Drug Addiction Treatment Blog

There has not been alot of research on lesbians and alcoholism or drug addiction, os it is difficult to describe the issues they face. However, current studies suggest that on the average lesbians are more likely to use alcohol than other women, use other drugs in conjunction with alcohol at a higher rate, report higher rates of drug abuse and continue drinking at a higher rate as they grow older. It onl stands to rason that a higher percentage of lesbians enter alcohol rehab than other women. For this reason and the accompanying issues, lesbian alcohol rehabs have had to be designed.

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Methamphetamine Treatment as HIV Prevention

For about a decade in California, the drug most tightly linked with HIV infection in Gay Bisexual Men has been crystal methamphetamine. The drug conveys a sense of heightened sexuality in the short term and is associated with risky sexual behaviors and extremely high rates of HIV infection in those seeking treatment. Sixty percent of the participants in Dr. Shoptaw’s study reported HIV-positive status, a prevalence much higher than his group has observed among GBM seeking treatment for cocaine (30 percent), alcohol (15 percent), or heroin (5 percent) abuse.

“The reductions in risky sexual behavior in this study exceeded those observed in HIV prevention trials among Gay BBisexual Men. We conclude that treatment for crystal meth abuse fits into a comprehensive HIV prevention strategy,” says Dr. Shoptaw. The findings have already made an impact: These data helped policymakers at the California Office of AIDS decide to allocate $3 million for programs that address methamphetamine abuse among GBM.

Methamphetamine and the Blues

The researchers were not surprised by the high percentage of their study participants who reported depression symptoms at the beginning of the study. Gay Bisexual Men are three times as likely as heterosexual men to have clinical depression.

Crystal Methamphetamine abusers often say they take the drug to kick the blues, but results from the current study suggest that continuing abuse may serve to relieve low moods related to stimulant withdrawal rather than alleviate underlying chronic depression.

When they analyzed the temporal link between crystal methamphetamine abuse and depression, Dr. Shoptaw and his colleagues found that a urine sample indicating abuse of the drug within the past 5 days strongly predicted high BDI scores and abstinence strongly predicted low scores. In contrast, BDI scores did not predict episodes of future methamphetamine abuse, which is what would be expected if the men were abusing the drug to alleviate depression. “Meth abusers probably remember feeling better after taking the drug, but this perception may not match the physiology of long-term stimulant abuse,” says Dr. James Peck, a member of the research team who led the analysis of the depression data.

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Treatment Curbs Methamphetamine Abuse Among Gay and Bisexual Men Research Findings
Vol. 20, No. 4 (March 2006)

By Lori Whitten, NIDA NOTES Staff Writer

Behavioral therapy can help gay and bisexual men (GBM) reduce methamphetamine abuse and risky sexual behaviors and sustain these gains for 1 year, NIDA-funded researchers report. By the end of a 16-week trial of four different behavioral therapies, study participants’ stimulant-positive urine samples fell 31 percent, and their number of past-month sexual partners fell more than 50 percent—outcomes that regressed little at the followup visits. Symptoms of depression also improved.

Benefits of Behavioral Therapy Persist Up to One Year

Although all interventions were effective, participants who received contingency management (CM), cognitive-behavioral therapy (CBT) and CM, or culturally tailored Gay CBT (GCBT) submitted fewer stimulant-positive urine samples during treatment, compared with those in standard CBT.

Dr. Steven Shoptaw and colleagues at the University of California, Los Angeles and the Friends Research Institute recruited 263 methamphetamine-addicted GBM throughout Los Angeles County, particularly in Hollywood, where HIV prevalence is especially high. Of these, 162 completed the requirements for entering the treatment phase of the study, which were to attend six assessments and participate in at least two of four group sessions on abstinence skills during a 2-week “baseline period.” Men who met the requirements reported less severity and shorter duration of methamphetamine abuse than those who did not, despite having abused methamphetamine for 5 years and having spent $293 on the drug in the past month, on average. Half had engaged in unprotected anal intercourse (UAI) with someone other than their primary partner in the past month, and 84 percent of these men linked the behavior to methamphetamine abuse. Most participants (73 percent) reported symptoms of depression, with about 30 percent describing these as moderate to severe.

The researchers randomly assigned each patient to one of four behavioral therapies: cognitive-behavioral therapy (CBT), contingency management (CM), CBT+CM, or Gay CBT (GCBT). In CBT, participants analyzed situations and emotions linked with relapse, practiced ways to manage craving and thoughts about drug abuse, and discussed healthy behaviors in group sessions. In CM, participants received vouchers redeemable for groceries, transportation, and clothing if they submitted stimulant-negative urine samples. GCBT addressed standard CBT issues—including relapse, craving, and healthy behaviors—using specific examples from gay cultural events and environments. For example, they compared the experience of owning up to a drug problem with the experience of acknowledging sexual orientation by “coming out.” All four interventions were offered three times a week for 4 months.

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Pursuing New Medications

In recent years, people from all walks of life have sought treatment for addiction to powerful narcotic pain-relieving medications, such as OxyContin and Vicodin, that they have abused outside of a medical regimen. These medications share many properties with heroin, which currently ensnares more than a million people nationwide in the web of addiction. Those who become addicted to legal painkillers or street opiates now have a new medication to help them reclaim their lives. Approved by FDA in 2002, buprenorphine joins two other approved opiate treatment medications–methadone, used in long-term treatment, and the NIDA-developed opiate blocker naltrexone, used to help patients remain drug-free after they have stopped using opiates.

Buprenorphine is the first medication for opiate addiction treatment that can be prescribed by private physicians in offices and clinics. Use of this medication in mainstream medicine should help reduce the stigma still associated with drug abuse treatment, while encouraging more patients to seek treatment for addiction to heroin and other opiates. NIDA also is pursuing medications for cocaine and methamphetamine abuse and addiction, for which no medications are yet available. To fill this void, the Institute is applying the same scientific medications development methodologies that put effective opiate treatment medications into the hands of clinicians and their patients.

On one research track, clinical researchers are screening medications previously approved to treat other disorders. In these small-scale trials, several agents have appeared to weaken the addictive cycle of drug-craving, drug-seeking, and drug-taking. Among them are amantadine (currently used for Parkinson’s disease), disulfiram (Antabuse), baclofen (an antispasticity agent), tiagabine and topiramate (antiepileptics), and modafinil (used in narcolepsy). Disulfiram and naltrexone, both effective in treating alcoholism, may fill a critical need for medications that can help cocaine-abusing individuals who also abuse alcohol. Propranolol, a medication used to lower blood pressure, may help substance abuse patients stay the course during the critical early days of treatment, by alleviating their unpleasant withdrawal symptoms. Researchers are now conducting larger, longer studies to confirm these encouraging results. Because the medications work by a variety of different mechanisms, some of which may complement each other, researchers also will examine whether they may be more effective in combination than alone. Some may also work optimally with specific behavioral therapies.

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