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Addiction Treatment Curbs Crystal Methamphetamine Abuse Among Gay and Bisexual Men

Addiction Treatment Curbs Crystal Methamphetamine Abuse Among Gay and Bisexual Men

Behavioral therapy can help gay and bisexual men (GBM) reduce crystal 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.

Dr. Steven Shoptaw and colleagues at the University of California, Los Angeles and the Friends Research Institute recruited 263 crystal methamphetamine-addicted Gay and Bisexual Men throughout Los Angeles County, particularly in Hollywood, where HIV prevalence is especially high. Of these, 162 completed the requirements for entering the addiction 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 gay 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 gay 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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Multiple, Lasting Benefits

Participants reduced crystal methamphetamine abuse and risky sexual behaviors and experienced fewer depression symptoms in the last month of addiction treatment compared with the month before therapy, regardless of the therapeutic approach. Overall, they decreased crystal methamphetamine abuse from 9.6 to 2.4 days a month and reduced the number of past-month sexual partners from 9.8 to 4.3, on average. The percentage who reported unprotected insertive anal intercourse—a risk factor for HIV-infected individuals to transmit the virus to partners—fell from 36.9 percent to 16.7 percent by the end of treatment. Beck Depression Inventory (BDI) scores improved from 14.3 (in the “mild to moderate” range) at baseline to 5.4 (”minimal”) in the last week of addiction treatment.
Although all therapies benefited participants, response to the addiction treatments differed. During the addiction treatment period, participants in GCBT and the combined addiction treatments attended more weeks of therapy and submitted fewer stimulant-positive urine samples than those who received standard CBT during addiction treatment. Participants receiving GCBT showed a faster decrease in unprotected receptive anal intercourse— a risk factor for acquiring the virus from a partner—compared with those in standard CBT. Most participants (80 percent) took part in the 1-year followup. Generally, they sustained the lower levels of methamphetamine abuse, risky sexual behaviors, and depression observed at the end of addiction treatment
“It is encouraging that several types of behavioral treatment reduced both drug abuse and risky sexual behaviors among gay and bisexual men at high risk for contracting or transmitting HIV,” says Ms. Debra Grossman of NIDA’s Division of Neuroscience and Behavioral Research. However, more studies are needed to determine the components of addiction treatment that affect risky sexual behaviors and the link between crystal methamphetamine abuse and such behaviors in other populations, she adds.