This presentation describes the implementation of an empirically-supported intervention for methamphetamine abuse, and outcomes will be contrasted with an intensive family-based intervention in rural Western North Carolina

Curtin , Lisa

NC DOCKS at Appalachian State University

Renkert, Lauren

Thorp, Heather

English

The University of North Carolina at Greensboro

Lauren E. Renkert, PhD, LCSWLisa Curtin, PhDHeather Thorp, LCSW, CSAC, REATAppalachian State UniversityInstitute for Health and Human Services 2003:   in reports of manufacture (NCLD, 2008)and useWatauga County (WC): children found in labs  Dept. of Social Services’ (DSS) custodychildren reside in approximately 1/3 of MA manufacture sites (NDIC, 2002)WC organized a team, which developed Meth Lab Response ProtocolNC DMHDDSAS recognized need and encouraged submission of grant proposal WC developed model treatment program, which eventually became Family Solutions (FS) By 2006, NC DMHDDSAS provided grants to 4 Local Management Entities (LMEs), each selected 2 counties to participate• New River:  Watauga and Ashe (FS)• Foothills:  Caldwell and McDowell• Smoky Mountain:  Haywood and Macon• Western Highlands:  Buncombe and Rutherford(North Carolina Department of Transportation, 2010) Each LME was to develop its own treatment model Community collaboration and partnerships were encouraged Appalachian State University research team involved from the beginningNC Methamphetamine Initiative/ASU Partnership for Treatment Program Development and Evaluation(Renkert, Reed-Ashcraft, & Thorp, 2008) Intensive treatment for meth user and family Rapid Entry intake process:  DSS and FS staff conduct home visit within 24 hrs of abuse/neglect report to DS FS rapid entry assessment/intake occurs during acute 7-10 day withdrawal All family members assessed for treatment and service needsUDS or SDS administered on site(Renkert, Reed-Ashcraft & Thorp, 2008)Within 2 weeks, Support Network Intervention Team (SNIT) selected with client:  family members, friends, FS clinicians/staff, DSS workers, other school, agency, and community reps (Winek et. al,  2010) SNIT developed and begins to meet during subsequent 2-week subacute phase (For discussion of phases, see McGregor et. al, 2005)  SNIT met regularly: support, problem solving, overcomes barriers, accountabilityOther interventions used as needed:IOP, individual, family, and group therapiesAA/NACase management and supportTransportation, child care, and meals provided at group therapy meetingsServices delivered in homes, schools, community, and officeUDS and SDS administered randomly and routinely Clients progress through defined levels of treatment Treatment ≈ 1 yearWeekly supervision (for treatment fidelity) All other counties adopted this model NC DMHDDSAS encouraged use at all sites and provided ongoing training and supervision Manualized psycho-educational and cognitive-behavioral IOP treatment intervention• http://www.kap.samhsa.gov/products/manuals/matrix/pdfs/counselor_treatment_manual.pdf 16 weeks:  Early Recovery Skills, Relapse Prevention, Family Education, Social Support groups AA, NA, and drug screens expected Previous ―graduate‖ becomes peer co-leader Specific topics addressed in individual sessions and included in the manualNC DMHDDSAS adopted the model as a Best Practice intervention 3 year longitudinal study 2004-07Quasi-experimental design with comparison groups to be selected from other NC countiesQualitative process evaluation surveyed clients , clinicians, administrators, n = 29(Renkert, Reed-Ashcraft, & Thorp, 2008)Quantitative study included data collected from client case records at treatment sites and local DSSs, N = 317Local Management Entityn                                       %Foothills(Caldwell, McDowell)19                                      7.6New River(Ashe, Watauga)123                                    49.4Smoky Mountain(Haywood, Macon)79                                    31.7Western Highlands(Buncombe)28                                    11.3TOTAL249          100 Age:  X = 32.2 (SD = 9.25) 65% Female 92% CaucasianMarital Status45% never married31% divorced or separated22% married3% Widowed Education54% less than high school33% high school diploma or GED13% some college or college degree (n = 1) Employment32% employed (24% full-time)62.5% unemployed5.5% not in labor force Significant Difference (p < .0001)Family SolutionsMean Days = 356 (SD = 269.7)MatrixMean Days = 141.5 (SD = 131.4)Use based on UDS and SDS resultsAverage # = 8.6 (no difference between FS & Matrix)Time period covered by UDS and SDS (p < .0001)Family Solutions average 288 daysMatrix average 128 days (1)Ratio of positive screens to overall # of screens and (2) Continuous Abstinence RatesMethamphetamineOther StimulantsOverall Significant difference between Family Solutions and Matrix, F (1, 248) = 5.09, p = .025Family Solutions:  Mean = .03 (SD = .09)Matrix:  Mean = .08 (SD = .23)Overall, 80.2% of clients were continuously abstinent from methamphetamineNo differences were noted between Family Solutions (80.3%) and Matrix (80%)No significant difference between Family Solutions and Matrix Overall, 63.6% of clients were continuously abstinent from other stimulants No significant differences were noted between Family Solutions (59%) and Matrix (68%)No significant difference between Family Solutions and Matrix Overall, 31.7% of clients were continuously abstinentMatrix (40.5%) resulted in higher levels of overall continuous abstinence compared to Family Solutions (22.8%), Χ2 (df = 1, N = 249) = 9.01, p = .002Possibly related to greater time-period assessed by drug screens (288 days vs. 128 days)Quasi-experimental design Future analyses to control for time in treatment ―Real World‖ data collection:Missing dataDMHDDSAS eventually allowed sites to serve other stimulant usersUndocumented inconsistencies regarding eligibilityMandated changes to meet Medicaid Service definitions, including shortening to 14 weeksInconsistent fidelity across sitesWomen Caucasian Early 30’sHigh school education or lessUnemployedNever married Similar to previous findings (Drug and Alcohol Services Information System, 2004) Treatment can work Implications for real-world adoption of empirically-supported treatment programs even with various levels of fidelity Implications for locally-developed, culturally-sensitive treatment programs  Appeared acceptable to clientsMA-focused treatment effective for MA use: # of clients were continuously abstinent throughout treatment across sitesFS sites had significantly lower ratio of positive drug screens for methHigher rates of overall continuous abstinent in Matrix sitesUse of non-stimulant substance increases across time?FS primary focus on MA?  Implications of length of treatment and length of follow-up FS model includes family treatment and often DSS involvement  child and family well-being outcomes to be examined across sites Lauren Renkert: renkertle@appstate.edu Lisa Curtin: curtinla@appstate.eduHeather Thorp: thorpha@appstate.edu  Please do not cite without permission of authorsCenter for Substance Abuse Treatment (2006). Counselor’s Treatment Manual: Matrix Intensive Outpatient Treatment for People With Stimulant Use Disorders. DHHS Publication No. (SMA) 06-4152. Rockville, MD: Substance Abuse and Mental Health Services Administration.Drug and alcohol services information system (2004). Characteristics of primary amphetamine treatment admissions:  2001. Retrieved from http://www.oas.samhsa.gov/2k4/SpeedTX/SpeedTX.htm.Huddleston, C. W. (2005). Drug courts: An effective strategy for communities facing methamphetamine. Retrived from www.ojb.usdoj.gov/BJA.McGregor, C., Srisurapanont, M., Jittiwutikarn, J., Laobhripatr, S., Wongtan, T., & White, J. (2005).  The nature, time course and severity of methamphetamine withdrawal.  Society for the Study of Addition, 1 -- 10.  doi:  10.1111/j.1360-0443.2005.01160.xNational Clandestine Laboratory Database [NCLD] (2008). Maps of methamphetamine lab incidents, 1999-2007. Washington, DC: U.S. Drug Enforcement Administration.National Drug Intelligence Center [NDIC] (2002). Children at risk (2002-LO424-0001). Johnstown, PA: U.S. Department of Justice.North Carolina Department of Transportation  (May 16, 2010).  Retrieved from: http://www.ncdot.gov/travel/statemapping/download/nc_statemap_countyoutline.pdfOld Crow Medicine Show. (2008).  Methamphetamine. On Tennessee Pusher [CD].  Vancouver:  Nettwerk Records.Rawson, R. A., Marinelli-Casy, P., Anglin, M. D., Dickow, A., Frazier, Y. et al. (2004). A multi-site comparison of psychosocial approaches for the treatment of methamphetamine dependence. Addiction, 99, 708 – 711.Renkert, L., Reed-Ashcraft, K., & Thorp, H. (2008).  Process Evaluation: Executive Summary and Final  Report.Boone, NC:  Appalachian State University, Institute for Health and Human Services.Winek, J., Dome, L., Gardner, J., Sackett, C., Zimmerman, M. J., & Davis, M. (2010.) Support Network Intervention Team: A Key Component of a Comprehensive Approach to Family-Based Substance Abuse Treatment, Journal of Groups in Addiction & Recovery, 5(1), 45 — 69.  doi: 10.1080/15560350903543832(Photos  Courtesy of Watauga Democrat)Matrix Treatment Manual:http://www.kap.samhsa.gov/products/manuals/matrix/pdfs/counselor_treatment_manual.pdfhttps://ncadistore.samhsa.gov/catalog/productDetails.aspx?ProductID=17441

Methamphetamine treatment in rural western North Carolina [Presentation Slides]

http://libres.uncg.edu/ir/asu/f/Renkert_Curtin_Thorp__2010_NARMH_pres.pdf

Methamphetamine treatment in rural western North Carolina [Presentation Slides]

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