Introduction
In the broad class of amphetamines, methamphetamine (MA) remains the most commonly abused type. The dangers of methamphetamine are well-known policymakers, health care professionals, social service providers, and law enforcer. Over time, MA abuse can damage physical and mental capacities, family ties, employment prospects, and create cycles of arrest and rehabilitation (King, 2006).
Scrutinizing Drug Enforcement Administration findings, employment-related drug testing service provider Quest Diagnostics Inc. revealed that significant increases in production and trafficking during the 1990s made MA the most widely-used illegally manufactured synthetic drug in the United States (Quest Diagnostics, 2008). The 2007 runs of the Quest Diagnostics Drug Testing Index recorded lower positive methamphetamine results in the U.S. workforce, leading DEA Acting Administrator Michele M. Leonhart to crow that interdiction of illicit manufacturing and transport has worked.
But the optimism engendered by a reduction of around 73 percent in MA abuse from 2002 to 2004 and another 22 percent between 2006 and 2007 has to be considered in light of the fact that the 2007 data also shows a 5 percent rise in total amphetamine use in the general workforce. This suggests “switching from MA to other amphetamine forms.
Two Examples
Dissatisfied with the breadth of literature on effectiveness of treatment on MA abuse, Brecht et al. (2006) embarked on a longitudinal pre- and post-treatment study that covered employment and criminal activity among the criterion variables. Study instrument was an in-depth natural history interview on a sample of 349 randomly-selected admissions for MA abuse treatment in a publicly-funded county treatment system. Treatment outcomes were favorable in point of reduced abuse and crime, as well as increased employment compared to levels 24 months prior to admission. Regression analysis suggested that higher educational attainment, being male, mainstream white ethnicity, and longer treatment predisposed to better employment outcomes after treatment.
Kurtz (2005) narrowed his focus to one locality (Miami) and the minority of homosexuals to investigate the relationship between MA use, on one hand, and employment, social and personal relationships, on the other. The drug scene in Miami was already notorious in the 1990s, according to him, for widespread use of such “recreational drugs” as ecstasy, GHB (a depressant, also called “Georgia Homeboy” or “Grevious Bodily Harm”), and ketamine in clubs and circuit parties. From the gay subculture on the West coast, where it was initially adopted, the crystal MA fad spread to the swishy fringe of the Miami party scene. The author conducted four mini-focus groups of three to four participants each to plumb the motivations and consequences of crystal meth use among gay men. In this kind of rationalistic and self-defensive setting, the participants were quick to bemoan MA abuse for lost friendships, break-up’s with “partners”, paranoia and job loss. In addition, the groups claimed that they had been variously induced to try MA to assuage the alienation and loneliness so intrinsic to the homosexual syndrome, to allay anxieties about the possibility of contracting AIDS, to calm their panic at losing youthful looks, and to lose inhibitions over perverted sex acts. The author concluded by suggesting that interventions to eliminate MA use had to address socialization needs, their angst at finding “romance”, and the permissiveness about drug use that permeates the subculture.
Details on One Evidence-Based Study
Jett (2005) wrote an overview of the findings of the Substance Abuse Research Consortium. The background for the study starts with the November 2000 passage of California’s Proposition 36, the Substance Abuse and Crime Prevention Act (SACPA). The law loosened the penalties on drug abusers by permitting first- or second-time offenders to receive treatment in the community instead of going to jail. The state provided an annual budget up to fiscal 2006-07 to pay for a maximum of one year of drug treatment and six months of aftercare. The program had been extended to all 58 counties when the time came to assess effectiveness and financial impact. The government awarded the evaluation and analysis to UCLA’s Integrated Substance Abuse Program (ISAP). ISAP evaluated the status of more than 120,000 addicts from a benchmark period right before Proposition 36 passed (in order to derive a control group) and during the period when the state-funded program ran.
ISAP assessed four key areas: cost-offset, implementation, outcomes, and lessons learned. Study instruments covered a gamut from secondary research on treatment records and public datasets to focus groups, surveys, and participant observation.
The general cost-benefit findings:
- MA was the most widely-abused drug.
- SACPA more than paid for itself. Taxpayers saved an average of $2.50 and up to $4.00 for every dollar of outlay. The cost-benefit ratio was highest for addicts who completed the 30-month treatment program.
- Since SACPA participants earned increased employment opportunities, the incremental personal income tax they generated counted toward the financial benefits of the program. Otherwise, most of the savings came from reductions in jail and parole costs, however.
- Offenders who completed the program boasted lower recidivism and were more likely to remain employed.
In the second year of the program, surveys to update SACPA benchmarks on alcohol and other drug (AOD) abuse prevalence revealed that methamphetamine was so widely abused it already ranked ahead of alcohol, cocaine and marijuana as the “primary drug of abuse”. That year, California accounted for fully 40% of the nation’s MA addicts undergoing treatment. The author observed that two reasons for this were that: a) women, prone to abuse MA just as much as men, believed in the appetite-suppressant and figure control “benefit” of the drug; and, b) for a variety of reasons (see the aforementioned Miami qualitative study), MA was something of a cult drug among practicing homosexuals.
The Jett article was by way of a summing-up and introduction to the complete supplement-report on SARC. Nonetheless, the author could argue that there was empirical evidence for treatment fundamentals in respect of employed addicts. This included scheduling after-hours appointments and providing child-care services for working parents. On the other hand, the evidence generated by the evaluation affirmed that many MA abusers benefit more from residential programs and, as they progress, staying in sober-living houses which provide an alcohol- and drug-free environment.
Beyond SARC, the state Department of Alcohol and Drug Programs looks to stem the tidal wave of MA and other addiction in the state by commissioning more research into why people use drugs, by launching a social marketing ad campaign targeted principally at teenagers, homosexuals and young women; by encouraging grassroots community action to combat MA abuse; and by providing teachers, primary care personnel, and families a DVD series on negative consequences and treatment options for MA abuse; and by assuring all stakeholders that this “relapsing condition” is amenable to an established continuum of care. Indeed, the best news from the SARC experience may well be that MA abuse is just as amenable to treatment as other addictions.
References
Brecht, M. L., Greenwell, L., von Mayrhauser, C. & Angling, M. D. (2006) Two-year outcomes of treatment for methamphetamine use. Journal of Psychoactive Drugs; 415.
Jett, K. P. (2007). Substance Abuse Research Consortium (SARC): Introduction. Journal of Psychoactive Drugs, 313-7.
King, R. S. (2006). The next big thing? Methamphetamine in the United States. Washington, D.C.: The Sentencing Project.
Kurtz, S. P. (2005). Post-circuit blues: Motivations and consequences of crystal meth use among gay men in Miami. AIDS and Behavior, 9(1), 63-72.
Quest Diagnostics. Use of methamphetamine among U.S. workers and job applicants drops 22 percent in 2007 and cocaine use slows dramatically. 2008. Web.