Testing a Weapon Against Meth, Cocaine Dependence

Methamphetamine and cocaine use continue to pose a pervasive threat to individuals and communities nationally. Homegrown meth labs steadily crop up, particularly in the Pacific and Southwest regions of the country. These sites, where the drug frequently referred to as “poor man's cocaine” is manufactured, create a danger jeopardizing all members of a community.

The prevalence of meth labs has posed a particularly severe problem in Pierce County, Washington. This area holds the inglorious distinction of being the “number one meth-producing county in the country,” according to an award-winning series of articles published in the Kitsap Sun entitled “The Meth Toll.”

“It's like water,” Detective Sgt. Randy Drake, officer in charge of the West Sound Narcotics Enforcement Team, or WestNET, said of the meth trade in the newspaper series. “It just finds a way.” The series stated, “The trade is so difficult to dam because of the vise-like grip the addictive drug maintains over its users and because so much is independently produced.”

Pierce County struggled with the presence of more than 400 known meth labs in production as of 2004 and a per capita usage of the drug that was seven times that of the population nationally. County officials have readily acknowledged the impossibility of stopping the trade of a drug that is ruining countless lives, as addiction is swift and the cravings force extreme measures that include sex for drugs, theft, and arson. The impact of the drug's prevalence on children is alarming, as children of parents with meth dependence suffer neglect and danger as parents seek to feed their cravings. Children flood the foster care system as adults reach a dependence level that renders them incapable of parenting.

The Pierce County Alliance, focused largely on the psychosocial aspects of the disease of substance dependence, is the addiction treatment program used in conjunction with the Pierce County Drug Court system. The drug court processes more than 700 drug offenders annually. But while the drug court system can be very effective for certain individuals, it is also the case that judges, counselors, and clients alike have been frustrated by continued high relapse rates, particularly among meth users. This convinced the Pierce County Alliance to consider other options, leading it to begin a pilot program intended to evaluate the effectiveness of Hythiam Inc.'s PROMETA® Treatment Program in treating meth and cocaine dependence in the family and felony drug court.

The PROMETA Treatment Program is a unique outpatient treatment program for methamphetamine, cocaine, and alcohol dependence that integrates physiological, nutritional, and psychosocial therapies and is designed to help patients meet their individual recovery goals. The PROMETA Treatment Program includes the use of prescription medications administered after medical assessment; treatment lasts for approximately one month. A benzodiazepine antagonist, GABA modulator, and antihistamine are included in the treatment program.

It is well known that participants in drug court systems tend to be highly motivated. Stringent requirements are placed on those going through the program, including repeated drug screens, psychosocial counseling, and parenting classes. But while these programs are effective for many, some participants cannot maintain abstinence. Perhaps one reason is that the underlying brain disease manifesting in chronic drug use is not being addressed. The PROMETA Treatment Program was specifically designed to address more aspects of this multifaceted disease in an integrated fashion.

Pilot design

The Pierce County Alliance's 90-day pilot started in March 2006, and included an additional three-month follow-up program. Those at high risk of relapse or unable to maintain abstinence were offered the chance to participate. Forty clients who were in the county's felony or family drug courts for various offenses volunteered, with their status in drug court not affected by agreeing or refusing to participate. Three participants did not complete the treatment program and were excluded from the analysis.

Each participant was deemed to be addicted to cocaine, methamphetamine, or both, and had an extensive history of use and had been unable to sustain abstinence for any significant period. Participants opted for the PROMETA Treatment Program for a variety of reasons: to improve their quality of life, to maintain abstinence, or to prevent incarceration due to noncompliance with drug court requirements.

Forty persons originally enrolled in the pilot program. Three were unable to complete the treatment program. Of the 37 participants included in the analysis, 15 had been in drug court for less than six months, six had been in for six to 12 months, and 16 had been in for more than 12 months. Sixteen participants (13 women and three men) came from the family drug court and 21 (six women and 15 men) were from the felony drug court. Program participants had a mean age of 32.6 at the time of entry into one of the drug courts (28.2 for those in family court and 35.7 for those in felony court). Participants self-defined their racial affiliation as follows: 30 as white, three as black, two as Hispanic, one as Asian, and one as Pacific Islander.

All participants signed a “consent-for-treatment” document describing the PROMETA Treatment Program. All participants were medically evaluated and were included only if they were not dependent on benzodiazepines or opiates and did not have a medical or psychiatric illness that in the opinion of the physician prevented their participation.The PROMETA Treatment Program was offered on an outpatient basis. Each participant received an initial medical exam and blood test. All participants received three consecutive visits with medically supervised infusions of medications and oral nutritional supplements. After 21 days, participants received a second set of two infusions. The first month's medical and nutritional support treatment was integrated with ongoing psychosocial therapy, consisting of individual and group counseling sessions.

The pilot program assigned treatment counselors who completed baseline and weekly data collection forms; monitored weekly random, observed forensic urine drug screens; conducted group and individual treatment sessions; and referred participants to additional treatment and support as needed. Counselors conducted follow-up with each participant 90 days after the first infusion.

The effectiveness of the PROMETA Treatment Program was measured by the following observations:

• Participants' self-reports on level of cravings or desire to use;

• Results of random urinalysis and breath analysis, with all positive urinalysis results confirmed by gas chromatography/mass spectrometry (GC-MS);

• Return to drug use;

• Incarceration;

• Employment status;

• Education status by the end of the pilot period; and

• Status of living arrangements, specifically if the participant was homeless or had shelter arrangements.

Encouraging results

In June 2006, interim results from the pilot were released at the National Association of Drug Court Professionals' annual conference. Across the board, pilot participants showed improvements in their substance dependence, both physically and emotionally. That initial analysis was based on results from a three-month period starting when the first enrolled participant commenced the PROMETA Treatment Program (March 20, 2006, to June 16, 2006). At that time, 217 urine samples had been analyzed.

The new data discussed here report results based on analysis of a 90-day period following each individual participant's commencement. The total number of urine samples during this period was 415. Participants showed improvements in a variety of areas.

Drug-free success. Of the 415 random urine samples collected, one was positive for alcohol, one for marijuana, three for cocaine and four for amphetamine/methamphetamine. Thus, 98% of the urinalysis tests were negative.

Program retention and return to use. Only three of the 40 original participants did not complete the medical portion of the PROMETA Treatment Program. One was removed from the program because he was recharged on his original offense and was no longer eligible for drug court; one was admitted for inpatient mental health care unrelated to drug use; and one did not return after completing only a portion of the medical treatment. At the end of the full 90-day pilot period for the other 37 participants, 35 had not returned to drug use and none were reincarcerated.

Minimized cravings. All participants who completed the full 90-day pilot reporting requirements, 31 of 37, reported zero on a methamphetamine cravings scale. Cravings were measured on an analogue scale of 0 to 10, with 10 being extreme craving.

Enhanced education. At the end of 90 days of treatment, several of the participants had shown increased educational achievement. The number of GED recipients in the group increased from seven to 10. The number of trade school participants rose from just two to nine in just 90 days.

Improved quality of life. At the start of the pilot program, 11 of the participants were homeless. After the 90-day program, just one participant remained homeless. At the start, 17 of the participants were still living with family members or friends who were not necessarily clean and sober (this was defined as an “unstable” living arrangement). After 90 days of treatment, only two participants remained in such an environment.

Summary

The most salient result of the PROMETA Treatment Program is participants' reporting of the almost total elimination of cravings for their drug of choice, compared with very high levels of cravings witnessed at the start of the pilot. We observed exceptionally high levels of abstinence, as confirmed by negative urinalysis for 98% of all samples. In a population that is very difficult to treat, 92% of participants did not return to drug use during the 90-day pilot period.

The improvements evident in every area measured, particularly the elimination of cravings, an exceptionally high rate of drug abstinence, and the near universal compliance with treatment requirements, portend an excellent prognosis for long-term treatment recovery for nearly every participant.

The reported elimination of cravings may have had far-reaching implications, changing the course of treatment and further accelerating the road to recovery for many. After these individuals were treated in accordance with the PROMETA Treatment Program, the effects of meth no longer masked non-drug related psychological problems, thus permitting an accurate diagnosis and referral to proper mental health services.

At the end of the 90-day pilot program, treatment counselors had these additional observations about participants:

• Improved physical appearance;

• Greater cognitive alertness;

• More focus and more engagement in the treatment process;

• Reduced denial and blame placing, with greater acceptance of responsibility for one's own actions and own recovery; and

• Better outcomes for their children. Nineteen of 42 children with a parent in the family drug court program had been reunited with their biological family as a result of the parent's success in treatment. The other parents remained in treatment with good promise for successful completion.

The Pierce County Drug Court's PROMETA Treatment Program pilot offers encouraging empirical support for those with substance dependence and for the communities in which they live. In the pilot, we observed that participants from a high-risk population far exceeded expectations in every area measured. The pilot results sound a clear call for increased funding for further study and use of the PROMETA Treatment Program in targeted populations that want to improve success with traditional treatment methods or that have shown limited success in treatment programs.

This paper was prepared for, and with the assistance of, the developer of the PROMETA Treatment Program, Hythiam, Inc. The Pierce County Alliance and the medical provider became licensees to perform the pilot; however, the fee for the PROMETA Treatment Program was waived by Hythiam for pilot participants. All other funding was provided by the Pierce County Alliance.

Clinical studies are under way to evaluate the PROMETA Treatment Program and to confirm reports from physicians providing the PROMETA Treatment Program in their practices. Only a physician licensed to treat with the PROMETA Treatment Program can determine if it is appropriate for any individual patient. The medications used in the PROMETA Treatment Program are Food and Drug Administration (FDA) approved for uses other than treating dependence on alcohol, cocaine, or methamphetamine. Therefore, the risks and benefits of using these medications to treat dependence on these substances have not been evaluated by the FDA. Hythiam does not manufacture, distribute, or sell any medications and has no relationship with any manufacturers or distributors of medications used in the PROMETA Treatment Program.