What Have We Learned From Evaluations of Methamphetamine Programs/Strategies?

The bulk of the evaluations of meth programs/strategies have been conducted on psychosocial treatments for meth users. Some of these approaches have shown strong evidence of success for meth users. There is some preliminary evidence suggesting that medications can be beneficial for meth users, but work in this area is at an early stage. Finally, there is some evidence that certain prevention approaches can affect initial use of meth and legislative approaches can be effective in reducing the production of methamphetamine.

Treatment
Meth is a stimulant drug like cocaine; therefore, treatments for meth are often similar to those utilized for cocaine users. There are two primary classes of treatment for meth users: psychosocial and pharmacological. Psychosocial treatments focus on changing behavior by addressing the psychological and social factors related to drug use while pharmacological treatments focus on behavior change via medications. We know little about the interaction between the two classes of treatment or if certain psychosocial treatments are better for some groups than others.

Cognitive behavioral and contingency management treatment models have been shown to be effective as psychosocial treatments for meth users. In a recent experimental study of contingency management for meth users, those who received contingency management in addition to the standard treatment (either the matrix model or a mix of cognitive behavior therapy and relapse prevention) used meth less often and remained abstinent longer than the standard treatment-only group. Drug courts, which also utilize contingency management techniques, have been shown to be effective in successfully intervening and managing meth offenders. Drug courts may even be more effective for meth than other drug users; in one study meth users had higher graduation rates than users of other drugs. Drug court data also show that meth users under legal coercion tend to stay in treatment longer and do as well as, or better than, others not facing legal pressure to receive treatment. The Matrix Model, which incorporates cognitive behavioral therapy, positive reinforcement, family involvement, 12-step programs, motivational interviews, and urine testing, has been shown to decrease meth and other drug use as well as improve psychosocial functioning and mental health when compared to various, more traditional counseling approaches.

There are currently a number of clinical trials of medications to treat methamphetamine abuse underway. Preliminary studies of imipramine, an antidepressant, have shown that it improves treatment retention, but not use. Vigabatrin, an anticonvulsant, has been shown to decrease use in the short term. One pharmacological treatment that has recently demonstrated promise is PROMETA, a medication designed to address the physical symptoms of dependence including cravings, withdrawal, and anxiety. A recent quasi-experimental study of PROMETA produced promising findings showing that meth cravings and meth use decreased following the use of PROMETA. Zoloft (Sertraline) has been shown to have negative effects; there is evidence that it increases use, cravings, and depression.

Prevention
Prevention programs to teach individuals about the dangers of drugs, change perceptions about drugs, and/or prevent drug use are not new, but the use of programs directly and exclusively focusing on meth coincides with the recent use of other approaches to address meth. Meth prevention programs have primarily targeted youth and adolescents. Media and public service campaigns, such as the Montana Meth Project, have demonstrated some positive results regarding perceptions of, and attitudes toward, meth use. However, few studies have examined or been able to demonstrate behavior changes resulting from these campaigns. Further, when strategies such as MethWatch have incorporated public service campaigns as part of a larger effort to reduce meth-related problems, evaluations have failed to differentiate between the effects of the campaign versus other components included in the overall strategy. Evaluations of the long-term effects of universal prevention interventions (programs designed to address risky behavior for a whole population group that has not been identified on the basis of individual risk) have shown that some of these programs may prevent meth use in the long-term even though they do not specifically target meth in the program.

Legislation
There have been many state and federal laws enacted to restrict the sale of chemicals used to manufacture meth. The effects of such legislation on the manufacture of meth appear at first glance to be positive and immediate. However, it is too early to tell if these effects, if any, will be sustained over time or if these laws may produce unintended consequences such as decreasing health care costs associated with the decline in the number of meth labs. Further, little thorough evaluation has been conducted on the most recent series of legislative initiatives (2004 and later) targeting the over-the-counter sale of pseudoephedrine. The few evaluations that have been conducted have failed to control for other efforts to address the meth problem that were implemented at the same time. Thorough evaluations of the effects of older legislation to regulate sales of precursor ingredients in California showed short term reductions in meth-related arrests for large scale producers, indicating the success of the initiative. However, as these producers were able to determine how to circumvent the regulations (e.g., purchasing ingredients outside the United States) arrests for production increased. Moreover, anecdotal evidence suggests that a reduction in the local production of meth can result in an increase in the importation of higher-quality meth. On the positive side, some evaluations have shown reduced health care costs and hospital-related admissions related to the decrease in meth manufacturing resulting from legislative initiatives.

MethWatch
While a number of communities have implemented MethWatch (a program in which retailers voluntarily limit access to precursor chemicals and report suspicious purchases, meth manufacturers and residents are notified of oversight by retailers, and awareness of the meth problem is raised), there have been few, limited attempts to evaluate it. Only one outcome evaluation report, produced by Kansas MethWatch, is currently publicly available. Preliminary results from the MethWatch study show that in the year following statewide implementation of the program, those sites with strong implementation had a positive impact on the perceived availability of meth and a decrease in the use of meth by high school seniors. A process evaluation conducted in Michigan suggests that the program was successful in mobilizing the community around prevention efforts and served as a catalyst for subsequent meth efforts. This occurred even after state legislation restricted access to precursor chemicals (what retailers were asked to do voluntarily for the program) and in concert with other efforts to address meth.

Law Enforcement
Law enforcement efforts address the manufacture, possession, and distribution of meth. Specifically, efforts include drug lab seizures, multijurisdictional task forces, and street-level drug enforcement. Most of the evidence of effectiveness is anecdotal with summary data listing statistics such as the total number of seized labs and meth-related arrests. There are a few process evaluations that describe the implementation of meth law enforcement programs. One study funded by BJA commissioned agencies to develop and implement Clandestine Laboratory Enforcement Programs (CLEPs). CLEPs are similar to more traditional drug lab enforcement efforts except for the added focus on addressing health, safety and environmental issues caused by the volatile nature of meth. Results from this study provided information to assist in planning, organizing, and managing CLEPs.

| | |
| | |