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

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

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

4. 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)

5. 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

6. 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

7. 4-month treatment schedule

8. 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

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

10. 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

11. 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)

12. 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)

13. 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?