Table 3.
Treatment studies involving negative reinforcement processes in methamphetamine users.
| Author (first author, year) | Meth Group (N) | Comparison Group (N) | Meth Chronicity [M(SD)] | Comorbid Diagnoses | Gender Examined? | Study Design | Intervention | NR Variables | Results |
|---|---|---|---|---|---|---|---|---|---|
| Psychotherapy Interventions | |||||||||
| Carrico et al. (54) | 55 HIV+ MSM randomly assigned to positive affect intervention | 55 HIV+ MSM randomly assigned to attention-control | N/R | N/R | N/A | Pre- and post-intervention, 3-month f/u | Positive affect intervention vs. attention control delivered during CM | Negative and positive affect | PA intervention ↑ positive affect, mindfulness, ↓ craving, stimulant use |
| Glasner-Edwards et al. (55) | 526 | None | N/R | Depression | No | Longitudinal, 3 yr f/u | 16-week Matrix Model: CBT, family edu. groups, support groups, individual sessions | Depression symptoms | Dep. severity ↓ treatment adherence Dep. at f/u ↑MA use outcomes MA abstinence ↓ depressive symptoms Dep. ↑ overall impairment |
| Glasner-Edwards et al. (4) | 526 | None | N/R | Anxiety | No | Longitudinal, 3 yr f/u | 16-week Matrix Model: CBT, family edu. groups, support groups, individual sessions | Anxiety symptoms | Anx. ↓ treatment adherence, ↑ family, medical, drug, psychiatric problems |
| Glasner-Edwards et al. (56) | 526 | None | N/R | 34% with current dx of mood, anxiety, or antisocial personality disorders | Yes | Longitudinal, 3 yr f/u | 16-week Matrix Model: CBT, family edu groups, support groups, individual sessions | Depression & anxiety symptoms | Anx. ↓ substance use outcomes, ↑ utilization of health services, ↑ psychiatric symptoms 3-years post-treatment |
| Glasner-Edwards et al. (57) | 9 stimulant users assigned to MBRP intervention | 13 stimulant users assigned to health education | N/R | N/R | No | Longitudinal, baseline and treatment end | 8-week MBRP | Salivary cortisol stress response, subjective stress, anxiety, craving | MBRP ↓ salivary cortisol, subjective stress, anxiety, & craving in response to post-tx stress-test |
| Hopwood et al. (58) | 94 tx completers | 21 d/c tx | N/R | 21% Dep., 17% phobias, 16% PTSD, 20% Borderline PD, 28% ASPD | No | Longitudinal, 30-180 days | Group therapy focused on functional analysis and relapse prevention + NA/AA techniques | Emotion regulation, negative emotionality | ↑ ability to regulate negative emotions ↑ tx persistence -↓ negative emotionality ↑ tx outcomes |
| Kay-Lambkin et al. (59) | 135 MA + comorbid depression | 52 MA without depression | N/R | N/A | No | Baseline, 5 weeks, 6 months | Self-help book vs. 2 sessions CBT/MI vs. 4 sessions CBT/MI | Depression symptoms | DEP+>DEP: severity of MA use, change in MA use from baseline to 5 weeks DEP+ only: ↓ dep. at 5 weeks w/ 3-4 sessions |
| Peck et al. (60) | 162 gay and bisexual men | None | 8.34(5.9) years | 73.2% mild or higher severity depression | N/A | 16-week randomized clinical trial, 26- and 52-week f/u | Random assignment to: CBT, CM, CBT+CM, Gay-specific CBT | Depression symptoms | All participants reported ↓ MA use and dep. symptoms up to 1-yr post-tx, MA use in past 5 days predicted Dep. symptoms, Dep. symptoms did not predict MA use |
| Polcin et al. (61) | 111 | 106 | N/R | N/R | No | Baseline, 2-, 4-, 6-month follow-up | 9-session Intensive MI vs. 1-session standard MI + 8 nutrition edu. sessions | Psychiatric problems and problem severity | Intensive MI only: psych. prob. ↓ days, ↓ psych. prob. Severity from baseline to 2-month |
| Polcin et al. (62) | 111 | 106 | N/R | N/R | No | Baseline, 2-, 4-, 6-month follow-up | 9-session Intensive MI vs. 1-session standard MI + 8 nutrition edu. sessions | Depression symptoms | Across interventions: ↓ psych. prob. severity from BL to 2-month predicted ↓ use prob. severity |
| Exercise Interventions | |||||||||
| Rawson et al. (63) | 69 | 66 | N/R | N/R | No | Pre- and post-intervention | 8-week structured exercise program vs. health education sessions | Depression & anxiety symptoms | Exercise intervention: ↓ Dep. & Anx. symptoms overall; Dose effect: ↑exercise sessions ↓ Dep. & Anx. symptoms |
| Wang et al. (64) | 24 | N/A | 83.92(56.04) months | N/R | No | counterbalanced | Acute exercise session vs. active reading session | Craving | Acute exercise session ↓ craving |
| Wang et al. (65) | 25 | 25 | Exer.: 83.32(53.71) months Att. CTL: 83.92 (58.32) | N/R | No | Baseline, 6-week, post-tx | 12-week RCT of aerobic exercise vs. attentional control | Craving | Exercise intervention ↓ craving |
| Pharmacotherapy Interventions | |||||||||
| Cruickshank et al. (66) | 13 | 18 | N/R | Elevated Dep. & Anx. Symptoms but specifics N/R | No | 2 week randomized placebo-controlled, double-blind, trial of mirtazapine | Narrative therapy counseling + mirtazapine or placebo | Depression & anxiety symptoms, stress | No sig. group diff. for any symptom measure |
| Elkashef et al. (67) | 79 | 72 | Bupropion: 10.42(7.59) yrs Placebo: 9.97(6.10) | Dep. symptoms on HAM-D Bupropion: 19% Placebo: 21% | Yes | Randomized, placebo-controlled, double-blind trial of bupropion | Bupropion + group CBT vs. placebo + group CBT | Depression symptoms | No group differences in dep. symptoms or craving |
| Heinzerling et al. (68) | Baclofen: 25, Gabapentin: 26 | Placebo: 37 | Baclofen: 8.8(7.43) yrs Gabapentin: 10.12(6.28) yrs Placebo: 9.59(5.92) yrs | Dep. symptoms on BDI | No | 16-week, randomized, placebo-controlled, double-blind trial of two GABAergic medications: baclofen & gabapentin | Relapse prevention groups + baclofen, gabapentin, or placebo | Depression symptoms | No sig. group diff. in craving, retention, or depression |
| Shoptaw et al. (69) | Sertraline + CM: 61, Sertraline only: 59 | Placebo + CM: 54, Placebo only: 55 | Sertraline + CM: 10.1(6.0) yrs sertraline only: 9.9(6.1) yrs placebo + CM: 8.7(5.4) yrs placebo only: 8.5(4.8) yrs | Depression symptoms on BDI | No | Randomized, placebo-controlled, double-blind trial | 12-weeks: sertraline+CM vs. sertraline only vs. placebo+CM vs. placebo only | Depression symptoms, craving | No sig. effects of sertraline; sertraline contraindicated for MA dependence; CM: higher proportion of 3-weeks abstinence |
| Shoptaw et al. (70) | 36 | 37 | Buproprion: 11(9.6) yrs Placebo: 8.3(5.8) yrs | Depression symptoms on BDI | No | 12-weeks longitudinal | Buproprion vs. placebo, in addition to CM+CBT | Depression symptoms, craving | No sig. diff. between bupropion and placebo on reducing dep. symptoms or craving |
| Brain Stimulation Interventions | |||||||||
| Liang et al. (71) | 24 rTMS | 24 sham rTMS | Real: 6.5(4.4) Sham: 8.5(4.2) days | Real: 4.6(3.0) Sham: 5.6(3.3) yrs | No, males only | 10-sessions randomized, double-blind, controlled trial | 10 Hz rTMS to left DLPFC | Depression & anxiety symptoms | Real rTMS: ↓ Dep. & Anx. symptoms, craving; Both groups: ↓ withdrawal symptoms → ↓ craving and ↓ anx. but not dep. |
| Lin et al. (72) | 40 rTMS | 40 sham rTMS, 25 waitlist/no treatment | Real: 197.10(16.87); Sham: 189.23(14.31); Wait-list: 190.08(15.17) days | Real: 8.30(.81); Sham: 7.15(.73); Wait-list: 8.92(1.22) yrs | No, males only | 5 sessions/week for 6-weeks, randomized, double-blind, controlled trial | 10 Hz rTMS to left DLPFC | Depression & anxiety symptoms | Real rTMS: ↓ dep. & anx. symptoms; Sham & CTL: ↑ dep. symptoms |
| Su et al. (73) | 15 rTMS | 15 sham rTMS | Real: 3.00(1.56); Sham: 2.80(1.70) months | Real: 40.33(32.04); Sham: 60.80(41.40) months | No, males only | 5-session, randomized, double-blind, controlled trial | 10 Hz rTMS to left DLPFC | Depression & anxiety symptoms | Real TMS: ↓ craving; Both groups: ↓ dep. symptoms, no change in anx. symptoms |
ASPD, antisocial personality disorder; BDI, Beck depression inventory; CBT, cognitive behavior therapy; CM, contingency management; DLPFC, dorsolateral prefrontal cortex; f/u, follow-up; HIV, human immunodeficiency virus; MA, methamphetamine; MBRP, mindfulness-based relapse prevention; MI, Motivational interviewing; MSM, men who have sex with men; N/R, Not reported; PA, positive affect; PD, personality disorder; PTSD, posttraumatic stress disorder; rTMS, repetitive transcranial magnetic stimulation.