Intervention for amphetamine-type stimulant (ATS) use in the therapeutic community

Abstract

An estimated 14.3 52.5 million people worldwide use meth/amphetamine (used here to refer to amphetamine and methamphetamine), increasing to between 38 and 100.1 million when cocaine and Ecstasy are included. ATS use is associated with a range of negative physical and mental health consequences, resulting in substantial costs to the community in health care, criminal justice and other psychosocial factors, including child protection and family support. Although there are few evidence-based treatments for this population group, ATS were the fourth most common principal drug of concern for which treatment was sought in 2009 10 in Australia.

While the majority presented for counselling, 13.9% entered residential treatment, including therapeutic communities (TCs) in 2009 10. Thus far, evidence-based interventions for this group are based on individual cognitive behavioural therapy. This thesis describes the development and evaluation of a Group Intervention for ATS users (GIATS) (n=125; 83 males) compared with Treatment as Usual (TAU) (n=122; 75 males) in a quasi-experimental study of ATS users accessing treatment in 11 Australian TCs. Participants were interviewed and completed self-report questionnaires of psychosocial measures at T1 (baseline: Time 1) entry to the study and at two follow-up points over 18 months. Results provided an important profile of ATS users, describing their severity of dependence, history of lifetime and current substance use, and severe symptomatology on mental health and psychosocial measures.

Results for both groups at T3 (second follow-up: Time 3) showed statistically significant and clinical improvement over baseline on a number of measures, however; there was no difference between groups. Overall, results at T3 showed reduced substance use and criminal offending, as well as improvement on a range of psychosocial measures, including mental and physical health, psychopathology and executive function.

These findings provide evidence supporting the effectiveness of the GIATS. Aspects considered to be most beneficial include activities based on Acceptance Commitment Therapy (ACT) and mindfulness. These are notable, given the severe deficits in cognitive functioning and level of comorbid presentations that were evident within this treatment population.

Considerations for further research include investigating of the benefit of targeted interventions, the role of reactive aggression in maintaining substance use in association with severe depression and poor executive function, and the ways in which personality factors and psychopathology may be improved during treatment to support retention and maintenance of prosocial outcomes.