181352 Associations of Substance Use-Related Problems with Methamphetamine Use and Craving: Prospective Findings from a Clinical Trial

Tuesday, October 28, 2008

Pin-Chieh Wang, PhD , Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA
Steve Shoptaw, PhD , Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA
Keith Heinzerling, MD , Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA
Alice Huber, PhD , Division of Alcohol and Substance Abuse, Washington State DSHS, Olympia, WA
Walter Ling, MD , Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA
Although depression and substance use-related problems are common among abusers of methamphetamine, the clinical course of these factors in the treatment of methamphetamine dependence remains largely undocumented. This study assessed associations between baseline levels of substance use-related problems and levels of depression ratings on outcomes from treatment for methamphetamine dependence in 229 methamphetamine abusers who participated in a 12-week randomized, placebo-controlled trial of sertraline (50 mg/day) for methamphetamine dependence. Self-reported methamphetamine use and craving were measured weekly using Substance Use Inventory (SUI) and Visual Analog Scale (VAS). Self-reported substance use-related problems and depressive symptoms were collected at baseline using the Addiction Severity Index (ASI) and Beck Depression Inventory (BDI). A Poisson regression model showed that depression ratings were positively associated with methamphetamine craving at baseline [Odds ratio= 1.5, 95%CI (1.3, 1.7)]. A mixed model showed that baseline depression scores predicted greater reductions in drug craving over time [Mean score difference=8.3, 95%CI (2.0, 14.6)]. There was no association between baseline depression rating and methamphetamine use during treatment. The estimates of associations between depression and substance use-related problems showed that depression can dampen the associations between medical problems and methamphetamine use, may suppress the effects of family problem on methamphetamine craving, and may contribute to greater reduction in methamphetamine craving when an individual experiences alcohol and psychological problems. Findings indicate that baseline depressive symptoms may be indicative of participants improving during treatments for methamphetamine dependence, which may have clinical relevance for guiding treatment regimens for methamphetamine abuse.

Learning Objectives:
1. Describe the effects of baseline levels of substance use-related problems on the treatment of methamphetamine dependence may vary according to the conditions of baseline depression rating. 2. Articulate the interaction between baseline depressive symptoms and substance use-related problems on outcomes from treatment for methamphetamine dependence. 3. Assess the modification effect of baseline depression ratings when evaluating treatments for methamphetamine dependence.

Keywords: Substance Abuse Treatment, Psychological Indicators

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Sertraline (Zoloft®) and identical placebo were provided by the manufacturer (Pfizer Inc.) in 50 mg tablet doses. All participants were started on sertraline or placebo at 50 mg/day. On the eighth day following randomization, dose was increased to 50

Qualified on the content I am responsible for because: I am appointed as a statistician in University of California, Los Angeles, and I am the first author of this study using the secondary data collected from a clinical trial. I do not have any conflict of interst.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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