The Methamphetamine Treatment Project (MTP) offers the opportunity to examine co-occurring psychiatric conditions in a sample of 1016 methamphetamine users participating in a multisite outpatient treatment study between 1999-2001. Participants reported high levels of psychiatric symptoms, particularly depression and attempted suicide, but also anxiety and psychotic symptoms. They also reported high levels of problems controlling anger and violent behavior, with a correspondingly high frequency of assault and weapons charges. Findings continue to support the value of integrated treatment for co-occurring conditions, especially the importance of training counseling staff to handle psychotic symptoms when needed.

This article presents an addiction treatment model based on craving identification and management (CIM). Craving is broadly defined as the desire to use alcohol or other drugs; it increases the likelihood of use of these substances. In the CIM Model treatment interventions are referenced to craving, i.e., helping clients to identify their craving level and equipping them with strategies to avoid use. Four causes of craving are identified: (1) environmental cues (triggers): exposure to people, places, and things associated with prior drug-using experiences may cause immediate and overwhelming craving; (2) stress: addicted persons experience stress as craving; (3) mental illness; and (4) drug withdrawal: symptoms of both mental illness and withdrawal lead to craving if clients associate use with relief of these symptoms. The CIM Model incorporates four service delivery elements: Relapse Prevention Workshop, individual counseling, medical/psychiatric services, and screening for ongoing drug use. At its core, the CIM Model asks clients to be aware of craving, analyze its causes, and, based on those causes, implement specific strategies to prevent and manage craving. The CIM Model combines several treatment components, including control of exposure to environmental cues, establishment of a daily schedule, the use of behaviors that dissipate craving (tools), and treatment (with medications when appropriate) of mental health and withdrawal symptoms. The CIM Model is a client-derived approach to achieving and maintaining sobriety based on a process of analyzing craving and managing it with an individualized program of recovery activities.

The Methamphetamine Treatment Project is a multisite trial that compares the effectiveness of eight models of outpatient treatment for methamphetamine dependence to that of the Matrix model. These eight "treatment-as-usual" models represent diverse approaches developed in a variety of settings to serve markedly different populations. The theoretical foundations of these treatments are described as well as the settings in which they are delivered. To facilitate comparisons, details are presented with respect to frequency of group and individual sessions, duration of treatment, therapist qualifications, and access to ancillary services. The populations served by these programs vary with respect to race and ethnicity. Most programs serve primarily non-Hispanic Caucasians, but some programs serve significant proportions of Hispanics, Asians, Pacific Islanders, and Native Americans. Usual route of administration of methamphetamine also varies by site, with snorting, smoking, and injecting each reported as the most common route of administration at one or more sites. The Minnesota model and cognitive-behavioral approaches are most commonly used in these programs, although contingency management and psychodynamic approaches are also represented. The intensive phase of treatment ranges between four and 24 weeks; the number of hours per week of client contact varies between one and 13. This trial will provide the opportunity to test the effectiveness of a wide range of treatments currently in use in community settings.

The Center for Substance Abuse Treatment funded the Metamphetamine Treatment Project to evaluate and compare treatment approaches for methamphetamine users. As part of this study, drug use patterns, history of physical or sexual abuse, history of suicidality, and psychopathology were assessed in 1,016 methamphetamine-dependent outpatients entering treatment between 1999 and 2001 at eight sites across the western United States. The sample was predominately female and racially diverse. The mean age of the participants was 32.8 years. Most were methamphetamine smokers, but there were marked regional variations. Suicidality and physical or sexual abuse were common and measures of current psychopathology were high. These clinical issues were associated with more frequent use of methamphetamine and, more strongly, with concurrent use of other drugs. Therefore, the relationship between polydrug use and psychopathology in methamphetamine users warrants further investigation.

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