Methamphetamine: How effective are current treatment programs?

This series of articles has provided a brief overview of methamphetamine – its effects on mind and body, social costs, the scope of the problem in Wyoming and Uinta County, and with today’s installment, treatment for those affected by the substance.

Typically, drug treatment programs are divided into outpatient, where participants continue to live and work in their community, and inpatient, where those in treatment are placed in a hospital or residential setting where their freedom is more limited and they will live until program completion. Traditionally, outpatient treatment programs are 8-12 weeks in length, and hospital-based or residential inpatient programs are 21 or 28 days in length. Aftercare group treatment follows both outpatient as well as inpatient interventions with the patient attending once per week for one year. During the course of treatment, random urine testing of the patient averages one time per week. These are examples of typical substance abuse treatment programs consistent with currently prevailing standards of care. An innovation in drug treatment allowed for the “half-way house,” a hybrid program, usually of six months duration, where the patient lives and attends daily meetings but returns to work in the community concurrently. Other experimental treatment models are in use but the above protocols have been standard for years.

As we review data on treatment failures, we find methamphetamine users are highly over represented, i.e., standard treatment protocols are not working well for methamphetamine abusers. Recalling that dopamine cells are killed by repeated use of methamphetamine, that these cells are a critical part of the brain’s “natural reward” system, i.e., needed for motivation and to keep interest in pleasurable things, and finally that it takes 2-3 years for regeneration of these cells following abstinence from the drug, these treatment failures make more sense.

Methamphetamine is an extremely potent central nervous system stimulant with effects lasting 12-24 hours. Following the “high” from the drug is a “crash” or long period of depression and exhaustion which stands in sharp contrast to the euphoric, energetic effect initially obtained from the drug. Repetitive, compulsive use of methamphetamine is in large part attributable to efforts to avoid the extreme depression as the high wears off, i.e., withdrawal, and the user desperately seeks to regain even a normal mood state. It therefore becomes difficult to remain drug free when to do so means you will remain depressed for a very long time; 2-3 years with an average being about 2 years.

Effective treatment of methamphetamine abuse, according to Dr. Sushma Taylor, CEO of Centerpoint, the model methamphetamine treatment program in California, requires longer treatment protocols. He prescribes 9-12 months of intensive outpatient work consisting of 3-4 hours, 4-5 times per week with various levels patients advance through based on successful participation, or 3-6 months of intensive inpatient treatment. Additionally, both programs are followed by extended aftercare groups lasting two years. First year aftercare groups should meet 2-3 times per week and once per week for the second year as patients are able to progress. Random urine samples need to be taken two times per week to assure abstinence or to identify relapses. Individual sessions with substance abuse professionals need to be regularly available to help patients deal with attendant hurt and anger which may be too personal for group settings.

Eventually, individuals will be exposed to environmental cues such as smells, certain places, or people which will trigger cravings for the drug and require support be available and accessed by those in recovery. Relapse-prevention in aftercare helps to address this ahead of time so those tempted to use have a plan in place. Family involvement is important to treatment and family education, in addition to “family week,” an intensive week-long component conducted by therapists with educational and family interactional dynamic analysis and intervention provided to participants, is essential to healing. Relapse-prevention will be facilitated by a family support group and by a continuing peer-support group.

Getting former methamphetamine users back to work as productive, contributing members of the community as soon as practical and sustainable for the patient is important for both the person in recovery from methamphetamine abuse and the community to which prior users often owe some restitution. However, aftercare support, extended beyond traditionally typical times, will be a critical treatment component supporting the methamphetamine user’s recovery and decreasing chances that the person will again turn to methamphetamine and give up life as a productive, responsible, law-abiding citizen.