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Testing a Weapon Against Meth, Cocaine Dependence

September 1, 2007
by Terree Schmidt-Whelan, PHD, CDP and JAMES F. BOYLE, MS, CDP
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A drug court sees progress with an innovative treatment program

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.