
3
2
1
0
CM
Control
Matrix Model in Treatment of
Methamphetamine Depenence
Design: Randomized clinical trial.
Method: 978 treatment-seeking, MA-dependent persons were randomly
assigned to receive either TAU at each site, or a manualized 16-week treatment
(Matrix Model) for their MA dependence.
Results: Those who were assigned to Matrix treatment attended more clinical
sessions, stayed in treatment longer, provided more MA-free urine samples
during the treatment period, and had longer periods of MA abstinence than
those assigned to receive TAU.
Measures of drug use and functioning collected at treatment discharge and 6
months post-admission indicate significant improvement by participants in all
sites and conditions when compared to baseline levels, but the superiority of
the Matrix approach did not persist at these two time points.
Conclusions: Study results demonstrate a significant initial step in
documenting the efficacy of the Matrix approach. Although the superiority of
the Matrix approach over TAU was not maintained at the posttreatment time
points, the in-treatment benefit is an important demonstration of empirical
support for this psychosocial treatment approach.
Rawson, R et al Addiction vol 99, 2004
Matrix Model
Is a manualized, 16-week, non-residential, psychosocial
approach used for the treatment of drug dependence.
Designed to integrate several interventions into a
comprehensive approach. Elements include:
– Individual counseling
– Cognitive behavioral therapy
– Motivational interviewing
– Family education groups
– Urine testing
– Participation in 12-step programs
Days of Methamphetamine Use in Past
30 (ASI)
12
11.5
Mean Days Use
10
8
6
4.4
4
2
0
BL
Tx end
Possible is 0-30; tpaired=20.90; p-value<0.000 (highly sig.)
Matrix
TAU
12
10
8
6
4
2
0
mean number of visits
Mean Number of Weeks in Treatment
d
ra
Py
eo
at
S
nM
DA
O
Sa
eo
at
nM
Sa
o
ieg
nD
Sa
u
ul
ol
on
H
rd
wa
ay
H
a
es
M
ta
s
Co
r
co
s
ng
lli
n
Co
Bi
SITE
10
8
6
4
2
0
Matrix
TAU
ra
Py
eo
at
S
nM
DA
Sa
O
eo
at
nM
Sa
o
ieg
nD
Sa
u
ul
ol
on
H
rd
wa
ay
H
a
es
M
ta
s
Co
r
co
s
ng
lli
n
Co
Bi
d
mean number of MA-free UA's
Mean Number of UA’s that were MA-free
during treatment
SITE
Urinalysis Results
Results of Ua Tests at Discharge, 6
months and 12 Months post admission **
Matrix Group
D/C: 66% MA-free
6 Ms: 69% MA-free
12 Ms: 59% MA-free
TAU Group
65% MA-free
67% MA-free
55% MA-free
**Over 80% follow up rate in both groups at all points
MSM-specific cognitive behavioral therapy, and contingency
management for the treatment of methamphetamine dependent
MSMs
Design: Randomized clinical trial
Methods: 162 MSM randomly assigned to one of 4
conditions; CM, CBT, CBT plus CM, MSM-specific
CBT.
Results: All conditions showed significant
reductions in meth use by self-report and urinalysis,
with CM and CM plus CBT showing significantly
better reductions. Gay specific intervention also
showed promise.
Shoptaw et al Drug and Alcohol Dependence, 79,
2005
Sex Risks Reduced with Treatment: UARI
Past 30 Days
3.5
3
2.5
CBT
CM
CBT+CM
GCBT
2
1.5
1
0.5
2(3)=6.75, p<.01
os
12
-M
os
M
6-
ks
16
-W
ks
12
-W
W
ks
8-
W
ks
4-
Ba
se
l
in
e
0
Medications
Currently, there are no medications that can
quickly and safely reverse life threatening
MA overdose.
There are no medications that can reliably
reduce paranoia and psychotic symptoms,
that contribute to episodes of dangerous
and violent behavior associated with MA
use.
Status of Medication Research for Methamphetamine
Dependence
Negative Results
Imipramine
Desipramine
Tyrosine
Ondansetron
Fluoxetine
Under Consideration
Gabapentin
Modafinil
Topirimate
Disulfiram
Lobeline
Aripiprazole
Promising Evidence: Bupropion; Methylphenidate
SR
Promising Pharmacotherapies?
Newton, T. et al (Biological Psychiatry, Dec, 2005) Bupropion
reduces craving and reinforcing effects of methamphetamine in
a laboratory self-administration study.
Elkashef, A. et al (recently completed; reported at the ACNP
methamphetamine satelite meeting in Kona, Hawaii) Bupropion
reduces meth use in an outpatient trial, with particularly strong
effect with less severe users.
Tiihonen, J. et al (recently completed; reported at the ACNP
methamphetamine satelite meeting in Kona, Hawaii)
Methylphenidate SR (sustained release) has shown promise in
a recent Finnish study with very heavy amphetamine injectors.
Prenatal Meth Exposure
Preliminary findings on infants exposed
prenatally to methamphetamine (MA) and
nonexposed infants suggest…
– Prenatal exposure to MA is associated with an
increase in SGA (small for gestational size).
– Neurobehavioral deficits at birth were identified in
NNNS (Neonatal Intensive Care Unit Network
Neurobehavioral Scale) neurobehavior, including
dose response relationships and acoustical analysis
of the infant’s cry.
Lester et al 2005
METH Use Leads to Severe Tooth
Decay
“METH Mouth”
Source: The New York Times, June 11, 20
Dental Problems
•
Methamphetamine-related tooth decay,
often called “meth mouth,” may be
caused by:
The acidic nature of the drug
The drug’s ability to dry the mouth, reducing
the amount of protective saliva around the
teeth
Drug-induced cravings for sugary carbonated
beverages
The tendency of users to grind and clench
their teeth
The long duration of the drug’s effects (12
hours), which leads to long periods when
users are not likely to clean their teeth
Source: Methamphetamine use and oral health. JADA.
2005;136:1491.
Meth Use in Hawaii
As of the middle of May, not even halfway through the
year, the city medical examiner's office already recorded
38 deaths connected to crystal methamphetamine. So,
we're well on the way to exceeding last year's total of 68.
Deaths:
2005 (mid-May) - 38 deaths
2004 - 68 deaths
2003 - 56 deaths
2002 - 62 deaths
2001 - 54 deaths
2000 - 34 deaths
Adolescent Meth Abuse Treatment
Admissions
Matrix
– 2002
– 2003
– 2004
Phoenix
– 2002
– 2003
– 2004
(Boys)
16%
25%
22%
(Girls)
63%
67%
69%
(Boys)
25%
23%
27%
43%
51%
53%
MA Psychosis Inpatients from 4 Countries
No. of patients having
symptoms (%)
Psychotic symptom
Lifetime
Current
Persecutory delusion
Auditory hallucinations
Strange or unusual beliefs
Thought reading
Visual hallucinations
Delusion of reference
Thought insertion or made act
Negative psychotic symptoms
Disorganized speech
Disorganized or catatonic behavior
130 (77.4)
122 (72.6)
98 (58.3)
89 (53.0)
64 (38.1)
64 (38.1)
56 (33.3)
35 (20.8)
75 (44.6)
39 (23.2)
27 (16.1)
38 (22.6)
20 (11.9)
18 (10.7)
36 (21.4)
19 (11.3)
14 (8.3)
Srisurapanont et al., 2003
MA Psychosis
69 physically healthy, incarcerated Japanese
females with hx MA use
– 22 (31.8%) no psychosis
– 47 (68.2%) psychosis
19 resolved (mean=276.2±222.8 days)
8 persistent (mean=17.6±10.5 months)
20 flashbackers (mean=215.4±208.2 days to initial
resolution)
– 11 single flashback
– 9 Recurrent flashbacks
Yui et al.,
2001
Polymorphism in DAT Gene associated with MA
psychosis in Japanese
Ujike et al., 2003
Methamphetamine
Methamphetamine and Sex
Percent Responding
"Yes"
My sexual drive is increased by the use of …
100
90
80
70
60
50
40
30
20
10
0
85.3
70.6
55.6
55.3
43.9
male
female
18.1 20.5
11.1
opiates
alcohol
cocaine
meth
Primary Drug of Abuse
(Rawson et al., 2002)
Percent Responding
"Yes"
My sexual pleasure is enhanced by the use of
…
100
90
80
70
60
50
40
30
20
10
0
73.5
66.7
44.7
38.2
male
female
24.4
16.0 18.2
11.1
opiates
alcohol
cocaine
meth
Primary Drug of Abuse
(Rawson et al., 2002)
Percent Responding
"Yes"
My sexual performance is improved by the use of
…
100
90
80
70
60
50
40
30
20
10
0
58.8 61.1
32.4
male
female
24.4
19.1
18.4
15.9
11.1
opiates
alcohol
cocaine
meth
Primary Drug of Abuse
(Rawson et al., 2002)
Methamphetamine
Cognitive and Memory Effects
Memory Difference between Stimulant
and Comparison Groups
Stimulant (n=80)
Comparison (n=80)
7
Mean Scores
6
5
4
3
2
1
0
Word Recall**
Picture Recall**
Differences between Stimulant and
Comparison Groups on tests requiring
perceptual speed
Stimulant (n=80)
Comparison (n=80
Mean Scores
100
80
60
40
20
0
Digit Symbol**
Trail Making A*
Trail Making B**
Longitudinal Memory
Performance
number correct
25
20
control
baseline
3 mos
6 mos
15
10
5
0
rclw
rclp
wrec
test
prec
Frequency of Impairment by Neuropsychological Domain
60
60
% Impaired
Controls
MA Users
50
50
40
40
30
30
20
20
10
10
0
Attention/
Psychomotor
Speed
Learning
and
Memory
Working
Memory
Fluency
Inhibition
Executive Systems Function
0
Defining Domains:
Executive Systems Functioning
a.k.a. frontal lobe functioning.
Deficits on executive tasks assoc. w/:
– Poor judgment.
– Lack of insight.
– Poor strategy formation.
– Impulsivity.
– Reduced capacity to determine
consequences of actions.
Methamphetamine
Gender Differences
Women’s Issues
Craving
A
nx
Pa
ie
ra
ty
no
id
Id
ea
tio
n
Ps
yc
ho
tic
is
m
Ph
ob
ic
Ho
st
ili
ty
1.40
An
xi
et
y
So
m
O
at
bs
iz
es
at
io
si
ve
n
In
Co
te
m
rp
pu
er
ls
so
iv
na
e
lS
en
si
tiv
ity
De
pr
es
si
on
Mean BSI Score
Behavior Symptom Inventory (BSI)
Scores at Baseline
1.60
all significant at p< .001
Female
1.20
Male
1.00
0.80
0.60
0.40
0.20
0.00
Beck Depression Inventory (BDI)
Scores at Baseline
20.00
p < .001
18.00
Mean BDI Score
16.00
14.00
12.00
10.00
8.00
6.00
4.00
2.00
0.00
Female
Male
Self-Reported Reasons for Starting
Methamphetamine Use
40%
35%
*p< .001
Male
30%
Female
25%
20%
15%
10%
5%
0%
*to lose weight
*to relieve depression
Female Methamphetamine
Users: Social Characteristics
and Sexual Risk Behavior
Semple SJ, Grant I, Patterson TL
Women and Health
Vol. 40(3), 2004
Demographics (n=98)
Ethnicity
–
–
–
–
–
44% Caucasian
33% African American
16% Latina
2% Native American
5% Other
Education
– 96% had less than a college education
Marital Status
– 54% had never been married
Employment
– 77% were unemployed
Demographics
Psychiatric Health Status
– 38% reported having a psychiatric diagnosis
53% depression
17% bipolar
14% schizophrenia
Patterns of Use
– 83% smoked
Context of Meth Use
– Meth was used primarily with either a friend
(95%) or a sexual partner (84%).
Social and Legal Problems
– 36% reported having a felony conviction.
Reasons for Meth Use
Reasons for using meth were wide-ranging:
– To get high (56%)
– To get more energy (37%)
– To cope with mood (34%)
– To lose weight/feel more attractive (29%)
– To party (28%)
– To escape (27%)
– To enhance sexual pleasure (18%)
Sexual Partners of Meth-Using Women
On average women had 7.8 sexual partners in a twomonth period (SD=10.7, range 1-74).
84% had casual partners during the past two months.
– 90% of all casual partners were reported to be meth
users.
31% had an anonymous partner in the past two months.
– 76% of anonymous sex partners were meth users.
No spouses or live-in partners were reported to be HIVpositive.
Sexual Risk Behavior
Participants engaged in an average of 79.2 sex
acts over a two-month period.
Most sexual activity was unprotected. The
average number of unprotected and protected sex
acts over the two-month period was 70.3 and 8.8,
respectively.
In terms of unprotected sex:
– 56% of all vaginal sex acts were unprotected
– 83% of all anal sex acts were unprotected
– 98% of all oral sex acts were unprotected
Methamphetamine
Route of Administration
Percent Using by Route
Route of Methamphetamine
Administration
64
70
60
50
40
30
20
24
11
10
0
Route of Administration
intranasal (IN)
smoke (SM)
inject (IDU)
MA-Free Samples by Route
% of MA-free UA (3 wks)
0.7
0.6
0.5
0.4
0.3
IN
SM
IDU
0.2
0.1
0
P<.05
BSI Psychiatric Symptoms by Route
30
25
20
BL PST
TX-End PST
6-Mo PST
12-Mo PST
15
10
5
0
IN
SM
Positive Symptom Total (PST)
IDU
P<.05
Prevalence of Hepatitis C in the
U.S.
Hepatitis C is the most common blood borne
infection in the United States (CDC, 1998).
Hepatitis C virus (HCV) is efficiently transmitted
via injection drug use, which is the primary risk
factor for acquiring HCV (CDC, 2003).
The vast majority of injecting drug users in the
United States already are infected with HCV
(Hagan et al., 2001) with prevalence estimates
of 90% infection among individuals who injected
for 5 or more years (Garfein et al., 1996).
Hepatitis C and IV Drug Use:
Why Does it Matter?
IDUs are largest group of HCV infected
persons in U.S.
Approximately 1 million IDUs infected
Highest prevalence (80-90%) and
incidence (10-20%)
Source of most HCV transmission
HCV and substance use CAN be treated
together.
SOURCE: Brian Edlin, M.D., Institute for Health Policy Studies, University of California, San Francisco.
How Does Injection Drug Use Lead
to Hepatitis C Transmission?
Transfer of HCV-infected blood by sharing
needles/syringes
Contamination of drug preparation
equipment
Hepatitis C infection is acquired more
rapidly after initiation of injection drug use
than other viral infections (such as HIV
and hepatitis B)
Hepatitis C by Route
57
60
% Prevelance
50
40
30
21.05
20
22
IN (n=38)
SM (n=202)
IDU (n=72)
Total (n=314)
10
10
0
P<.05
Motivations Associated with
Meth Use among HIV+ MSM
Meth makes sex more pleasurable
Meth facilitates sexual experimentation
Meth helps participants to cope with an HIV+
diagnosis
Meth use provides a temporary escape from
being HIV+
Meth use helps the individual to manage
negative self-perceptions and social rejection
associated with being HIV+
SOURCE: S. Semple, et al. (2002) Journal of Substance Abuse Treatment, 22: 149-156
Club Drug Trends
Gay and Bisexual Male Substance Users
Jan 1, 1999 – Dec 31, 2004
70
60
50
Crystal
Percentage
40
Ecstasy
GHB
30
Special K
20
Club Drugs*
Other
Drugs**
10
Ju
l-D
Ja
nJu
n
99
(n
=5
93
ec
)
99
Ja
(n
=6
nJu
18
n
)
00
Ju
(n
=7
l-D
65
ec
)
00
Ja
(n
n=8
Ju
01
n
)
01
(
n=
Ju
10
l-D
73
ec
)
01
Ja
(n
=8
nJu
31
n
)
02
Ju
(n
=8
l-D
66
ec
)
02
Ja
(n
=7
nJu
55
n
)
03
Ju
(n
=7
l-D
30
ec
)
03
Ja
(n
=6
nJu
72
n
)
04
Ju
(n
=5
l-D
16
ec
)
04
(n
=4
57
)
0
•All club drugs (includes combination of crystal, ecstasy, GHB, special K ) **Other drugs (includes cocaine, crack, amyl nitrate, barbiturates)
11/16/05
Other Data on Meth-Using MSM
The following data is based on a sample of
90 HIV+ meth-using MSM:
– 46% identified as “binge” users
– Average binge lasted 5.6 days
– Binge users reported significantly more social
difficulties, sexual risk behaviors, and mental
and physical health problems
SOURCE: Patterson and Semple (2003) Journal of Urban Health, 80: iii77-iii87.
Exposure Risks by Geography, 2002
MSM
IDU
Het
Other
LA
MSM+
IDU
71.3% 7.0% 6.6%
4.6%
10.4%
SF
74.3% 8.8% 13.5%
1.7%
1.7%
Bakersfield
42.7% 28.4% 12.4% 10.3%
6.2%
Rvrsd/SnBrn 61.1% 14.4% 10.2%
6.8%
8.1%
NYC
9.8%
16.0%
29.5% 41.5% 3.2%
CDC, WONDER, 2004
In Los
Angeles
County,
heroin
injectors at
low risk;
gay male
meth users
at extreme
risk
% HIV Positive
Local Prevalence Data Sharpens
Understanding of HIV Epidemic
70
60
50
40
30
20
10
0
MMT-LAC Her-LAC
MethHWD
LAC HIV Epi (1999-2004); UCLA/ISAP (1998-2004)
Meth-RC
Methamphetamine and HIV in MSM:
A Time-to-Response Association?
100
90%
Percent HIV+
80
62%
60
41%
40
20
0
26%
8%
Probability
Sample*
Recreational
User**
Chronic Non
Treatment***
Outpatient
Drug-Free****
Residential****
* Deren et al., 1998, Molitor et al., 1998; ** Reback et al., in prep,
*** Reback, 1997; **** Shoptaw et al., 2002; ****VNRH, unpublished data
Treatment as Prevention
Substantial HIV risk decreases with Rx
Reductions begin soon after Rx starts
Lapses to unsafe sex are common
Individual factors can affect outcomes
AIDS prevention programs cannot reach
all at risk
Stall et al., 1999
Methamphetamine Use and HIV Risk
Behaviors Among Heterosexual Men –
Preliminary Results from Five Northern
California Counties, December 2001 –
November 2003*
*
Methamphetamine Use and HIV Risk Behaviors Among Heterosexual Men Preliminary Results from Five Northern California Counties, December
2001 – November 2003. Morbidity and Mortality Weekly Report. 2006;55:273277.
Objective of Study
Assess the association between
methamphetamine (MA) use and high-risk
sexual behaviors among heterosexual
men
Methods
Participants
– 1,011 men completed interviews
Living in low-income neighborhoods of Alameda,
Contra Costa, San Francisco, San Joaquin, and
San Mateo counties in northern California
18-35 years old
Analyses in this report were restricted to men who
reported having female sex partners exclusively
during the preceding 6 months, leaving 968
participants
Methods Continued
• Staff-Administered Interviews
Sexual-activity matrix
• Information recorded of up to 10 partners
during the preceding 6 months
• Sex and category of each sex partner
• Vaginal or anal intercourse
• Use of condoms
Methods Continued
• Staff-Administered Interviews Continued
Self-reported MA use (recent use and historical
use)
Self-report of ever having been tested for HIV or
chlamydial infection
Self-report of ever giving or receiving money or
drugs for sex or of having been forced into sex
Results
Recent MA users were more likely than
men who had never used MA to:
Be sexually active with a female partner
Have multiple female partners
Have a casual or anonymous female partner
Have anal intercourse with a casual or
anonymous female partner
Have a female partner who injected drugs
Have ever received money or drugs for sex from
a male or female partner
Results Continued
Recent MA use
n = 58
Never used MA
n = 817
No.
(%)
No.
(%)
Sexually active, past 6 mos
54
93.1
583
72.2
Anal sex with a female, past 6
mo
16
29.6
69
11.9
Casual or anonymous female
partner
35
64.8
259
44.4
1
21
38.9
367
63.1
2
18
33.3
87
14.8
3 to 5
9
16.7
100
17.2
>5
6
11.1
28
4.8
Partner who injected drugs
6
11.1
13
1.7
Ever received money or drugs
for sex
9
15.5
28
3.5
No. of female partners
Implications of Results
• The growing prevalence of HIV among
heterosexuals, together with the increased
use of MA nationwide and the findings of this
study, suggest the potential for MA to
influence heterosexual transmission of HIV
• Suggests the need for states to consider
including referrals to MA prevention and
treatment programs in their HIV prevention
programs
Sample Characteristics
305 Adolescents (13-18 years old)
Average Age ~ 16yrs old (sd=1.138)
Gender: 70.2% Males
Ethnicity: 55.3% White & 33.1% Latino
Ethnic Identification
60
55.3
Percent
50
40
33.1
30
20
3
1
n
ia
As
O
7.6
10
0
er
th
k
ac
Bl
te
hi
o
tin
La
W
Ethnicity
Drug of Choice: N=305
Methamphetamine
Pot
Alcohol
Methamphetamine & Pot
Methamphetamine & Alcohol
Pot & Alcohol
Cocaine
Opiates (Heroin)
Other
74 (24.3%)
149 (48.9%)
24 (7.9%)
9 (3%)
6 (2%)
26 (8.5%)
6 (2%)
3 (1%)
8 (2.6%)
Drug Use by Gender
90
85.1
80
70
63.7
60
50
36.3
40
30
20
14.9
10
0
Meth
Other
Males
Females
Treatment History
by Drug Use
Total
(N=275*)
*30 Missing
METH
(n=85)
OTHER
(n=190)
%
Completed
% Not
Completed
139
(50.5%)
136
(49.5%)
37
(43.5%)
46
(54.1%)
102 (53.7%)
88
(46.3%)
Legal Problems
Missing Data*
Total
(n=268)
OTHER
(n=189)*
METH
USERS
(n=79)*
177
124
53
(66.0%)
(65.6%)
(67.1%)
Illegal Behaviors
Arrest
Probation
Juvenile Hall
Psychological Distress
Missing Data*
Depression*
Suicidality
Attempted Suicide
Does not want to live
Like to injure
yourself
Psychopathology*
Paranoid Feelings
Losing Mind
Hearing Voices
P<.05
Total
% Yes
(n=275)
128
(46.5%)
OTHER
(n=196)
83
(42.6%)
METH
USERS
(n=79)
45
(57.7%)
72
(26.2%)
48
(24.5%)
24
(30.8%)
87
(31.6%)
53
(27.0%)
34
(43.0%)
Methamphetamine
Incarceration
Primary Substance Reported
by California Inmates
(N=22,903)
6
Marijuana
11.5
Alcohol
15
Heroin
17.4
Other
21.5
Cocaine
28.8
Methamph.
0
5
10
15
20
25
30
Methamphetamine Use, SelfReported Violent Crime, and
Recidivism Among Offenders in
California Who Abuse
Substances *
*
Cartier J, Farabee D, Prendergast M. Methamphetamine Use, SelfReported Violent Crime, and Recidivism Among Offenders in
California Who Abuse Substances. Journal of Interpersonal
Violence. 2006;21:435-445.
Objective of Study
Examine the associations between
methamphetamine (MA) use and three
measures of criminal behavior: (a) selfreported violent criminal behavior, (b)
return to prison for a violent offense, and
(c) return to prison for any reason.
Methods
Participants
– 808 low- to medium-level inmates
Clear history of substance abuse
Within 12 months of release
Half the sample entering an in-prison substance
abuse (SA) program and the other half from a
neighboring prison that offered no formal SA
treatment
Matched by age, ethnicity, sex offender status, and
commitment offense
Methods Continued
• Baseline and 12-Month Follow-Up Interviews
Modified versions of criminal justice treatment
evaluation forms developed by researchers at
Texas Christian University
Sections on sociodemographic background, family
and peer relations, health and psychological
status, criminal involvement, in-depth drug-use
history, and an AIDS-risk assessment
Methods Continued
Drug Trade Involvement
– Self-report of sales, distribution, or manufacturing of
drugs during the 30 days prior to follow-up
One-Year Recidivism
– Based on California Department of Corrections
records
– General recidivism (return to prison for any reason)
– Violent crime (murder, manslaughter, robbery,
assault)
Results
Those who used MA (81.6%) were
significantly more likely than those who
did not use MA (53.9%) to have been
returned to custody for any reason or to
report committing any violent acts in the
30 days prior to follow-up (23.6% vs.
6.8%, respectively)
Results Continued
After controlling for drug trade
involvement, MA use was still significantly
predictive of self-reported violent crime
and general recidivism
Implications of Results
• These findings suggest that offenders who
use MA may differ significantly from their
peers who do not use MA and may require
more intensive treatment interventions and
parole supervision than other types of
offenders who use drugs
Possible Limitations
•
Self-Reports
But evidence exists that the concordance of
self-report with actual crime committed is
quite high
•
Absence of Arrest Records
Reliance on records that contain only the
offense for which the parolee was convicted,
or pled guilty to, not the full array of charges
cited at arrest
•
Drop-Out
Lost 19% of the original cohort to follow-up
But no significant differences between this
subgroup and the larger group in basic
demographic variables and recidivism rates
Methamphetamine
Cognitive and Memory Effects
Memory Difference between Stimulant
and Comparison Groups
Stimulant (n=80)
Comparison (n=80)
7
Mean Scores
6
5
4
3
2
1
0
Word Recall**
Picture Recall**
Differences between Stimulant and
Comparison Groups on tests requiring
perceptual speed
Stimulant (n=80)
Comparison (n=80
Mean Scores
100
80
60
40
20
0
Digit Symbol**
Trail Making A*
Trail Making B**
Longitudinal Memory
Performance
number correct
25
20
control
baseline
3 mos
6 mos
15
10
5
0
rclw
rclp
wrec
test
prec
Frequency of Impairment by Neuropsychological Domain
60
60
% Impaired
Controls
MA Users
50
50
40
40
30
30
20
20
10
10
0
Attention/
Psychomotor
Speed
Learning
and
Memory
Working
Memory
Fluency
Inhibition
Executive Systems Function
0
Defining Domains:
Executive Systems Functioning
a.k.a. frontal lobe functioning.
Deficits on executive tasks assoc. w/:
– Poor judgment.
– Lack of insight.
– Poor strategy formation.
– Impulsivity.
– Reduced capacity to determine
consequences of actions.