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The CSAT Methamphetamine Treatment Project

The CSAT Methamphetamine Treatment Project. A Multi-site Trial of a Manualized Psychosocial Protocol for the Treatment of Methamphetamine Dependence. Richard Rawson Ph.D. U.C.L.A. Integrated Substance Abuse Programs (I.S.A.P.) The MTP Site Investigators

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The CSAT Methamphetamine Treatment Project

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  1. The CSAT Methamphetamine Treatment Project A Multi-site Trial of a Manualized Psychosocial Protocol for the Treatment of Methamphetamine Dependence Richard Rawson Ph.D. U.C.L.A. Integrated Substance Abuse Programs (I.S.A.P.) The MTP Site Investigators Funded by the Center for Substance Abuse Treatment

  2. What Is Methamphetamine? • Powerfully addictive stimulant • that dramatically affects the • central nervous system • Made easily in clandestine labs • with OTC ingredients

  3. How Is Methamphetamine Taken? • Methamphetamine comes in many forms and can be: • Smoked • Snorted • Orally Ingested • Injected

  4. Scope of the Methamphetamine Problem Worldwide • According to surveys and estimates by WHO and UNDCP, methamphetamine is the most widely used illicit drug in the world except for cannabis. • World wide it is estimated there are over 35 million regular users of methamphetamine, as compared to approximately 15 million heroin users and 10 million cocaine users

  5. Scope of Methamphetamine Use in the United States • Methamphetamine abuse, long reported as the dominant drug problem in Honolulu, Hawaii and San Diego, CA, has become a substantial drug problem in other sections of the West, Midwest & Southwest, as well. • Indications that it is spreading to rural and urban sections of the South and East coast. • Once traditionally associated with white, male, blue-collar workers. • Now is being used by more diverse population groups that change over time and differ by geographic area.

  6. Groups with High Rates of Meth Use • Women • Residents in Western/Midwestern Rural Areas and Small/Medium Cities • Predominantly Caucasian, Increasing Numbers of Hispanics • Gay Men

  7. CSAT MTP Project Goals: • To study the clinical effectiveness of the Matrix Model • To compare the effectiveness of the Matrix model to other locally available outpatient treatments • To establish the cost and cost effectiveness of the Matrix model compared to other outpatient treatments • To explore the replicability of the Matrix model and challenges involved in technology transfer

  8. Manuals in Psychosocial Treatment • Reduce therapist differences • Ensure uniform set of services • Can more easily be evaluated • Enhance training capabilities • Facilitate research to practice

  9. Matrix Model ofOutpatient Treatment Organizing Principles of Matrix Treatment • Program components based upon scientific literature on promotion of behavior change. • Program elements and schedule selected based on empirical support in literature and application. • Program focus is on current behavior change in the present and not underlying “causes” or presumed “psychopathology”. • Matrix “treatment” is a process of “coaching”, educating, supporting and reinforcing positive behavior change.

  10. Matrix Model ofOutpatient Treatment Organizing Principles of Matrix Treatment • Non-judgemental, non-confrontational relationship between therapist and patient creates positive bond which promotes program participation. • Therapist as a “coach” • Positive reinforcement used extensively to promote treatment engagement and retention. • Verbal praise, group support and encouragement other incentives and reinforcers.

  11. Matrix Model ofOutpatient Treatment Organizing Principles of Matrix Treatment • Accurate, understandable, scientific information used to educate patient and family members • Effects of drugs and alcohol • Addiction as a “brain disease” • Critical issues in “recovering” from addiction

  12. Matrix Model ofOutpatient Treatment Organizing Principles of Matrix Treatment • Behavioral strategies used to promote cessation of drug use and behavior change • Scheduling time to create “structure” • Educating and reinforcing abstinence from all drugs and alcohol • Promoting and reinforcing participation in non- drug-related activities

  13. Matrix Model ofOutpatient Treatment Organizing Principles of Matrix Treatment • Cognitive-Behavioral strategies used to promote cessation of drug use and prevention of relapse. • Teaching the avoidance of “high risk” situations • Educating about “triggers” and “craving” • Training in “thought stopping” technique • Teaching about the “abstinence violation effect” • Reinforcing application of principles with verbal praise by therapist and peers

  14. Matrix Model ofOutpatient Treatment Organizing Principles of Matrix Treatment • Involvement of family members to support recovery. • Encourage participation in self-help meetings • Urine testing to monitor drug use and reinforce abstinence • Social support activities to maintain abstinence

  15. Matrix ModelAn Integrated, Empirically-based, Manualized Treatment Program

  16. Elements of the Matrix Model • Engagement/Retention • Structure • Information • Relapse Prevention • Family Involvement • Self Help Involvement • Urinalysis/Breath Testing

  17. The Matrix Model • Urine or breath alcohol tests once per week, weeks 1-16

  18. Table 1. Sites participating in the MTP (from Herrell et al, 2000) Coordinating Center Principal Investigators Directors University of California at Los Angeles (UCLA) Integrated Substance Abuse Programs (ISAP) M. Douglas Anglin, Ph.D. Richard A. Rawson, Ph.D. Patricia Marinelli-Casey, Ph.D. , Project Director Jeanne Obert, MFT, Clinical Alice Huber, Ph.D. Research Chris Reiber, Ph.D. Statistics Grantee / Site* Principal Investigator Lead Evaluator County of San Mateo, Belmont, CA: Two sites: ODASA and Pyramid Yvonne Frazier, Ph.D. County of San Mateo, Alcohol and Drug Services; Belmont, CA Joseph Guydish, Ph.D. University of California at San Francisco; San Francisco, CA East Bay Community Recovery Project, Hayward, CA Joan Zweben, Ph.D. East Bay Community Recovery Project; Hayward, CA Judith Cohen, Ph.D., M.P.H. East Bay Community Recovery Project; Hayward, CA Matrix Institute, Costa Mesa, CA Michael McCann, M.A. Matrix Institute; Costa Mesa, CA Vikas Gulati, B.S. Matrix Institute; Costa Mesa, CA New Leaf Treatment Center, Lafayette, CA Gantt Galloway, Pharm.D. New Leaf Treatment Center; Lafayette, CA Janice Stalcup, Ph.D. New Leaf Treatment Center; Lafayette, CA San Diego Association of Governments, San Diego, CA Susan Pennell, M.A. San Diego Association of Governments; San Diego, CA Cynthia Burke, Ph.D. San Diego Association of Governments; San Diego, CA South Central Regional Mental Health Center, Billings, MT Denna Vandersloot, B.S. South Central Regional Mental Health Center; Billings, MT Russell H. Lord, Ph.D. Montana State University; Billings, MT St. Francis Medical Center, Honolulu, HI A lice Dickow, B.A. St. Francis Women’s Addiction Treatment Center, Hawaii; Honolulu, HI Ewa Stamper, Ph.D. St. Francis Women’s Addiction Treatment Center, Hawaii; Honolulu, HI

  19. Site Duration of Treatment Intensive Phase Individual Sessions Group Sessions 12-Step Program Involvement Site 1 8 wks 1x/wk x 4-8 wks, 30-50 min each 4x/wk x 4-8 wks, 3hr each, families attend 1x/wk required; 1x/wk x 4-8 wks Site 2 12 wks 1x/wk x 12 wks, 1 hr each 5x/wk x 2wk, 3x/wk x 2wks, 2x/wk x 8 wks recommended Site 3 12 wks 1x/wk x 12 wks, 1 hr each none recommended Site 4 16 wks 1x/wk x 16 wks, 10-15 min each 3x/wk x 16 wks, 1 hr each required; 3x/wk x 16 wks Site 5 12 wks 1x/wk x 12 wks, 30-60 min each 3x/wk x 12 wks, 90 min each and 2x/wk x 12 wks, 60-90 min each required; 1x/wk x 12 wks Site 6 12 wks 1x/wk – 2x/mo x 12 wks, 1 hr each 2x/wk x 12 wks, 90 min each, families attend 1x/2 wks recommended Site 7 16 wks 1x/wk x 16 wks, 1 hr each 2x/wk x 16 wks, 2 hrs each recommended Site 8 12 wks 2x/wk x 12 wks, 1 hr each 1x/wk x 12 wks, 2 hrs each required; 6 meetings Table 2. Treatment-As-Usual: Elements of Treatment

  20. Site TAU (n) Matrix 16-week (n) Total Site 1 69 73 142 Site 2 78 77 155 Site 3 77 76 153 Site 4 50 57 107 Site 5 61 63 124 Site 6 73 70 143 Site 7 24 22 46 Site 8 54 54 108 Overall TOTAL 486 492 978 Table 3. Enrollment in the MTP by Site and Treatment Condition

  21. Characteristic Summary % Male 45 Age (Yrs.), mean (sd) 32.8 (8.0) Ethnicity (%) Caucasian 60 African-American 2 American Indian 3 Asian/Pacific Islander 17 Hispanic 18 Educational Attainment Level (yrs.), mean (sd) 12.2 (1.7) % Employed 69 % Married (and not separated) 16 Overall Substance Use Patterns-Lifetime (yrs.), mean (sd) Methamphetamine 7.54 (6) Alcohol 7.6 (8.5) Cocaine 1.75 (3.5) Cannabis 7.15 (8) Overall Substance Use Patterns—Days in Past 30, mean (sd) Methamphetamine 11.53 (9.6) Alcohol 4.72 (7.3) Cocaine 0.21 (1) Cannabis 4.38 (8.3) Preferred Route of Administration of MA (%) Oral 0 Nasal 11 Smoked 65 IV- injection 24 Table 4. MTP Participant Characteristics (taken from baseline ASI)

  22. Sample Description

  23. Baseline Demographics

  24. Gender Distribution of Participants

  25. Ethnic Identification of Participants

  26. Marital Status of Participants

  27. Employment Status of Participants

  28. Route of Methamphetamine Administration

  29. Changes from Baseline to Treatment-end

  30. Days Paid for Work in Past 30 Possible is 0-30; tpaired=6.01; p-value<0.000 (highly sig.)

  31. Total Income (Past 30 days)of Participants tpaired=2.34; p-value=0.02 (sig.)

  32. ASI Composite Scores Possible is 0-1; Higher : worse problem tpaired: *p-value<0.03 (sig.), **p-value<0.000 (highly sig.)

  33. Days of Methamphetamine Use in Past 30 (ASI) Possible is 0-30; tpaired=20.90; p-value<0.000 (highly sig.)

  34. Days of Marijuana Use in Past 30 (ASI) Possible is 0-30; tpaired=8.02; p-value<0.000 (highly sig.)

  35. Days of Alcohol Use in Past 30 (ASI) Possible is 0-30; tpaired=6.47; p-value<0.000 (highly sig.)

  36. Beck Depression Inventory (BDI) Total Scores Possible is 0-63; tpaired=16.87; p-value<0.000 (highly sig.)

  37. BSI Scores (mean) 1Possible, all scores, is 0-4; *all p-values<0.000 (highly sig.)

  38. Positive Symptom Total (PST) from Brief Symptom Inventory (BSI) Possible is 0-53; tpaired=14.33; p-value<0.000 (highly sig.)

  39. Site (TAU length, wks.) TAU Mean SD Matrix 16-week Mean SD Site 1 (8) 17.2 25.2 Site 2 (12) 21.7 26.1 Site 3 (12) 6.3 28.4 Site 4 (16) 22.8 31.5 Site 5 (12) 15.4 25.7 Site 6 (12) 2.1 25.2 Site 7 (16) 13.8 35.4 Site 8 (12) 3.9 22.2 Overall summary 12.7 26.8 Table 5. Summary of the number of clinical contacts made by participants, by treatment group and site

  40. Figure 3. Participant retention throughout treatment, by site and treatment group

  41. Site TAU length (wks.) Log-rank Chi-square p Site 1 8 -20.07 33.17 <0.0001 Site 2 12 -9.49 4.98 0.026 Site 3 12 -8.39 3.68 0.055 Site 4 16 1.64 0.26 0.610 Site 5 12 -22.30 28.74 <0.0001 Site 6 12 -17.46 17.87 <0.0001 Site 7 16 -5.01 3.34 0.067 Site 8 12 -10.59 7.99 0.005 Table 7. Comparison of retention between groups within sites, with Matrix truncated to the length of TAU at each site

  42. Figure 4. Percent completing treatment, by group

  43. Figure 5. Mean number of MA-free urine samples, by treatment length and treatment group (Matrix group data truncated to the length of TAU)

  44. Site (TAU length, wks.) Raw Data Truncated Data Matrix16 TAU Matrix16 TAU t p mean SD mean SD mean SD mean SD Site 1 (8) 6.23 3.38 3.75 3.38 -0.76 0.45 Site 2 (12) 6.25 4.19 4.86 4.19 -0.94 0.35 Site 3 (12) 5.75 3.62 4.61 3.62 -1.52 0.13 Site 4 (16) 8.44 8.6 8.44 8.6 0.13 0.89 Site 5 (12) 5.19 1.72 4.30 1.72 -3.70 0.0003 Site 6 (12) 4.24 3.27 3.3 3.27 -0.04 0.97 Site 7 (16) 7.0 4.54 7.0 4.54 -1.50 0.14 Site 8 (12) 5.39 3.30 4.28 3.30 -1.23 0.22 Table 8. Summary of the number of MA-free urine samples provided by participants, by treatment group and site

  45. Site (TAU length, wks.) Raw Data Truncated Data Matrix16 TAU Matrix16 TAU t p mean SD mean SD mean SD mean SD Site 1 (8) 3.575 2.754 2.877 2.754 -0.982 0.328 Site 2 (12) 3.753 2.474 3.377 2.474 -1.47 0.144 Site 3 (12) 3.197 1.805 3.013 1.805 -2.16 0.033 Site 4 (16) 6.140 5.560 6.140 5.560 -0.546 0.586 Site 5 (12) 3.889 1.279 3.429 1.279 -3.393 0.001 Site 6 (12) 2.429 2.342 2.314 2.342 0.2 0.841 Site 7 (16) 4.682 2.542 4.682 2.542 -1.586 0.121 Site 8 (12) 2.833 2.130 2.519 2.130 -0.551 0.583 Table 9. Longest MA abstinent period by treatment group and site

  46. Figure 2. Mean number of weekly data visits attended, by treatment length and treatment group (Matrix group data truncated to the length of TAU)

  47. clean missing dirty Discharge UA Resultby Attendance During Treatmentand Group Matrix 16 TAU

  48. Figure 1. Overall participant follow-up by treatment condition and time point

  49. MA- missing MA+ 6-mos. F.U. UA Resultby Attendance During Treatment and Group TAU Matrix 16

  50. Figure 5. Urinalysis Results: %Meth Negative

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