Amphetamine Addiction Treatment and Adolescents

Literature Review
Amphetamine is a stimulant drug mainly used in the treatment of ADHD and narcolepsy (sleeping disorder). Drug Enforcement Administration (DEA) has classified amphetamine as a schedule II drug, which means that they can be used for medication and has a high potential for abuse (Drug Enforcement Administration, n.d.). Common prescription drugs include Ritalin, Adderall, and Dexedrine. Amphetamine is also used for recreation purposes and popular street names include Crank, Black Beauties, Uppers, Bennies, Ice, and Speed (Drug Enforcement Administration, n.d.).
In 2016, approximately 34.2 million people had used amphetamine and its derivatives - MDMA (ecstasy) and methamphetamine hydrochloride (United Nations Office on Drugs and Crime, 2019). Amphetamines are mostly taken orally as capsules or tablets (Tablets can either be crushed or injected). Crystal methamphetamine hydrochloride is smoked or inhaled. Methamphetamine powder dissolves in water and can be injected intravenously (Drug Enforcement Administration, n.d.). Studies indicate that amphetamine addiction is a global problem and adolescents are the most affected. Also, the stimulant is easily accessible. The devastating consequences of amphetamine addiction has renewed interest among health care professionals on the most effective treatment intervention.
This literature review will explore whether cognitive behavioral therapy (CBT) is the best approach for treating amphetamine addiction. The following questions will be answered:
1. What are the effects of amphetamine use?
2. Is behavioral therapy effective at treating amphetamine addiction in adolescence?
3. What are the limitations of the matrix model?
What are the Effects of Amphetamine Use?
Amphetamine use is not a new phenomenon. Its usage can be traced back to 1930s when it was used to treat asthma and narcolepsy (Drug Enforcement Administration, n.d.). During World War II, soldiers on either side of the war used amphetamine to stay alert and be more efficient. Today, adolescents are using illicit amphetamines to boost their performance in school. It has resulted in high addiction rates among teens. Amphetamine addiction affects both the user and society at large. The user can no longer live a productive life and the society incurs rising health care costs in treating stimulant-related disorders.
The effects of amphetamine use vary from acute to chronic. The acute effects include alertness, decreased fatigue, increase confidence, exhilaration, improves performance for tasks that need sustained attention and impair performance for tasks that require smooth accurate muscle movements. The chronic effects include psychosis similar to paranoid schizophrenia, paranoia, hallucinations, violent behavior, picking at the skin and preoccupation with own thought processes (Drug Enforcement Administration, n.d.).
Is Behavioral Therapy Effective at Treating Amphetamine Addiction in Adolescence?
In 2016, only one out of six people with stimulant use disorders globally sought treatment (United Nations Office on Drugs and Crime, 2019). The low rates of treatment have been attributed to the absence of a medical model for addiction treatment. Generally, treating amphetamine addiction in adolescents is challenging because there are no proven effective medications. Also, there is a high rate of relapse, severe cravings, and episodes of hallucinations and psychosis among users. Currently, cognitive behavioral therapy (CBT) approach is used to treat amphetamine addiction. CBT is a type of psychotherapy that focuses on the relationship between thoughts, feelings, and actions related to psychoactive substance use and recovery (United Nations Office on Drugs and Crime, 2019).
The most common program under CBT is the matrix model. A matrix model is a proven effective, evidence-based protocol that is used to treat psychostimulants use disorders. It is a manualized 16-week treatment that involves cognitive behavioral techniques, 12-step meetings (self-help programs), weekly urine monitoring, individual counseling, family education groups, and social support groups (Rawson et al., 2004).
Rawson et al., 2006 carried out a large-scale multisite study that compared treatment outcomes between manualized 16-week treatment (matrix model) and treatment as usual (TAU). The study was carried out by seven investigative teams in 8 outpatient settings in California, Montana, and Hawaii between 1999 and 2001. Six of the outpatient sites was in California and the remaining two sites were in Montana and Hawaii respectively. Each site was to recruit 150 individuals on methamphetamine treatments of which half would be randomly selected to participate in TAU and the other half to join matrix model treatment. All participants in the study were 18 years and above. Overall, 978 treatment-seeking individuals participated in the study.
In most sites, the matrix model was superior to TAU in treatment outcomes. The key indicators of treatment efficacy were retention rates, session attendance, period of methamphetamine (MA) abstinence, and MA-free urine tests during treatments, discharge and 6-month follow up point. The results of each indicator are as follows:
Retention Rates
Retention rate indicates the success of each treatment outcome. Multivariate analysis was used to determine the retention rates between matrix model treatment and TAU. The results suggest that "matrix participants were 38 percent more likely to complete treatment than TAU participants" (Rawson et al., 2004). It means that the matrix model is more effective compared to TAU.
Session Attendance
CBT is an outpatient treatment method. So, a participant's attendance in treatment sessions indicates the effectiveness of treatment. Chi-squared test was used to compare session attendance between matrix model and TAU. The results show that session attendance for matrix model was 40.9 percent while TAU was 34.2 percent and the difference was statistically significant (Rawson et al., 2004). Therefore, the matrix model is a more effective treatment intervention compared to TAU.
MA-Free Urine
Weekly urine tests are done to test for MA. The means for each urine sample provided by participants from each group was calculated to determine which treatment method had more clean urine. A higher mean indicates that the urine samples are clean and treatment is more effective. The results show that means for matrix participants was higher than TAU participants in all sites. For example, in site 5, the mean of MA-free urine was 4.3 for matrix participants and 1.7 for TAU participants (Rawson et al., 2004). It implies that the matrix model is more effective than TAU.
Period of MA Abstinence
Urine tests determine the period of MA abstinence. The longer the mean period of continuous sobriety, the more effective the treatment. In all the sites, the mean period of MA abstinence for matrix condition was higher than the TAU condition. For example, in site 3, the mean for the most prolonged period of abstinence was 3.2 and 1.8 for matrix and TAU conditions respectively (Rawson et al., 2004). So, the matrix model is the most effective treatment.
MA-Free Urine at Discharge and 6-Months Follow Up
At the end of the treatment period, each participant was tested for MA. After 6 months, a follow-up test was also done on all the available participants. Analysis of variance test was used to determine the differences in each of the two groups. The results show that the percentage of urine tests at discharge was "66 percent for matrix and 69 percent for TAU" (Rawson et al., 2004). Urine tests done after 6 months show that “both Matrix and TAU had 69 percent MA-free urine samples” (Rawson et al., 2004). Overall, there were no significant differences in urine tests done at discharge and 6-month follow up for the two treatment groups.
The findings of the study imply that the matrix model was superior during treatment only. During discharge and after 6-months follow up, there was no difference between the matrix model and other psychosocial treatments. Thus, the matrix model has a greater treatment efficacy over the other psychosocial treatments.
What are the Limitations of the Matrix Model?
Matrix model is the most effective method of treating amphetamine addiction. However, health care providers need to be aware of its limitations. Massah, Effatpanah & Shishehgar (2017) conducted a study on problems of matrix model in treating Methadone dependency. A random sample of 42 women from 12 methadone clinics participated in the study. Ten therapists were also interviewed on the effectiveness of the matrix model in methadone treatment.
The results of the study showed that the matrix method is lengthy, expensive and required intensive training of clinic staff (Massah et al., 2017). Most of the women in the study noted that the matrix model is long and they get bored in the course of treatment. The length of treatment contributed to high dropout rates among the participants. The women in the study also claimed that the 16-week long treatment sessions was effective in reducing their cravings for methadone; however, it was costly. Most women were not in a position to pay for the treatment, so they preferred brief interventions which is less expensive. One of the therapists observed that matrix model requires intensive staff training because it is a 16-week standard treatment.
This study is related to amphetamine addiction because it highlights the limitations of the matrix model. To reduce the high dropout rates associated with the matrix model, amphetamine patients should be informed that the duration of treatment despite being long is important for their recovery. Amphetamine clinics should also consider discounts for patients who are unable to cater for treatment costs.


References
Drug Enforcement Administration. (n.d.). Drugs of Abuse. Retrieved from https://www.dea.gov/sites/default/files/sites/getsmartaboutdrugs.com/files/publications/DoA_2017Ed_Updated_6.16.17.pdf#page=50
Massah, O., Effatpanah, M., & Shishehgar, S. (2017). Matrix Model for Methamphetamine Dependence among Iranian Female Methadone Patients: The First Report from the Most Populated Persian Gulf Country. Iranian Rehabilitation Journal, 15(3), 193-198. doi:10.29252/nrip.irj.15.3.193
Rawson, R. A., Marinelli-Casey, P., Anglin, M. D., Dickow, A., Frazier, Y., & Gallagher, C. (2004). A multi-site comparison of psychosocial approaches for the treatment of methamphetamine dependence. Addiction, 99(6), 708-717. doi:10.1111/j.1360-0443.2004.00707.x
United Nations Office on Drugs and Crime. (2019). Treatment OF Stimulant Use Disorders: Current Practices and Promising Perspectives. Retrieved from https://www.unodc.org/documents/drug-prevention-and-treatment/Treatment_of_PSUD_for_print_1X_09.03.19.pdf