TL neuro

March 19, 2014

Methamphetamine Relapse Rates

Filed under: Methamphetamine — mtaffe @ 11:53 am

A new paper describes the course of relapse in methamphetamine addicts who are seeking cessation treatment.

Mary-Lynn Brechta, Diane Herbeck. Time to relapse following treatment for methamphetamine use: A long-term perspective on patterns and predictors, http://dx.doi.org/10.1016/j.drugalcdep.2014.02.702

The authors examined methamphetamine (MA) using individuals who were admitted to Los Angeles County Substance Use Disorder treatment systems. This study used a California state database with individuals admitted primarily in 1996. The authors then tried to locate as many as possible for interview, resulting in a sample size of 350 people who were interviewed 3 years after their initial entry in the system. Of these 277 were re-interviewed 2-4 years later.  The first figure is a survival curve calculated from the available data.

Microsoft Word - fig1-1.docxThis analysis makes it clear that over half the sample had relapsed to MA use within a year. Out of the total relapsing population 36% had done so within a month of exiting treatment, 14% from months 2-6 and 11% in the second six month interval post-treatment. A pretty dismal outcome, but probably reflective of a lot of substance discontinuation therapy/attempts. Overall the study reports 77% of users had relapsed within 5 years. Of the individuals who were able to be followed for 5 years post-treatment (N=206), 23% of them had been clean for 5 years. The study is pretty diverse, as might be expected for LA. The sample was 56% male, 17% African American and 30% Hispanic/47% non-Hispanic white. The average age at admission was 29 but 30% of the sample had started using MA before age 16.

The study then examined several user characteristics to determine which might be associated with the odds of relapsing. They found that parental drug use and a history of selling MA were both associated with greater odds of relapsing. Maintaining some sort of self-help or treatment program was associated with a degree of protection against relapse. These analyses show that individuals without parental drug use and a history of selling MA that remained on some sort of self-help or treatment program had about 50% odds of relapse after 5 years whereas only about 10% of those who had either parental drug use or a MA selling history and did not maintain any sort of therapy were able to remain abstinent.

The take away message for this lab is that current treatment approaches for MA addiction are not as effective as we would like. Any additional avenues for reducing relapse after an individual has entered therapy for their MA use would be a significant help.

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