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Addiction Science & Clinical Practice
Published in: Addiction Science & Clinical Practice 1/2021

Open Access 01-12-2021 | Research

A novel brief treatment for methamphetamine use disorders in South Africa: a randomised feasibility trial

Authors: K. Sorsdahl, D. J. Stein, S. Pasche, Y. Jacobs, R. Kader, B. Odlaug, S. Richter, B. Myers, J. E. Grant

Published in: Addiction Science & Clinical Practice | Issue 1/2021

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Abstract

Background

Effective brief treatments for methamphetamine use disorders (MAUD) are urgently needed to complement longer more intensive treatments in low and middle income countries, including South Africa. To address this gap, the purpose of this randomised feasibility trial was to determine the feasibility of delivering a six-session blended imaginal desensitisation, plus motivational interviewing (IDMI) intervention for adults with a MAUD.

Methods

We enrolled 60 adults with a MAUD and randomly assigned them 1:1 to the IDMI intervention delivered by clinical psychologists and a control group who we referred to usual care. Feasibility measures, such as rates of recruitment, consent to participate in the trial and retention, were calculated. Follow-up interviews were conducted at 6 weeks and 3 months post-enrollment.

Results

Over 9 months, 278 potential particiants initiated contact. Following initial screening 78 (28%) met inclusion criteria, and 60 (77%) were randomised. Thirteen of the 30 participants assigned to the treatment group completed the intervention. Both psychologists were highly adherent to the intervention, obtaining a fidelity rating of 91%. In total, 39 (65%) participants completed the 6-week follow-up and 40 (67%) completed the 3-month follow-up. The intervention shows potential effectiveness in the intention-to-treat analysis where frequency of methamphetamine use was significantly lower in the treatment than in the control group at both the 6 week and 3-month endpoints. No adverse outcomes were reported.

Conclusions

This feasibility trial suggests that the locally adapted IDMI intervention is an acceptable and safe intervention as a brief treatment for MAUD in South Africa. Modifications to the study design should be considered in a fully powered, definitive controlled trial to assess this potentially effective intervention.
Trial registration The trial is registered with the Pan African Clinical Trials Registry (Trial ID: PACTR201310000589295)
Literature
1.
Forouzanfar MH, Alexander L, Anderson HR, Bachman VF, Biryukov S, Brauer M, et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet (London, England). 2015;386(10010):2287–323.CrossRef
2.
Stein DJ, Seedat S, Herman A, Moomal H, Heeringa SG, Kessler RC, et al. Lifetime prevalence of psychiatric disorders in South Africa. Br J Psychiatry J Ment Sci. 2008;192(2):112–7.CrossRef
3.
Pluddemann A, Myers BJ, Parry CD. Surge in treatment admissions related to methamphetamine use in Cape Town, South Africa: implications for public health. Drug Alcohol Rev. 2008;27(2):185–9.PubMedCrossRef
4.
Peltzer K, Simbayi L, Kalichman S, Jooste S, Cloete A, Mbelle M. Drug use and HIV risk behaviour in three urban South African communities. J Soc Sci. 2009;18:143–9.
5.
Meredith CW, Jaffe C, Ang-Lee K, Saxon AJ. Implications of chronic methamphetamine use: a literature review. Harv Rev Psychiatry. 2005;13(3):141–54.PubMedCrossRef
6.
Darke S, Kaye S, McKetin R, Duflou J. Major physical and psychological harms of methamphetamine use. Drug Alcohol Rev. 2008;27(3):253–62.PubMedCrossRef
7.
Kaye S, McKetin R, Duflou J, Darke S. Methamphetamine and cardiovascular pathology: a review of the evidence. Addiction. 2007;102(8):1204–11.PubMedCrossRef
8.
Watt MH, Myers B, Towe SL, Meade CS. The mental health experiences and needs of methamphetamine users in Cape Town: A mixed methods study. South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde. 2015;105(8):685–8.PubMed
9.
Meade CS, Towe SL, Watt MH, Hobkirk AL, Skinner D, Myers B, et al. HIV testing behaviors and attitudes among community recruited methamphetamine users in a South African township. AIDS Behav. 2015;19(1):186–91.PubMedPubMedCentralCrossRef
10.
Pluddemann A, Flisher AJ, McKetin R, Parry C, Lombard C. Methamphetamine use, aggressive behavior and other mental health issues among high-school students in Cape Town, South Africa. Drug Alcohol Depend. 2010;109(1–3):14–9.PubMedPubMedCentralCrossRef
11.
Stuart AM, Baker AL, Denham AMJ, Lee NK, Hall A, Oldmeadow C, et al. Psychological treatment for methamphetamine use and associated psychiatric symptom outcomes: A systematic review. J Subst Abuse Treat. 2020;109:61–79.PubMedCrossRef
12.
Minozzi S, Saulle R, De Crescenzo F, Amato L. Psychosocial interventions for psychostimulant misuse. Cochrane Database Syst Rev. 2016; 9:CD011866.PubMed
13.
Shoptaw SJ, Kao U, Heinzerling K, Ling W. Treatment for amphetamine withdrawal. Cochrane Database Syst Rev. 2009;2:Cd003021.
14.
15.
Degenhardt L, Glantz M, Evans-Lacko S, Sadikova E, Sampson N, Thornicroft G, et al. Estimating treatment coverage for people with substance use disorders: an analysis of data from the World Mental Health Surveys. World Psychiatry. 2017;16(3):299–307.PubMedPubMedCentralCrossRef
16.
Meade CS, Towe SL, Watt MH, Lion RR, Myers B, Skinner D, et al. Addiction and treatment experiences among active methamphetamine users recruited from a township community in Cape Town, South Africa: a mixed-methods study. Drug Alcohol Depend. 2015;152:79–86.PubMedPubMedCentralCrossRef
17.
Myers B, Kline TL, Doherty IA, Carney T, Wechsberg WM. Perceived need for substance use treatment among young women from disadvantaged communities in Cape Town, South Africa. BMC Psychiatry. 2014;14:100.PubMedPubMedCentralCrossRef
18.
Myers B, Fakier N. Alcohol and drug abuse: removing structural barriers to treatment for historically disadvantaged communities in Cape Town. Int J Soc Welfare. 2008;17:156–65.CrossRef
19.
Myers B, Louw J, Pasche S. Inequitable access to substance abuse treatment services in Cape Town, South Africa. Substance Abuse Treat Prevent Policy. 2010;5:28.CrossRef
20.
Rawson RA, Shoptaw SJ, Obert JL, McCann MJ, Hasson AL, Marinelli-Casey PJ, et al. An intensive outpatient approach for cocaine abuse treatment. The Matrix model. J Substance Abuse Treat. 1995;12(2):117–27.CrossRef
21.
Shoptaw S, Rawson RA, McCann MJ, Obert JL. The Matrix model of outpatient stimulant abuse treatment: evidence of efficacy. J Addictive Dis. 1994;13(4):129–41.CrossRef
22.
Gouse H, Magidson JF, Burnhams W, Remmert JE, Myers B, Joska JA, et al. Implementation of cognitive-behavioral substance abuse treatment in Sub-Saharan Africa: treatment engagement and abstinence at treatment exit. PLoS ONE. 2016;11(1):e0147900.PubMedPubMedCentralCrossRef
23.
Grant JEDC, Odlaug BL. Treatments that work: treating impulse control disorders: a cognitive-behavioral therapy program, therapist guide. Oxford: Oxford University Press; 2011.
24.
Grant JE, Donahue CB, Odlaug BL, Kim SW, Miller MJ, Petry NM. Imaginal desensitisation plus motivational interviewing for pathological gambling: randomised controlled trial. Br J Psychiatry J Ment Sci. 2009;195(3):266–7.CrossRef
25.
Pasche SC, Sinclair H, Collins P, Pretorius A, Grant JE, Stein DJ. The effectiveness of a cognitive-behavioral intervention for pathological gambling: a country-wide study. Ann Clin Psychiatry. 2013;25(4):250–6.PubMed
26.
Grant JE, Potenza MN, Weinstein A, Gorelick DA. Introduction to behavioral addictions. Am J Drug Alcohol Abus. 2010;36(5):233–41.CrossRef
27.
Eldridge SM, Chan CL, Campbell MJ, Bond CM, Hopewell S, Thabane L, et al. CONSORT 2010 statement: extension to randomised pilot and feasibility trials. Pilot Feasibil Stud. 2016;2:64.CrossRef
28.
Chan AW, Tetzlaff JM, Altman DG, Laupacis A, Gotzsche PC, Krle AJK, et al. SPIRIT 2013 Statement: defining standard protocol items for clinical trials. Rev Panam Salud Publica. 2015;38(6):506–14.PubMed
29.
Sobell LC, Maisto SA, Sobell MB, Cooper AM. Reliability of alcohol abusers’ self-reports of drinking behavior. Behav Res Ther. 1979;17(2):157–60.PubMedCrossRef
30.
Fals-Stewart W, O’Farrell TJ, Freitas TT, McFarlin SK, Rutigliano P. The timeline followback reports of psychoactive substance use by drug-abusing patients: psychometric properties. J Consult Clin Psychol. 2000;68(1):134–44.PubMedCrossRef
31.
Flannery BA, Volpicelli JR, Pettinati HM. Psychometric properties of the Penn Alcohol Craving Scale. Alcohol Clin Exp Res. 1999;23(8):1289–95.PubMedCrossRef
32.
Anton RF, Moak DH, Latham P. The Obsessive Compulsive Drinking Scale: a self-rated instrument for the quantification of thoughts about alcohol and drinking behavior. Alcohol Clin Exp Res. 1995;19(1):92–9.PubMedCrossRef
33.
Bohn MJ, Krahn DD, Staehler BA. Development and initial validation of a measure of drinking urges in abstinent alcoholics. Alcohol Clin Exp Res. 1995;19(3):600–6.PubMedCrossRef
34.
Haro JM, Kamath SA, Ochoa S, Novick D, Rele K, Fargas A, et al. The Clinical Global Impression-Schizophrenia scale: a simple instrument to measure the diversity of symptoms present in schizophrenia. Acta Psychiatrica Scand Supplement. 2003; 416:16–23.CrossRef
35.
Bagby RM, Ryder AG, Schuller DR, Marshall MB. The Hamilton Depression Rating Scale: has the gold standard become a lead weight? Am J Psychiatry. 2004;161(12):2163–77.PubMedCrossRef
36.
Maier W, Buller R, Philipp M, Heuser I. The Hamilton Anxiety Scale: reliability, validity and sensitivity to change in anxiety and depressive disorders. J Affect Disord. 1988;14(1):61–8.PubMedCrossRef
37.
Sheehan KH, Sheehan DV. Assessing treatment effects in clinical trials with the discan metric of the Sheehan Disability Scale. Int Clin Psychopharmacol. 2008;23(2):70–83.PubMedCrossRef
38.
Leon AC, Olfson M, Portera L, Farber L, Sheehan DV. Assessing psychiatric impairment in primary care with the Sheehan Disability Scale. Int J Psychiatry Med. 1997;27(2):93–105.PubMedCrossRef
39.
Cumming C, Troeung L, Young JT, Kelty E, Preen DB. Barriers to accessing methamphetamine treatment: a systematic review and meta-analysis. Drug Alcohol Depend. 2016;168:263–73.PubMedCrossRef
40.
Myers B, Williams PP, Govender R, Manderscheid R, Koch JR. Substance abuse treatment engagement, completion and short-term outcomes in the Western Cape province, South Africa: Findings from the Service Quality Measures Initiative. Drug Alcohol Depend. 2018;185:278–84.PubMedCrossRef
41.
Keoleian V, Stalcup SA, Polcin DL, Brown M, Galloway G. A cognitive behavioral therapy-based text messaging intervention for methamphetamine dependence. J Psychoactive Drugs. 2013;45(5):434–42.PubMedPubMedCentralCrossRef
42.
Wechsberg WM, Jewkes R, Novak SP, Kline T, Myers B, Browne FA, et al. A brief intervention for drug use, sexual risk behaviours and violence prevention with vulnerable women in South Africa: a randomised trial of the Women’s Health CoOp. BMJ Open. 2013;3(5):e002622.PubMedPubMedCentralCrossRef
43.
Baker A, Boggs TG, Lewin TJ. Randomized controlled trial of brief cognitive-behavioural interventions among regular users of amphetamine. Addiction. 2001;96(9):1279–87.PubMedCrossRef
44.
O’Neill J, Tobias MC, Hudkins M, London ED. Glutamatergic neurometabolites during early abstinence from chronic methamphetamine abuse. Int J Neuropsychopharmacol. 2014;18(3):pyu059.PubMedCrossRef
45.
Brecht ML, Herbeck D. Time to relapse following treatment for methamphetamine use: a long-term perspective on patterns and predictors. Drug Alcohol Depend. 2014;139:18–25.PubMedPubMedCentralCrossRef
46.
Spedding MF, Stein DJ, Sorsdahl KR. Task-shifting psychosocial interventions in public mental health: a review of the evidence in the South African context. In: South Afr Health Rev. Durban: Health Systems Trust; 2015. p. 73–88.
47.
Hobkirk AL, Watt MH, Myers B, Skinner D, Meade CS. A qualitative study of methamphetamine initiation in Cape Town, South Africa. Int J Drug Policy. 2016;30:99–106.PubMedCrossRef
Metadata
Title
A novel brief treatment for methamphetamine use disorders in South Africa: a randomised feasibility trial
Authors
K. Sorsdahl
D. J. Stein
S. Pasche
Y. Jacobs
R. Kader
B. Odlaug
S. Richter
B. Myers
J. E. Grant
Publication date
01-12-2021
Publisher
BioMed Central
Published in
Addiction Science & Clinical Practice / Issue 1/2021
Electronic ISSN: 1940-0640
DOI
https://doi.org/10.1186/s13722-020-00209-3

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