A multidisciplinary team of University of Iowa researchers made the recommendation in a review article that appeared in the April 2003 issue of the Journal of Substance Abuse Treatment. The team also identified areas of research that could help improve treatment, including retention and new drug therapies.
Improving treatment is critical as meth abuse has increased in the past decade. From 1992 to 1999, admissions to meth abuse treatment programs more than doubled in the United States -- from nearly 14 people per 100,000 to 32 per 100,000. States with the highest rates of meth abuse admissions were Idaho (207 per 100,000), Utah (168 per 100,000) and Iowa (118 per 100,000), according to the federal Substance Abuse and Mental Health Services Administration.
"In reviewing studies we found that treatment does work if you can give people sufficient access to treatment," said James Hall, Ph.D., UI associate professor of pediatrics, social work, public health and nursing and one of the review authors. "We were worried that you need a special care ward or other special setting, but at least based on the data we reviewed, that doesn't seem to be the case."
What seems to make a difference is time. Meth effects can last up to six months for just one use, and the drug can do greater damage to a person's physical, behavioral and thinking functions than many other illicit drugs or alcohol. For this reason, it takes much longer to treat a person with a meth addiction than it does to treat someone with a cocaine or heroin problem. This time factor is also one reason why so many meth treatments currently fail.
Most adult residential drug treatment programs -- the essential first stop for breaking an addiction -- have been shortened from 45 or 30 days to only 10 to 14. The problem is even worse for adolescents. Residential treatment programs for that age group have "dried up" due to budget cuts, Hall said.
"If you are a regular meth user, you will need more time to detox before you can accept the treatments, which are very cognitive," he said. "We don't know exactly how long you need, but we do know the current two-week time isn't sufficient. Likely, a minimum of 30 days of residential treatment allows the meth abuser to regain essential thinking and decision-making skills."
The article calls on researchers to study what residential treatment length would be effective for meth users to then take advantage of outpatient care.
Most state and insurance programs will not pay for treatment beyond two weeks, so even if a medical need is confirmed, funding needs also must be addressed, Hall said. In addition, there are few prison treatment programs for substance abuse.
"The emphasis on dealing with meth has been punishment and imprisonment, but we may do well as a society to reserve prison for those who are involved in illegal drug sales or violence and support treatment for abusers," Hall said.
Methamphetamines initially were used as dietary supplements and for psychotherapy. Side effects caused the drug to fall from normal prescribed use. However, people discovered methamphetamines made them feel relaxed and began using the drugs recreationally. Abusers grind pills into powder, which they then snort like cocaine, or they dissolve it into a liquid and inject it.
Hall and colleagues also support investigating whether certain prescription drugs might be used to treat meth abuse.
"It may seem counterintuitive to treat a drug abuse with a medication, but heroin treatments indicate it's possible," Hall said. "Meth abuse alters brain chemistry and functioning, and it's not clear whether these changes are temporary or permanent. However, I don't think all psychotherapy and behavior therapies can deal with the brain chemistry changes as quickly as appropriate medication could."
The National Institute On Drug Abuse (NAIDA), part of the National Institutes of Health, is working to develop medications that can counteract drug use. Hall said there is potential to find a drug that could specifically block the effects abusers seek from meth.
The UI review article was supported in part by a NAIDA grant. In addition to Hall, UI researchers involved in the review included lead author Margaret Cretzmeyer, research assistant in the UI School of Social Work; Mary Vaughan Sarrazin, Ph.D., research scientist in internal medicine at the UI Roy J. and Lucille A. Carver College of Medicine; Diane Huber, Ph.D., associate professor in the UI College of Nursing; and Robert Block, Ph.D., associate professor of anesthesiology in the UI Carver College of Medicine.
STORY SOURCE: University of Iowa Health Science Relations, 5137 Westlawn, Iowa City, Iowa 52242-1178
CONTACT: Media: Becky Soglin (writer), (319) 335-6660, becky-soglin@uiowa.edu.
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ABSTRACT:
[Note: Abstract (and possibly full text)Full accessible at http://www.sciencedirect.com/science/journal/07405472]
Journal of Substance Abuse Treatment
Volume 24, Issue 3 , April 2003, Pages 267-277
Journal
Journal of Substance Abuse Treatment