Finding an evidence based intervention for methamphetamine-using women

May 2017
Methamphetamine use disorder is a serious health concern in the Middle East region, especially in Iran. This is because of the domestic production of methamphetamine with accessible ingredients and the inexpensive price.

It is a serious health concern among opioid-dependent and methadone patients. For example, female methadone patients with methamphetamine use disorder constitute a large population of illicit drug users in Iran. This group uses methamphetamine to increase physical energy and relieve the depressant effects of high dose methadone. Most female methadone patients with methamphetamine use disorder suffer poor psychological well-being and impaired social functioning. This is combined with poly substance use, poor readiness to change methamphetamine use and poor methadone treatment outcomes.

There is no pharmacological treatment for methamphetamine use disorder. Long-term psychological interventions, such as cognitive-behavioral therapy, are the main treatment modalities. The Matrix Model of Intensive Outpatient Treatment is an approved psychological treatment and has been provided for this group of illicit drug users in Iran.  However it is expensive and the provision of treatment is not often feasible in methadone treatment settings. Additionally, the treatment is long and needs professional staff training.

To overcome the operational barriers to implementation, brief cognitive-behavioral treatment (ie four sessions) has been suggested. This treatment model was first developed by Professor Amanda Baker and colleagues in Australia and has been approved by the Australian Government as a standard treatment guide for regular amphetamine use. The Baker treatment model is a cost-effective and feasible intervention which consists of motivational interviewing techniques, management of craving and relapse prevention techniques. Furthermore, this treatment model does not need intensive staff training and can be provided with high fidelity in drug treatment services. Two randomised controlled trials in Australia confirmed the feasibility and effectiveness of the Baker treatment model in reducing regular amphetamine use sustained at six month follow-up. This was accompanied by improvements in the social and health contexts of the Australian participants.

As a PhD student, I designed a multi-centre randomised controlled trial with my supervisor Professor Kate Dolan at NDARC. The study aimed to use the Baker treatment model to reduce methamphetamine use disorder among a group of methadone-maintained women in Tehran, Iran. The other aims of the study were to promote the social and health contexts of the participants. Overall 120 women were randomly recruited from four large methadone treatment services. Sixty participants received four weekly sessions of brief cognitive-behavioural therapy as well as daily homework assignments. The intervention was not limited to four sessions of treatment. Participants were strongly encouraged to practise the learnt cognitive-behavioural skills for at least one hour a day at home. This was continued for four consecutive weeks and was checked at each treatment session by the study psychologists. Sixty control participants received four sessions of standard drug information on a weekly basis. Overall, each treatment and standard drug information session took 60 minutes. Participants were followed at weeks zero, four and twelve. The study results confirmed that the treatment intervention significantly reduced the number of days of methamphetamine use, while improving psychological well-being and social functioning among the participants. This was accompanied with improvements in readiness to change methamphetamine use and reduced heroin and benzodiazepine use. All results remained significant at follow-up. Furthermore, the attrition rate was low and client engagement was high.

From the interviews we found that a combination of learning cognitive-behavioural skills, doing daily homework assignments as well as other factors such as stable housing, drug-free families and friends, a lack of involvement in sex work and increased motivations to change, facilitated their pathways to recovery.

While methamphetamine use disorder is a global health concern, there are few studies of psychological interventions for this group. To date, there were no previous studies specifically addressing methamphetamine use disorder among female methadone patients. The study findings indicated that the Australian model of amphetamine use treatment was easily adaptable in an Iranian context. Furthermore, the treatment was feasible and effective for women in methadone treatment services in Iran. The study findings may have important implications for reducing methamphetamine use disorder in methadone treatment clients in Australia and other countries. Conducting further randomised controlled trials is suggested to examine the long-term effectiveness of this treatment modality.