Suzette Glasner-Edwards

Depression among methamphetamine users: association with outcomes from the Methamphetamine Treatment Project at 3-year follow-up.

Although depression is highly comorbid with substance use disorders, little is known about the clinical course and outcomes of methamphetamine (MA) users with depressive symptoms and syndromes. In this study of MA-dependent individuals entering psychosocial treatment, we predicted that (1) depressive symptoms would decline during treatment, an effect that would vary as a function of MA use and (2) depression diagnoses post-treatment would be associated with poorer outcomes. Participants (N = 526) were assessed for depression, substance use, and psychosocial outcomes at baseline, treatment discharge, and 3-year follow-up. Depressive symptoms declined significantly during treatment, an effect that was greatest among those who abstained from MA. Major depression at follow-up was associated with poorer MA use outcomes and impairment across multiple domains of functioning. The findings highlight the relationship of depressive symptoms and diagnoses to treatment outcomes, and suggest a need for further studies of depression in populations using MA.

Psychopathology in methamphetamine-dependent adults 3 years after treatment.

INTRODUCTION AND AIMS Although psychiatric symptoms are frequently observed in methamphetamine (MA) users, little is known about the prevalence of psychiatric disorders in MA-dependent individuals. This is the first study to examine the association of psychiatric disorders with substance use and psychosocial functioning in a large sample of MA users 3 years after treatment. We predicted that psychiatric diagnoses and severity would be associated with substance use and poorer overall functioning over the 3 year post-treatment course. DESIGN AND METHODS Participants (N = 526) received psychosocial treatment for MA dependence as part of the Methamphetamine Treatment Project and were reassessed for psychosocial functioning and substance use at a mean of 3 years after treatment initiation. DSM-IV psychiatric diagnoses were assessed at follow-up using the Mini-International Neuropsychiatric Interview. Psychosocial functioning was assessed using the Addiction Severity Index. RESULTS Overall, 48.1% of the sample met criteria for a current or past psychiatric disorder other than a substance use disorder. Consistent with prior reports from clinical samples of cocaine users, this rate was largely accounted for by mood disorders, anxiety disorders and antisocial personality. Those with an Axis I psychiatric disorder evidenced increased MA use and greater functional impairment over time relative to those without a psychiatric disorder. DISCUSSION AND CONCLUSIONS This initial investigation of psychiatric diagnoses in MA users after treatment indicates elevated rates of Axis I and II disorders in this population and underscores the need for integrated psychiatric assessment and intervention in drug abuse treatment settings.

Evidence-Based Practices in Addiction Treatment: Review and Recommendations for Public Policy

The movement in recent years towards evidence-based practice (EBP) in health care systems and policy has permeated the substance abuse treatment system, leading to a growing number of federal and statewide initiatives to mandate EBP implementation. Nevertheless, due to a lack of consensus in the addiction field regarding procedures or criteria to identify EBPs, the optimal processes for disseminating empirically based interventions into real-world clinical settings have not been identified. Although working lists of interventions considered to be evidence-based have been developed by a number of constituencies advocating EBP dissemination in addiction treatment settings, the use of EBP lists to form policy-driven mandates has been controversial. This article examines the concept of EBP, critically reviews criteria used to evaluate the evidence basis of interventions, and highlights the manner in which such criteria have been applied in the addictions field. Controversies regarding EBP implementation policies and practices in addiction treatment are described, and suggestions are made to shift the focus of dissemination efforts from manualized psychosocial interventions to specific skill sets that are broadly applicable and easily learned by clinicians. Organizational and workforce barriers to EBP implementation are delineated, with corresponding recommendations to facilitate successful dissemination of evidence-based skills.

Clinical course and outcomes of methamphetamine-dependent adults with psychosis

Little is known about the association between psychosis and treatment outcomes in methamphetamine (MA) users. Using data from 526 adults in the largest psychosocial clinical trial of MA users conducted to date, this study examined psychiatric, substance use, and functional outcomes of MA users with concomitant psychotic illness 3 years after treatment. The presence of a psychotic disorder was associated with increased health service utilization and higher levels of psychiatric symptomatology across multiple domains over time. MA users with co-occurring psychotic illness may therefore benefit from early psychosocial and/or pharmacologic interventions to address psychiatric symptoms.

Risk Factors for Suicide Attempts in Methamphetamine-Dependent Patients

The purpose of this study was to identify risk factors for suicide attempts (SA) in methamphetamine (MA)-dependent patients. MA-dependent adults (N = 526) who participated in the Methamphetamine Treatment Project were interviewed before and three years after treatment. Baseline psychiatric, medical, demographic, and substance use characteristics were assessed using the Addiction Severity Index and the Beck Depression Inventory (BDI). Lifetime history of SA was assessed at follow-up. Risk factors for SA included gender, intravenous MA use, BDI > 20 at baseline, and clinically significant psychiatric history. Psychiatric characteristics of MA users are strongly associated with SA, warranting careful assessment of psychiatric history.

Anxiety Disorders among Methamphetamine Dependent Adults: Association with Post‐Treatment Functioning

Although anxiety is one of the most prominent psychiatric complaints of methamphetamine (MA) users, little is known about the association between anxiety disorders and treatment outcomes in this population. Using data from 526 adults in the largest psychosocial clinical trial of MA users conducted to date, this study examined psychiatric, substance use, and functional outcomes of MA users with concomitant anxiety disorders 3 years after treatment. Anxiety disorders were associated with poorer alcohol and drug use outcomes, increased health service utilization, and higher levels of psychiatric symptomatology, including suicidality. Addressing anxiety symptoms and syndromes in MA users may be helpful as a means of optimizing treatment outcomes.

Identifying methamphetamine users at risk for major depressive disorder: findings from the methamphetamine treatment project at three-year follow-up.

Little is known about risk factors for depression in methamphetamine users. Using data from 526 adults in the largest psychosocial clinical trial of methamphetamine users conducted to date, this study examined clinical, demographic, and substance use characteristics that predict the presence of a diagnosis of major depressive disorder (MDD) three years after treatment for methamphetamine dependence. The results indicate that two risk factors predict a diagnosis of MDD: a Beck Depression Inventory total score greater than 20, and one or more prior suicide attempts. These risk factors identify methamphetamine users who may benefit from early interventions for psychiatric symptoms.

Health conditions in methamphetamine-dependent adults 3 years after treatment.

Objectives:Medical conditions in methamphetamine (MA) users have not been well characterized. Using both self-report and physical examination data, the aims of this study were to (1) describe the frequency of medical conditions in a sample of MA users 3 years posttreatment; (2) evaluate the association between medical conditions and MA use frequency; and (3) examine the relationship of route of administration with medical outcomes. Methods:MA-dependent adults (N = 301) who participated in the Methamphetamine Treatment Project were interviewed and examined 3 years after treatment. Medical, demographic, and substance use characteristics were assessed using the Addiction Severity Index and Life Experiences Timeline. Current and lifetime medical conditions, electrocardiogram characteristics, and physical examination abnormalities were assessed. Results:Among the most frequently reported lifetime conditions were wounds and burns (40.5%, N = 122) and severe dental problems (33%, N = 99), and a significant proportion of the sample evidenced prolonged corrected QT interval (19.6%, N = 43). Although health conditions were not associated with MA use frequency during follow-up, intravenous MA use was significantly associated with missing teeth (odds ratio = 2.4; 95% confidence interval, 1.2–4.7) and hepatitis C antibodies (odds ratio = 13.1; confidence interval, 5.6–30.1). Conclusion:In this sample of MA users, dental problems and corrected QT prolongation were observed at elevated rates. Although posttreatment MA use frequency was not associated with a majority of medical outcomes, intravenous MA use exacerbated risk for dental pathology and hepatitis C. Longer term follow-up research is needed to elucidate health trajectories of MA users.

Does Posttraumatic Stress Disorder (PTSD) Affect Post-Treatment Methamphetamine Use?

Objective: Although trauma is a well-established risk factor for substance use disorders, little is known about the association between posttraumatic stress disorder (PTSD) and treatment outcomes among methamphetamine users. In the present study, we examine the relationship between PTSD and post-treatment methamphetamine use outcomes, hospitalizations, and overall psychiatric impairment. Methods: Using data from 526 adults in the largest psychosocial clinical trial of methamphetamine users conducted to date, this study examined (a) treatment outcomes of methamphetamine users with concomitant PTSD 3 years after psychosocial treatment for methamphetamine dependence and (b) PTSD symptom clusters as risk factors for post-treatment relapse to methamphetamine use. Results: PTSD was associated with poorer methamphetamine use outcomes; methamphetamine use frequency throughout the 3-year follow-up was significantly greater among individuals with a PTSD diagnosis, and those with PTSD had more than five times the odds of reporting methamphetamine use in the 30 days prior to the follow-up interview, odds ratio (OR) = 5.2, 95% CI [2.0–13.3]. Additionally, higher levels of other Axis I psychopathology were observed among methamphetamine users with PTSD. Avoidance and arousal symptoms predicted post-treatment methamphetamine use. Conclusions: Addressing these high-risk PTSD symptoms and syndromes in methamphetamine users may be helpful as a means of improving treatment outcomes in this population.

Bulimia Nervosa Among Methamphetamine Dependent Adults: Association With Outcomes Three Years After Treatment

Although weight loss is among the most commonly cited reasons for using methamphetamine (MA), little is known about the association between eating disorders and treatment outcomes in this population. This study examined psychiatric, substance use, and functional outcomes of MA users (N = 526) with bulimia nervosa 3 years after treatment for MA dependence. Bulimia nervosa was observed among 2.4% (N = 13) of the participants and was associated with poorer MA use outcomes, increased health service utilization, and higher levels of functional impairment. Addressing MA use among adults with eating disorders may be helpful as a means of improving treatment outcomes.