Models of intervention and care for psychostimulant users, 2nd edition - monograph series no. 51

Survey data pertaining to treatment seeking

Page last updated: April 2004

The service context in which interventions are provided is important in attracting and retaining people who present at such treatment facilities. This is particularly important for users of amphetamines as they have not traditionally sought treatment (Klee, 1997). Services are often reported by amphetamine users as not being amphetamine-oriented or attractive (Kamieniecki et al., 1998). There is little in the way of specific treatment available for amphetamine users and existing psychosocial treatment has often been designed to manage alcohol or opiate dependence (Vincent, Shoobridge, Ask, Allsop & Ali, 1998).

There are no controlled trials that we are aware of that have examined the impact of treatment context on entry into, or retention in, treatment among amphetamine users. However, researchers in the UK (Klee, Wright, Carnwath & Merrill, 2001; Wright & Klee, 1999; Wright, Klee & Reid, 1999) and Australia (Hando, Topp et al., 1997; Vincent et al., 1998; Vincent, Shoobridge, Ask, Allsop & Ali, 1999) have conducted surveys among amphetamine users to determine their treatment needs and preferences and barriers to effective service delivery.

In Sydney, Australia, Hando et al. (1997) conducted interviews with 200 regular amphetamine users and reported a growing need for treatment that focuses on amphetamine–specific issues. Amphetamine users who had attended treatment reported being most satisfied with natural therapies, consulting a general practitioner (GP), or moderating use either alone or with the support of friends and relatives. Amphetamine dependence was determined to be a key factor in prompting users to moderate use and seek treatment. Hando et al. recommended that interventions should aim to increase users' awareness of dependence symptoms and adverse consequences of dependence. The most popular treatment option reported was amphetamine substitution, although nominated by only 18% of the sample. Counselling was the second most popular treatment option with the authors recommending that evaluations of motivational interviewing (MI) and cognitive behaviour therapy (CBT) be conducted. The availability of natural therapies, such as massage and acupuncture, was recommended due to their attractiveness among amphetamine users (see Chapter 8: Pharmacological interventions for a brief review of alternative therapies). A range of goals, including abstinence and controlled use, was seen as important. Hando and colleagues (1997) have reported that most health practitioners remain largely unfamiliar with amphetamine-related problems and that education is required.

Vincent et al. (1999) conducted a survey among 100 amphetamine users in Adelaide, South Australia and compared 15 dependent amphetamine users who felt the need for treatment with 37 who did not feel they required treatment. Compared to the latter, those expressing the need for treatment were more likely to have experienced aggressive outbursts since starting to use amphetamines, to have experienced depression both before and after starting amphetamine use, and to report experiencing hallucinations and panic attacks since starting to use the drug. The best independent predictors of feeling the need for treatment were greater time spent unemployed, poor general health and the development of aggression since using amphetamines. Having previously sought help for amphetamine-related problems was best predicted by higher severity of dependence and poorer social functioning.
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Given the extent of psychological morbidity among amphetamine users feeling the need for treatment, Vincent et al. (1998) have recommended that clinicians treating amphetamine users need to be skilled in the assessment, management and appropriate referral of people with comorbid mental health problems. Comorbidity experts have suggested that treating only one disorder, when a comorbid disorder is present, can increase relapse risk for both disorders (Jenner, Kavanagh, Greenaway & Saunders, 1998).

In terms of services, the survey conducted by Vincent and colleagues (1999) revealed that GPs were seen by users as important sources of assistance. Vincent and colleagues suggested that GPs should be trained on the issues and that shared care arrangements between treatment agencies and GPs be encouraged. Peer support and education were also identified as potentially important, given the importance users placed on peer information and help. In addition to training GPs, peer educators and clinicians, Vincent et al. suggested that existing drug treatment services need to be improved to more adequately meet the needs of amphetamine users.

In Manchester, UK, Klee and colleagues have reported data on amphetamine users' attitudes towards treatment (Wright et al., 1999), factors associated with sustained abstinence (Klee, Wright & Morris, 1999), characteristics of amphetamine users who present to treatment and do not return (Wright & Klee, 1999) and on violent and aggressive behaviour among users (Wright & Klee, 2001). A matched case control study among 58 amphetamine users was conducted, where for each drug agency client interviewed, another amphetamine user (not in contact with drug services) was also interviewed (Wright & Klee, 2001; Wright et al., 1999).

Wright et al. (1999) recommended several methods to attract more amphetamine users into treatment. These included increased information about services available to amphetamine users, public display of agency policies on confidentiality, education and training of health professionals, availability of resources to improve staff credibility, consideration of specialist services for amphetamine users, drop-in centres that allow users to seek advice and support, partnerships between non-specialist services and drug agencies and interventions to inform and support families.

Similar to Australian findings, Klee and colleagues (1999) reported that motivation to abstain from amphetamines was driven initially by psychological health problems and severe social dysfunction. Maintenance of abstinence was achieved through professional support and/or informal support from partners, parents and friends during treatment. On the basis of these findings, Klee et al. (1999) recommended that interventions should be sensitive to the motives underlying the use of the drug and the functions it performs and aim to increase self-awareness; evaluate individual needs and potential for change; and focus on coping and interpersonal skills. They also recommended the development of treatment protocols.

Wright and Klee (1999) further argued that staff should have experience of working with stimulant users and offer support and guidance, especially at the user's first appearance at an agency. As many amphetamine users find it difficult to seek help, often because of their paranoid and aggressive behaviour, the development of effective treatment services would require effective responses to such presentations (Wright & Klee, 2001). Staff should be trained in communication strategies and safety procedures necessary to deal with aggressive behaviour (Centre for Mental Health, New South Wales Health Department, 2002).
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John, Kwiatkowski and Booth (2001) compared AOD use, psychological morbidity and entry into treatment for substance abuse among 583 out-of-treatment IDUs. Compared to IDUs who used opiates only or opiates plus stimulants, those using only psychostimulants reported the most severe alcohol problems and had the highest psychological symptom scores for paranoia, hostility and psychoticism and were far less likely to enter treatment. The authors recommended that clinicians should be able to treat potential psychological problems and alcohol abuse among psychostimulant users in order to offer a comprehensive and attractive treatment approach.

Thus, survey data have highlighted a number of key issues regarding service delivery to amphetamine users.