Effective and readily available treatment is recognized as a necessary tool in reducing substance abuse. However, a number of obstacles exist in treating methamphetamine abusers—in particular, limited access, funding, professional training, and research. For example, many of the rural areas affected by methamphetamine do not have any local substance abuse treatment providers, and those that exist generally do not have adequate funding or expertise.
In addition, simply engaging methamphetamine abusers into treatment is a problem, as preliminary information reports that they may abuse the drug for a much longer period before entering treatment than persons abusing most other drugs. Methamphetamine abusers may be slower to enter treatment because the health care systems in communities affected by methamphetamine are often ill suited to properly diagnose and meet the treatment needs of methamphetamine abusers. For example, in many rural communities, medical and mental health staff may be inadequately trained to recognize and deliver effective methamphetamine-relevant treatment interventions.
When methamphetamine abusers do enter treatment, they encounter a variety of physical and mental health issues, many related to the biological effects of methamphetamine on the brain. Withdrawal symptoms, lasting between 2 days and 2 weeks, include depression, fatigue, anxiety, anergia, drug craving, and severe cognitive impairment. Also, research shows that protracted brain dysfunction persists for months after methamphetamine use stops. Other clinical issues include continuing paranoia, hypersexuality, irritability, drug craving in response to conditioned cues, and violence.
While methamphetamine-specific approaches to treatment are rare, some successes have been seen. For instance, science-based behavioral and psychological approaches have shown great promise—many of these were developed to treat cocaine abusers but have been adapted to methamphetamine abusers. In addition, a program of medication discovery and development is being conducted to produce pharmacotherapies treating methamphetamine abusers. Following are the guiding principles related to treatment recommended by the Task Force.
Guiding Principles
Treatment must be guided by research.
Treatment of methamphetamine abusers should be guided by research findings. For circumstances in which there is no existing research evidence, treatment recommendations should be developed through a consensus process
combining the opinions of professionals from research and clinical domains.
Research must be disseminated to treatment providers in a manner that ensures that effective or evaluated best practices are adopted.
While the United States has made great progress in drug treatment research, this research has not been consistently disseminated to and implemented by providers.
Methamphetamine treatment should be conducted by individuals with knowledge of methamphetamine, its use, and its abuse.
Treatment of methamphetamine abusers should be conducted by individuals who have accurate knowledge of the effects of methamphetamine abuse and how these effects impact treatment and recovery.
Treatment of methamphetamine abusers should address their specific needs.
Treatment strategies should incorporate and reflect the unique problems facing methamphetamine abusers during their recovery, including the mental health issues often
produced by methamphetamine abuse.
Treatment should be provided as part of a comprehensive continuum of care.
To ensure maximum effectiveness and efficiency of treatment, methamphetamine abusers must have access to a full continuum of care. In addition, treatment should include case management and links to primary care and mental health services, as appropriate. Treatment should also be culturally appropriate and encourage the participation of family members and others close to the abuser.
With proper resources and appropriately trained providers, treatment provided within the criminal justice system is effective.
Scientific studies demonstrate that appropriately treating incarcerated addicts reduces their later drug abuse by between 50 and 70 percent and their later criminality and resulting re-arrests by between 50 and 60 percent.
Treatment for parents is a form of prevention for children.
Research has shown that parental influence is a major factor in children's drug abuse patterns. Treatment programs for parents enhance protective factors among young children by removing them from a drug-taking environment and by teaching parents skills for avoiding drug abuse.
Treatment for methamphetamine abusers should address the needs of groups that are particularly at risk.
Methamphetamine has impacted a number of specific population groups to a disproportionate degree according to anecdotal reports; therefore, treatment for methamphetamine abusers should consider the needs of severely impacted groups.
Treatment in rural areas of the country poses particular problems.
In rural areas, access to and availability of health care in general and substance abuse treatment in particular are problematic. For example, geographical distances between providers and those in need of services, the lack of continuing training for providers, and the need for residential treatment all contribute to the problem.
Needs and Recommendations
Following are needs and recommendations for action based on the previous guiding principles:
- Increase the methamphetamine treatment capacity in the community and in correctional facilities.
- Increase treatment access by providing health insurance parity for substance abuse treatment.
- Increase treatment resources to address sufficiently the protracted recovery period of methamphetamine abusers in treatment. (Research suggests that methamphetamine treatment must be of a sufficient duration to address adequately the extended timetable of methamphetamine recovery.)
- Provide effective outreach services to individuals in need of treatment.
- Train and encourage mental health and
medical professionals to identify and refer methamphetamine abusers to appropriate treatment settings.
- Ensure that the service delivery system includes a comprehensive continuum of care that meets the specific needs of methamphetamine abusers.
- Increase the ability of publicly funded treatment systems to respond rapidly to emerging drug problems, particularly in underserved rural areas.
- Develop methamphetamine treatment
guidelines.
- Facilitate the adoption of effective research-based approaches to the treatment of methamphetamine abuse through such methods as disseminating existing research findings and training clinicians and supervisors.
- Fund and evaluate models of methamphetamine treatment that employ empirically
supported treatment strategies adapted for specific high-priority target populations.
- Ensure followup services for abusers who are released from prisons and jails.
- Increase resources for drug court participation by methamphetamine abusers.
Research Priorities
Following are the priorities for research initiatives to increase the volume and quality of knowledge about methamphetamine treatment:
- Support research that helps tailor established science-based behavioral and psychological treatment strategies to methamphetamine abusers and the development and testing
of new, innovative models of treatment for methamphetamine addiction and dependence.
- Support further research in medications development to address such
issues as methamphetamine overdose, methamphetamine-induced psychosis,
withdrawal dysphoria, protracted symptoms that contribute to relapse, and neurological and neurocognitive damage.
- Conduct research that advances the understanding of methamphetamine, particularly its effects on pregnant women, treatment of exposed infants, reasons why abusers tend to use for long periods (in some cases, 5 to 7 years) before entering treatment, strategies for engaging abusers in treatment earlier, and the cognitive disability manifested in abusers.
- Conduct research on and evaluations of treatment programs for children and adolescents.
- Conduct research that contributes to an understanding of how methamphetamine acts on individual nerve cells, neurotransmitters, and brain structures.
- Conduct research on which models of drug courts work best and which models of prison and followup treatment programs are most cost effective for methamphetamine abusers.
- Evaluate the effectiveness of methamphetamine treatment programs on an ongoing basis.
