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Methamphetamine Treatment

Methamphetamine - Is It A Special Population?
Treating Methamphetamine in the Therapeutic Community

Methamphetamine, an addictive stimulant commonly referred to as “crystal meth,” “crank,” “ice,” or simply“meth,” has risen to prominence in recent years as a major drug of abuse in this country. The drug, which can come in pill form, capsules, powder, and chunks and can be smoked, injected, inhaled or swallowed, acts as a stimulant on the central nervous system.

Short-term effects of the drug include increased alertness, intense feelings of euphoria, and insomnia, while long-term effects can include violent behavior, anxiety, and psychotic characteristics such as paranoid delusions and hallucinations. Chronic meth users have been shown to suffer temporary or permanent damage to brain structures responsible for decision-making, memory, and motor skills. 

Unfortunately, more and more Americans are being drawn into the dangerous trap of meth use. According to the 2003 National Survey on Drug Use and Health, approximately 12.3 million Americans ages 12 and over have tried meth. A 2005 survey conducted by the National Association of Counties (NACO) found that 58 percent of the sheriffs and child welfare officials surveyed say methamphetamine abuse is the biggest drug problem in their counties.

And this is a problem that is growing rapidly, as meth continues to spread throughout the country. The same NACO study found that 67 percent of the sheriffs surveyed reported an increase in meth-related arrests in the last year. The Drug Abuse Warning Network found a 160 percent increase in meth-related emergency room visits over the last ten years. And in just one year, between 2002 and 2003, meth-related admissions to substance abuse treatment increased by ten percent.

In the words of Chris Jones, a member of the clinical staff from Pathway Society, Inc., a San Jose, California-based TCA member, “The methamphetamine problem in the US is epidemic. Just as the nation experienced the crack cocaine craze of the 80’s, we are experiencing the usage of methamphetamine today.”

Responses to the Methamphetamine Wave

Fortunately, the growing meth problem has not escaped the attention of policymakers and the general public. In the first six months of 2005, Congress had introduced 20 methamphetamine-related bills. The Congressional Addiction, Treatment and Recovery Caucus sponsored an April 6 briefing in the Cannon House Office Building that highlighted the principles of effective meth treatment. And language in the Fiscal Year 2006 Senate Labor, Health, and Education Appropriations bill explicitly acknowledges the scope of the meth problem, stating that the Appropriations Committee “remains very concerned about the prevalence of methamphetamine use.”  

However, some policymakers and members of the public appear to hold the belief that treatment for methamphetamine addiction is a lost cause. A review of the bills introduced this year in Congress reveals an abundance of proposals to enhance interdiction and law enforcement, but very little focus on treatment.

While TCA commends Congress for its efforts in combating the spread of meth, we believe much of the legislation reflects the mistaken assumption that methamphetamine addiction is not responsive to treatment and therefore not a part of the public policy solution.Public policy should look to funding existing programs that are evidence-based and have been shown to be effective in treating addiction. It would be a mistake to believe that the successes these programs have had in treating other addictive substances are not applicable to methamphetamine.

Successes Treating Methamphetamine Use

The reality, according to TCA members and other treatment professionals, is that meth is in fact very treatable.

Jeff Bliesath, a clinician from Pacific House of San Diego, a program run by TCA member Mental Health Systems, points out that in the 1980’s, crack cocaine was thought by many to be untreatable. This was proven to be wrong, and yet some have fallen into the same patterns of thinking when it comes to methamphetamine treatment.

In the words of Marcus Thompson, Intake Coordinator from Pathway Society, “Meth users can (and do!) recover with the proper motivation, appropriate treatment, and an adequate support system.”

Dr. Ken Bachrach, a clinician at Southern California-based TCA member Tarzana Treatment Center, concurs.

“Overall success rates have been the same or better in Tarzana’s programs after the meth wave came as compared to before. Meth users initially experience some cognitive deficits, but otherwise there is not much of a difference between them and other users.”

Statistics vary in describing methamphetamine treatment efficacy, but all confirm that, at least for some members of the population, substance abuse treatment does work.

Colorado’s Alcohol and Drug Abuse Division reported in 2003 that 80% of meth users were abstinent at discharge from treatment, while the State of Utah gave a 61% figure.

Several different addiction counselors at Pathway Society gave estimates of one-year abstinence rates that ranged from 30% to 35% for meth users treated at their facilities.

Dr. Bachrach has found that in Tarzana’s TCs, meth users complete treatment in slightly lower percentages than patients using other drugs.

These differing treatment outcomes suggest that evidence-based research on treatment protocols, methodology, and modalities is essential.

Treatment approaches

TCA members and other treatment providers employ a variety of methods for treating meth addiction, but the different approaches all conform to the basic principles of addiction treatment. Many agree that what is needed is a lifestyle change, and that meth users in TCs or other evidence-based treatment programs can be treated effectively alongside users of other drugs. Many also agree that meth users can require some modifications to standard treatment protocols in order to account for the temporary brain impairments caused by heavy meth usage. 

TCA member WestCare, which has experience treating meth users in Nevada, California, and several other states, emphasized these special mental health considerations in oral testimony given by TCA President Richard Steinberg on April 21, 2005 in front of the Senate Labor, Health and Human Services and Education Appropriations Subcommittee.

“WestCare’s experience is that long-term meth abusers require longer terms of treatment than abusers of other substances, in part because of the length of time required for the brain to heal from meth-caused damage. From our perspective, there appear to be significant mental health consequences to meth abuse, implications that are different from those associated with abuse of other substances such as cocaine or heroin.”

For Dr. Bachrach, adapting to the special challenges posed by meth users has allowed Tarzana to improve their programs as a whole. “We have seen some improvement [in treatment outcomes], as we’ve adapted our strategies across the board in response to the influx of meth.”

According to Dr. Bachrach, Tarzana now employs more motivational interviews and presents information more slowly and deliberately in the beginning stages of treatment, a reaction to the short-term cognitive deficits of meth users during the detox stage. Tarzana has also educated their staff on what to expect from newly admitted meth users, such as the common psychological symptoms and learning difficulties.

Pacific House, like other programs, has had success applying standard TC treatment components to meth users. Mr. Bliesath statedthat his program has not had to make any major modifications to its programs, despite the fact that approximately two-thirds of his clients are now meth users. He echoes the experiences of WestCare and Tarzana, however, in pointing out that meth users sometimes need to be watched a bit closer in the first few weeks to check for any underlying mental illnesses.

Methamphetamine addiction has also been successfully treated in outpatient settings. The Matrix Model, has been found to be particularly effective for meth users. The Matrix Model is a 16-week program that calls for three days of treatment per week using behavioral, educational, and 12-step counseling techniques specially developed for treating stimulant abuse. In one federally funded study, the Methamphetamine Treatment Project, meth users treated under the Matrix Model were found to attend more clinical sessions, stay in treatment longer, and remain abstinent more frequently than those treated with standard outpatient treatment protocols.

Regardless of treatment modality, one thing is clear: We can, and should, continue to use evidence-based substance abuse treatment to fight the scourge of methamphetamine addiction.