Pattern of Methamphetamine Use and the Time Lag to Methamphetamine Dependence.

OBJECTIVES: Use of methamphetamine (MA) commonly co-occurs with the use of other substances. The present study aims to examine substance initiation patterns of other substances, including alcohol, nicotine, inhalants, and cannabis (OTH), in MA users and its consequence on the time lag of MA dependence. METHODS: Sociodemographic, environmental, and clinical data were obtained from MA users at a Thai substance treatment center. The Semi-Structured Assessment for Drug Dependence and Alcoholism was employed to diagnose drug dependence. RESULTS: Of 991 MA users, 52.6% were males, and the average age was 26.8 ±â€Š7.1 years. The mean age of first MA use (18 years) was greater than the mean age of first use of alcohol (17 years), nicotine (16 years), and inhalants (15 years) (P < 0.001), but was comparable with the mean age at the first use of cannabis (P > 0.05). Family history of MA use and nicotine dependence were associated with early MA onset. Participants who used MA as their first drug (MA>OTH) were more likely to be female and less likely to smoke intensely and to be exposed to severe traumatic events than those who used MA later than other substances (OTH>MA). The time lag from age at onset of MA use to MA dependence was shorter in OTH>MA than in MA>OTH (3 vs 5 years; χ = 5.7, P = 0.02, log-rank test). CONCLUSIONS: A higher proportion of women was observed in MA>OTH than in OTH>MA. The use of other substances before MA increases the individual's vulnerability in shortening the interval between age at onset of MA use and MA dependence in a substance treatment cohort.

Sex Differences in Methamphetamine Use and Dependence in a Thai Treatment Center.

BACKGROUND AND OBJECTIVE: Males and females who use methamphetamine (MA) differ in sociodemographics, MA diagnoses, comorbidities, and brain activity. The objective of this study was to investigate sex differences in the characteristics of MA use and dependence in patients at a Thai substance treatment center. METHODS: Demographic, MA use, and diagnostic data for 782 MA users were obtained by using the Semi-Structured Assessment for Drug Dependence and Alcoholism-Thai version. Categorical comparisons of males (n = 413, 53%) and females (n = 369, 47%) were made by chi-square test. Factors significantly differentiating men and women with respect to MA-dependence were identified by logistic regression analysis controlling for demographic, diagnostic, and MA use variables. RESULTS: Males admitted to residential drug treatment for MA use had an earlier age of onset for both MA use (17.7 ±â€Š4.1 vs 19.7 ±â€Š6.2 years; t = -5.3, P < 0.001) and dependence (20.4 ±â€Š5.2 vs 22.2 ±â€Š6.4 years; t = -3.6, P < 0.001). Females were more likely than males to be MA-dependent (79% vs 60%; χ1 = 33.7, P < 0.001), and to experience MA withdrawal (65.3% vs 48.9%; χ1 = 21.4, P < 0.001), withdrawal-related hypersomnia (77.2% vs 64.8%; χ1 = 14.5, P < 0.001), fatigue (77.5% vs 70.3%; χ1 = 5.2, P = 0.02), and psychomotor retardation (64.5% vs 57.0%; χ1 = 4.5, P = 0.03). Similarly, females had heavier (eg, largest daily amount [χ1 = 12.4, P < 0.001), more frequent (χ1 = 5.1, P = 0.02]) and greater lifetime episodes of MA use (χ1 = 24.1, P < 0.001) than males. After controlling for such variables by logistic regression, being female remained a significant factor influencing the occurrence of MA-dependence (odds ratio [OR] 2.7, 95% confidence interval [CI] 1.8-4.1, P < 0.001). Shared associated factors (or comorbidities) for MA-dependence in both sexes included nicotine dependence (in males: OR 4.1, 95% CI 2.4-7.0, P < 0.001; and in females: OR 2.4, 95% CI 1.3-4.4, P = 0.007), greater lifetime episodes of MA use (in males: OR 3.5, 95% CI 1.9-6.4, P < 0.001; and in females: OR 5.9, 95% CI 3.1-11.4, P < 0.001), and more frequent use (in males: OR 5.1, 95% CI 2.8-9.1, P < 0.001; and in females: OR 3.6, 95% CI 1.9-6.9, P < 0.001). Comorbid antisocial personality disorder predicted MA-dependence in males only (OR 3.7, 95% CI 1.6-8.6, P = 0.002). CONCLUSIONS: The current study highlights both common (eg, nicotine dependence and severity of MA use) and sex-specific differences (eg, MA use/dependence characteristics and comorbidities), including sex itself, with respect to MA-dependence in a Thai treatment cohort.

Treatment of methamphetamine-induced psychosis: a double-blind randomized controlled trial comparing haloperidol and quetiapine.

RATIONALE: To our knowledge, only a few double-blind randomized controlled trials with antipsychotic drugs have been conducted to examine the treatment of methamphetamine-induced psychosis (MAP). OBJECTIVES: The aims of this study are to compare the antipsychotic and adverse events of quetiapine, an atypical antipsychotic drug, to haloperidol, a standard treatment for primary psychotic disorder, in individuals with MAP. METHODS: Eighty individuals with MAP were randomly assigned into two groups, i.e. treatment with quetiapine (n = 36) and haloperidol (n = 44). Sixty-eight patients (85 %) completed the study protocol, i.e. treatment with quetiapine at least 100 mg per day or haloperidol at least 2 mg per day orally once a day for 4 weeks. The doses were increased every 5 days until no psychotic symptom was observed from the Positive and Negative Syndrome Scale (PANSS). Data were analysed by survival analysis with Cox's proportional regression analysis, general estimating equations and log-rank tests. RESULTS: Thirty-two (89 %) subjects from the quetiapine group and 37 subjects (84 %) from the haloperidol group met the remission criteria at the end of the study. Baseline PANSS total scores of quetiapine and haloperidol groups were 82.4 ± 16.6 and 90.0 ± 18.4, respectively (mean ± SD; p = 0.06). The change-from-baseline scores were -47.8 for the quetiapine group and -53.2 for the haloperidol group. There were no significant differences between the antipsychotic effects (coefficient value = -2.6, p = 0.32, 95%CI = -7.6, 2.5) and the adverse effects of quetiapine and haloperidol. CONCLUSIONS: Quetiapine may be used as an antipsychotic treatment for MAP with comparable therapeutic effects and adverse events to treatment with classical antipsychotic drugs.

Clinical features of methamphetamine-induced paranoia and preliminary genetic association with DBH-1021C→T in a Thai treatment cohort.

AIMS: To explore the clinical features of methamphetamine-induced paranoia (MIP) and associations between MIP and a genetic polymorphism in dopamine ß-hydroxylase (DBH-1021C→T). DESIGN: Retrospective analysis of clinical presentation and genetic association by χ(2) test and logistic regression analysis. SETTING: A Thai substance abuse treatment center. PARTICIPANTS: A total of 727 methamphetamine-dependent (MD) individuals. MEASUREMENTS: Clinical: Semi-Structured Assessment for Drug Dependence and Alcoholism (SSADDA) and the Methamphetamine Experience Questionnaire (MEQ). Genetic: DBH-1021C→T. FINDINGS: Forty per cent of individuals (289 of 727; 39.8%) with MD had MIP. Within-binge latency to MIP onset occurred more rapidly in the most recent compared with initial MIP episode (P = 0.02), despite unchanging intake (P = 0.89). Individuals with MIP were significantly less likely to carry lower (TT/CT) compared with higher (CC) activity genotypes (34.3 versus 43.3%; χ(2) 1 = 5, P = 0.03). DBH effects were confirmed [odds ratio (OR) = 0.7, P = 0.04] after controlling for associated clinical variables (MD severity, OR = 3.4, P < 0.001; antisocial personality disorder, OR = 2.2, P < 0.001; alcohol dependence, OR = 1.4, P = 0.05; and nicotine dependence, OR = 1.4, P = 0.06). TT/CT carriers were more likely to initiate cigarette smoking (OR = 3.9, P = 0.003) and probably less likely to be dependent on alcohol (OR = 0.6, P = 0.05). CONCLUSIONS: Among methamphetamine-dependent individuals, paranoia appears to occur increasingly rapidly in the course of a session of methamphetamine use. Severity of methamphetamine dependence and antisocial personality disorder predicts methamphetamine-induced paranoia. The genetic polymorphism in dopamine ß-hydroxylase is associated with methamphetamine-induced paranoia and influences smoking initiation.

Treatment for inhalant dependence and abuse.

BACKGROUND: Inhalants are being abused by large numbers of people throughout the world, particularly socio-economically disadvantaged children and adolescents. The neuropsychological effects of acute and chronic inhalant abuse include motor impairment, alterations in spontaneous motor activity, anticonvulsant effects, anxiolytic effects, sensory effects, and effects and learning, memory and operant behaviour (e.g., response rates and discriminative stimulus effects). OBJECTIVES: To search and determine risks, benefits and costs of a variety treatments for inhalant dependence or abuse. SEARCH STRATEGY: We searched MEDLINE (1966 - February 2010), EMBASE (Januray 2010) and Cochrane Central Register of Controlled Trials (CENTRAL) (February 2010). We also searched for ongoing clinical trials and unpublished studies via Internet searches. SELECTION CRITERIA: Randomised-controlled trials and controlled clinical trails (CCTs) comparing any intervention in people with inhalant dependence or abuse. DATA COLLECTION AND ANALYSIS: Two reviewers independently selected studies for inclusion, assessed trial quality and extracted data. MAIN RESULTS: No studies fulfilling the inclusion criteria have been retrieved. IMPLICATIONS FOR PRACTICE: due to the lack of studies meeting the inclusion criteria, no conclusion can be drawn for clinical practice. IMPLICATIONS FOR RESEARCH: as a common substance abuse with serious health consequences, treatment of inhalant dependence and abuse should be a priority area of substance abuse research.

Substance-dependence rehab treatment in Thailand: a meta analysis.

OBJECTIVE: To synthesize the substance-dependence researches focusing on rehab treatment phase. MATERIAL AND METHOD: Several criteria were used to select studies for meta analysis. Firstly, the research must have focused on the rehab period on the substance-dependence treatment, secondly, only quantitative researches that used statistics to calculate effect sizes were selected, and thirdly, all researches were from Thai libraries and were done during 1997-2006. The instrument used for data collection was comprised of two sets. The first used to collect the general information of studies including the crucial statistics and test statistics. The second was used to assess the quality of studies. RESULTS: Results from synthesizing 32 separate studies found that 323 effect sizes were computed in terms of the correlation coefficient "r". The psychology approach rehab program was higher in effect size than the network approach (p < 0.05). Additionally, Quasi-experimental studies were higher in effect size than correlation studies (p < 0.05). Among the quasi-experimental studies it was found that TCs revealed the highest effect size (r = 0.76). Among the correlation studies, it was found that the motivation program revealed the highest effect size (r = 0.84). CONCLUSION: The substance-use rehab treatment programs in Thailand which revealed the high effect size should be adjusted to the current program. However, the narcotic studies which focus on the rehab phase should be synthesized every 5-10 years in order to integrate new concept into the development of future the substance-dependence rehab treatment program, especially those at the research unit of the Drug Dependence Treatment Institute/Centers in Thailand.

HIV infection among substance abusers in Thanyarak Institute On Drug Abuse, Thailand, 1987-2002.

A study of HIV infection among substance abusers from 1987 to 2002 was performed in Thanyarak Institute on Drug Abuse (TIDA). From 118,676 anti HIV tests (6,076 - 10,626 tests each year) of TIDA inpatients, 17,526 tests were positive (474 - 2,041 tests each year) In 71,403 new substance abuse cases (3,724 - 6,184 cases each year), 12,401 cases were positive (17.4%), highest in 1990 28.3% and then decreased to 8% in the last three years. In injecting drug users (IDU), the mean anti HIV positivity rate was 21.7% (range 19.2 - 29.4%) higher than those among non IDU about 8 times 2.8% (range 1.9 - 3.6%). The HIV incidence rates were from inpatients that were previously anti-HIV negative, the authors found the mean incidence rate was 7.3% per year. Anti HIV positive cases were highest in injecting heroin users (IHU) about 36.8% (range 31.5 - 46.1%). Although numbers of IHU in Thailand have decreased in the last 6 years because of changing to use methamphetamine by smoking and dying from HIV subtype B'. The authors must continue the effective preventive programs of both avoid sharing injecting equipments and promoting 100% condom program to control this reservoir of HIV infection.

The results of drug dependence treatment by therapeutic community in Thanyarak Institute on Drug Abuse.

A study of drug dependence treatment by therapeutic community (TC) in Thanyarak Institute on Drug Abuse from 1986 to 2000 was undertaken. 2,881 cases joined the TC program during this period (males 2,471 or 85.8%, females 410 or 14.2%). There were 278 cases who completed the TC program (males 261 or 93.9%, females 17 or 6.1%). The program course is at least one and a half year. The average duration of treatment in TC for the completion group was 27.6 +/- 7.1 months. The mean age was 30.9 +/- 6.4 years. About half of them had had a high school education. The majority (84.6%) of them were i.v. heroin addicts. The average drug-use duration was 9.8 +/- 5.7 years. After they completed the program, the clients were followed-up for five years. 203 cases (73.0%) were abstinent from drugs. Of this figure 21 cases (7.6%) had died during the follow-up from illness and accidents not directly related to relapsing to drugs. 75 cases (27.0%) relapsed to drugs. There were no significant differences between the abstinent and relapse cases in age, education, marital status, characteristic of addiction, previous treatment data and I.Q. Duration of treatment in the abstinent cases was longer (3.7 months) than the relapse cases. Significant differences (p < 0.05) were found in some personality characteristics. The relapse cases were neurotic-introversion personality type and had abnormal scores with low or high scores in hypersensitive character. They were likely to be easily stimulated to go back to using drugs. Although the TC program required much time and material resources to operate, the results of treatment were highly effective. The results of this study provide the rational to expand this TC program in order to provide more opportunities to the increasing demands for an effective treatment intervention for Thai addicts.

Prevalence and genotypes of hepatitis C virus infection among drug addicts and blood donors in Thailand.

Hepatitis C virus (HCV) is an infectious agent that has the potential to cause chronic liver disease, cirrhosis and hepatocellular carcinoma. We determined the prevalence and genotypes of HCV infection among groups of drug addicts: intravenous drug users (n = 134), methamphetamine users (n = 100), inhaled-drugs users (n = 19) and alcoholics (n = 50); a group of blood donors acted as a control. The control group consisted of 179 randomly-selected anti-HCV positive samples: these were subjected to HCV RNA screening and genotyping. The anti-HCV test was performed by ELISA: HCV RNA screening was by nested RT-PCR that employed primers from the 5' noncoding region. The genotype assay was based upon analysis of the 5' NCR amplified sequences and RFLP. Hepatitis C virus was highly prevalent among all groups of drug addicts (12-70%). In 2000. among the new blood donors (n = 66,340) at the National Blood Center, Thai Red Cross, anti-HCV prevalence amounted to 0.98%. The HCV genotype distribution showed that the most prevalent genotype was 3a, followed by 1b and 6a. Our data demonstrated the very high prevalence of HCV infection in IVDUs, a finding that is consistent with the blood-borne nature of the virus. In order to curb HCV infection, a determined effort to educate both the general population and high-risk groups is required; such a program of education would address both general and particular methods of transmission, especially the use of non-sterile needles etc.