Dr Nicole Leea, Professor Steve Allsopb, Frances Kay-Lambkinc, Dr Rebecca McKetind, Associate Professor Amanda Bakere, Professor Richard Mattickd, Professor David Kavanaghf, Ms Angela Harneya and Ms Amy Pennaya
a Clinical Research Program, Turning Point Alcohol & Drug Centre
b NDRI Curtin University
c Centre for Mental Health Studies, University of Newcastle
d National Drug and Alcohol Research Centre, University of NSW
e Centre for Mental Health Studies, University of Newcastle
f University of Queensland
beyondblue Victorian Centre of Excellence
Project completion year
An estimated 73,000 Australians are dependent on methamphetamine. A particular challenge in treating users is the high level of psychiatric co-morbidity. The prevalence of mental health disorders among substance users in treatment is estimated to be around 70 per cent. Methamphetamine use and withdrawal is significantly associated with depression and although rates of depression and methamphetamine use are on the increase, it is still not clear how best to manage people with these co-morbid conditions.
This study builds on the previous work of the investigators, which indicated that a combination of Motivational Interviewing (MI) and Cognitive Behaviour Therapy (CBT) produced important gains among regular methamphetamine users across a number of domains. The project developed and subsequently piloted the effectiveness of an integrated co-morbidity intervention against an amphetamine-only intervention and no intervention, among a group of people with co-morbid methamphetamine dependence and depressive symptoms.
Following initial assessment, 27 participants were randomly assigned to one of the three groups. Two groups received six sessions of either integrated co-morbidity intervention or methamphetamine-only treatment. The control group participants were given a self-help booklet. Follow-up assessments were made at seven weeks, three months and six months.
Many individuals expressed interest in receiving treatment specifically addressing their methamphetamine use and symptoms of depression, including some individuals already engaged with other drug dependence or mental health disorders. However, as in similar studies, this client group proved difficult to recruit, and initial enthusiasm did not guarantee participation in the project.
Substantial reductions in the average days of methamphetamine use were indicated at immediate follow-up for this small sample overall. On average, use slightly increased again at three months, with some reduction sustained at six months.
The overall sample indicated reduction of recently experienced symptoms of depression and psychological distress. Those who received treatment indicated a slightly larger decrease in average symptom score than the no-treatment group. At the six month follow-up, five of nine individuals who had previously indicated current depression (with four receiving treatment) no longer met diagnostic criteria for depression.
Many individuals experienced significant improvement in mental health symptoms following reduction or cessation of methamphetamine use. Data is limited but indicates support for previous study findings that mental health symptoms are reduced as a result of substance use treatment.
In this small sample, an individual’s readiness for change related to their level of engagement or attendance to treatment. Participants at contemplative and preparatory stages of changing their drug use attended fewer treatment sessions.
Implications for policy, practice and further research
While integrated treatment could not be proven as superior to non-integrated treatment, this study reinforces previous research that indicated psychological approaches help reduce methamphetamine use and mental health symptoms. The study also indicated that potential benefits can come from self-help, drug-specific and integrated behavioural intervention.
Outcomes of the study suggest further research should introduce a stepped-care approach for this client group. Stepped care would involve an initial focus on a client’s drug use, and for those with ongoing mental health problems, the next step would be an assertive treatment for their depression.
Additional resources are needed for recruitment campaigns, as are strategies to motivate individuals’ engagement in treatment attendance.