Efforts to Reduce Meth Use and Sexual Risk Mary McFarlane, PhD Division of STD Prevention Centers for Disease Control and Prevention

Meth Withdrawal Can last from 2-10 days Injectors suffer severe withdrawal Symptoms Depression Fatigue Anergia Paranoia Anxiety Agitation Confusion Rawson (2006)

Challenges to success Retention rates are low Relapse rates are high Severe paranoia and psychosis Craving Dysphoria Anhedonia Rawson (2006)

Contrary to popular opinion… Meth users respond to treatment in a similar manner as other substance abusers respond. No differences between meth and other drug users in: Retention rates Urinalysis results during treatment Treatment program completion rates Huber, Link and Rawson (1997)

Pharmacologic Treatment No current medication effectively “treats” the withdrawal from meth or the craving Some evidence indicates that these drugs may be helpful: Bupropion Methylphenidate SR Newton et al., 2005; Elkashef et al., 2006; Tiihonen,et al., 2006

Matrix Treatment Model Elements of the model include: Therapist support Group/Individual participation 12-step or other spiritual group involvement Relapse prevention and education Family involvement Structure UCLA Integrated Substance Abuse Programs, 2006

4-month treatment schedule

Intervention Study for Methamphetamine-Dependent MSM Treatment-seeking, meth-dependent MSM enrolled in behavioral intervention with 4 arms: Gay-specific cognitive behavioral therapy (CBT) CBT based on MATRIX Contingency management (CM -- “peeing for dollars”) CM + CBT 40 participants in each arm Behavioral interventions were 90 minute sessions, 3x weekly for 16 weeks CM provides positive reinforcement in form of vouchers for producing drug-free urine samples Participants earn up to $200-$1,000 in vouchers Observed urine samples collected 3x weekly Reduces rates of heroin, cocaine, alcohol use Shoptaw et al, 2005

Research on Drug Treatment to Reduce Risk: Post-treatment Reduction of URA (30-day) Shoptaw et al., 2005

Results The following behaviors significantly decreased for all conditions by 4 months post BL (end of treatments), and 6 and 12 month later: recent meth use recent URA recent UIA recent number of partners No difference between groups Shoptaw et al, 2005

Sexual Risk Reduction Interventions for Substance Users: In Progress Project MIX – DHAP, PRB (5-year project ending Sept 2007) Meth-focused Intervention Pilot – DHAP, PRB (2-year project beginning Sept 2006)

Media Campaigns: Lack of Evaluation Data Media approach to catch the attention of MSM and change norms, attitudes, and behaviors Community mobilization around campaigns, but generally lack evaluation data Examples from 2005: “Huge Sale!” – HIV Prevention Forum, New York City “Crystal Mess” – San Francisco DPH Montana Meth Project (teens in general)

Summary Treatment for meth dependence does exist and can be effective Recovery is possible and many or most brain changes are reversed after abstinence Is prevention of meth use possible?