Alice Huber

Sexual HIV risk among gay and bisexual male methamphetamine abusers

The current report examined HIV-related high risk sexual behaviors among a small sample of gay and bisexual male methamphetamine abusers in Los Angeles. Participants were 16 methamphetamine-abusing or -dependent gay or bisexual males who participated in a treatment demonstration project between 1989 and 1993. All participants completed the NIDA/WAVE survey, a detailed inventory of HIV-related risk behaviors. Findings indicate a strong connection between methamphetamine abuse and high-risk sexual behavior. For the 12 months prior to treatment 62.5% of participants reported having anal insertive sex without a condom, and 56.3% reported having sex with someone who had HIV. Drug use before or during sex, measured on a 5-point Likert scale, was frequent (M = 4.27, SD = 0.7). Implications for treatment of gay and bisexual male methamphetamine abusers and prevention of HIV among this population are discussed.

Integrating treatments for methamphetamine abuse: A psychosocial perspective

The recent West Coast experience with increased methamphetamine use is showing signs of spreading to other parts of the US. The risk of corresponding medical and psychosocial problems has led to a call to action at the highest levels of government. The next few years will likely witness a substantial increase in treatment research on methamphetamine abuse/dependence, with particular emphasis on the development and application of novel pharmacotherapies. The evaluation of these agents presupposes that we understand the clinical syndrome resulting from chronic methamphetamine use. To establish a clear picture of the biological and psychological sequellae of methamphetamine use, we compare two cohorts (500 methamphetamine and 224 cocaine users) treated at the same outpatient clinic over the past nine years, using identical manualized treatments. The results suggest that while there are important differences in group characteristics and drug effects, the total response to treatment was quite comparable.

Methamphetamine and cocaine users: differences in characteristics and treatment retention.

Abstract The use of methamphetamine and cocaine have both produced significant public health problems during the past two decades. Although these powerful psychostimulants have many common acute and chronic effects, there are some important differences in who uses these drugs and the consequences of their use. This article reports on two large cohorts of treatment-seeking cocaine and methamphetamine users who entered treatment at the same facility over the same four-year period of time. Patterns of use differed significantly. Cocaine users have more episodic use patterns, spend more money on purchasing their drugs, and use alcohol more heavily. Methamphetamine users include a higher proportion of women, more frequently use on a daily basis, use marijuana more often, and experience more severe medical and psychiatric consequences. Despite the differences in the stimulant drug effects and consequences. the treatment response to a multicomponent, outpatient program is very similar.

Status of Methamphetamine Users 2–5 Years After Outpatient Treatment

Abstract Increasing numbers of methamphetamine users sought treatment during the decade of the 1990s. Little is known about the post treatment status of methamphetamine users who enter treatment. The data presented in this paper describe the outcome status of a group of a convenience sample of 114 methamphetamine users from a total group of 500 methamphetamine users who were treated 2–5 years prior to a follow up interview. Since the sample was not randomly selected, no specific treatment outcome attribution is possible. Methamphetamine use and other drug use of the follow up sample was substantially reduced from pretreatment levels. In general, the follow up status of the sample was much improved as compared to before treatment. However, headaches and depression were reported at a similar rate at follow up as had been reported at treatment admission.

A Comparison of Injecting and Noninjecting Methamphetamine Users

Abstract The injection of illicit drugs exposes the user to a variety of risks that are not associated with other routes of administration. Information regarding differences between injecting and noninjecting methamphetamine (MA) users is provided. The population studied included MA dependent men and women (n = 427) from the Matrix Institute on Addictions in San Bernardino County, California. The sample was divided into two groups according to their injecting status; 55 individuals (13%) reported injecting, and 372 (87%) reported no history of injecting MA. Differences were found in specific use patterns and in medical, criminal, and psychological histories between the two groups.

Comparison of General and Detailed HIV Risk Assessments Among Methamphetamine Abusers

Investigators have long focused on refining the accuracy of HIV risk assessment. One concern is that HIV risk measures either cover general risk behaviors or assess a few specific behaviors. We compared a standardized general measure (Risk for AIDS Behavior, RAB) and a recently developed behaviorally detailed measure (Behavioral Questionnaire-Amphetamine, BQA) in three samples of methamphetamine-dependent individuals in drug treatment in Southern California (76 gay men, 57 heterosexual men, and 33 heterosexual women). Our results indicate that RAB depicted gay men at significantly higher risk than either heterosexual men or women. However, RAB Total score failed to discriminate between HIV-infected and HIV-uninfected gay men. By contrast, BQA discriminated between HIV-infected and HIV-uninfected men as measured by significantly more instances of unprotected anal receptive intercourse. General measures, e.g., RAB, may have utility for describing broad risk factors across heterogeneous groups of substance users. More detailed measures, e.g., BQA, may be necessary for distinguishing behavioral risk differences within high-risk populations such as substance-abusing gay men.

Outpatient Non-Opioid Detoxification for Opioid Withdrawal: Who Is Likely to Benefit?

The authors examined characteristics of successful completers of an outpatient clonidine/oxazepam detoxification procedure for opioid dependence. Of 215 initial applicants, 167 received medication, and 65 successfully completed by taking a dose of naltrexone. Those who completed were more likely to have last used an opioid other than heroin, to be heroin smokers, rather than intravenous users, to have used benzodiazepines in the 30 days before treatment, and to have abstained from opioids for a longer time before presenting for treatment. New users (for less than 2 years) did no better than those using longer than 2 years. These findings may help in the continued refinement of patient placement criteria.

Opioid effects and opioid withdrawal during a 24 h dosing interval in patients maintained on buprenorphine

In maintenance patients methadone has been shown to produce considerable changes in opioid effects and withdrawal over the dosing interval. As a partial agonist buprenorphine may be expected to produce smaller changes, but the nature and magnitude of these changes have only been described for single doses. In the present study opioid effects and withdrawal were described in patients maintained on buprenorphine. Twenty four opioid dependent subjects were administered 16 mg buprenorphine tablets sublingually for 10 days. On day 10 plasma samples were collected and physiological, subjective and observer-rated measures collected pre-dose and at 14 time points during the dosing interval. No significant respiratory depression was observed. Consistent with the partial agonist properties of buprenorphine, other physiological and subjective changes were also of small magnitude. However, even at a once daily dose of 16 mg some patients experienced significant opioid withdrawal that was maximal at the end of the dosing interval. Buprenorphine maintenance should be associated with a high level of safety and a low level of disruption caused by changing opioid effects over the dosing interval, but some patients may require high doses or other strategies to completely suppress withdrawal.

Moving research into community settings in the CSAT methamphetamine treatment project: the coordinating center perspective.

Abstract The CSAT Methamphetamine Treatment Project (MTP) has been established to conduct a ground-breaking exercise in bringing research into a closer relationship with community-based treatment service organizations. In this article, some of the opportunities and challenges faced by the MTP coordinating center as it has attempted to bring research into community treatment organizations are described. Initially, there has been an active, energetic effort to design the study protocol, focus the activities of the project, and prioritize the tasks to be accomplished. The methods for training the research staff and monitoring the conduct of the research in the community sites are described. A number of observations have been made about the different “cultures and values” of the researchers and the seven clinical organizations where the project has been conducted. The myriad mistakes made and lessons learned about how to conduct a rigorous randomized clinical trial in community treatment organizations may be important for future research-treatment efforts. There has been a wealth of experience gained in the first year of this project that may be of use as efforts move forward to reduce the gap between research and practice.

Methamphetamine Users Entering Treatment: Characteristics of the Methamphetamine Treatment Project Sample

The Center for Substance Abuse Treatment funded the Metamphetamine Treatment Project to evaluate and compare treatment approaches for methamphetamine users. As part of this study, drug use patterns, history of physical or sexual abuse, history of suicidality, and psychopathology were assessed in 1,016 methamphetamine-dependent outpatients entering treatment between 1999 and 2001 at eight sites across the western United States. The sample was predominately female and racially diverse. The mean age of the participants was 32.8 years. Most were methamphetamine smokers, but there were marked regional variations. Suicidality and physical or sexual abuse were common and measures of current psychopathology were high. These clinical issues were associated with more frequent use of methamphetamine and, more strongly, with concurrent use of other drugs. Therefore, the relationship between polydrug use and psychopathology in methamphetamine users warrants further investigation.