Contrasting Three Treatment Approaches to Methamphetamine Addiction
Jerrod G. Cronshaw
This research paper compares and contrasts three applicable treatments for methamphetamine-addicted clients in outpatient settings: psychotherapy with cognitive-behavioral therapy (CBT), the Matrix model, and self-help/12-step groups. Methamphetamine use has reached epidemic proportions worldwide, with no sign of slowing down. The effects of meth use are daunting and destructive, with micro, meso and macro level consequences. Due to reductions in the number of inpatient treatment centers, outpatient services with limited treatment timeframes have become the norm, and three specified treatment modalities emerge as best-suited for outpatient settings. Though each modality comes with specific benefits and limitations, the Matrix model emerges as the more viable option, regarding treatment outcomes and efficacy and appropriateness for outpatient settings. Due to identified treatment implications, clinicians may benefit from this research by implementing specified treatment modalities that are better suited to their clients’ needs.
* This is a revised version of a research paper for a graduate class in the Criminal Justice Department at the University of Nevada Las Vegas.
It’s the causes, not the dependent person that must be corrected. That’s why I see the United States’ War on Drugs as being fought in an unrealistic manner. This war is focused on fighting drug dealers and the use of drugs here and abroad, when the effort should be primarily aimed at treating and curing the causes that compel people to reach for drugs. – Chris Prentiss (Chris Prentiss Quotes, 2018, para. 1)
Firsthand experience interning at substance abuse treatment centers, initially as an undergrad and now as a graduate student, has demonstrated a clear and pervasive issue affecting the lives of countless individuals and their families: methamphetamine addiction. The infamous war on drugs has led to mass incarceration of individuals struggling with substance use disorders, but as has been clearly demonstrated in research and available statistics, incarceration has proven ineffective at deterring or curbing use. Dobkin and Nicosia (2009) state that “despite substantial efforts to reduce the supply of, and demand for, illicit drugs, use of certain drugs has continued to grow … [and] methamphetamine is of particular concern due to the rapid increase in its use and the belief that it causes substantial amounts of crime” (p. 324). Although these concerns may be exaggerated, the numbers, themselves, are indisputable and point towards methamphetamine use remaining a substantial problem that this current drug war fails to eradicate.
Abuse of the illegal psychostimulant, methamphetamine (METH), has become an international public health problem with an estimated 15–16 million users worldwide, a total which exceeds the number of people who abuse heroin and cocaine and makes meth the second most widely abused drug after cannabis. (Krasnova & Cadet, 2009, p. 360)
The numbers vary somewhat, but “according to the World Drug Report 2005 … worldwide, of the 200 million individuals ages 15 to 64 who engaged in illicit drug use on one or more occasion(s) from 2003–2004, 26.2 million used amphetamines, including meth” (Tyner & Fremouw, 2008, p. 286). Taymoori and Pashaei (2016) place the more recent worldwide numbers much higher, at 30-40 million addicts (p. 1). Also mentioned in the World Drug Report (2006) is that the global amphetamine retail market, including amphetamine, methamphetamine, and ecstasy, had – at the time of the report - a staggering value of 28 billion (p. 139). Tyner and Fremouw (2008) declare that “estimates of lifetime prevalence (number of U.S. citizen who engage in meth use in their lifetimes) to be 4.9% and incidence rates (number of new MA users) to be 0.6% (yearly) and 0.2% (monthly)” (p. 286). On top of that, the authors also identify the United States as having some of the highest documented rates of meth consumption, compared to other countries (Tyner & Fremouw, 2008, p. 285). Regarding substance abuse treatment, the Substance Abuse and Mental Health Services Administration (2013) purports that “in 2012, 23.1 million persons aged 12 or older needed treatment for an illicit drug or alcohol use problem” (p. 86).
Additional statistics outlined in the 2012 report include the following: 4.0 million persons aged 12 or older (1.5 percent of the population) received treatment for a problem related to the use of alcohol or illicit drugs; 1.2 million received treatment for the use of both alcohol and illicit drugs; 1.0 million received treatment for the use of illicit drugs but not alcohol; 1.4 million received treatment for the use of alcohol but not illicit drugs; 1.5 percent or 3.8 million persons aged 12 or older received any form of substance use treatment within the past year, with 2.1 million receiving treatment at a self-help group, 1.5 million at an outpatient rehabilitation facility, 1.0 million at an inpatient facility, and 388,000 receiving treatment at a prison or jail (Substance Abuse and Mental Health, 2013, p. 83). Statistics on parolees or probationers struggling with substance use disorders is also high.
In 2012, adults aged 18 or older who were on parole or a supervised release from jail during the past year had a higher rate of illicit drug or alcohol dependence or abuse (34.0 percent) than their counterparts who were not on parole or supervised release during the past year (8.6 percent). In 2012, probation status was associated with substance dependence or abuse. The rate of substance dependence or abuse was 37.0 percent among adults who were on probation during the past year, which was higher than the rate among adults who were not on probation during the past year (8.2 percent). (Substance Abuse and Mental Health, 2013, p. 82)
Because the war on drugs maintains its focus on enforcement, there exists an unfortunate lack of funding for treatment and prevention programs, both of which have proven effective at reducing substance use rates, including meth-related (Manning et al., 2016). Nowhere is this lack of funding more obvious than here in Las Vegas, where inpatient treatment centers typically have an up to six month waitlist for admittance. Outpatient treatment represents the more viable option, though mandated clients, for example, must strictly adhere to specifically outlined requirements or face program termination and immediate incarceration by their probation officers or judges. Indeed, there appears to be a shift in attitudes regarding placement of substance users into treatment programs rather than incarceration in jails or prisons, and reasoning may be attributable to the failure of this so-called war on drugs and its misguided focus on enforcement, without having that desired effect of curtailing use.
Statement of the Problem
Experience interning at various treatment centers has no doubt influenced personal objectives regarding this research topic. Meth appears to be the drug of choice for the majority of local clients presenting with substance use disorders. Some clients have insurance, mostly state-funded through the Affordable Care Act. But what of those countless others who have no insurance and are not privy to the benefits of treatment? Few clients are able to receive inpatient treatment; hence, outpatient remains, perhaps, the best one can hope for. With options limited, the problem boils down to this: We know mass incarceration of drug addicts is ineffective. We also know that meth use is a serious and widespread problem that affects the quality of life for users and non-users alike, including here in Las Vegas. Because the majority of persons struggling with meth addiction and who seek help shall likely end up receiving outpatient treatment, and taking into account limited funds available for treatment – attributable to failed policies of the War on Drugs – as well as the pressing need to identify best treatment practices, the choice was made to compare three treatment approaches conventionally utilized in outpatient settings: traditional psychotherapy with cognitive behavioral interventions (CBT), the Matrix model, and self-help/12-step groups. Which approach is best suited for short-term outpatient treatment and produces more positive long-term results?
These three approaches are unique, but each offers a short-term treatment conducive to outpatient settings. Based on personal experience interning at various treatment facilities, traditional psychotherapy, usually offered in a group and/or individual setting and comprised of cognitive behavioral or other therapeutic interventions, seems to be the standard operating procedure at most outpatient clinics here in Las Vegas. On the other hand, the matrix model, though not as commonly utilized when compared to traditional forms of psychotherapy, is a “program [that] consists of relapse prevention groups, education groups, social support groups, individual counseling, and urine and breath testing delivered in a structured manner over a 16-week period … [and] the treatment is a directive, non-confrontational approach which focuses on current issues and behavior change” (Obert et al., 2000, p. 157). Finally, self-help groups such as Crystal Meth Anonymous, Narcotics Anonymous, and 12-step-based “represent an important, readily available and pervasive resource in substance abuse recovery, whether or not associated with formal treatment” (Donovan & Wells, 2007, p. 121). Adding credence to the notion of self-help groups as a valuable tool for combating meth addiction, Donovan and Wells (2007) suggest that “more actively integrating 12-Step approaches into the treatment process may provide low- or no-cost options for methamphetamine abusers and increase the capacity for providing treatment” (p. 121).
Rightly considered one of the more hazardous illicit drugs, methamphetamine is known for its highly addictive and enormously destructive nature. As substance use treatment providers in Las Vegas, this author and his colleagues encounter client populations struggling with deleterious effects brought on by this particular drug and its misuse. The situation is dire and not limited to any town, city or state. Due to, what seems, continuously rising numbers of clients seeking treatment, there exists a necessity to determine best treatment practices, which is what this research paper aims to discover.
Because the majority of persons struggling with meth addiction opt for treatment in outpatient settings, the decision was made to compare three treatment approaches conventionally utilized in outpatient treatment centers: traditional psychotherapy, the Matrix Model, and self-help groups. The purpose of this research is twofold; first, to identify which approach is best suited for short-term outpatient treatment, and second, which approach produces more efficacious results. The choice to research these specific treatment approaches was based on several factors: outpatient treatment has become the norm, a result of insurance limitations and inadequate resources leading to services that are often short-term; and results of the research may prove beneficial to treatment providers and their clients.
Ultimately, identifying best treatment practices for meth-addicted clients in outpatient settings permits more effective services to be rendered. Potential impact of this research is profound, in that treatment protocols and planning may be enhanced to better serve client needs, resulting in more efficacious client outcomes. The research method utilized for this paper is secondary data analysis and draws from various sources, including, primarily, the UNLV library, with a general aim of conducting a review of literature. Studies identified in the secondary data analysis run the gamut from quantitative and qualitative, experiments, cross-sectional, longitudinal, chi square analysis, evaluation, and several other forms of research design. The hypothesized proposal regarding which treatment is best-suited to clients in outpatient settings is that the Matrix model, with 12-step facilitation implemented as an adjunct to treatment, is more efficacious than traditional psychotherapy or standalone participation in 12-step self-help groups, though it, like the others, has both limitations and benefits.
Hello. You may or may not know me. I destroy homes. I tear families apart, I’ll
take your children and that is just the start. I’m more precious than diamonds,
more valued than gold. The sorrows I bring are a sight to behold. If you need
me, I’m easily found. I’m all around you in every city and every town. I live
with the rich, I live with the poor. I live down the street even next door. I’m
made in a lab, just not the kind you think. I can be made under the kitchen
I can be made in the closet or in the woods. If this doesn’t scare you to death, it certainly should.
I have many names, but one you’d know best. My name is Crystal meth. My powers are awesome, just try me and see. Try me twice, and your soul will belong to me. Once I possess you, you’ll steal and you’ll lie. You’ll do what it takes just to get high. The crimes you’ll commit for the high and fame will be worth millions once I get in your veins. You’ll lie to your mom and steal from your dad. When you see their tears, you won’t even be sad. You’ll forget your morals and how you were raised, once I teach you my worthless ways. I’ll take your friends, your control, your pride; but I’ll always be with you, right by your side. You’ll give up your friends, your family, your home. When you run out you’ll be all alone. I’ll take and I’ll take till there’s nothing to give, and when I’m through you’ll be lucky to live. You can try me for fun, but I’m no game. Given the chance, I’ll drive you insane. I’ll give you nightmares, while you lie sweating in bed. I’ll be the evil voices inside your head. You shouldn’t have tried me, how many times were you told? But you challenged my powers, how could you have been so bold? You couldn’t say no, and just walked away. If you could do it all over again what would you say? I’ll be your master, you’ll be my slave. Don’t fear being lonely, I’ll walk with you to your grave. I’ll show you more pain, than your deepest betrayal. So come take my hand, as I lead you to Hell. - Alicia VanDavis (My Name is Meth, 2012, para. 4)
Methamphetamine is an illegal stimulant whose destructive power endures decades after first hitting the market. This substance first originated in Japan, followed by widespread use during World War Two by countries such as Germany and the United States (Zorick, Rad, Rim, & Tsuang, 2008, p. 144). History of methamphetamine in America ranges from legal to illegal and culminates in an epidemic that spans coast to coast and affects people of all races, ethnicities, genders, and sexual orientations (Brecht, O'Brien, von Mayrhauser, & Anglin, 2004, p. 90-91).
Amphetamine tablets were available in the United States without a prescription until 1951; inhalers containing amphetamine were available over the counter until 1959. Initially, the illicit amphetamine market consisted of diverted pharmaceutical amphetamine, but in 1970, the drug was rescheduled to the more restrictive Schedule II, which lessened its availability. Illicit manufacturers began making meth using the “P2P” method. In the 1980s, two simpler production methods were developed: the “Nazi” method, which used ephedrine or pseudoephedrine, lithium, and anhydrous ammonia, and the “cold” method which used ephedrine or pseudoephedrine, red phosphorus, and iodine crystals. At the same time, large quantities of a smokable and highly pure form of d -methamphetamine hydrochloride (“ice, crystal”) began to be imported into Hawaii from Far Eastern sources. From Hawaii, use of “ice” moved to the West Coast. (Roll, Ling, & Rawson, 2014, p. 9)
The illicit form of meth widely used today results in harmful consequences on society, users, and their families. Healey (2016) states that “the use of ice has psychological and medical consequences for users, disrupts families and communities, is linked to violence and property crime, and damages the environment” (p. 3). Clients presenting into treatment typically experience a variety of meth-related consequences, including “psychosis and mental illness … [and] long-term use that can result in memory loss, aggression and increased risk of stroke and heart failure” (Healey, 2016, p. 3). Meth also affects the central nervous system more substantially than other drugs by easily passing through the blood brain barrier, and it also has a longer half-life (Tyner & Fremouw, 2008, p. 286). Krasnova and Cadet (2009) identify that meth use adversely affects the brain and results in cognitive impairment and dysfunction by causing “damage to dopamine and serotonin axons, loss of gray matter accompanied by hypertrophy of the white matter, and microgliosis in different brain areas” (p. 286).
Mac (2017) says that “behavioral effects of methamphetamine use include violence, an increase in sexual behaviors, repetitive and focused behaviors such as cleaning, twitching, excessive talking, hyperactivity, and sleepiness towards the end of the effects … [and] psychological effects … include anxiety, paranoia, hallucination, delirium, irritability, depression, and dysphoria” (p. 17). Meth use is also associated with dependence, depression, and unsafe sexual practices (Smout et al., 2008, p. 99). Various dangers presented to the public, as pointed out by Healey, include that “ice … is linked to violent criminal attacks against innocent bystanders, risk taking behavior, road deaths, robberies and vicious assaults against frontline health workers and law enforcement responders” (p. 3).
“We call meth ‘Tina’ – the name of a fun party girl – to distract from the reality of the risky substance we’re using” (Cook, 2017, para. 22). Other names include batu, ice, go-fast, crystal, dope, tweek and crank, among others. Meth can be ingested a variety of ways, including via smoking or injecting, where it enters the bloodstream immediately, produces an instant and intense rush, and is associated with higher addiction potential; or by snorting or swallowing, which results in euphoria - minus the rush, and can take anywhere from three to five minutes (snorting) or 15 to 20 minutes (swallowing) to take effect (How is Methamphetamine Used, 2013). The rush and euphoria experienced from ingesting meth includes a “period of mood elevation, increased energy, and increased goal-directed activity [that] may persist up to 8 to 12 hours” (Zorick, Rad, Rim, & Tsuang, 2008, p. 144). The crash, or comedown period, however, is extremely uncomfortable and includes incessant cravings that permeate long after the initial rush wears off.
I remember the aftermath being horrific. The comedown tore me asunder, and I swore I’d never do it again. Then midweek, when the horrible consequences had faded, a little voice in my head – I describe it as ‘a voice that doesn’t belong to you’, a creeping vampire – started to whisper, “You could definitely do that again.” (Cook, 2017, para. 5)
Inpatient and Outpatient Settings
I understood, through rehab, things about creating characters. I understood that creating whole people means knowing where we come from, how we can make a mistake and how we overcome things to make ourselves stronger. – Samuel L. Jackson (Samuel L. Jackson Quotes, n.d., para. 1)
Both inpatient and outpatient treatment settings provide a means for meth users to engage in self-change and develop coping skills that can help them overcome substance addictions. For the purposes of this paper, outpatient settings are identified as more appropriate venues, rather than inpatient, due to a seeming reduction of available inpatient facilities and various insurance limitations, among other reasons. Moreover, the trend of outpatient services becoming the norm was documented by Mushanyu, Nyabadza, and Stewart (2015), who suggest that inpatient admissions will continue decreasing over the next five years, while outpatient admissions rise substantially (p. 11). Las Vegas, for example, has innumerable outpatient facilities, though the number of inpatient centers is in the single digits. Nonetheless, much of the research supports increased viability and efficacy of inpatient treatment versus outpatient (Brecht, Greenwell, Mayrhauser, & Anglin, 2006; Mushanyu, Nyabadza, & Stewart, 2015).
It was noted that the estimated incidence for methamphetamine abuse related to data on inpatient rehabilitants had a sharp decrease as compared to that of outpatient rehabilitants, suggesting that inpatient rehabilitation programs have an increased potential of positively changing the lives of many methamphetamine addicts. (Mushanyu, Nyabadza, & Stewart, 2015, p. 11)
Regardless, inpatient treatment centers are ostensibly diminishing, while outpatient facilities and client admissions continue to grow. Because of this trend, identifying best treatment practices for inpatient settings is fruitless, and focus should remain on clients; hence, research concerning outpatient settings is the more viable option.
Because of similarities concerning negative consequences of stimulant use, Huber et al. (1997) say that “most of the current strategies for treating methamphetamine abuse and dependence are borrowed from experiences with treating cocaine addicts” (p. 48). On the same token, “treatment of [meth use] is the most difficult in the domain of drug abuse treatment … [with] relapse [being] the main challenge of the treatment among meth abusers” (Taymoori & Pashaei, 2016, p. 2). Popular strategies utilized by outpatient treatment centers may include traditional psychotherapy with cognitive behavioral interventions utilized in individual and group sessions, the Matrix Model, and pharmacotherapy and/or self-help groups as an adjunct to treatment. Research associated with psychotherapy, the Matrix Model, and self-help groups is, therefore, examined in order to determine which method proves most efficacious at treating meth-related substance use disorders in the outpatient setting, including reducing rates of substance use and promoting longer periods of abstinence.
Psychotherapy with CBT
Courage doesn’t happen when you have all the answers. It happens when you are ready to face the questions you have been avoiding your whole life. – Shannon L. Adler (Shannon L. Adler Quotes, 2016, para. 1)
Because substance use is considered a symptom of some underlying issue(s) not yet addressed by the client, traditional psychotherapy provides an opportunity, as therapists might say, to peel back the onion, layer by layer, in order to get to the core of the problem. This involves willingness by clients to examine past traumas or other life events that truly are at the core of their onion. Many outpatient facilities implement, what can only be described as, traditional individual and group psychotherapy as primary forms of treatment, rather than the intense and multifaceted Matrix Model method. Utilizing psychotherapy in both individual and group sessions involves basic components of rapport building and strengthening the therapeutic alliance; demonstrating unconditional positive regard and empathic listening and responding; and implementing various techniques, including reflections of feeling, reflections of meaning, confrontation, and immediacy.
Additionally, clinicians typically prefer to use cognitive behavioral therapy (CBT) interventions during the course of psychotherapy sessions. Regarding CBT, Donovan and Wells (2007) add that “behavioral interventions remain the standard of treatment for methamphetamine dependence, although the effectiveness of most counseling interventions has not been tested rigorously” (p. 121). CBT is an evidence-based form of therapy that attempts to identify and correct maladaptive behavioral patterns by enabling clients to “learn to identify and correct problematic behaviors by applying a range of different skills that can be used to stop drug abuse and to address a range of other problems that often co-occur with it” (Principles of Drug Addiction Treatment, 2012). CBT also involves the teaching of different skills, such as “thought stopping, craving management, relapse analysis, and adoption of healthy lifestyle behaviors” (Shoptaw et al., 2005, p. 126).
A central element of CBT is anticipating likely problems and enhancing patients’ self-control by helping them develop effective coping strategies. Specific techniques include exploring the positive and negative consequences of continued drug use, self-monitoring to recognize cravings early and identify situations that might put one at risk for use, and developing strategies for coping with cravings and avoiding those high-risk situations. (Principles of Drug Addiction Treatment, 2012, para. 2)
Research clearly demonstrates effectiveness for various therapeutic approaches utilized in psychotherapy, including CBT. Carroll et al. (2014) identifies that CBT has “a comparatively strong level of empirical support across a range of psychiatric disorders, including substance use disorders” (p. 436). This assertion is supported by Shoptaw et al.’s (2005) study, which identified a positive correlation between CBT and lower rates of meth use, though the authors also pointed out that “incorporating contingency management with CBT significantly reduced methamphetamine use and increased attendance at therapy sessions over standard CBT during treatment as measured using urine drug screening results” (p. 132). Though Carroll et al.’s research focused on cocaine-dependent individuals, results showed that participants were more likely to obtain three consecutive weeks of abstinence during actual treatment, which indicates more robust long-term outcomes; and six-month follow-up with participants demonstrated “significant enduring benefits … [and] the effects of treatment on the percentage of urine specimens that were negative for all illicit drugs also approached statistical signiﬁcance” (p. 441).
McElhiney, Rabkin, Rabkin, and Nunes’ (2009) study identified effectiveness for implementation of CBT interventions, along with client use of the drug modaﬁnil, and results dictated a reduction in both cravings and positive urine screenings during the course of treatment (p. 36). Hider (2015) references benefits associated with CBT in helping adolescent meth users “identify and plan for triggers … [and] identify and change their self-deprecating thinking patterns” (p. 10). Shoptaw et al. (2008) also pinpointed how CBT interventions helped reduce substance use during treatment and at the one-year mark after cessation of services (p. 291). Smout et al. (2008) compared treatment outcomes of clients who received psychotherapy with CBT versus psychotherapy with ACT and found that participants demonstrated comparable attendance, reductions in meth use, reductions in negative consequences and dependence symptoms, and overall 40 to 50 percent abstinence rates (p. 105). Hellem, Lundberg, and Renshaw (2015) also suggest that implementing CBT interventions may help reduce short-term meth use: “Experimental and nonexperimental studies evaluating psychological approaches for the treatment of co-occurring mood disorders and substance use disorders show varying results but overall show that motivational interviewing combined with CBT may result in short-term reduced substance use and improvements in mental status” (p. 20). On the flipside, there remain various limitations associated with psychotherapy that utilizes CBT.
A number of obstacles impede the delivery of CBT and other empirically validated therapies in clinical practice, including the limited availability of professional and specialty training programs that provide high-quality training, supervision, and certification in CBT; high rates of clinician turnover and lack of a CBT-trained work force in many treatment settings; the relative complexity and cost of training clinicians in CBT; and high case loads and limited resources in many settings. (Carroll et al., 2014, p. 436)
As human beings, our greatness lies not so much in being able to remake the world… as in being able to remake ourselves. – Mahatma Gandhi (Mahatma Gandhi Quotes, 2015, para. 1)
The Matrix Model is a highly intensive program designed to meet various needs and provide a means to, essentially, remake oneself or, at minimum, change the trajectory of one’s life. “The Matrix Model was developed in 1986 with support from the National Institute on Drug Abuse (NIDA), and evaluated with support from the Center for Substance Abuse Treatment (CSAT) in the largest clinical trial network study to date on methamphetamine treatment” (Hazelden Publishing, 2005). Rawson et al. (2002) describe the Matrix Model as a technique delivered by licensed and trained clinicians via individual and group therapy sessions that includes “techniques and materials from the cognitive behavioral therapy literature, with accurate information on the effects of stimulants, family education, positive reinforcement for behavior change and treatment compliance and 12-step program participation” (p. 108). Other potential focal points include acquiring group skills training and relapse prevention and analysis, with the goal of helping clients learn how to “discontinue stimulant abuse, encourage to treat from the beginning to the end, understand the risks of relapse, and prevent relapse” (Taymoori & Pashaei, 2016, p. 2).
The Matrix Model uses key cognitive-behavioral principles as the foundation of its program, with specific goals to: (1) stop drug use; (2) learn issues critical to addiction and relapse; (3) receive education for family members affected by addiction and recovery; (4) become familiar with self-help programs; and (5) receive weekly monitoring by urine toxicology and breath alcohol testing. Treatment materials … are manualized to aid in treatment standardization. (Huber et al., 1997, p. 44)
Research concerning efficacy of the Matrix Model demonstrates “a measurable degree of response of methamphetamine abusers to psychosocial intervention” (Huber et al., 1997, p. 49). “The Matrix Model is evidence-based, cost-effective, and meets the needs of our nation's treatment programs, 89 percent of which offer intensive outpatient services” (Hazelden Publishing, 2005). Rawson et al (2008) add that “2-5 years after an index treatment episode, there are a substantial number of [meth] users who are abstinent, employed, and not under the supervision of the criminal justice system” (p. 117). Rawson et al. (2004) declare that “[patients] who were assigned to Matrix treatment attended more clinical sessions, stayed in treatment longer, provided more [meth]-free urine samples during the treatment period and had longer periods of [meth] abstinence than those assigned to receive [traditional therapy]” (p. 708).
Furthermore, Amiri, Mirzaee, and Sabet (2016) discuss how cravings to use methamphetamine were reduced during treatment in the Regulated 12-Session Matrix Model, and that “all statistical results indicate positive efficacy of treatment” (p. 81). Smout et al. (2010) back up that assertion by describing how attendance and abstinence rates in their CBT study were “well short of those achieved in the Matrix program, with its 36 90-minute group CBT sessions” (p. 105). Smout et al. (2008) also identified that the Matrix program had higher abstinence rates compared to brief CBT (p. 99). Clearly, research on the Matrix Model demonstrates effectiveness in treating substance use disorders, particularly those involving methamphetamine, with rates exceeding those of standard psychotherapy.
The Matrix approach produces consistently better treatment retention and program completion than the [treatment as usual] condition in overall analyses, and delivers more treatment ‘events’ than [treatment as usual] at most sites. The Matrix approach also appears to result in more [meth]-free urine samples and longer periods of in-treatment abstinence than most [treatment as usual] conditions during the active treatment period. (Rawson et al., 2004, p. 716)
Self-Help and 12-Step Groups
Is sobriety all that we are to expect of a spiritual awakening? No, sobriety is only a bare beginning; it is only the first gift of the first awakening. If more gifts are to be received, our awakening has to go on. As it does go on, we find that bit by bit we can discard the old life - the one that did not work - for a new life that can and does work under any conditions whatsoever. – Bill W. (Our Awakening Has To, 2014, para. 1)
Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and Crystal Meth Anonymous (CMA) are examples of self-help groups, which are non-therapeutic, 12-step-oriented, fellowship gatherings of substance users and alcoholics. Members identify the Twelve Steps as key to helping addicts recover from substance use disorders, including meth and other stimulants. Prominent in the Twelve Steps are notions of powerlessness and acceptance, belief in a Higher Power of one’s own choosing, and having a spiritual awakening by “turning one’s will over to a higher power” (Lyovin, 2012, p. 3). Donovan and Wells (2007) identify that “twelve-step and mutual/self-help groups represent an important, readily available and pervasive resource in substance abuse recovery, whether or not associated with formal treatment” (p. 122).
According to the Substance Abuse and Mental Health Services Administration (2013), “in 2012, among the 4.0 million persons aged 12 or older who received treatment … in the past year, 2.1 million persons received treatment at a self-help group, and 1.5 million received treatment at a rehabilitation facility as an outpatient” (p. 83). This seems to indicate that higher numbers of persons seek assistance through self-help groups than treatment centers, though it should be noted that many outpatient programs require their clients to attend self-help groups as an adjunct to treatment, thus potentially inflating those numbers.
Research on the efficacy of 12-step and other self-help group attendance is, as Hatch-Maillette et al. (2016) point out, “scarce, despite the widespread practice of encouraging or requiring 12-step group attendance as part of recovery, and despite the emergence of Cocaine Anonymous and Crystal Meth Anonymous” (p. 75). On the other hand, available research, though much more focused on Alcoholics Anonymous, identifies that “more actively integrating 12-Step approaches into the treatment process may provide low- or no-cost options for methamphetamine abusers and increase the capacity for providing treatment” (Donovan & Wells, 2007, p. 121). In addition, Wells et al. (2014) purport that “there is strong research support for the ability of these therapies to increase attendance and active involvement in 12-Step fellowships, improve drinking or other substance use outcomes, and have long-lasting effects (p. 265). Furthermore, Hatch-Maillette et al. (2016) identify that “attendance at Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) was associated positively with abstinence at 1-year, but not 5-year follow-up for stimulant users completing treatment” (p. 75). Besides perceived benefits of attending, Hatch-Maillette et al. (2016) also determine that “both readiness to engage in 12-step content … and specific prior attendance and active participation (defined as speaking, having duties at, or engaging in related activities) with 12-step programs, were the main signs pointing to future involvement in these same areas” (p. 80). The concept of spirituality and being able to experience a spiritual awakening is associated with better long-term outcomes, and maintaining a “sense of purpose, gratitude, forgiveness - all aspects of spirituality - and belief in a higher power predicted the number of steps worked and the quality of recovery … among participants in addiction treatment” (Slaymaker, 2009, para. 6).
There are, understandably, concerns about self-help groups, as outlined in the literature. A potential barrier encountered in self-help groups and, as mentioned by Capuzzi and Stauffer (2012), is the “subtle pressure to conform to group norms, values, and expectations” (p. 249). “Equally troubling, AA maintains that when an alcoholic fails, it is his fault, not the program's … [and] this message can be devastating” (Johnson, para. 14). Additionally, a central tenet of self-help groups is the ability of members to accept powerlessness over their addictions, or asserting a self-diagnosis that they have a problem with substance abuse. “Collectively, the [AA] group believes self-diagnosis is the only real diagnosis; in self-diagnosis, there is a recognition and realization of the problem, and only then can a person work towards the solution” (Kirkpatrick, 1999, para. 2). The notion of what is, more or less, taking responsibility and forming acceptance of one’s addiction is not a requirement for clients who seek treatment in professional settings, though ascertaining that self-diagnosis in self-help and 12-step attendance enables clients to approach recovery in a more active manner. In treatment settings, motivational interviewing, particularly, is utilized by clinicians in order to help clients move through the stages of change; hence, mandated and other clients who may not recognize that they have a problem or whom remain in denial may be better suited to professional treatment settings, rather than self-help groups.
Laudet and White (2005) point counselors to the lack of consistent empirical support for [self-help groups’] effectiveness, as well as a general lack of trained professionalism; the risk that members may become overly dependent on the group; that members may, and sometimes do, get bad advice from other group members; and that the usefulness of these groups is limited in time or in scope. (Capuzzi & Stauffer, 2012, p. 249)
Methodology and Findings/Results
Due to convenient access, the majority of sources utilized for this secondary data analysis were culled from UNLV’s online library portal. Other sources utilized in this research include the Substance Abuse and Mental Health Services Administration, websites such as the National Institute on Drug Abuse, and Capuzzi and Stauffer’s textbook Foundations of Addictions Counseling. Actual data was gathered and analyzed after spending countless hours poring over online journal articles and studies, websites, and previous textbooks. Examining data presented in journal articles entailed peering through and deciphering the authors’ study designs, methods, results, and discussion sections.
Findings on substance use and the war on drugs clearly indicate that this so-called war is inefficient at deterring meth use or reducing consumption. Moreover, statistics concerning meth and other substance use and treatment admissions indicate a high amount of users, with increasing numbers seeking treatment. Research related to traditional psychotherapy with CBT demonstrates strong empirical support, lower rates of meth use - both short and long-term, diminished cravings, and increased ability for clients to identify and plan for triggers, change self-deprecating thinking patterns, reduce negative consequences and dependence symptoms, and achieve 40 to 50 percent abstinence rates (Smout et al., 2008, p. 105). Obstacles include limited training availability, supervision, and certification in CBT, high clinician turnover rates, and high training costs and caseloads (Carroll et al., 2014, p. 436).
Results of research on the Matrix model, as compared to traditional psychotherapy with CBT, identify higher long-term rates of abstinence, higher rates of employment post-completion, greater client participation and completion rates, more negative urine samples, and reduced cravings. Research on self-help groups and meth users was limited, though shorter-term efficacy was identified, as were benefits to meth users who have no access to formal treatment, the role of spirituality in creating more substantial outcomes, and previous participation and present motivation as important factors in ongoing attendance. Limitations of self-help group attendance include inability to conform to group norms and expectations, placing the burden of relapse onto the person, recognition of powerlessness and the notion of having a substance-use problem, lack of empirical support for participation effectiveness, and the lack of professional treatment.
Discussion and/or Implications
According to the research, all three treatment modalities present substantial benefits to clients, though benefits of the Matrix model, which include more efficacious long and short-term client outcomes, appear substantially better than treatment via traditional psychotherapy or self-help groups alone. Nonetheless, limitations concerning the Matrix model involve the issue of clients having to participate in the required full number of sessions, which may be more than insurance companies are willing to cover. Moreover, having available staff members who are properly trained in the curriculum presents a challenge to many agencies, especially nonprofits. But ideally, the Matrix model should be the preferred choice of outpatient clinics, because of documented benefits outlined in the research. This treatment is also conducive with outpatient curriculums and has proven effective at increasing abstinence rates and quality of life for clients. In cases where implementing the Matrix model in outpatient settings is unattainable, psychotherapy with CBT is a good alternative, though based on available research, participation in self-help or 12-step groups as an adjunct to treatment is also beneficial. Due to some meth users being unable to afford or unwilling to engage in treatment, participation in self-help or 12-step groups is the third best option, though limitations outlined above represent barriers for those individuals.
Conducting this research provided a means to explore three separate treatment options for meth-addicted clients, and although answers were ascertained regarding which modality is best suited for outpatient settings and is ultimately more efficacious, obstacles remain that might impede implementation of the identified option. The Matrix model has a fantastic curriculum that best suites outpatient settings and results in greater treatment outcomes, though 12-step/self-help group attendance should also be utilized as an adjunct to treatment. Though some sort of professional treatment is recommended for meth-addicted persons, those who cannot partake are advised, at bare minimum, to attend self-help groups and work the Twelve Steps. Traditional psychotherapy with CBT is also beneficial, as proven by the research, and being able to peel that onion during individual or group psychotherapy sessions represents an important benefit that helps clients identify underlying issues contributing to their substance use. Regardless of how one feels about professional or nonprofessional forms of treatment, meth addiction is something that can be curbed and, ultimately, put into remission. The war on drugs, with its emphasis on enforcement and prohibition, has proven ill-suited in eliminating the meth problem, while treatment, on the other hand, has proven efficacious at reducing meth use and promoting more positive outcomes. Perhaps, it is time politicians stop turning a blind eye and take note of this proven alternative. After all, clinicians certainly have.
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