A large California study finds favorable effects for inpatients and outpatients; women's gains are larger.
By Lori Whitten, NIDA NOTES Staff Writer
Methamphetamine abusers can achieve long-term abstinence with the help of standard communitybased drug abuse treatment. Nine months after beginning therapy, 87 percent of patients treated for heavy or long-term methamphetamine abuse in California outpatient and residential programs were abstinent from all drugs, according to a NIDA-supported analysis. "In the public dialogue, and even among professionals in the field, one sometimes hears that meth abuse is 'not treatable.' But that view is not borne out by recent clinical trials or our study, which shows that community-based treatment reduces drug abuse and other problems," says lead investigator Dr. Yih-Ing Hser.
"Because methamphetamine abusers respond to treatment, getting them into therapy is a top priority. For women, there is added urgency to help them avoid exposing the children they may bear to the consequences of prenatal drug exposure."
Dr. Hser and colleagues at the University of California, Los Angeles analyzed data from the California Treatment Outcome Project (CalTOP), an ongoing study that has followed the progress of adult substance abusers treated at 43 outpatient and residential programs throughout the State since April 2000. The researchers focused on 1,073 patients who reported that methamphetamine abuse was their primary drug problem (572) or that they had abused the stimulant regularly for at least 1 year before beginning treatment (501). Most were in their 30s or younger, White or Latino, unemployed, and on public assistance; most had an arrest history. They had abused methamphetamine for about 9 years, on average, and nearly one-quarter (22 percent) reported injecting drugs at least once. Although 64 percent had children aged 18 or younger, one-third of parents did not live with their children in the month before beginning treatment. One parent in five reported that a child protection court had ordered that his or her children live with someone else, and 6.3 percent had their parental rights terminated by the State.
The patients received the addiction treatment services routinely provided by each program. These usually included group therapy, with an average of 69 drug-related and 51 alcohol-related sessions during the first 3 months of treatment. On average, the patients also received 22 sessions on dealing with mental health symptoms and 13 addressing psychosocial problems, including family, parenting, and employment.
More than 60 percent of the patients completed 3 months of treatment. Among all the patients in the study—those who finished 3 months and those who did not—the average reported frequency of methamphetamine abuse fell from 2.7 to 0.5 days per month from the start of treatment to 9 months later. The portion who were abstinent from all drugs rose from 55 percent to 87 percent in the same interval, and 68 percent were abstinent and also not incarcerated. Patients improved in all areas—drug and alcohol abuse; mental health symptoms; and employment, family, and legal problems—except one: men's medical problems.
Dr. Thomas Hilton of NIDA's Division of Epidemiology, Services and Prevention Research says these findings should reassure professionals working in the addiction, social services, and criminal justice fields that current therapies work for these troubled patients. "Dr. Hser's findings suggest that treatments available in the community help meth abusers reduce drug abuse and start to get their lives back on track, echoing prior research," he says.
Dr. Hser's findings confirm gender differences seen in other studies: Women began treatment with more severe psychosocial problems than men (see chart) and benefited more. Although treatment retention levels were similar for the two sexes, the women made greater gains in the areas of family relationships and medical problems, while achieving similar improvements in all other areas at the 9-month followup. The women's better outcomes may have resulted in part from more intensive services (see chart); as well, Dr. Hser says that many women in the study had a powerful motivator—family. "Many were trying to maintain or regain custody of their children by demonstrating improvement during treatment. Others had 'hit bottom,' saw how drug abuse was hurting their families, and decided to make a change," she says.
|WOMEN RECEIVE MORE SERVICES IN SOME AREAS For some problems, women received more services than men during the first 3 months of treatment.
||Women (No. of interventions†)
||Men (No. of interventions†)
|†Includes counseling sessions, medical appointments, and prescriptions. *Outpatients. ‡Outpatient and residential.
"Because methamphetamine abusers respond to treatment, getting them into therapy is a top priority. For women, there is added urgency to help them avoid exposing the children they may bear to the consequences of prenatal drug exposure," says Dr. Hser.
|MEN, WOMEN EXPERIENCE DIFFERENT PROBLEMS Women beginning treatment for
methamphetamine abuse reported more psychosocial problems, while men reported more crime and criminal justice involvement.
|Family and Social Circumstances
|Children living with someone else by court order
|Parental rights terminated
|Family abused substances
|Physically abused (past month)
|Sexually abused (past month)
|On public assistance
|Criminal Justice System Involvement
|Arrest in past year
|Criminal activity (past month)
|Psychiatric Symptoms (Past Month)
|Difficulties with understanding,
|Prescribed psychiatric medicine
Dr. Hser and her colleagues continue to analyze CalTOP data, aiming to determine the longer-term impact of therapy and identify ways programs can improve outcomes. "Enhancing psychiatric, parenting, and employment services would better match patients' needs, and my team plans to study the relationship between help for these problems and longer-term outcomes," says Dr. Hser. They also plan to investigate whether women-only treatment is more effective for pregnant methamphetamine abusers than mixed-gender programs.
"The field needs more research following meth abusers over time to get a picture of the long-term outcomes of treatment, relapse episodes, and whether these patients require additional support to sustain gains made during therapy," says Dr. Hilton. "Because the availability of community health and social services varies across States, we cannot generalize the findings from one State, such as California. We need data from across the country," he adds.
Hser, Y.-I.; Evans, E.; and Huang, Y.-C. Treatment outcomes among women and men methamphetamine abusers in California. Journal of Substance Abuse Treatment 28(1):77-85, 2005. [Abstract]
Volume 20, Number 5 (April 2006)