Six Things Rural Communities Can Do About their Meth Problems

A flu epidemic can be stemmed and treated as individuals bring themselves or family members in for medical care. But a meth epidemic is much harder to stop.

As an illegal substance, there are barriers between meth addicts and cures: the risk of imprisonment, fines, loss of child custody, and stigma from the sober community. On top of this, methamphetamine affects the decision-making parts of the brain, making it physiologically and psychologically much more difficult to quit.

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Money is tight in America’s rural places, but meth lab busts are too expensive for this problem to be ignored.

There are no treatments developed specifically for meth addiction, though a great deal of treatment options for other substances have been tried for methamphetamine addiction with limited success. What it comes down to is that there is no single approach that has been shown to work effectively for meth addiction. This doesn’t mean that a combination of treatments cannot be effective. The stakes are much too high for us not to try.

“…the availability of a continuum of levels of care including medical services and, at a minimum, supportive services that address legal problems, employment issues, and that provide social resources are essential to the treatment of stimulant use disorders and methamphetamine in particular.” -The Chemical Dependency Bureau Best Practice Committee in Montana

Here are some things rural communities can do about their meth problem:

  1. Educate the community. If addicts are going to make a full recovery within their communities, they need to have a community to come back to. Education is both a preventative step in combating further addictions in the community, and a step in treatment. Addicts need to know that the sober community will ultimately accept them and help them come clean. There needs to be support and incentive at the end of the addictions tunnel for an addict to stay in treatment.
  2. Provide employment for recovering addicts. Employment was the greatest predictor for completion of the drug court program in this study. More research is needed in this area, however, as a different study found that serious psychological distress was the greatest predictor for employment status among participants who reported meth use. It is possible that psychological stability was the real predictor in the first study mentioned above.
  3. Get addicts into treatment programs. Whether through family intervention, increased community awareness, or through arrest, addicts need to be directed into residential treatment programs. Prison is unlikely to help addicts recover from addiction, though long-term imprisonment may reduce crime.
  4. Help addicts remain in treatment. In outpatient cases, it is important that treatment is accessible in terms of hours of service, transportation to treatment, finances, and childcare. Phones must be answered immediately as meth addicts are likely to hang up if put on hold. Providers and/or family members should call and pursue any no shows.

    “…the client must experience progress and believe that immediate attention will be given to critical medical and psychological/psychiatric problems.” –The Chemical Dependency Bureau Best Practice Committee in Montana

  5. Treatment needs to be long-term. Meth addiction causes lasting changes to the brain, documented in depth here, which make it much more difficult to quit. 45-120 days into treatment, addicts hit what is referred to as a “wall,” where they become increasingly depressive and crave the drug even more.
  6. Withdrawal symptoms need to be addressed. In order to retain addicts in treatment, withdrawal symptoms need to be attenuated. There is one promising medication almost ready for clinical trial, Ibudilast, that suppresses glial cell activation. Glial cells are non-neuronal cells that provide support and insulation for brain neurons. Glial cell activation critically contributes to neuropathic pain, opioid dependency, and withdrawal. It is hoped that Ibudilast will help reverse some of the physical changes methamphetamine creates in the brain and so reduce dependency on the drug. Steven Shoptaw at UCLA is now conducting a Ib clinical trial of Ibudilast for treatment of methamphetamine addiction. Source

    “…the meth abuser is in severe emotional turmoil; they are unable to experience pleasure, suffer from paranoia, and cycles of depression and euphoria. These conditions serve to make the abuser very ambivalent; both wanting to stop but also resistant to implementing cessation. The intense craving that accompanies methamphetamine withdrawal reinforces the notion that nothing but more of the drug could alleviate craving.” –The Chemical Dependency Bureau Best Practice Committee in Montana

The following treatment approaches have been shown to be the most successful at producing urine samples negative for meth.

  • Cognitive-behavioral therapy. According to the Illinois Attorney General,

    “Successful meth treatment requires the use of cognitive-behavioral therapy. The cognitive-behavioral therapy approach, which focuses on how the way we think affects our feelings and actions, helps patients identify and plan for the triggers associated with the substance abuse. This approach prepares the addict for life-long recovery.” Source

    With the aid of a therapist, addicts are engaged in identifying their drug use history, current drug use, mental status, and relationships with significant others as well as triggers that make them use the drug again. Once triggers for use are identified, the addict can learn to avoid high-risk trigger situations and learn new ways to cope with them. Returns to meth use are not seen as failures, but rather opportunities to learn. Treatment needs to be highly interactive in order to be successful, especially if it is on an outpatient basis. Here is a study examining the efficacy of cognitive-behavioral therapy.

  • Contingency management. According to this meta study, addicts seem to respond to direct rewards as an alternative to meth use while in treatment. The authors introduce CM as based on the theory that a drug operates as a positive reinforcer, therefore CM delivers rewards for sobriety that are more appealing than those of the drug.There is evidence, however, that meth addicts are unlikely to respond to long-term motivators. When given a choice between a smaller amount of money now and a larger amount of money later, they will choose the former. CM for meth addicts would need to reflect this.Contingency management is usually used in combination with psychosocial approaches.It’s efficacy is backed by this large-scale study (sample size= 113 participants) comparing treatment as usual to treatment plus contingency management. They found that retention in treatment was equal in both groups, but the CM group provided significantly more negative urine samples and had significantly longer periods of sobriety (5 weeks as opposed to 3).It is important to note that CM studies have not examined the long-term sobriety of participants post-study.
  • The Matrix Model. This approach is a more complex amalgamation of approaches, including 12-step elements similar to other addictions treatments. There is a community outreach element focused on creating community support in friends and family, as well as group therapy amongst addicts. When compared to treatment as usual, this study found that participants in Matrix treatment attended more clinical sessions, stayed in treatment longer, and provided more meth-free urine samples during treatment with longer periods of abstinence. This was a large-scale study of 978 patients, randomly assigned to treatment as usual or the Matrix Model, over an 18-month period. A different study found that retention in treatment was higher for Matrix participants as opposed to treatment as usual, and Matrix participants provided more meth-free urine samples at all of their sites except a drug court site. The differences in negative urine samples between treatments dissolved at the discharge interview (66% for Matrix participants and 69% for treatment as usual), at the six-month follow-up (69% for both), and at the 12-month follow-up (70% for Matrix and 73% for treatment as usual).

None of these treatments are very encouraging on their own if we hope to slow the tide of meth addiction in rural America. A two-thirds success rate is just about all we can hope for as of yet, and even here we cannot be sure that the success is life-long.

What is needed are complex, multi-approach treatments that take financial strain, child custody, and legal issues into account. These treatments need to monitor clients on an outpatient basis for years after treatment ends in order to really assure efficacy. And ultimately, we are still waiting on the brain research that will help to find real, evidence-based cures for methamphetamine addiction.

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About Laurel Sindewald

Laurel is an alumna of Warren Wilson College with a BS in Conservation Biology and a BA in Philosophy. She is a writer for Rural System, Inc.

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